Functional recovery after macula involving retinal detachment and its correlation with preoperative biomarkers in optical coherence tomography

Abstract

To introduce an ETDRS grid-based classification for macula involving retinal detachment (MIRD) with or without center (foveal) involvement and to identify biomarkers in preoperative optical coherence tomography (OCT) associated with a favorable postoperative functional outcome in eyes with center involving retinal detachment (CIRD). One hundred and two eyes of 102 consecutive patients (f/m: 35/67) with primary rhegmatogenous retinal detachment, preoperative evidence of MIRD (perifoveal involvement of ≤ 6.0 mm), and successful retinal surgery were included in this retrospective cohort study. Eyes were assigned to 5 grades of MIRD (G1–G5), based on the extent of detachment in the ETDRS grid. Eyes with a detached foveal status (CIRD) were assigned to G4 or G5. In CIRD, the following OCT biomarkers were quantified and correlated with mean BCVA (logMAR) at 3 months postsurgery, using univariate and multivariable regression models: grade of detachment, extent of intraretinal edema, height of foveal detachment, subretinal folds, and epiretinal membrane. Forty-one of 102 eyes (40.2%) presented with an attached foveal status, defined as either outer (G1: 11.8%) or inner (G2: 18.6%) macular involvement or fovea-threatening MIRD (G3: 9.8%). Sixty-one eyes (59.8%) showed CIRD (G4 or G5). Eyes with CIRD had significantly worse postoperative BCVA than eyes without foveal involvement (0.355 logMAR vs. 0.138 logMAR, p<0.001). If CIRD was limited to three outer ETDRS quadrants (G4), mean BCVA was better compared to CIRD involving all four ETDRS quadrants (G5) (0.254 logMAR vs. 0.522 logMAR, p<0.001). Reading ability (BCVA ≤ 0.4 logMAR) was restored in 97.6% of eyes with G1–G3 compared to 86.9% of eyes with G4 (p=0.072) and 52.4% of eyes with G5 (p<0.001). In multivariable regression analysis of eyes with CIRD, a lower grade of detachment (G4 vs. G5: p<0.05) and lower extent of cystoid edema (focal/none vs. wide: p<0.001) were both associated with better postoperative function. The functional outcome after MIRD may be worse in the presence of foveal involvement (CIRD), but a lower grade of detachment and the absence of intraretinal edema can predict a good recovery in spite of CIRD.

Outer retinal features in OCT predict visual recovery after primary macula-involving retinal detachment repair

“…Our data could not detect prognostic effects of preoperative parameters such as foveal height of detachment, degrees of macular areas detached, shorter duration of macular detachment or visual loss until surgery, as is commonly established [ 1 , 5 , 6 , 22 , 23 ]. The subgroup without foveal detachment shows better baseline and final visual acuity, in accordance with these reports, but our subgroups were too small to make a statistical conclusion ( S2 Table ).…”

“…Preoperative features of optical coherence tomography (OCT) such as photoreceptor length, height of foveal detachment, inner retinal undulation and inner retinal separations have been discussed as biomarkers of visual recovery [ 3 , 4 ]. In cases of foveal detachment, visual recovery seems better if the macula is only partially detached, compared to a complete macular detachment [ 5 ]. Moreover, a preserved foveal depression despite foveal detachment seems predictive of a better functional outcome [ 6 ].…”

Optical Coherence Tomography Findings in Rhegmatogenous Retinal Detachment: A Systematic Review

“…Klaas and colleagues used SD-OCT to define a more precise classification of rhegmatogenous retinal detachment according to the state of the macula and the fovea. They also showed that the grade of retinal detachment and the extent of the cystoid macular edema were good preoperative biomarkers to predict functional recovery in eyes with detached fovea [ 30 ].…”

“…Among the potential biomarkers predicting functional recovery, the grade of detachment and the extent of cystoid macular edema seems promising in eyes with a detached fovea, as well as the integrity of the ellipsoid zone [ 14 , 30 ]. The extent of the detachment, the postoperative foveal contour, the integrity of the ellipsoid zone and of the external limiting membrane, and the presence of outer retinal folds, seem to be predictors of visual prognoses and metamorphopsia following a successful vitrectomy [ 12 , 15 , 16 , 17 , 22 , 28 , 48 , 49 ].…”

Intravitreal Dexamethasone Implant at the Time of Silicone Oil Removal to Treat Persistent Macular Edema after Rhegmatogenous Retinal Detachment Repair

“…Our results revealed that macular-on status had a predictive role in functional recovery after DEX-I for recalcitrant CME. RRD-related macular status has a strong correlation with visual recovery after retinal surgery [ 35 ]. In particular, macular OCT biomarkers, including the presence and extension of cystoid edema before surgery and outer retinal layer integrity after surgery, correlate with functional outcomes [ 35 ].…”