First Author: C.Doefler Poulsen DENMARK
Co Author(s): J. Grauslund T. Peto 0 0 0 0 0 0 0 0 0
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To detect characteristic changes in autofluorescence (AF) images in patients with primary rhegmatogenous retinal detachment (RRD) and to compare these with changes in best corrected visual acuity (BCVA) preoperatively and at 2 month follow-up.
This study was performed at the Department of Ophthalmology, Odense University Hospital (OUH) in Denmark. This is the only vitreo-retinal unit in the Region of Southern Denmark, covering a population of 1.2 million inhabitants.
A clinical prospective study of 99 eyes in 99 patients undergoing surgery for primary RRD between 1st of January 2013 and 12th of July 2013. All patients underwent surgery with pars plana vitrectomy (PPV) and had either gas or silicone oil tamponade. Patients were examined preoperatively and at a 2-months follow-up. Examinations included best corrected visual acuity (BCVA), slit lamp biomicroscopy, spectral domain optical coherence tomography (SD-OCT) (Topcon 3D-OCT 2000) and wide-field imaging (Optos 200Tx color and AF). Additional data collected included age, gender, previous eye history (including cataract surgery), present symptoms, IOP, time from RRD to surgery, preoperative proliferative vitreoretinopathy (PVR) graded according to standardized protocol as follows: A (vitreous haze, pigment, vitreous cells and clumps) , B (wrinkling of inner retinal suface, vessel tortuosity, rolled, irregular edge of tear), or C (full thickness retinal starfolds) , peroperative data, complications, Pelli Robson test, Ishihara and multifocal-ERG. Retinal changes in wide-field images were graded using fellow-eye as reference for normal appearance. Twenty-nine patients with major retinal changes, non-gradable images or surgery on fellow-eye were excluded to avoid potential incorrect grading. SD-OCT was used preoperatively to confirm whether fovea was attached or detached. P-value <0.05 was considered statistically significant.
Out of 99 eyes, 88 attended for baseline and 2 months follow-up and 59 had gradable images with characteristics studied in this part of the study. Exclusions were: poor images (n=8), major surgery or changes on fellow-eye (n=11), no baseline or 2-month image (n=7), re-detachment at 2-month follow-up (n=1) and eyes traumas (n=2). Retinal changes seen in study group were comparable to changes in the excluded (data not shown). In wide-field color images RRD appeared shallowed (n=22; 37.3%), bullous (n=14; 23.7%) or combined (n=23; 39.0%). In AF images all bullous detachments appeared highly hypofluorescent with well-defined borders whereas shallow and combined detachments appeared with no or discrete, diffuse hypofluorescence (p-value <0.01). A hyperfluorescent leading edge (HLE), which showed the demarcation of the detached retina, was observed in 92.9% of bullous detachments and in 84.4% of shallow and combined detachments. Retinal holes/tears appeared hyperfluorescent. Preoperative PVR (A, B, C) was present in 46 (78.0%) eyes. In AF images PVR appeared hypofluorescent (n=38; 82.6%) or showed combined hypofluorescence with small hyperfluorescent granules (n=8; 17.4%). There was a tendency towards a worse postoperative BCVA in eyes with a combined hypofluorescence (mean ETDRS: 58.0±8.3 letters) compared to purely hypofluorescence (mean ETDRS: 64.5±11.8 letters), p-=0.15.
Optos 200Tx wide-field color and AF imaging are fast and easy examinations that providing an excellent overview of retinal changes following RRD. AF is a reliable method to demark retinal detachment and to identify areas with PVR changes as well as retinal holes and tears.