Macular morphologic changes following successful retinal detachment repair by scleral buckling surgery

Background/Aim: Spectral domain optical coherence tomography (SD-OCT) is very useful for accurate examination of macular microstructure. The aim of this study was to evaluate macular morphologic changes after successful retinal detachment (RD) surgery by scleral buckling using SD-OCT and assess their impact on vision repair. Methods: SD-OCT examination was performed 1, 6 and 12 months in 27 eyes following scleral buckling (SB) surgery with successful anatomical repair of rhegmatogenous retinal detachment (RRD) which also affected the macular region. The examination was performed in a 6mm diameter central macular region and included measurements of the central foveal thickness (CFT), average overall retinal thickness and thickness of the outer and inner retinal layers separately. The numerical values of operated eyes were compared with those of the fellow (control) eyes. The condition of the outer limiting membrane (ELM) and inner segment/outer segment of the photoreceptors (IS/OS) was also examined. Results: The mean total and outer retinal thickness (TRT and ORT) in the reattached regions in the operated eyes were significantly thinner than the corresponding regions of the fellow (control) eye, and throughout the follow-up period the difference was statistically significant. There was a statistically significant difference in TRT (after 1 month p=0.021, after 6 months p=0.026, after 12 months p=0.027) and ORT (after 1 month p=0.018, after 6 months p=0.019, after 12 months p=0.021) between the eyes with a longer pre-operative duration of macular detachment of 2 weeks and eyes with shorter detachment period. Disruptions of the photoreceptors IS/OS and ELM on OCT examination after one month were observed in 37.04% eyes, after 6 months in 29.6% eyes, and at the end of the follow-up period in 14.8% eyes. A statistically significant difference was found in the frequency of disruptions of the IS/OS and ELM depending on the preoperative duration of RD (p= 0.007). Conclusion: Overall decrease in the mean retinal thickness after successful anatomical repair of RD is result of decreases in the thicknesses of outer retinal layers. The alterations of the external limiting membrane and inner and outer photoreceptors segments observed on the early SD-OCT scans are mostly associated with limited visual recovery. The prolonged macular detachment leads to damage to the neurosensory tissue of the retina and especially the photoreceptors, which may explain the limited visual recovery after successful scleral buckling RD repair.

A Patient With Optic Nerve Pit Maculopathy Successfully Treated With Juxtapapillary Laser Photocoagulation

Optic disc pits are rare and congenital or acquired anomalies of the optic disc, usually remaining asymptomatic. However, serous macular detachment or optic disc maculopathy is the most common complication, causing significant visual deterioration, without a current consensus about treatment. A 55-year-old woman with a past medical history of diabetes mellitus and systemic hypertension was referred for an abnormal finding in the retina. The Corrected Distance Visual Acuity (CDVA) was 20/40 in the right eye and 20/30 in the left eye. Marcus-Gunn was negative and Slit-lamp biomicroscopy revealed no pathologic findings in both eyes. Funduscopic examination showed an excavation in the inferotemporal part of the Optic Nerve Head (ONH) with serous macular detachment extending to the optic disc. Based on clinical examination and paraclinical imaging fluorescein Angiogeraphy (FAG) Optical Coherence Tomography (OCT), optic pit maculopathy was diagnosed and the patient underwent Juxtapapillary Laser Photocoagulation (JLP). After 2 years of follow-up, there were anatomical and functional improvements.

Multimodal imaging of bilateral immunogammopathy maculopathy associated to Waldenström’s macroglobulinemia

