THREE-DIMENSIONAL RETINAL DISPLACEMENT BEFORE AND AFTER MACULAR PUCKER SURGERY

Abstract

Purpose: To measure the coronal and sagittal retinal displacement before and after surgery for epiretinal membranes in InfraRed horizontal foveal sections and optical coherence tomography scans and describe displacement tridimensionality, vision loss, and metamorphopsia.

Methods: Retrospective series with greater than 6-month average follow-up before and after surgery. The record included best-corrected visual acuity, optical coherence tomography, M-charts, and InfraRed retinography. Overall, pre- and postoperative coronal and sagittal retinal displacement across the entire field, concentric circles at 0.5-, 1.5-, and 4.5-mm radii, and the central horizontal and vertical meridian were calculated as the optical flow of consecutive images.

Results: This study comprised 10 patients (4 men, 6 women), with 22.7 ± 25.2 months follow-up before surgery and 16.2 ± 7.3 months after. Best-corrected visual acuity reduced before surgery (0.15 ± 0.67 logarithm of minimum angle of resolution to 0.38 ± 0.85 logarithm of minimum angle of resolution; P < 0.05) and increased afterward (0.086 ± 0.61 logarithm of minimum angle of resolution; P = 0.003). Preoperative coronal displacement was 30.1 ± 29.1 µm versus 67.0 ± 23.4 µm after (P = 0.002). Sagittal retinal displacement was 140.9 ± 84.6 µm before surgery, 339.7 ± 172.5 µm after (P = 0.017), and 357.6 ± 320.8 µm across the entire follow-up. Preoperative best-corrected visual acuity decreases correlated with the foveal coronal displacement. Vertical metamorphopsia correlated with the average coronal displacement within a 4.5-mm radius. Pre- and postoperative sagittal displacement correlated with horizontal metamorphopsia (P = 0.006 and P = 0.026). Postoperative sagittal displacement correlated with postoperative best-corrected visual acuity (P = 0.026) and foveal thickness (P = 0.009).

Conclusion: This study confirms that postoperative displacement is greater than preoperative and that sagittal displacement is greater than coronal and correlates with best-corrected visual acuity and metamorphopsia changes.

Fig. 1.

Visual acuity (BCVA; top right; A) and foveal thickness (bottom right; B) during follow-up. Note the decrease between T_E–T₀ and subsequent recovery.

Fig. 2.

Vertical and horizontal metamorphopsia during follow-up.

Fig. 3.

Pt 12 coronal (A) and sagittal (B) displacement vectors displaying the entire course of the disease from the earliest (−24 months) to the latest (+30 months) available visit (T_E–T_L). The sagittal OCT scan (B) is a horizontal foveal scan taken where the dashed black line is in (A). Vision in the same time frame returned close to pre-op values from 0.22 logMAR (20/33 Snellen) to 0.30 logMAR (20/40 Snellen).

Fig. 4.

Pt 14 coronal displacement between T_E (12 months before surgical indication was given) and T_L (48 months after surgery). Note the erratic direction of displacement vectors and their module (length of the arrow): they indicate quite a significant change in retinal topography after surgery and visual improvement from 20/50 (0.29 logMAR at T_E) dropping to 20/80 (0.60 logMAR at T₀) and improving to 20/25 (0.09 logMAR at T_L).

Fig. 5.

Pt 12 tangential (A) and sagittal (B) displacement vectors between 24 months before surgery and surgery (T_E–T₀). The sagittal OCT scan (B) is a horizontal foveal scan taken where the dashed black line is in (A). Vision in the same time frame dropped from 0.22 logMAR (20/33 Snellen) to 0.30 logMAR (20/66 Snellen). Note the relative scarcity of tangential dislocation compared with sagittal.

Fig. 6.

Pt 12 coronal (A) and sagittal (B) displacement vectors between right before surgery and 30 months later (T₀–T_L). The sagittal OCT scan (B) is a horizontal foveal scan taken where the dashed black line is in (A). Vision in the same time frame increased from 0.52 logMAR (20/66 Snellen) to 0.30 logMAR (20/40 Snellen).