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.

Keywords: Biomarker; CIRD; Center Involving Retinal; Detachment; Fovea-off; MIRD; Macula Involving Retinal Detachment; Macula-off; Macula-on; Morphology; Nomenclature; OCT; Optical coherence tomography; Retinal detachment; Rhegmatogenous.

Fig. 1

Flow chart depicting process of data acquisition and eligibility criteria for in- and exclusion of patients resulting in a retrospective cohort of 102 eyes of 102 patients with primary rhegmatogenous macula involving retinal detachment (MIRD)

Fig. 2

Illustration for 5 grades of macula involving retinal detachment (MIRD) based on the morphological extent of involvement using the ETDRS grid in optical coherence tomography (OCT)

Fig. 3

Infrared-image (IR) with ETRDS grid and SD-OCT (30°) of 6 eyes, representing 5 grades of macula involving retinal detachment (MIRD). a–c represent MIRD without center involvement (G1–G3). d CIRD with limited macular detachment (G4): ∂ marks one outer macular quadrant where no subretinal fluid can be detected in volume or radial scans. e, f show detachment involving all 4 outer macular quadrants (marked with ∂) defined as G5 (“CIRD with complete macular detachment“). Dotted white circles in a–c indicate subretinal fluid within this circle. A drawn through white circle indicates that subretinal fluid does not cross this boundary. White and black arrows mark margin of detachment correlating to localization in IR/OCT scans; ƒ in d represents height of foveal detachment (FDH = 291 μm, measured perpendicularly to RPE in 1:1 resolution); * marks focal (e) and wide (f) cystoid intraretinal edema with a perifoveal radius of ≤ 3.0 mm (black dotted circle/lines) serving as cutoff