Contrast sensitivity and central vision in reattached macula

Incidence of Metamorphopsia After Successful Rhegmatogenous Retinal Detachment Surgery: A Systematic Review and Meta-Analysis

PURPOSES

To investigate the incidence and factors influencing the occurrence of metamorphopsia in patients with simple rhegmatogenous retinal detachment (RRD) after surgery.

METHODS

Relevant studies of metamorphopsia were identified by searching in PubMed, Embase, and Cochrane until August 2022. Meta-analysis of the incidence of metamorphopsia after rhegmatogenous retinal detachment surgery was performed using Review Manager 5.4 statistical software.

RESULTS

A total of 12 studies reported 1133 participants with 469 patients with postoperative metamorphopsia. The meta-analysis showed a higher incidence of metamorphopsia in macular-off cases compared with macular-on RRD (RR = 2.88, 95% CI: 2.35 to 3.52). The use of perfluorocarbon liquid (PFCL) during pars plana vitrectomy (PPV) reduced the incidence of metamorphopsia (RR = 0.61, 95% CI: 0.41 to 0.92). There was no evidence of any important difference in metamorphopsia between participants in the PPV group and the scleral buckling (SB) group (RR = 1.04, 95% CI: 0.82 to 1.33). There was little or no difference in metamorphopsia between gas and silicon oil (SO) in the PPV group (RR = 0.89, 95% CI: 0.69 to 1.13).

CONCLUSION

The incidence of postoperative metamorphopsia is higher in macular-off RRD, and PFCL should be a preferred choice to prevent postoperative metamorphopsia in macula-off RRD cases.

Postoperative Photoreceptor Integrity Following Pneumatic Retinopexy vs Pars Plana Vitrectomy for Retinal Detachment Repair: A Post Hoc Optical Coherence Tomography Analysis From the Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial

Importance

Pneumatic retinopexy (PnR) is associated with superior visual acuity and reduced vertical metamorphopsia compared with pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD). It is important to determine postoperative photoreceptor integrity with both surgical techniques.

Objective

To compare photoreceptor integrity on spectral domain-optical coherence tomography (SD-OCT) between PnR and PPV at 12 months postoperatively.

Design, Setting, and Participants

Post hoc analysis of the Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) conducted between August 2012 and May 2017 at St Michael's Hospital, Toronto, Ontario, Canada. Primary RRDs with specific criteria were included. Data were analyzed between April and August 2020.

Intervention

Randomization to PnR vs PPV stratified by macular status.

Main Outcomes and Measures

Difference in proportion of patients with discontinuity of the ellipsoid zone (EZ) and external limiting membrane (ELM) between groups assessed independently by 2 masked graders at an external masked image reading center.

Results

A total of 150 participants completed the 12-month follow-up visit. A total of 145 patients (72 PPV and 73 PnR) had gradable spectral-domain optical coherence tomography at 12 months. Analysis of the central 3-mm (foveal) scans found that 24% (n = 17 of 72) vs 7% (n = 5 of 73) displayed EZ discontinuity (difference, 17%; odds ratio [OR], 4.204; 95% CI, 1.458-12.116; P = .005) and 20% (n = 14 of 71) vs 6% (n = 4 of 73) displayed ELM discontinuity (difference, 14%; OR, 4.237; 95% CI, 1.321-13.587; P = .01) in the PPV and PnR groups, respectively. Analysis of the 6-mm (foveal and nonfoveal) scans revealed that EZ and ELM discontinuity was greater in the PPV vs PnR groups (EZ, 32% [n = 23 of 72] vs 11% [n = 8 of 73]; difference, 21%; OR, 3.814; 95% CI, 1.573-9.249; P = .002; ELM, 32% [n = 23 of 71] vs 18% [n = 13 of 73]; difference, 14%; OR, 2.211; 95% CI, 1.015-4.819; P = .04).

Conclusions and Relevance

Discontinuity of the EZ and ELM was more common at 12 months postoperatively following PPV vs PnR for RRD repair. The findings of this post hoc analysis suggest that less discontinuity of the EZ and ELM may provide an anatomic basis for the previously reported superior functional outcomes with PnR, although the analysis does not prove a cause-and-effect relationship.

Trial Registration

ClinicalTrials.gov Identifier: NCT01639209.

Postoperative vision-related quality of life in macula-off rhegmatogenous retinal detachment patients and its relation to visual function

Objective

To determine the vision-related quality of life (VR-QOL) after surgery for macula-off rhegmatogenous retinal detachment (RRD) in relation to visual acuity, contrast acuity, and color vision.

Methods

In a prospective observational study, we included 55 patients with a macula-off RRD. Best corrected visual acuity (BCVA), color vision (saturated and desaturated color confusion indices (CCI)) and contrast acuity were measured at 12 months postoperatively in both the RRD eye and the fellow control eye, and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was filled out.

