Relationship between visual function and macular microstructure in highly myopic patients undergoing surgery for rhegmatogenous retinal detachment

Abstract

Objective: To analyze the relationship between visual function and macular microstructure in highly myopic patients undergoing surgery for rhegmatogenous retinal detachment (RRD).

Methods: Fifty-eight highly myopic patients treated in the Baoding No. 1 Central Hospital between December 2021 and September 2023 were selected as the research participants for retrospective analysis. All patients were complicated with RRD and underwent retinal reattachment surgery at Baoding No. 1 Central Hospital after diagnosis. Best-corrected visual acuity (BCVA) examinations were performed before and 3 months after surgery, and visual field mean sensitivity (MS) and fixation stability (FS) were measured by microperimetry. Additionally, changes in postoperative macular microstructure and micro blood flow were determined by optical coherence tomography (OCT), and their correlations with visual function were analyzed.

Results: Patients showed reduced BCVA, MS, and FS after surgery (all P<0.05), with 70.69% of them presenting with macular microstructural changes, mainly ellipsoid zone disruption and external limiting membrane disruption. Patients with macular microstructural changes exhibited significantly decreased BCVA, MS, and FS than those without (all P<0.05). In terms of micro blood flow, the BCVA, FS, and MS of patients with macular microstructural changes were negatively correlated with the foveal avascular zone (FAZ) area but were positively related to FAZ morphological index, PSCP, and VSCP (all P<0.05).

Conclusions: Changes in patients' visual function after surgery for RRD can be effectively evaluated by observing the macular ellipsoid, the integrity of the external limiting membrane, and the alterations in micro-blood flow, enabling the formulation of early and targeted interventions.

Keywords: High myopia; foveal avascular zone; macular microbleed; macular microstructure; rhegmatogenous retinal detachment.

Figure 1

Typical fundus B-ultrasound image. A. Weak echoes and striated and banded echoes are captured in the vitreous cavity of the left eye, and the banded echoes are connected to the optic disc and temporal bulbar wall echoes; B. A strong intravitreal band echo is captured in the left eye, which is connected to the optic disc echo, and a blood flow signal is seen on color Doppler flow imaging.

Figure 2

Comparison of changes before and after surgery. A. Comparison of BCVA before and after surgery; B. Comparison of FAZ area before and after surgery; C. Comparison of FAZ morphological index before and after surgery; D. Comparison of VSCP between the surgical eye and the contralateral eye after surgery; E. Comparison of VSCP between the surgical eye and the contralateral eye after surgery; F. Comparison of MS between the surgical eye and the contralateral eye after surgery; G. Comparison of FS between the surgical eye and the contralateral eye after surgery. Notes: BCVA, Best-corrected visual acuity; FS, fixation stability; MS, mean sensitivity; FAZ, foveal avascular zone; PSCP, perfusion densities of the superficial capillary plexus; VSCP, vessel densities of the superficial capillary plexus.

Figure 3

Comparison of BCVA (A), MS (B) and FS (C) between patients with and without macular microstructural changes. Notes: BCVA, Best corrected visual acuity; MS, Mean sensitivity; FS, Fixation stability.

Figure 4

Comparison of blood flow density indices between patients with and without macular microstructural changes. A. FAZ area; B. FAZ morphological index; C. PSCP; D. VSCP. Notes: FAZ, Foveal avascular zone; VSCP, Vessel densities of superficial capillary plexus; PSCP, Perfusion densities of superficial capillary plexus.

Figure 5

Relationship between macular blood flow density and visual function. A. Correlation of BCVA with FAZ area, FAZ morphological index, PSCP, and VSCP; B. Correlation of MS with FAZ area, FAZ morphological index, PSCP, and VSCP; C. Correlation of FS with FAZ area, FAZ morphological index, PSCP, and VSCP. Notes: FAZ, Foveal avascular zone; VSCP, Vessel densities of superficial capillary plexus; PSCP, Perfusion densities of superficial capillary plexus.