Long-term follow-up with optical coherence tomography and microperimetry in eyes with metamorphopsia after macula-off retinal detachment repair

Abstract

Purpose To report the long-term sequential morphological and functional results in eyes with metamorphopsia after retinal detachment (RD) repair. Patients and methods In six eyes of six patients aged 58.7±11.0 years with metamorphopsia after successful buckling surgery for macula-off RD, best-corrected visual acuity (BCVA), fundus biomicroscopy, Amsler grid test, time-domain optical coherence tomography (TD-OCT) and central 121 microperimetry (MP-1) were performed at months 1, 3, 6, 12, and 18. At 5 to 6 years after surgery all patients underwent also spectral domain (SD)-OCT. Results Three eyes slowly recovered pre-RD BCVA. In the remaining three eyesFwith good final BCVAFthe interrupted junction line between photoreceptor cell inner and outer segments (IS/OS) was progressively less evident after RD surgery; and the external limiting membrane was preserved on SD-OCT examination. In all eyes post-operative metamorphopsia faded with time, but fully disappeared in 6 years only in two eyes without photoreceptor abnormalities. One of the two eyes with subretinal fluid up to 6 months and IS/OS disruption had central dense scotoma with relatively unstable fixation on MP-1 and persistent metamorphopsia. Macular sensitivity (MS) increased from 9.7 ± 7.1 at month 1 to 13.5 ± 5.6 dB at the final check, and was weakly (r ¼ 0.33) correlated with post-operative BCVA and OCT abnormalities. Conclusion Long-standing metamorphopsia can occur after successful macula-off RD repair even without detectable photoreceptor disruption on OCT. Post-operative BCVA recovery weakly correlates with increasing MS, and late restoration of the photoreceptor layer may be observed

Impact of Metamorphopsia on Quality of Life after Successful Retinal Detachment Surgery

“…These results are consistent with the findings of previous reports [4-8]. In a series of 129 eyes operated on for RD, Okamoto et al [6] reported a 39% incidence of metamorphopsia with a mean M-charts score of 0.3°, which means that metamorphopsia was moderate in intensity.…”

“…In a series of 129 eyes operated on for RD, Okamoto et al [6] reported a 39% incidence of metamorphopsia with a mean M-charts score of 0.3°, which means that metamorphopsia was moderate in intensity. Several methods exist to assess metamorphopsia, including the Amsler grid, [4, 5, 7], M-charts [8], differential perimetry, preferential hyperacuity, and shape discrimination hyperacuity tests. Home-monitoring devices based on preferential hyperacuity testing have also recently been proposed to quantify the visual deformations in a more familiar environment [25].…”

“…The postoperative quality of vision may be disappointing for both the patient and the surgeon [3]. Metamorphopsia is one of the major complaints reported by patients after retinal reattachment, with prevalence varying between 34.5 and 100% [4-8]. Since the advent of optical coherence tomography (OCT), the microstructure changes taking place in reattached retina have been extensively studied [9-23] and it has been shown that metamorphopsia can be linked to several retinal defects, including cystoid cavities in the nuclear layers, outer retinal folds (ORFs), and dropout of the inner and outer segment photoreceptor junction.…”

Metamorphopsia: An Overlooked Visual Symptom

“…The most frequent OCT findings in patients with metamorphopsia were presence of ERM, disruption of the inner segment/outer segment, cystoid macular edema, macular hole, or subretinal fluid, even though no OCT retinal changes could be detected after rhegmatogenous retinal detachment surgery in 32 out of 50 eyes with metamorphopsia [76]. Rossetti et al [78] also reported that long-standing metamorphopsia could occur after successful macula-off rhegmatogenous retinal detachment repair even without detectable signs of PR disruption on OCT. The persisting metamorphopsia appeared to come from retinal vertical displacement by rhegmatogenous retinal detachment surgery [76].…”

Quick Referral and Urgent Surgery to Preempt Foveal Detachment in Retinal Detachment Repair

“…Postoperative visual distortion affects even eyes that regained excellent vision and eyes without detectable photoreceptor disruption in spectral domainYoptical coherence tomography (SD-OCT). 7,8 Consequently, many ophthalmologists consider fovea-on rhegmatogenous RD of recent onset to be a surgical emergency to avoid foveal involvement and minimize photoreceptor damage caused by a foveal detachment. 9Y11 Ho et al 2 reported that urgent surgery should be considered based on the close proximity of the RD border to the fovea, especially if it is within 1 disc diameter, to prevent foveal involvement.…”