Hemi-macular detachment: En face optical coherence tomography characteristics and clinical implications

Session Details

Session Title: Free Paper Session 17: Imaging II

Session Date/Time: Saturday 09/09/2017 | 08:00-09:30

Paper Time: 08:48

Venue: Room 120

First Author: : J.Potic SWITZERLAND

Co Author(s): :    C. Bergin   C. Giacuzzo   A. Daruich   J. Pournaras   L. Konstantinidis   T. Wolfensberger              

Abstract Details

Purpose:

Based on the location of retinal detachment (RD) and degree of retinal edema, several different types of RD have been reported. The aim was to report observation and optical coherence tomography (OCT) characteristics of a specific subgroup of RD: hemi-macular detachment (HMD).

Setting:

Prospective non-randomized cohort study was conducted at Jules-Gonin Eye Hospital, in Lausanne, Switzerland, during the period from February 2015 until March 2017 and included 194 patients. Among them, 9 eyes had partially detached macula on preoperative OCT.

Methods:

EnFace and B-scans OCT were performed in 9 patients with HMD preoperatively and 1 month after pars plana vitrectomy with gas (n=5) or silicone oil tamponade (n=4).

Results:

Patients had superior temporal tears and subretinal fluid (SRF) accumulation temporally. Preoperatively mean central macular thickness (mCMT) was 340±62µm, median best corrected visual acuity (mBCVA) was 0.4 IQR [0.2-0.4] logMAR, and there was SRF up to half of the fovea (85±85µm), creating a subfoveal pocket of fluid. SRF slightly decreased at the border of the fovea in most cases (78.56 ± 68.1 µm at 100 µm, 82.9 ± 55.4 µm at 200 µm, 81.8 ± 54.3 µm at 300 µm). Typically RD remained shallow para-centrally (88.0 ± 55.2 µm at 400 µm, 113.2±66.4 µm at 500 µm) with a slight but restrained elevation of SRF until reaching a distance greater than the radius to major vessels of the macula arcade i.e. between 1000 µm and 3000 µm (122.0±81.6µm at 1000µm and 548.1±348.8 µm at 3000 µm from the fovea). At 1 month postoperatively mCMT decreased (274±42µm) but patients reported visual disturbances (8/8, NA=1). mBCVA was 0.2 [0.1-0.3] logMAR. Where the RD touched the fovea an outline was visible on EnFace OCT with modifications in the outer retinal layers.

Conclusions:

EnFace OCT allows the identification of HMD, a distinct subgroup of RD, which demonstrates a residual watermark at the edge of the detachment in the macular area. Typically, this RD is shallow at the beginning with slight elevation until reaching vascular arcade, where more SRF starts to accumulate. VA recovery in these cases is good, although most patients reported visual disturbances.

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