Fundus autofluorescence and spectral domain optical coherence tomography as predictors for long-term functional outcome in rhegmatogenous retinal detachment
To detect pre- and postoperative retinal changes in fundus autofluorescence (AF) and spectral domain optical coherence tomography (SD-OCT) and to correlate these with functional outcome in patients with primary rhegmatogenous retinal detachment (RRD).
A prospective, 30-month study of patients operated with 25-gauge vitrectomy for primary RRD. Patients were examined preoperatively and after 6 and 30 months, using ultrawide-field AF images (UWFI) (Optos 200Tx) and SD-OCT (Topcon 3D OCT-2000) imaging.
Of 84 patients (84 eyes) included at baseline, 100.0 and 86.9% were re-examined at month 6 and 30, respectively.
Preoperative findings such as macular attachment, detachment > 750 μm from foveola, lack of intraretinal separation, and subfoveal elevation ≤ 500 μm were all associated with better BCVA at months 6 and 30. Postoperative disruption of the photoreceptor layer was associated with poor BCVA at month 6 (p < 0.001) but not at month 30.
At baseline, AF-demarcation of RRD was demonstrated by a hyperfluorescent edge in 92.0% and was associated with visual impairment at months 6 (p = 0.003) and 30 (p = 0.003).
Visual outcome at month 30 was good (≤ 0.3 logMAR (≥ 20/40 Snellen)), regardless of the preoperative, macular status. However, with significantly better visual outcome in patients with macula attachments versus partly or totally macular detachments (p < 0.001).
Fundus AF and SD-OCT is able to identify retinal reestablishment up to 30 months after primary RRD, with good correlation to BCVA. These findings emphasize the importance of long-term studies for final visual recovery.
KeywordsFundus autofluorescence Long-term outcome Optical coherence tomography Visual outcome Rhegmatogenous retinal detachment Vitrectomy
CDP, JG, TP, and AG contributed to the concept and design of the study. CDP contributed to the acquisition of data. MPP contributed to the grading of SD-OCT images.
Data analyses were performed by CDP, who also wrote the initial draft of the paper. AG, TP, and JG revised the paper critically for intellectual content. All the authors approved the final version of the paper.
This study was funded by grants from Alice Rasmussen Memorial Fund, the Foundation of A. P. Møller and Chastine Mc-Kinney Møller, the Research Grant at the University of Southern Denmark, Director Jakob Madsen and Wife Olga Madsen Foundation, King Christian the X Foundation, Henry and Astrid Møller’s Foundation, A.J. Andersen and Wife Foundation, Einar Willumsen’s Memorial Fund, Department of Clinical Research Foundation at Odense University Hospital, the Region of Southern Denmark, and the Institute of Clinical Research at the University of Southern Denmark.
The included data has not been presented before.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
This study was approved by the Danish Data Protection Agency and the Research Ethics Committee of the Region of Southern Denmark. All parts of the study were conducted in accordance with the Helsinki declaration II and in accordance with good clinical practice.
Informed consent was obtained from all individual participants included in the study.
- 2.Wong CW, Wong WL, Yeo IY, Loh BK, Wong EY, Wong DW, Ong SG, Ang CL, Lee SY (2014) Trends and factors related to outcomes for primary rhegmatogenous retinal detachment surgery in a large asian tertiary eye center. Retina 34(4):684–692. https://doi.org/10.1097/IAE.0b013e3182a48900 CrossRefGoogle Scholar
- 5.Heimann H, Bartz-Schmidt KU, Bornfeld N, Weiss C, Hilgers RD, Foerster MH (2007) Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study. Ophthalmology 114(12):2142–2154. https://doi.org/10.1016/j.ophtha.2007.09.013 CrossRefGoogle Scholar
- 6.Pastor JC, Fernandez I, Rodriguez de la Rua E, Coco R, Sanabria-Ruiz Colmenares MR, Sanchez-Chicharro D, Martinho R, Ruiz Moreno JM, Garcia Arumi J, Suarez de Figueroa M, Giraldo A, Manzanas L (2008) Surgical outcomes for primary rhegmatogenous retinal detachments in phakic and pseudophakic patients: the retina 1 project—report 2. Br J Ophthalmol 92(3):378–382. https://doi.org/10.1136/bjo.2007.129437 CrossRefGoogle Scholar
- 7.Heimann H, Zou X, Jandeck C, Kellner U, Bechrakis NE, Kreusel KM, Helbig H, Krause L, Schuler A, Bornfeld N, Foerster MH (2006) Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of 512 cases. Graefes Arch Clin Exp Ophthalmol 244(1):69–78. https://doi.org/10.1007/s00417-005-0026-3 CrossRefGoogle Scholar
- 8.Mitry D, Awan MA, Borooah S, Siddiqui MA, Brogan K, Fleck BW, Wright A, Campbell H, Singh J, Charteris DG, Yorston D (2012) Surgical outcome and risk stratification for primary retinal detachment repair: results from the Scottish retinal detachment study. Br J Ophthalmol 96(5):730–734. https://doi.org/10.1136/bjophthalmol-2011-300581 CrossRefGoogle Scholar
- 11.Dell'Omo R, Mura M, Lesnik Oberstein SY, Bijl H, Tan HS (2012) Early simultaneous fundus autofluorescence and optical coherence tomography features after pars plana vitrectomy for primary rhegmatogenous retinal detachment. Retina 32(4):719–728. https://doi.org/10.1097/IAE.0b013e31822c293e CrossRefGoogle Scholar
- 19.Burton TC (1982) Recovery of visual acuity after retinal detachment involving the macula. Trans Am Ophthalmol Soc 80:475–497Google Scholar
- 21.Hood DC, Zhang X, Ramachandran R, Talamini CL, Raza A, Greenberg JP, Sherman J, Tsang SH, Birch DG (2011) The inner segment/outer segment border seen on optical coherence tomography is less intense in patients with diminished cone function. Invest Ophthalmol Vis Sci 52(13):9703–9709. https://doi.org/10.1167/iovs.11-8650 CrossRefGoogle Scholar
- 23.Holz FG, Bellman C, Staudt S, Schutt F, Volcker HE (2001) Fundus autofluorescence and development of geographic atrophy in age-related macular degeneration. Invest Ophthalmol Vis Sci 42(5):1051–1056Google Scholar
- 24.Schmitz-Valckenberg S, Bindewald-Wittich A, Dolar-Szczasny J, Dreyhaupt J, Wolf S, Scholl HP, Holz FG, Fundus Autofluorescence in Age-Related Macular Degeneration Study G (2006) Correlation between the area of increased autofluorescence surrounding geographic atrophy and disease progression in patients with AMD. Invest Ophthalmol Vis Sci 47(6):2648–2654. https://doi.org/10.1167/iovs.05-0892 CrossRefGoogle Scholar