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Structure-function relationship following primary vitrectomy for rhegmatogenous retinal detachment of intermediate severity

Session Details

Session Title: Imaging II

Session Date/Time: Friday 12/09/2014 | 16:30-18:00

Paper Time: 17:42

Venue: Boulevard C

First Author: : A.Abdullatif EGYPT

Co Author(s): :    H. Mortada   M. Abdelhakim   H. El Said        

Abstract Details

Purpose:

The purpose of this study was to study the structure-function relationship following primary vitrectomy for rhegmatogenous retinal detachment by correlating findings on spectral domain optical coherence tomography and visual acuity.

Setting:

This is a prospective interventional non-randomized case series at Kasr Al-Ainy teaching hospital, Cairo University. Seventy eyes, of 70 patients, with rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy of intermediate severity (PVR
Methods:

Patients underwent primary vitrectomy, with or without phacoemulsification and intraocular lens (IOL) implantation. One-time cross-sectional analysis of the retinal structure at 4 weeks postoperatively was chosen. The presence or absence of vitreoretinal interface abnormalities, intra-retinal fluid and subretinal fluid (SRF), were evaluated. Also the status of the inner segment/outer segment (IS/OS) junction and external limiting membrane (ELM) were judged in the images as disrupted or complete. In the scan that showed the largest defect, the extent of disruption was measured along a 1.8 mm-diameter area centered on the fovea. The extent of disruption in the IS/OS line and ELM were graded according to their length into four grades similar to that done by Otani et al (2010) in diabetic macular edema; grade 0 (intact), grade 1 (mild disruption, i.e. <400 micron), grade 2 (moderate disruption, i.e. ≥400 microns but <1400 micron) and grade 3 (severe disruption, i.e. ≥1400 micron, or completely lost). The correlations between SD-OCT findings and postoperative best-corrected visual acuity (BCVA) were analyzed.

Results:

All patients achieved complete postoperative reattachment with 95% SOSR and mean logMAR BCVA one month following the surgery of 0.79± 0.35. The values of BCVA showed statistically significant difference between patients with ERM and those without (p=0.017). There was statistically significant correlation between both the length of IS/OS and ELM defect and the visual acuity (r= 0.782, p< 0.001 for IS/OS, r 0.650, p=0.02 for ELM). The values of BCVA showed statistical significant difference between the four classified grades (p= 0.009 for IS/OS and p=0.011 for the ELM). Our study showed statistically significant correlation between length of IS/OS defect and the duration of retinal detachment (r= 0.602, p= 0.05).

Conclusions:

Primary vitrectomy achieves high primary anatomical success rates. SD-OCT is a valuable, noninvasive tool for evaluating foveal microstructural changes. Incomplete visual acuity recovery after anatomically and clinically successful repair has been attributed to several factors: subretinal fluid, epiretrinal membranes and interruption of either IS/OS line or ELM. The extent of IS/OS and ELM disruption could be a measure of the structural and functional health of the photoreceptors and can explain poor visual outcome in successful retinal detachment surgery with an otherwise normal foveal contour.

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