Abstract
PurposeAssess the relationship between photoreceptor degeneration and visual function after retinal reattachment surgery (RRS) in a prospective cohort.MethodsPatients with rhegmatogenous retinal detachment (RRD) were reviewed before and 6 months after vitreoretinal surgery. Optical coherence tomographical thickness of the outer nuclear layer (ONL), outer retinal segment (ORS), retinal pigmented epithelium to ellipsoid zone (RPE-EZ) and external limiting membrane to EZ (ELM-EZ) were recorded 6 months post-operatively. These were compared to best corrected visual acuity (BCVA) and retinal sensitivity (Humphrey visual field).ResultsThirteen macula-off and 8 macula-on RRD patients were included. The mean ONL thickness was higher after macula-on RRD compared to macula-off RRD (97.70 ± 3.62 μm vs. 73.10 ± 4.98 μm). In all RRD eyes, every 1 μm decrease in ONL thickness correlated with a 0.052 dB decrease and in retinal sensitivity and every 1 μm decrease in ORS thickness was associated with a 0.062 dB reduction in retinal sensitivity. ORS, ELM-EZ and RPE-EZ thickness did not correlate with BCVA post-RRS.ConclusionThere was greater ONL and ORS thinning following macula-off compared to macula-on RRD. Correlations between ONL and ORS thinning with decreased retinal sensitivity may be explained by RRD-induced photoreceptor death.
Highlights
There are significant geographical variations in the incidence of rhegmatogenous retinal detachment (RRD) of between 6.3 and 17.9 per 100,000 of population [1]
Subretinal caspase-8 and -9 levels increase as the area of detachment increases in human RRD and TUNEL-positive nuclei are detected in the outer nuclear layer (ONL) 1–7 days after RRD, which are changes that suggest photoreceptors degenerate by apoptosis [12, 13]
We investigated the relationship between outer retinal thickness and visual acuity and perimetric retinal sensitivity
Summary
There are significant geographical variations in the incidence of rhegmatogenous retinal detachment (RRD) of between 6.3 and 17.9 per 100,000 of population [1]. Retinal function is impaired by altered synaptic connectivity in the outer plexiform layer, imperfect photoreceptor outer segment regeneration, failed reconstitution of the RPE cone sheath and scarring within the retina [6]. Evidence for photoreceptor degeneration after RRS includes thinning of the outer nuclear layer (ONL), reduced cone mosaic density and suppression of genes regulating photoreceptor function [7,8,9,10,11]. Subretinal caspase-8 and -9 levels increase as the area of detachment increases in human RRD and TUNEL-positive nuclei are detected in the ONL 1–7 days after RRD, which are changes that suggest photoreceptors degenerate by apoptosis [12, 13]. Vitreous levels of pro-apoptotic molecules intercellular adhesion molecule-1 (ICAM-1), induced by Fas ligation, and monocyte chemoattractant protein-1 (MCP-1) are upregulated after RRS [7, 14,15,16]
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