Early Photoreceptor Alterations After Retinal Detachment Repair

Abstract

Purpose: The importance of outer retinal microstructure, specifically the external limiting membrane (ELM) and ellipsoid zone (EZ), was recently highlighted for visual recovery after rhegmatogenous retinal detachment (RRD). Quantitative assessment of the EZ/ELM reflectivity, termed the relative EZ reflectivity (rEZR), is a novel SD-OCT imaging biomarker for photoreceptor integrity. This study evaluates the rEZR's functional relevance after anatomically successful RRD repair, as well as its association with the surgical techniques.

Methods: Patients with primary RRD, treated at the Department of Ophthalmology, University of Bonn/Germany between April 2021 and April 2023 and presenting to the six-week postoperative review with complete retinal reattachment, were identified. The rEZR (arbitrary units [AU]) was determined in the postoperative imaging data. Linear-mixed effect models, corrected for patient's age and preoperative macula-on/macula-off RRD situation, were applied to assess the association of the rEZR with the postoperative best-corrected visual acuity (BCVA) and with the previously applied surgical techniques.

Results: A total of 187 patients with a median [interquartile range (IQR)] age of 70.0 [9.7] years (32.1% female) were included. Out of those, 91.4% (n = 171) underwent vitrectomy and 8.6% scleral buckling. Higher rEZR values were significantly associated with a better BCVA (coefficient estimate [CE] = 0.3009 [0.1620; 0.4398], P < 0.001) and scleral buckling (CE = 12.20 [0.33; 24.07], P < 0.044).

Conclusions: This study supports the functional relevance of outer retinal impairment, as quantified by rEZR, and its association with surgery-related variables in the early postoperative period after RRD repair. Further research is needed to better understand the importance of longitudinal rEZR changes to finally achieve the best visual outcomes for RRD patients.

Figure.

Exemplary patient. Representative (pseudophakic) patient with macula-off RRD in the right eye (A, see sketch) presenting with a preoperative BCVA of 1.0 logMAR (20/200 Snellen, 0.2 decimal) in the right and 0.0 logMAR (20/20, 1.0 decimal) in the fellow eye. SD-OCT line scans demonstrate the extent of the retinal detachment with foveal involvement (A, right column). Surgical RRD repair was performed on the day of the first presentation with 23g PPV, laser photocoagulation, and gas endo tamponade (no intraoperative use of heavy liquid). Retinal reattachment was demonstrated at a postoperative FU1 visit six weeks after surgery (B). Furthermore, the normal macular configuration was present in clinical assessment and SD-OCT imaging (B, first row). Postoperative BCVA was 0.4 logMAR (20/50 Snellen, 0.4 decimal). An en-face heat-map representation of the rEZR (color-coded from black to yellow indicating lower to higher rEZR values) demonstrates, despite complete retinal reattachment and the absence of any other macular pathology, worse outer retinal integrity in the study eye (B, first row) compared to the healthy fellow eye (B, second row).