OCT Can Help Predict Visual Outcomes in Macula-Off Retinal Repair

Low mean preoperative central retinal thicknesses (CRT) are associated with a good visual prognosis for patients who underwent macula-off rhegmatogenous retinal detachment (RRD) repair, according to a study published in Retina. The research also shows that patients with worse preoperative visual acuity and greater subretinal fluid height have a higher likelihood of experiencing improvements to their vision after the procedure.

Researchers included in their review 49 eyes of 48 patients (64.6%, men, mean age 57.15±16.42 years) who were treated for nontraumatic RRD with macula-off repair surgery between 2012 and 2017. They used pre- and postoperative optical coherence tomography (OCT) images, as analyzed by 2 retina surgeons, to determine the morphological changes to the retina following the procedure, and they collected best-corrected visual acuity data (BCVA) from the patients’ records. 

Patients with a BCVA of 20/40 or better were considered to have “good” final vision, and those with 20/200 or worse were considered to have “poor” final vision. 

They found that 29 eyes (59%) had a final good BCVA of 20/40 or better (≤0.3013 logMAR), and 20 (41%) had a final BCVA worse than 20/40 (>0.3013 logMAR). Prior to the procedure, the mean CRT across the study was 182.44±65.75 mm and the subretinal fluid height was 693.68±405.78 mm. The eyes with vision better than 20/40 demonstrated a smaller baseline CRT on OCT (96 mm) compared with the eyes with visual outcomes worse than 20/40 (161 mm, P =.048). Overall, most patients (44, 90%) experienced improvement in BCVA from baseline after the surgery. Only 2 patients had poor visual outcomes with BCVAs of 20/200 or worse. Both those patients exhibited disruption of the external limiting membrane and ellipsoid zone (EZ) on preoperative OCT, researchers report.

In analyzing postoperative OCT images, researchers note a significant difference in that patients with a postoperative EZ disruption were more likely to have had a final BCVA worse than 20/40 as compared with those who did not (P =.047). Postoperative external limiting membrane disruption also made it less likely patients would achieve BCVA better than 20/40 (P =.069). Also, inner retinal cystic changes seemed to make it significantly more likely patients would have a postoperative EZ disruption, the study shows. The OCT analysis also suggests a preoperative disrupted external limiting membrane is significantly associated with the postoperative development of a disrupted EZ (P =.004). 

“We found that eyes with persistent EZ disruption were less likely to have a BCVA of 20/40 or better at latest follow-up” researchers explain. “Moreover, we found that eyes with IRC, ELM disruption, and greater SRF height on preoperative OCT were more likely to exhibit postoperative EZ disruption.”

Study limitations include its limited sample size, although it is larger than “most previous reports looking at macula-off cases alone,” according to the researchers. They also could not confirm the true duration of detachment of each eye.

Reference

Guan I, Gupta M, Papakostas T, et al. Role of optical coherence tomography for predictingpostoperative visual outcomes after repair of macula-off rhegmatogenous retinal detachment. Retina. 2021;41(10):2017-2025. doi:10.1097/IAE.0000000000003162