Results

Operated and fellow control eyes differed significantly in mean LogMAR BCVA (P<0.0001), median Log contrast acuity (P<0.0001), saturated CCI (P = 0.009), and desaturated CCI (P = 0.016). Significant correlations were observed between the NEI VFQ-25 overall composite score and postoperative LogMAR BCVA (R = −0.551, P<0.0001), contrast acuity (R = 0.472, P<0.0001), saturated CCI (R = −0.315, P = 0.023), and desaturated CCI (R = −0.283, P = 0.044).

Conclusions

A lower VR-QOL was highly correlated to a worse postoperative BCVA and contrast acuity and to a lesser extent to color vision disturbances.

Postoperative recovery of visual function after macula-off rhegmatogenous retinal detachment

PURPOSE

To determine which factors affect the recovery of visual function in macula off rhegmatogenous retinal detachment (RRD).

METHODS

In a prospective study of forty-five patients with a primary macula-off RRD of 24 hours to 6 weeks duration, the height of the macular detachment was determined by ultrasonography. At 12 months postoperatively, best corrected visual acuity (BCVA), contrast acuity, and color confusion indexes (CCI) were obtained.

RESULTS

Macular detachment was present for 2-32 (median 7) days before repair. A shorter duration of macular detachment was correlated with a better CCI saturé (p = 0.0026) and lower LogMAR BCVA (better Snellen visual acuity) (p = 0.012). Also, a smaller height of macular detachment was correlated with a lower LogMAR BCVA (p = 0.0034). A younger age and lower pre-operative LogMAR BCVA at presentation were both correlated with better postoperative contrast acuity in the total group (age: p = 1.7×10(-4) and pre-operative LogMAR BCVA: p = 0.0034).

CONCLUSION

Functional recovery after macula-off RRD is affected by the duration and the height of the macular detachment. Recovery of contrast acuity is also affected by age and BCVA at presentation.

MEETING PRESENTATION

ARVO annual meeting 2013, May 7, Seattle, Washington, United States of America.

TRIAL REGISTRATION

trialregister.nl NTR839.

Long-term follow-up with optical coherence tomography and microperimetry in eyes with metamorphopsia after macula-off retinal detachment repair

PURPOSE

to report the long-term sequential morphological and functional results in eyes with metamorphopsia after retinal detachment (RD) repair.

PATIENTS AND METHODS

in six eyes of six patients aged 58.7 ± 11.0 years with metamorphopsia after successful buckling surgery for macula-off RD, best-corrected visual acuity (BCVA), fundus biomicroscopy, Amsler grid test, time-domain optical coherence tomography (TD-OCT) and central 12° microperimetry (MP-1) were performed at months 1, 3, 6, 12, and 18. At 5 to 6 years after surgery all patients underwent also spectral domain (SD)-OCT.

RESULTS

three eyes slowly recovered pre-RD BCVA. In the remaining three eyes-with good final BCVA-the interrupted junction line between photoreceptor cell inner and outer segments (IS/OS) was progressively less evident after RD surgery; and the external limiting membrane was preserved on SD-OCT examination. In all eyes post-operative metamorphopsia faded with time, but fully disappeared in 6 years only in two eyes without photoreceptor abnormalities. One of the two eyes with subretinal fluid up to 6 months and IS/OS disruption had central dense scotoma with relatively unstable fixation on MP-1 and persistent metamorphopsia. Macular sensitivity (MS) increased from 9.7 ± 7.1 at month 1 to 13.5 ± 5.6 dB at the final check, and was weakly (r=0.33) correlated with post-operative BCVA and OCT abnormalities.

CONCLUSION

long-standing metamorphopsia can occur after successful macula-off RD repair even without detectable photoreceptor disruption on OCT. Post-operative BCVA recovery weakly correlates with increasing MS, and late restoration of the photoreceptor layer may be observed.

Macular function of successfully repaired macula-off retinal detachments

PURPOSE

To assess the macular function of successfully repaired macula-off retinal detachments in the long term and to evaluate the relationship between duration of macular detachment and functional recovery.

METHODS

Of 214 consecutive patients, 29 who were operated on because of unilateral retinal detachment with at least 6 months of follow-up and whose best-corrected visual acuity was better than 0.05 Snellen chart value in both eyes were examined. Operated eyes were included in group I, and the fellow eyes were included in group II. Macular functions were evaluated in terms of visual acuity, contrast sensitivity, color vision, visual field, and visual evoked potentials after reattachment.

RESULTS

All macular functions except P100 amplitudes in the operated eyes were significantly less than those in the fellow eyes (P = 0.28) following reattachment after nearly 5 years. It was found that the longer the duration of macular detachment (except detachment duration of < or = 7 days), the smaller the increase in visual acuity, contrast sensitivity, and color vision defect scores (P = 0.000, P = 0.034, and P = 0.0003, respectively).

