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  • Assessing Photoreceptors After Repair of Macula-Off RD

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD

    Journal Highlights

    American Journal of Ophthalmology, June 2020

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    Macula-off retinal detachment (RD) can be repaired by pars plana vitrecto­my with gas tamponade, but visual out­comes often are disappointing. Clinical factors such as macula-off duration and detachment height are known to affect prognosis after RD. Using a multimodal approach, Reumueller et al. explored the role of another factor—retinal regeneration—in RD outcomes. They found that even though cone morphol­ogy and function improved by 56 weeks postoperatively, structural and function­al impairment remained.

    This prospective fellow-eye com­parison case series took place in an outpatient clinic at the Medical Uni­versity of Vienna. Using a combination of spectral-domain optical coherence tomography (SD-OCT), adaptive-op­tics OCT (AO-OCT), and microper­imetry (MP), the authors examined five eyes of five patients at six weeks (baseline) and 56 weeks (follow-up) after vitrectomy with gas tamponade for macula-off RD. They also evaluated the patients’ five healthy fellow eyes. The same eight corresponding regions at foveal eccentricities of 2.5 and 6.5 degrees were analyzed in each eye. Main outcome measures were cone density, cone pattern regularity, signal attenua­tion, and retinal sensitivity.

    The patients’ mean age was 59.8 years, and their macula-off duration ranged from 0.5 to 5.5 days. Morpho­logic assessment with AO-OCT at base­line showed severe pattern irregularity, and SD-OCT showed attenuated outer retinal bands with severely reduced signal intensity in RD eyes compared with healthy fellow eyes.

    Although cone pattern regularity improved from baseline to follow-up in the RD eyes (p < .001), irregularity persisted in 63% of AO-OCT images at follow-up, and severe signal reduction was observed in 45.5% of SD-OCT B-scans. Mean cone density at the inner-outer segment junction and cone outer segment tips was approximately 20,000/mm2 (2.5 degrees) and 16,000/mm2 (6.5 degrees), respectively, for healthy fellow eyes at baseline and follow-up. In contrast, cone density was much lower for RD eyes at baseline (range, 200-15,600/mm2; p < .001)—and although improvement was observed at follow-up (p < .001), mean density was lower in RD eyes at the inner-out­er segment junction and cone outer segment tips (range, 7,790-9,555/mm2; p < .001).

    Functional assessment with MP in healthy fellow eyes showed mean reti­nal sensitivity of 18 dB at baseline and follow-up; it was much lower in RD eyes (14.30 dB and 14.64 dB, respec­tively) and did not improve substan­tially. Overall, SD-OCT grading and MP sensitivity correlated strongly with AO-OCT grading and cone density (rho values > .750).

    The combination of AO-OCT, SD-OCT, and MP provides helpful insight into cone regeneration after vitreoret­inal procedures. Despite evidence that cone morphology improves, there can be ample functional and morphologic distortion of cones, along with reduced retinal sensitivity, a year after successful reattachment. Hence, successful repair “does not equal restoration of the outer photoreceptor segment,” said the au­thors.

    The original article can be found here.