Multimodal imaging of eyes with metamorphopsia after vitrectomy for rhegmatogenous retinal detachment

Abstract

Purpose: To assess the retinal features in eyes with postoperative metamorphopsia (POM) following rhegmatogenous retinal detachment (RRD) repair using multimodal imaging (MMI).

Methods: In this cross-sectional; case-control study, patients after successful RRD repair following 25-gauge vitrectomy, clear vitreous cavity, and corrected distance visual acuity (CDVA)>20/200 were categorized using Amsler chart: cases with POM and controls without POM. MMI was performed on swept-source platform (Triton, Topcon Inc) and the confocal scanning laser ophthalmoscope system (Spectralis HRA, Heidelberg). The measures assessed were CDVA, morphological features on optical coherence tomography, autofluorescence, and multicolor imaging (MCI).

Results: Thirty-nine eyes were included in each group. Cases had greater number of eyes with total RRD (P = 0.029) preoperatively; abnormal foveal contour (P = 0.036), ellipsoid zone (EZ) disruption (P < 0.001) and poorer postoperative CDVA (P = 0.046) as compared to controls. Outer retinal folds and retinal shift (unintentional translocation of retina after reattachment surgery for RRD) did not differ significantly between the groups (P = 0.48 and 0.35, respectively). On MCI, the distribution of detected ERM was similar between the groups (P = 0.25). Postoperative CDVA was significantly worse in eyes with POM.

Conclusion: POM is affected by extent of RRD, postoperative foveal contour, and EZ status but not by retinal shift.

Keywords: Amsler chart; metamorphopsia; multimodal imaging; rhegmatogenous retinal detachment; vitrectomy.

Figure 1

The SS-OCT scans were seen for the foveal contour (flattening and widening of retinal layers) (a), presence of ERM (b), and cystoid macular edema (c), disruption of ELM (d), IS/OS junction (e), and presence of SRF (f)

Figure 2

FAF images were seen as outer retinal folds as concentric bands of hyper- or hypoautofluorescence (white arrows) at the posterior pole (a); retinal displacement was present. Lines of increased autofluorescence (white arrows) were seen parallel to the retinal vessels, which indicates the original location of retinal vessels before RRD. These retinal vessels were displaced unintentionally after successful RRD repair from their original location (b)

Figure 3

Multicolor images were studied for the presence of ERM (a and b) and other abnormal macular structures

Figure 4

Frequency distribution of postoperative CDVA bar chart showing that postoperative metamorphopsia was more commonly and higher percentage complained in patients with ≤20/200 (lower CDVA) category and almost equal and very less percentage of patients in 20/40–20/120 and 20/20–20/30 (better CDVA) category, respectively