Aim: Our aim is to report a case with bilateral Waldenström’s macroglobulinemia (WM) associated maculopathy, assessed with multimodal imaging including swept source optical coherence tomography (SS-OCT) and OCT-Angiography (OCT-A). Methods: Observational case report. Case presentation: A 61-year-old diabetic woman with history of treated WM currently in remission, presented with progressive bilateral visual loss. Best-corrected visual acuity was 20/100 in the right eye (RE) and 20/200 in the left eye (LE). Fundus examination showed bilateral microaneurysms and retinal punctuate hemorrhages and a large macular serous detachment in the LE. There was no retinal ischemia on FA nor macular dye leakage. SS-OCT showed a significant schisis-like intraretinal fluid accumulation in the RE and a large prominent macular detachment with significant subretinal fluid accumulation in the LE. Retinal and choriocapillaris vascular densities were normal on OCT-A. Conclusion: Our case illustrated characteristic multimodal imaging findings in WM associated maculopathy such as schisis-like intraretinal fluid accumulation and angiographically silent serous macular detachment. OCT-A could non-invasively analyze macular vascular densities layer-by-layer, without noticing any vascular anomaly.

The bifurcation and bump signs: optical coherence tomography (OCT) findings overlying neurosensory retinal detachment

Purpose To expand the description of a common OCT finding of outer plexiform layer (OPL) splitting overlying neurosensory retinal detachment from various causes, along with a thickened outer plexiform bump at the transition from attached to detached retina.Methods etrospective review of our practice’s image teaching collection and database of retina journal articles looking for representative examples of OPL splitting overlying macular detachment. Each of our patient’s scans were then analyzed to see if the location or angle of detachment influenced these findings.Results We analyzed 12 eyes (12 patients) with splitting of the OPL within paracentral detached retina (the “bifurcation sign”) from various causes. A localized thickening of the OPL (the “bump sign”) was present in 6 of these eyes. Although explicitly described in only one publication, the bifurcation sign could be found in numerous prior publications within our journal database. The bump sign, also explicitly described in one prior publication, was also seen in most of these published cases. Surprisingly, these findings appeared unrelated to either the angle of detachment or nasal versus temporal location. We then synthesized our findings with the current literature to help elucidate what this can teach us about current OCT nomenclature for the outer plexiform and outer nuclear layers.Conclusion OPL changes are commonly found with retinal detachment. We suggest a modified classification of the OCT OPL and outer nuclear layers which is only applicable when the normal OCT anatomy is altered either by the OCT technician or overlying retinal detachment.

Hyperviscosity-related retinopathy and serous macular detachment in Waldenström’s macroglobulinemia: A mortal case in 5 years

Purpose: To present a 5-year mortal case of Waldenström’s macroglobulinemia-related retinopathy and serous macular detachment. Case report: A 63-year-old man, with unremarkable medical history, presented with bilateral decreased vision for 2 months. Fundus examination revealed bilateral scattered retinal hemorrhages, exudates, venous tortuosity, and serous macular detachment. Hematologic and biochemistry profiles showed pancytopenia with blood smear demonstrating erythrocyte rouleaux formation. Hyperviscosity syndrome was suspected and later Waldenström’s macroglobulinemia was diagnosed by bone marrow biopsy and high concentration of serum IgM. Plasmapheresis and subsequent chemotherapy were arranged. In spite of resolution of most retinal abnormalities, his visual acuity still showed no improvement with a persistent bilateral macular detachment. The patient then died 5 years after the diagnosis of Waldenström’s macroglobulinemia. Conclusions: Long-term toxicity of IgM to the retinal pigment epithelium may impede the resolution of the persistent serous macular detachment, resulting in an inability of recovery in his vision. Therefore, early diagnosis and timely reduction of serum paraproteins by plasmapheresis and chemotherapy is critical for preventing permanent damages to patients’ health and vision.

