ObjectiveTo evaluate the correlation between macular microstructure changes and visual outcome before and after scleral buckling for macular-off primary rhegmatogenous retinal detachment (RRD). MethodsA total of 43 eyes in 43 patients with RRD were enrolled in this retrospective study. All patients underwent scleral buckling and the retina was successfully reattached. Best corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT) were measured for all patients before and at 3 days, 1, 3 and 6 months after surgery. The height of subretinal fluids (SRF), the thickness of retinal neurosensory layer in foveal, and the thickness of outer nuclear layer (ONL) were measured. The microstructure changes of external limiting membrane (ELM), junction line and intermediate line of photoreceptor inner segment/outer segment (IS/OS) were observed. The correlation between morphologic changes in the macular foveal and BCVA on 6 months after surgery were also analyzed. ResultsThe mean preoperative BCVA was 1.18±0.93. The detached retinas had 3 types of SD-OCT images, including normal foveal contour without edema, diffuse edema with ONL cystoids cavities, diffuse edema with ONL cystoids cavities and wave-like ONL. The mean preoperative SRF height was (885.05±493.28) μm. The preoperative mean thickness of retinal neurosensory layer in foveal and ONL in the RRD eyes were thinner than the healthy fellow eyes (t=2.642, 1.895;P < 0.05). The fluids and cystoids cavities were absorbed, retina reattached in all the RRD eyes at 3 days after surgery. SRF had been detected in 100.0%, 93.0%, 77.8%, 46.5% RRD eyes on 3 days, 1 month, 3 months and 6 months after surgery, with heights of (219.00±117.02), (163.51±72.83), (101.27±64.47), (55.69±21.15) μm respectively. There were 3 patterns of residual SRF: diffuse, subfoveal multi-bleb, subfoveal single bleb. Compared with the healthy fellow eyes, there were significant differences in the mean thickness of foveal neurosensory layer (t=-10.658, -8.550, -6.955) and ONL thickness (t=-6.240, -5.424, -3.326, -3.323) at 3 days, 1 month, 3 months and 6 months after surgery(P < 0.05), except for the thickness of foveal neurosensory layer at 6 months after surgery (t=-2.186, P=0.570). The reattached retinas had 4 types of SD-OCT images, including: (1) disrupted ELM, IS/OS line and intermediate line; (2) intact ELM with disrupted IS/OS line and intermediate line; (3) intact ELM and IS/OS line with disrupted intermediate line; (4) intact ELM, IS/OS line and intermediate line. The mean postoperative BCVA at different time points were better than preoperative BCVA (t=-3.12, -4.89, -5.03, -4.53; P < 0.05). The postoperative BCVA of eyes with intact IS/OS was different from that of eyes with disrupted IS/OS at 6 months after surgery (t=2.609, P < 0.05). The preoperative SRF height, thickness of foveal neurosensory layer and ONL were correlated with the BCVA at 6 months after surgery (r=0.817, 0.028, 0.521; P < 0.05). ConclusionsMacular-off RRD eyes had SRF, thinner foveal neurosensory layer and ONL before and after scleral buckling. The disruption of ELM, IS/OS junction line and intermediate line can be seen in most of RRD patients. The thinner foveal neurosensory layer and ONL were correlated with the slow recovery of postoperative BCVA.
ObjectiveTo observe and analyze the effect of peripore cavity size on visual function of macular area before and after surgery for idiopathic macular hole (IMH). MethodsA retrospective clinical study. From July 2020 to February 2021, a total of 25 patients with 25 eyes with monocular IMH (operation group) diagnosed by ophthalmology examination in Department of ophthalmology, Fourth Hospital of Hebei Medical University were included in the study. The control group was contralateral healthy eyes. All subjects were examined by best corrected visual acuity (BCVA), microfield of vision, frequency domain optical coherence tomography (SD-OCT), and OCT angiography (OCTA). The diameter of macular hole was measured by SD-OCT. The cystic morphology of deep capillary plexus (DCP) was detected by en face OCT, and the cystic area was measured by Image J software. MP-3 microperimeter was used to measure central macular retinal light sensitivity (MS) and mean macular retinal light sensitivity (MMS). Central macular retinal light sensitivity (CMS), MMS and cystic cavity MS were measured in the operation group. MMS was measured in the control group. The microperimetry images were superimposed on the DCP layer of OCTA to identify and calculate the average MS within the lumen and compare it with the control group. Standard three incisions were performed in all affected eyes by vitrectomy of the flat part of the ciliary body + stripping of the inner boundary membrane + intraocular sterile air filling. Three months after the operation, the same equipment and methods were used to perform relevant examinations. Paired sample t test was used to compare MS between operation group and control group. Pearson correlation analysis was used to analyze the correlation between capsular area, macular hole diameter before and after operation and MS before and after operation. The correlation between BCVA and capsular area before and after surgery was analyzed by Spearman correlation analysis. ResultsIn the surgical group, the retinal MS was (4.24±3.07) dB. The MMS of control group was (19.08±6.11) dB. The MS in the surgical group was significantly lower than that in the control group, and the difference was statistically significant (t=10.832, P＜0.01). Before operation, the area of cyst was (1.04±0.55) mm2, and the diameter of macular hole was (564.80±166.59) μm. CMS and MMS were (2.27±2.29) dB and (9.08±3.65) dB, respectively. The diameter of macular hole (r=0.50, P=0.010) and BCVA before operation (r=0.57, P＜0.001) were positively correlated with peripore cavity area. Before operation, CMS and MMS were negatively correlated with peripore cavity area (r=－0.53, －0.47; P=0.010, 0.020). At 3 months after surgery, the capsular area was negatively correlated with CMS and MMS (r=－0.65,－0.76; P=0.020, 0.030). There was no correlation with BCVA (r=0.23, P=0.470). ConclusionsRetinal MS is decreased in the peri-capsular area of IMH pore. There is a positive correlation between capsule area, BCVA and macular hole diameter before operation. The capsular area is negatively correlated with CMS and MMS before operation.