1 New York Eye and Ear Infirmary, New York, NY
2 Mount Sinai School of Medicine, Mount Sinai Hospital, New York, NY
3 University of Rochester, Rochester, NY
4 Medical College of Wisconsin, Madison, WI
Commercial Relationships: Meenakashi Gupta, None; Michael Dubow, None; Alexander Pinhas, None; Nishit Shah, None; Patricia Garcia, None; Gennady Landa, None; Yusufu Sulai, None; Alfredo Dubra, US Patent No: 8,226,236 (P); Richard Rosen, Opko-OTI (C), Optos (C), Clarity (C), OD-OS (C), Topcon (R), Zeavision (F), Genetech (F), Optovue (C)
Purpose:Patients with macula-off rhegmatogenous retinal detachments can have poor visual recovery or metamorphopsia despite successful retinal reattachment. Subtle changes in the foveal structure, causing such visual disturbances, can be difficult to identify with standard examination and imaging tools. Adaptive Optics (AO) allows in vivo imaging of individual photoreceptors. Using an AO scanning laser ophthalmoscope, we evaluated the foveal photoreceptor appearance following repair of macula-off retinal detachments. AO images were compared with infrared and OCT imaging. Visual acuity and microperimetry were obtained for functional correlation.
Methods:Three patients who had previously undergone anatomically successful repair of rhegmatogenous macula-off retinal detachments were evaluated with AO following reattachment surgery. AO videos were recorded using a 790 nm light source and 1 degree field of view. Motion contrast images from several videos were used to create montages yielding a 2.5 degree field of view centered around the foveal depression. Montages from the affected eye were compared with corresponding montages from the unaffected eye. Spectralis infrared imaging (870 nm), Spectralis OCT, visual acuity and OCT/SLO microperimetry (Opko/OTI) were also obtained.
Results:In reattached retina, the appearance of mottling of the macula with infrared imaging (Fig 1A) and hyporeflectivity of the foveal IS/OS junction using OCT (Fig 1B) corresponded to patchy disruption of the foveal photoreceptor mosaic with AO imaging (Fig 1C). These findings were associated with reduced visual acuities and threshold sensitivities on microperimetry (Fig 2).
Conclusions:AO imaging of repaired macula-off retinal detachments demonstrated disruptions of the photoreceptor mosaic in regions of abnormal fundus infrared signal, irregular IS/OS junction and reduced visual function. Further AO studies will help us better understand microstructural and pathophysiological changes following retinal detachment repair.
Keywords: 697 retinal detachment 648 photoreceptors 550 imaging/image analysis: clinical
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