MACULAR DETACHMENT IN MORNING GLORY SYNDROME

Purpose:Thepurposeofthisstudyistoreportauniquecaseofmorning glorysyndrome.Methods: This study included ophthalmologic examination, opticalcoherencetomography and areviewoftherelevantliterature.Result: A 7-year-old girl with a history of morning glory syndromewas periodicallyexamined in ourclinic for5 years. Suddenly,shepresentedwiththecomplaintofdecreasedvision.Examinationsrevealed macular detachment. The visual field of the affected eye wassignificantly narrowed. OCT also revealed the presence of a fibrouscord in the centreof the optic nerve, which protruded into the vitreousbody.Discussion:Morningglorysyndromeis anuncommoncongenitaldisordercharacterizedbyawidelyenlargedpapillathatispink-orangeincolour,witha small glial tuft in thecentre. The retinalvessels are arranged radially in relation to the papilla. A pigmentedring surrounds the excavation. The incidence is not well known. Theeffectisgenerallyunilateral.Thissyndromemanifestsasopticatrophy. However, the atrophy does not progress. Visual impairmentsometimes occurs when maculardetachmentarises,as occurred inourpatient.After5yearsofobservation,ourpatient’svisiondramatically worsened as a result of macular detachment. There arevarious theories for the development of macular detachment in MGS:exudative, tractionand rhegmatogenous8.Nobreakwasfound inourpatient,sothecauseofthedetachmentwasmostlikelytheinflammatoryprocess

New optical coherence tomography grading system for macula-off rhegmatogenous retinal detachment: how off is off?

Background/AimsThe classification of retinal detachment is currently still based on many objective criteria such as duration of symptoms and funduscopic macular status, which leaves some important questions unanswered. The most important factor is the macular status, which is determined using direct or indirect ophthalmoscopy. Optical coherence tomography (OCT) has become a standard tool in clinical practice and enables detecting the exact extent of subretinal fluid in macula-off/on retinal detachment. We introduce a new and simple OCT-based grading system for macular detachment to provide a basis for further investigations to determine the optimal timing for surgery.MethodsWe retrospectively included 155 patients who were treated for retinal detachment. We defined the extent of the macular detachment in six stages based on the Early Treatment Diabetic Retinopathy Study (ETDRS) grid of the OCT scan.The outermost ring of the ETDRS grid was defined as zone 1, the middle ring as zone 2 and the inner ring as zone 3. Only zone 3 differed in the retinal detachment height grades (grade a <250 µm vs grade b >250 µm). Retinal detachment heights that could not be measured were considered grade 4 (ungradable) detachments.ResultsForty-seven patients had no macular involvement (grade 0). Regarding macular detachment, 14 patients had grade 1, 20 had grade 2, 9 had grade 3a, 29 had grade 3b and 36 had grade 4.ConclusionThe newly developed OCT grading system for macular involvement following retinal detachment is a crucial tool to objectively classify a retinal detachment in order to be able to make better statements in the future, like for defining the optimal time for surgical intervention. A secondary benefit of this grading system would be that it improves predicting postoperative visual acuity.

Comparison of the visual outcome between macula-on and macula-off rhegmatogenous retinal detachment based on the duration of macular detachment

ObjectiveTo compare the visual outcomes between macula-on and macula-off primary rhegmatogenous retinal detachment (RRD) based on the duration of macular detachment (DMD).Methods and AnalysisRetrospective study including 96 eyes with RRD (34 macula-on and 62 macula-off) repaired between June 2012 and March 2020. The final visual acuity (VA) was compared after the patients were divided by the status of the macula and their DMD.ResultsThe mean final VA of patients with macula-on RRD (group A) was logarithm of the minimum angle of resolution (logMAR) 0.04±0.07, which was not statistically different from that of individuals with macula-off RRD with DMD ≤3 days (group B; logMAR 0.05±0.06) (p=0.79). There were statistically significant differences in the final VA between group A and patients with macula-off RRD with DMD of 4–7 days (group C; logMAR 0.15±0.15) (p=0.017) as well as between group A and those with macula-off RRD with DMD ≥8 days (group D; logMAR 0.36±0.29) (p<0.001). There was no significant difference in the final VA between group B and C (p=0.33).ConclusionThe mean final VA of patients with macula-on RRD was comparable to that of the macula-off patients with DMD ≤3 days. Our findings suggest that if macula-on RRD could not be immediately repaired, a repair within 72 hours may result in similar outcomes, even if the macula detaches within that time frame. However, once the macula detaches, we do not observe statistically significant differences in outcome for repairs done within 7 days.