Name

130 - Prévalence et facteurs de risque d'atteinte des couches rétiniennes externes après chirurgie de décollement de rétine macula-off

Purpose: To report the prevalence of outer retinal layer (ORL) damage after macula-off rhegmatogenous retinal detachment (RRD) surgery and to determine associated preoperative risk factors. 

Methods: Two hundred and fifty-three eyes successfully operated for macula-off RRD were included in the study. The integrity of the external limiting membrane (ELM), ellipsoid zone (EZ) and cone interdigitation zone (CIZ) of the photoreceptors was assessed at 1 month and 6 months by two independent readers using spectral-domain optical coherence tomography. Risk factors were analyzed using univariate and multivariate logistic regression. The correlation between ORL integrity and visual outcomes was also evaluated.

Results: CIZ, EZ and ELM defects were found in respectively 198 (93.4%) eyes, 100 (47.2%) eyes, 64 (30.2%) eyes at 1 month and in 160 (63.2%) eyes, 44 (17.4%) eyes and 18 (7.1%) eyes at 6 months.  The percentage of eyes with intact bands increased from 6.6% at 1 month to 36.8% at 6 months whereas the percentage of eyes with combined CIZ, EZ and ELM defects decreased from 30.2% to 7.1%. In the multivariate analysis, duration of macular detachment was the only factor associated with ORL damage at 6 months (p = 0.007). The odds of having 2 or 3 band defects versus 1 and none increased respectively by a factor of 1.03 (95% CI, 1.01-1.06) and 1.04 (95% CI, 1.01-1.08) per day of macular detachment. BCVA significantly improved from 0.5 ± 0.3 at 1 month to 0.3 ± 0.3 logMAR at 6 months (p<0.001) and was strongly correlated with the number of affected bands (p<0.001).

Discussion: Outer retinal layer damage is common after macula-off retinal detachment surgery. Many previous studies have demonstrated that disruptions of the ELM, EZ and CIZ of the photoreceptors are correlated with decreased visual acuity after retinal reattachment. However, there is a lack of research on factors that might affect the integrity of outer retinal layers after RRD surgery. In this series prevalence of outer retinal band defects decreased over time, suggesting the photoreceptor’s ability to recover. Postoperative visual acuity was strongly associated with the number of affected bands. Duration of macular detachment was the main factor affecting the outer retinal layer integrity. Taken together, these results emphasize the importance of early surgical repair of macula-off RRD.

Conclusion: Prevalence of outer retinal band defects substantially decreased through the study period, confirming the ability of photoreceptors to recover over time. However, shorter interval to surgery and better visual outcomes were significantly associated with fewer defects within the ORL at 6 months. These findings suggest that postponed surgery for macula-off RRD may compromise the patient’s visual prognosis.