Abstract
PurposeTo determine the perioperative factors that are significantly correlated with the final visual acuity following reattachment of a macula-off rhegmatogenous retinal detachment (RRD) by vitrectomy.MethodsTwenty-nine eyes of 29 patients with a successfully reattached RRD by vitrectomy were retrospectively analyzed. Spectral-domain optical coherence tomographic images of the macular regions were used to measure the thicknesses of the retinal layers and the integrity of the microstructures of the photoreceptors at 2 weeks, 1, 2, 3, 6, 9, and 12 months following the vitrectomy. The best-corrected visual acuities (BCVA) were evaluated at the same times.ResultsThe improvement of the BCVA from the preoperative BCVA to that at postoperative Week 2 (-0.67 ± 0.69 logMAR units) was the largest change between adjacent observation periods for the entire study duration. It was significantly greater than the improvement between Week 2 and Month 12 (-0.32 ± 0.22 logMAR units; P<0.001). The thickness of the ellipsoid zone (EZ)-retinal pigment epithelium (RPE) increased significantly with time (P<0.001). The final BCVA was significantly correlated with the BCVA at Week 2 (r = 0.61, P<0.001), the EZ-RPE thickness at Week 2 (r = -0.40, P = 0.035), the integrity of the external limiting membrane (ELM) (r = -0.61, P = 0.003), and an intact EZ (r = -0.66, P = 0.001) at Week 2. Multiple stepwise regression analyses of the final BCVA showed that the BCVA at Week 2 (P = 0.017) and the integrity of the EZ at Week 2 (P = 0.006) were independent predictors of the final BCVA.ConclusionsThe significantly better BCVA and presence of an intact EZ at 2 weeks following vitrectomy and their significant correlations with the BCVA at Month 12 indicate that these perioperative values can be used to predict the BCVA at Month 12 after a reattachment of macula-off RRD following vitrectomy.
Highlights
The final best-corrected visual acuity (BCVA) was significantly correlated with the BCVA at Week 2 (r = 0.61, P
Multiple stepwise regression analyses of the final BCVA showed that the BCVA at Week 2 (P = 0.017) and the integrity of the EZ at Week 2 (P = 0.006) were independent predictors of the final BCVA
Many optical coherence tomography (OCT) studies have demonstrated that the integrities of the retinal hyperreflective outer bands, e.g., the external limiting membrane (ELM), the ellipsoid zone (EZ), and cone interdigitation zone (CIZ), are significantly correlated with the BCVA following a retinal reattachment.[12,13,14,15,16,17,18]
Summary
A rhegmatogenous retinal detachment (RRD) is a sight-threatening retinal disease, and currently, the only treatment for a RRD is a surgical reattachment of the retina. [1] Despite the high level of anatomic success of retinal reattachment surgery, [2,3,4] the improvement of the central vision may remain compromised because of functional damages to the retina during the detachment period. [5, 6]The preoperative factors reported to be associated with the functional recovery following reattachment of a macula-off RRD include the preoperative best-corrected visual acuity (BCVA), [7] duration of the macular detachment, [8] [9] height of the macular detachment, [10] [11] and age of the patient. [4] these preoperative factors can depress the preoperative vision in eyes with macula-off RRD. None of the studies examined the BCVA at the very early postoperative period, e.g., at 2 weeks It is still not known what perioperative factor is the best predictor of the final BCVA after successful reattachment of eyes with a macula-off RRD. Many OCT studies have demonstrated that the integrities of the retinal hyperreflective outer bands, e.g., the external limiting membrane (ELM), the ellipsoid zone (EZ), and cone interdigitation zone (CIZ), are significantly correlated with the BCVA following a retinal reattachment.[12,13,14,15,16,17,18] it is difficult to evaluate these retinal outer bands in the preoperative or the very early postoperative period because of the distortions of the detached retina
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