Natalia Figueiredo1, David Sarraf2, Frederic Gunnemann3, Srinivas R Sadda3, Aditya Bansal1, Alan R Berger1, David T Wong1, Radha P Kohly4, Peter J Kertes4, Roxane J Hillier5, Rajeev H Muni6. 1. Department of Ophthalmology and Vision Sciences (N.F., A.B., A.R.B., D.T.W., R.P.K., P.J.K., R.H.M.), University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology (N.F., A.B., A.R.B., D.T.W., R.H.M.), St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada. 2. Department of Ophthalmology (D.S., F.G., S.R.S.), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA. 3. Department of Ophthalmology (D.S., F.G., S.R.S.), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA; Doheny Image Reading Center (F.G., S.R.S.), Doheny Eye Institute, Los Angeles, California, USA. 4. Department of Ophthalmology and Vision Sciences (N.F., A.B., A.R.B., D.T.W., R.P.K., P.J.K., R.H.M.), University of Toronto, Toronto, Ontario, Canada; Kensington Vision and Research Centre (R.P.K., P.J.K., R.H.M.), University of Toronto, Toronto, Ontario, Canada; The John and Liz Tory Eye Centre (R.P.K., P.J.K.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 5. Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Thyme, United Kingdom; Institute of Translational and Clinical Research (R.J.H.), Newcastle University, Newcastle upon Thyme, United Kingdom. 6. Department of Ophthalmology and Vision Sciences (N.F., A.B., A.R.B., D.T.W., R.P.K., P.J.K., R.H.M.), University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology (N.F., A.B., A.R.B., D.T.W., R.H.M.), St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Kensington Vision and Research Centre (R.P.K., P.J.K., R.H.M.), University of Toronto, Toronto, Ontario, Canada; Keenan Research Centre for Biomedical Science (R.J.H., R.H.M.)/Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada. Electronic address: rajeev.muni@gmail.com.
Abstract
PURPOSE: Suboptimal functional outcomes after rhegmatogenous retinal detachment (RRD) repair may be related to photoreceptor abnormalities, including alterations of the ellipsoid zone (EZ) that may not be apparent on cross-sectional optical coherence tomography (OCT). This study assessed EZ recovery using en face OCT after RRD repair and its association with visual acuity. DESIGN: Post hoc analysis of a randomized controlled trial. METHODS: Patients with macula-off RRD were monitored at 3, 6, 12, and 24 months postoperatively and annually thereafter. En face OCT of the EZ slab were analyzed. Hyporeflective areas were colocalized with EZ abnormalities on cross-sectional OCT B-scans and measured by 2 masked graders. Primary outcome was change in area of EZ hyporeflectivity from 3 to 24 months, and its association with Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity recovery was also assessed. RESULTS: In total, 271 images of 61 patients were assessed. Mean area of hyporeflectivity significantly decreased from 3 to 24 months (-2.98 mm2; 95% CI, 1.82-4.13 mm2; P < .0001), with further reductions up to 4 years. Linear regression revealed an association between change in hyporeflective area and change in the ETDRS letter score from 3 to 24 months (β = -0.31, P = .009, R2 = 14.8%) and between duration of macula-off and change in hyporeflective area from 3 to 24 months (β = -0.37, P = .018, R2 = 13.7%). CONCLUSIONS: En face OCT provides a novel biomarker for visualizing and quantifying EZ recovery after RRD repair that is associated with ETDRS visual acuity recovery. A steady decline in the area of EZ hyporeflectivity was observed over many years with delayed recovery in patients with longer duration of macula-off.
PURPOSE: Suboptimal functional outcomes after rhegmatogenous retinal detachment (RRD) repair may be related to photoreceptor abnormalities, including alterations of the ellipsoid zone (EZ) that may not be apparent on cross-sectional optical coherence tomography (OCT). This study assessed EZ recovery using en face OCT after RRD repair and its association with visual acuity. DESIGN: Post hoc analysis of a randomized controlled trial. METHODS: Patients with macula-off RRD were monitored at 3, 6, 12, and 24 months postoperatively and annually thereafter. En face OCT of the EZ slab were analyzed. Hyporeflective areas were colocalized with EZ abnormalities on cross-sectional OCT B-scans and measured by 2 masked graders. Primary outcome was change in area of EZ hyporeflectivity from 3 to 24 months, and its association with Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity recovery was also assessed. RESULTS: In total, 271 images of 61 patients were assessed. Mean area of hyporeflectivity significantly decreased from 3 to 24 months (-2.98 mm2; 95% CI, 1.82-4.13 mm2; P < .0001), with further reductions up to 4 years. Linear regression revealed an association between change in hyporeflective area and change in the ETDRS letter score from 3 to 24 months (β = -0.31, P = .009, R2 = 14.8%) and between duration of macula-off and change in hyporeflective area from 3 to 24 months (β = -0.37, P = .018, R2 = 13.7%). CONCLUSIONS: En face OCT provides a novel biomarker for visualizing and quantifying EZ recovery after RRD repair that is associated with ETDRS visual acuity recovery. A steady decline in the area of EZ hyporeflectivity was observed over many years with delayed recovery in patients with longer duration of macula-off.