Quantitative assessment of outer retinal folds on enface optical coherence tomography after vitrectomy for rhegmatogenous retinal detachment

Abstract

We aimed to investigate the possible causes of metamorphopsia for rhegmatogenous retinal detachment (RRD) based on findings of enface optical coherence tomography (OCT). The study was a retrospective, consecutive case series of 33 eyes with macula-off RRD. Metamorphopsia was measured by M-CHARTS and enface OCT images covering a macular area of 6 × 6 mm square obtained at 1, 3, and 6 months postoperatively. Within the outer retinal slabs of enface OCT, multiple lines that looked like folds were delineated in all eyes at month 1, and we succeeded in extracting images of folds by subtracting retinal vessels. We calculated their density by an image-processing technique. The mean M-CHARTS scores were 0.62 ± 0.47 at month 1 and 0.30 ± 0.29 at month 6 (P < 0.001). The fold density was 8.3 ± 4.2 at month 1 and 6.1 ± 3.1 at month 6 (P = 0.0044). The M-CHARTS scores at 6 months were significantly associated with the fold density at 1 month (r = 0.515, P = 0.002). In conclusion, enface OCT visualized the outer retinal folds in eyes that had undergone successful RRD surgery, and a larger number of folds was related to the remaining metamorphopsia.

Enlightening new underpinnings in hydration retinal folds

“…10 The correlation between this important clinical finding and the visual prognosis is not completely clear, but previous studies hypothesize that preoperative undulations of the outer retina profile result in postoperative subclinical but persistent outer retinal folds and that those folds could be associated with metamorphopsia and lack of complete visual recovery in eyes with macula-off retinal detachment. 11,12 We were unable to find in the literature an HRF presentation as prominent as that of the case presented here. Additionally, our patient's preoperative SD-OCT revealed a peculiar finding of intraretinal space within the ONL in the parafoveal region.…”

Comparative analysis of metamorphopsia and aniseikonia after vitrectomy for epiretinal membrane, macular hole, or rhegmatogenous retinal detachment

“…Previous studies showed that outer retinal microstructure changes gradually improved during the postoperative period; moreover, postoperative visual acuity was associated with photoreceptor regeneration in eyes with ERM, eyes with MH, and eyes with RRD. [22][23][24][25][26][27][28][29] With respect to postoperative metamorphopsia and aniseikonia, several studies demonstrated no correlations with photoreceptor status; however, they revealed correlations with other factors, such as INL thickness, which suggested inner retinal displacement. [14,21,30] The prior results suggested that postoperative recovery of visual function was mainly dependent on affected retinal areas caused by different pathologies.…”

“…In eyes with macula-off RRD, we previously reported that findings of outer retinal folds and disrupted outer retinal bands on en face OCT were correlated with postoperative metamorphopsia. [26] In contrast, eyes with ERM exhibit dislocated retinal neurons including Müller cells, which display wave-guide coupling characteristics and light-guiding capability; [32] this type of dislocation might have a considerable impact on postoperative metamorphopsia. In the present study, postoperative metamorphopsia in eyes with ERM was significantly associated with CRT and findings of concentric fine folds in middle retina; both thickened retina and deep retinal folds suggest dislocation of retinal neurons.…”

A Splicing Mutation in Slc4a5 Results in Retinal Detachment and Retinal Pigment Epithelium Dysfunction

“…We searched the literature for retinal lesions resembling the white-line lesions, particularly as characterized by OCT. Outer and full-thickness retinal folds that develop as a complication of rhegmatogenous retinal detachment surgery [48] appear as pale linear features by color fundus imaging and corresponding hyperreflective intrusions by OCT, which distend the overlying retinal layers and cause a local increase in total retinal thickness [49][50][51]. Retinal folds with similar color fundus imaging and OCT features are also found in inherited forms of canine retinal dysplasia [52].…”

“…Although retinal folds in humans are not known to have genetic associations, several types of folds have been observed in rhegmatogenous retinal detachment (RDD) [84] and, more frequently, as a postoperative complication of surgery to correct this condition [49,51,[84][85][86][87][88]. Hydration folds, as detected by OCT prior to surgery, feature a corrugated appearance of the outer retina, which is typically completely detached from the underlying RPE [51,84]. By contrast, postoperative outer retinal folds are less frequent and appear as hyperreflective retinal intrusions between the RPE and outer plexiform layers.…”