Author: Wei Wei LEE (Canada)
Co-authors: Aditya Bansal, Srinivas Sadda, David Sarraf, Peter Kertes, Roxane Hillier, Rajeev Muni
Purpose
To assess the incidence of post-operative outer retinal folds (ORFs) following pneumatic retinopexy (PnR) vs pars plana vitrectomy (PPV) with en face and cross-sectional spectral-domain optical coherence tomography (SD-OCT) following rhegmatogenous retinal detachment (RRD) repair and to determine the association of ORFs with visual acuity (ETDRS letter score) and metamorphopsia (M-CHARTS) at 12 months post-operatively.
Setting/Venue
This study is a post hoc analysis of macula-off patients from The Pneumatic Retinopexy vs Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes randomized trial ('PIVOT') conducted at St. Michael’s Hospital, Toronto, Canada.
Methods
The incidence and morphological features of the ORFs were assessed with en face and cross-sectional OCT at 1 month post-operatively by two masked graders. Quantitative assessment of morphological features was performed with Image J. Visual acuity (ETDRS letter score) and quantitative metamorphopsia score (using M-CHARTs) were measured at 1 year. The primary outcome of this post hoc analysis was the difference in the proportion of patients with macula-off RRD with early post-operative ORFs (1 month post-operatively) in eyes undergoing PPV vs PnR. The secondary outcomes included the association of ORFs with functional outcomes including visual acuity (ETDRS letter score) and quantitative metamorphopsia measurement (M-CHARTS) at 12 months. We assessed the correlation of ORFs morphological features (height, distance from fovea, total area, perimeter, length and angulation) with functional outcomes.
Results
Eighty-eight of the 176 participants enrolled in PIVOT were macula-off RRD. 94.3% (83/88) of these had month 1 post-operative OCT scans that were gradable, 93.2% (41/44) in the PPV group and 95.5% (42/44) in the PnR group. The incidence of ORFs was 34.1% (14/41) in the PPV group and 14.3% (6/42) in the PnR group (p=0.034). ETDRS letter score at 1 year was 65.7±6.6 and 75.1±1.4 letters in patients with and without ORFs respectively (difference=9.4 letters, 95% CI=7.5-11.3, p=0.047). In the PPV group only, ETDRS letter score at 1 year was 62.8 ± 24.7 letters and 75.4 ± 9.2 letters in patients with and without ORFs respectively (difference=12.6 letters, 95% CI=0.05-24.59, p=0.04). Horizontal and vertical metamorphopsia scores were similar in patients with vs without ORFs: horizontal: 0.35 ± 0.12 vs 0.29 ± 0.07 (difference=0.06, 95% CI=0.01-0.11, p=0.69) and vertical: 0.25±0.07 vs 0.29±0.07 (difference=0.04, 95%CI=0-0.08, p=0.60) respectively. There was a negative correlation between the shortest distance of an ORF from the fovea with vertical metamorphopsia score (r=-0.507, p=0.045). The other quantitative measurements of ORF maximum height, total area, perimeter, length, angulation and total number of folds were not correlated with any of the functional outcomes.
Conlusions
In conclusion, this post-hoc analysis of the PIVOT trial demonstrated a higher risk of ORFs in PPV vs PnR at one month post-operatively with worse ETDRS visual acuity at one year in patients with ORFs compared to those without. This study provides further evidence that different surgical treatments for RRD repair result in varying integrity of retinal reattachment.
Financial Disclosure
No financial relation
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