Morphological and functional assessment of photoreceptors after macula-off retinal detachment with adaptive-optics OCT and microperimetry

Abstract Purpose Limited information is available on morphological and functional regeneration of photoreceptors after retinal detachment (RD) surgery. This observational clinical study compared morphological and functional changes of cones after vitrectomy for macula-off retinal detachment. Design Prospective fellow-eye comparative case series Methods Study Population Five eyes after vitrectomy with gas for macula-off retinal detachment (retinal detachment eyes, RDE) and five healthy fellow-eyes (HFE) of five patients (mean age 59.8 years, macula-off duration 0.5 days to 5.5 days) Observation Procedures Eyes were examined with AO-OCT, spectral domain OCT (SD-OCT) and microperimetry (MP) at 6 (baseline, BL) and 56 weeks (follow-up, FUP) after 23 gauge pars-plana vitrectomy and SF6 gas tamponade. Eight corresponding regions at foveal eccentricities of 2.5° (ecc 2.5) and 6.5° (ecc 6.5) were analysed in every eye. AO-OCT en-face images and SD-OCT B-Scans were graded regarding irregularity and loss of photoreceptor signals ranging from none to severe changes. The number of detectable cones at height of the inner-outer segment junction (IS/OS) and cone outer segment tips (COST) was counted manually in AO-OCT images. MP with a custom grid was used to assess retinal sensitivity at these locations. Main Outcome Measures Cone density, cone pattern regularity and signal attenuation, retinal sensitivity. Results In comparison to HFE, RDE showed highly irregular cone patterns in AO-OCT and irregular outer retinal bands in SD-OCT. Despite significant improvement of cone pattern regularity compared to BL (p .750). Conclusions The combination of AO-OCT, SD-OCT and microperimetry is a powerful tool to capture cone regeneration after vitreoretinal surgery. Our study shows that cone morphology and function improve within 56 weeks after RD surgery but structural and functional impairment is still present.