CONCLUSIONS

Macular functions except P100 amplitude cannot be recovered completely 5 years after retinal reattachment. There was no relation between the duration of macular detachment and the mean deviation in visual field and the P100 latency and P100 amplitude difference between both eyes.

Horizontal and vertical micropsia following macula-off rhegmatogenous retinal-detachment surgical repair

BACKGROUND

Dysmetropsia or distorted image size perception (smaller: micropsia; larger: macropsia) is known to occur after successful surgical re-attachment for macula-off rhegmatogenous retinal detachment. However, the vertical and horizontal components of size distortion have not been previously quantified separately. The purpose of this article is to describe horizontal and vertical dysmetropsia occurring in patients following pars plana vitrectomy and gas treatment (octafluoropropane, C(3)F(8) or sulfur hexafluoride, SF(6)) for macula-off rhegmatogenous retinal detachment.

MATERIAL AND METHODS

Four patients (mean+/-SD, 59+/-8 years; three women and one man) who had had pars plana vitrectomy and gas treatment for macula-off rhegmatogenous retinal detachment 6-7 months earlier underwent ocular examination, best corrected visual acuity test, threshold horizontal and vertical dysmetropsia measurement using a computerised version of the New Aniseikonia Test, slit-lamp examination and optical coherence tomography of the macula.

RESULTS

All patients had binocular visual complaints including difficulty judging distances or reading, rivalry or asthenopia. The logMAR visual acuity (mean+/-SD) in the operated eye was 0.52+/-0.199 and 0.02+/-0.171 in the unaffected eye. All patients perceived the image as smaller (micropsia) with the affected eye, with differences ranging from -9 to 0%. Four patients showed 3% or more size difference between horizontal and vertical meridians.

CONCLUSIONS

Dysmetropsia does occur in symptomatic patients following successful surgical repair of macula-off rhegmatogenous retinal detachment by pars plana vitrectomy and gas treatment. The effect on image size is heterogenous across the retinal area affected.

Functional assessment of reattached macula in nine cases with excellent Snellen acuities

PURPOSE

To compare the macular functions of patients with excellent visual acuity after retinal detachment (RD) surgery, with the healthy fellow eye.

METHODS

Of 214 patients, nine patients, who were successfully operated because of unilateral RD involving the macula and achieved excellent visual acuity, were analysed. The fellow eyes of the patients were taken as the control group. The macular functions were evaluated with visual acuity, contrast sensitivity, colour vision, visual field, and pattern VEP in operated and nonoperated eyes.

RESULTS

There was no significant difference in visual acuity, contrast sensitivity, colour vision, and VEP outcomes between operated and nonoperated eyes. However, it was seen that the mean deviation in the visual field was significantly higher in the operated eyes (5.8+/-1.8 dB) when compared with the undetached fellow eyes (3.1+/-1.8 dB), (t=12.5; P=0.013).

CONCLUSION

Even though the visual acuity, colour vision, contrast sensitivity, and VEP results returned to normal after a successful RD surgery, we found that the mean deviation measured by the visual field, which reflects the retinal sensitivity, was still significantly low after nearly 5 years follow-up.

Serial foveal densitometry and visual function after retinal detachment surgery with macular involvement

PURPOSE

Fundus reflection densitometry was used as an objective means for monitoring the recovery of foveal cone photopigments in nine patients who underwent anatomically successful surgery of a rhegmatogenous retinal detachment with macular involvement.

METHODS

Postoperative assessment of foveal densitometry, visual acuity, color matching, and the Amsler grid were performed at repeated intervals for up to 14 months.

RESULTS

Gradual recovery of foveal cone photopigments was found in all patients 1 to 14 months after surgery, with considerable interindividual variation. Maximal recovery to values equalling those in the fellow eye was found in only one patient with a macular detachment duration of 5 days. All other patients had final photopigment densities below those of the fellow eye. The length of the preoperative detachment period was inversely related to the recovery of photopigment. The recovery of photopigment seems to increase further in the second year after surgery. Visual acuity increased rapidly in all patients during the first 6 months after surgery, to levels ranging between 20/67 and 20/25; thereafter, visual acuity did not change. A return to normal color matching after an episode of pseudoprotanomaly was found in four of nine patients, whereas pseudoprotanomaly remained in five patients. Complete resolution of metamorphopsia after surgery was seen only in the patient who had the shortest detachment duration. Metamorphopsia was consistent with decreased foveal cone photopigment densities.

CONCLUSION

Foveal densitometry shows a slow recovery of the cone photopigments after reattachment, probably because of regrowth and realignment of the cone photoreceptor outer segments and metabolic recovery of the retinal pigment epithelium-cone photoreceptor complex. Recovery of photopigment, color matching, and metamorphosia follow a slower time course than recovery of visual acuity.