Association Between Photoreceptor Regeneration and Visual Acuity Following Surgery for Rhegmatogenous Retinal Detachment

Abstract

PURPOSE. The purpose of this study was to evaluate foveal regeneration and the association between retinal restoration and visual acuity following reattachment surgery for rhegmatogenous retinal detachment (RRD).METHODS. Twenty-nine eyes of 29 patients with successfully reattached macula-off RRD were retrospectively analyzed. We used spectral-domain optical coherence tomography to image macular regions and measure retinal thickness and Snellen chart visual acuity (VA) to evaluate best-corrected VA (BCVA) at 1, 2, 3, 6, 9, and 12 months after vitrectomy. Best-corrected visual acuity data were converted to the logarithm of the minimum angle of resolution scale. Opposite eyes were used as controls.RESULTS. The thicknesses of the external limiting membrane (ELM)-ellipsoid zone (EZ) and EZretinal pigment epithelium (RPE) were significantly thinner in involved eyes than in corresponding unaffected eyes at 1 month after surgery (P < 0.001 for both), and the thickness increased over time (P < 0.001 for both). Best-corrected visual acuity significantly improved over time (P < 0.001), and the improvement correlated with EZ-RPE thickness (r ¼ À0.45, P ¼ 0.021). Multiple regression analysis demonstrated the presence of a foveal bulge as the independent predictor of final BCVA (P < 0.001). Eyes with a foveal bulge had significantly better BCVA and greater EZ-RPE thickness than those without throughout the follow-up period. Significant restoration of the integrity of EZ and cone interdigitation zone (CIZ) was observed over time (P < 0.001 for both) in eyes with a foveal bulge.CONCLUSIONS. The thickness of EZ-RPE and cone density increased during foveal regeneration, as demonstrated by the continuous improvements in CIZ integrity over time, leading to the formation of foveal bulge and good vision following successful reattachment of macula-off RRD.

Changes in Retinal Vessel and Retinal Layer Thickness After Vitrectomy in Retinal Detachment via Swept-Source OCT Angiography

“…However, our results should be interpreted with caution. Contrary to other studies that reported the correlation between postoperative visual acuity and the integrity of outer retinal layer, [9][10][11]17,33 the EZ-RPE thickness (a parameter related to the outer retinal layer status used in this study) was not a significant contributing factor. Based on the results shown in Table 1, the EZ-RPE thickness was decreased in the RRD eyes compared with fellow eyes, both in the outer-retinal-defect group and the intact-outer-retina group.…”

“…Several previous studies have reported the recovery of outer retinal thickness and photoreceptors over time after retinal detachment surgery in macula-off RRD. 10,11,17 Ra et al 17 used electroretinography and OCT to report a longterm increase in cone density and outer retinal layer thickness after buckling surgery for RRD. They divided EZ-RPE thickness into EZ-CIZ thickness and CIZ-RPE thickness and showed an increase in both of them 12 months postoperatively compared with 6 months postoperatively.…”

“…They also showed that the OS length ratio between the RD eye and its fellow eye correlated well with postoperative visual acuity after surgery. Kobayashi et al 11 demonstrated that restoration of the outer retinal layers/bands at the fovea occurs following macula-off RRD repair, and the reappearance of a foveal bulge correlated significantly with postoperative visual acuity. Eyes with complete restoration of outer retinal layers, including the foveal bulge, showed better visual outcomes than eyes with partial restoration.…”

“…[5][6][7][8] In some optical coherence tomography (OCT) studies, microstructures, such as the preoperative ellipsoid zone (EZ)/external limiting membrane (ELM) integrity or backreflection integrity, postoperative EZ/ELM integrity, cone interdigitation zone (CIZ), or foveal bulge, were reported as prognostic factors after macula-off RRD surgery. [9][10][11] Kobayashi et al 11 reported that the degree of restoration of the outer retinal layers at the fovea is important in predicting the final best corrected visual acuity (BCVA). Recently, Woo et al 12 used optical coherence tomography angiography (OCTA) and reported an association between the deep foveal avascular zone (FAZ) area and final BCVA after maculaoff RRD surgery.…”

Single Intravitreal Injection of Etamsylate for the Treatment of Geographic Atrophy Associated with Submacular Hemorrhage

“…RPE has a wide variety of function, as such nutrient supply, oxidative stress protection, phagocytosis, and secretion of survival signals for retinal cells [5]. In addition, RPE has a potential for regeneration [6,7]. The sequence of events leading to GA is the progression of large drusen to hyperpigmentation, followed by regression of the drusen, hypopigmentation and ultimately RPE cell death, leading to atrophic area of the retina underlying choroids [8].…”