Author: taw dipu (India)
Co-authors: Meenakshi Thakar, Pooja Bansal, Akanksha Gautum, Priyadarshi Gupta, Varun Saini, Banu Pavitra
Purpose
To correlate outer nuclear layer thickness and visual acuity with duration of detachment. Primary outcome measure was outer nuclear layer thickness and ONL restoration post rhegmatogenous retinal detachment repair and correlation with duration of detachment. Secondary outcome measure were other structural changes seen in optical coherence tomography such as IS-OS disruption, ELM disruption, persistent sub retinal fluid and correlation of above with duration of detachment. Correlation of best corrected visual acuity with ONL and duration of detachment
Setting/Venue
it was a prospective, observational and comparative study, conducted at Vitreoretinal services of Gurunanak eye Centre, Maulana Azad Medical College, Delhi, India. We enrolled patients diagnosed and treated for retinal detachment from September 2015 to December 2017. A written informed consent was taken from each patient.
Methods
Patients were divided into three Groups, Group A patients operated within 1 month of RRD; Group B RRD repaired 1-3 months, Group C RRD repaired after 3 months. Each group had 15 patients with total of 45 patients (90 eyes). The OCT parameters and BCVA were noted 4 months post operative. To measure the mean outer nuclear layer, we chose the OCT image with the steepest foveal excavation from the radial scans across the foveal area. The outer nuclear layer thickness is the distance between the inner limiting membrane and the external limiting membrane at the central foveal. This was compared with patient’s normal eye to give the ONL restoration in percentage. Patients underwent either buckling surgery or parsplana vitrectomy depending upon the indication.
Results
The difference in ONL thickness was significant between Group A and C (p=0.001), Group B and C (p=0.049) but insignificant between Group A and B (p=0.246).The ONL restoration was significant between Group A and C (P=0.001), Group B and C (P=0.025) but insignificant between Group A and B (P=0.197). The difference in BCVA was significant between Group A and B (p=0.028), between Group A and C (p=0.001) and insignificant between Group B and C (p=0.052). With each day of RD there was 0.004 logMAR loss of vision. IS-OS disruption was significant between Group A and B (p=0.02) and Group A and C (p=0.001) and insignificant between Group B and C (P=0.05). Similarly, ELM disruption was significant between Group A and B (P=0.027) and Group A and C (p=0.001) but insignificant between Group B and C (p=0.104)
Conlusions
Our study reemphasis the need for early repair of RRD within 1 month. Beyond 1 month, though ONL restoration occurred the BCVA was worse in patients operated after 1 month. Most microstructural changes go hand in hand with the chronicity of detachment. With an increase in duration of detachment more number of patients had IS-OS junction disruption and ELM disruption. However, ERM, persistent SRF and intraretinal fluid had not correlation with duration of detachment and final BCVA. Longer follow up is required to give better idea about the ONL restoration, and other OCT parameters like IS-OS junction disruption, ELM disruption, intraretinal and sub retinal fluid, ERM formation.
Financial Disclosure
no financial interest
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