Relationship between macular microstructure and visual acuity after scleral buckling for macular-off primary rhegmatogenous retinal detachment by 3D-OCT

Abstract:

AIM: To investigate the correlation between macular mierostructure changes and visual outcomes after scleral buckling for macular-off primary rhegmatogenous retinal detachment(RRD)by three-dimensional optical coherence tomography(3D-OCT).

METHODS: Retrospective case review, the clinical data of scleral buckling in 30 eyes of 30 cases of RRD involving macular area were analyzed retrospectively. The changes of ellipsoid zone(EZ), external 1imiting membrane(ELM), subretinal fluid(SRF)and central retinal thickness(CRT)were observed and the relationship between them and best corrected visual acuity(BCVA)was analyzed by 3D-OCT at 2d, 2wk, 1, 3 and 6mo after operation.

RESULTS: Postoperative SRFH and CRT showed a descended trend. Postoperative BCVA showed an ascendant trend. Multiple comparisons: there were significant difference in each groups except SRFH(2wk vs 1mo, P>0.05), CRT(2d vs 2wk, P>0.05), BCVA(2d vs preoperation, 2wk vs preoperation, P>0.05). There are four forms of EZ and ELM::9 eyes, intact ELM and EZ(EZ+ELM+); B: 7 eyes, intact ELM with disrupted EZ:(EZ-ELM+); AC: 6 eyes, intact EZ with disrupted ELM:(EZ+ELM-); D: 8 eyes, disrupted ELM and EZ:(EZ-ELM-), the BCVA of the above four types are 0.15±0.04, 0.50±0.06, 0.54±0.05 and 0.59±0.09, there were significant difference in each groups except(C vs B, P>0.05)and(C vs D, P>0.05). The incidence of SRF was 87% 2d after operation, 46.6% patients had persistent SRF at 6mo after operation. Postoperative CRT was positively correlated with postoperative SRFH.

CONCLUSION: After scleral buckling, the macular microstructure showed dynamic changes. The effect of SRF may be manifested as BCVA delayed recovery. With the slow absorption of SRF, CRT decreased and BCVA increased. The intact ELM or EZ shows better vision, but the disrupted ELM means worse vision.

Key words:rhegmatogenous retinal detachment; scleral buckling surgery; optical coherence tomography; macula central fovea