MACULAR OCT FINDINGS AFTER SUCCESSFUL RHEGMATOGENOUS RETINAL DETACHMENT REPAIR; A COMPARISON BETWEEN CASES WITH AND WITHOUT VISUAL IMPROVEMENT

Abstract

Purpose: A comparative study using OCT to determine the possible causes associated with incomplete visual recovery after successful rhegmatogenous retinal detachment (RRD) repair in cases with and without visual improvement. Patients& methods: We studied 200 eyes of 200 patients with RRD that involved the fovea. The patients were examined and the findings recorded before and after surgery. The period from the onset of symptoms to presentation ranged from 3-60 days. OCT was performed at the 1st, 3rd, and 6th post-operative months. The patients were followed for a period from 6-18 months (mean 8.4 months). Results: On comparing the best corrected visual acuities (BCVAs) at 1st and 6th months, there was a mean gain of 3 Snellen lines (range; 1-6 lines) in 160 patients (80%) and no improvement in 40 patients (20%).The mean postoperative BCVA at 1,3 and 6 months of the improved patients was 6/60, 6/24,and 6/18 respectively (Log MAR equivalent of 1.00, 0.60 ,and 0.50 ). OCT of these 40 eyes without visual improvement showed subfoveal fluid in 10 eyes (25%), macular edema(ME) in 21 (52.5%) eyes, epiretinal membranes(ERM) in 15 eyes (37.5%), photoreceptor damage (distortion of the photoreceptors IS/OS junction in 31 eyes (77.5%), macular holes(MH) in 2 eyes (5%), and retinal pigment epithelium (RPE) degenerative changes in 11 eyes (27.5%). OCT of those with visual improvement also showed some abnormalities which contributed to incomplete visual recovery: ME in 21 eyes (13.2%), ERM in 9 (5.6%)eyes, subfoveal fluid in 40 eyes (25%), photoreceptor damage in 31 eyes (19.4%), and RPE degenerative changes in 12 eyes (7.5%). Conclusion: Incomplete and/or delayed visual recovery after successful retinal reattachment may occur even in cases with visual improvement due to many causes; photoreceptor damage, macular edema, epiretinal membranes, subfoveal fluid, macular holes, and RPE degenerative changes. OCT is a valuable and noninvasive tool for detecting, evaluating and follow-up of these cases.