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, 26 (9), 1209-16

Ultra-wide-field Autofluorescence Imaging in Non-Traumatic Rhegmatogenous Retinal Detachment

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Ultra-wide-field Autofluorescence Imaging in Non-Traumatic Rhegmatogenous Retinal Detachment

M T Witmer et al. Eye (Lond).

Abstract

Purpose: Rhegmatogenous retinal detachment (RRD) affects the function of the retina before and after surgical repair. We investigated ultra-wide-field autofluorescence (UAF) abnormalities in patients with acute RRD to improve our understanding of the functional changes in the retina before and after surgery.

Methods: In this retrospective study, we present the UAF imaging findings of 16 patients with acute, non-traumatic RRD. Imaging was obtained with the Optos 200 Tx (Optos) in 14 eyes preoperatively and in 12 eyes postoperatively. Twelve eyes had RRDs that involved the macula (group A), whereas four eyes had macula-sparing RRDs (group B).

Results: All patients (100%) with bullous retinal detachments demonstrated hypofluorescence over the area of retinal detachment. A hyperfluorescent leading edge (HLE) to the retinal detachment was observed preoperatively in 100% of eyes in group A and 75% of eyes in group B. Preoperative UAF through the fovea of group A eyes was normal (30%), hypofluorescent (50%) or hyperfluorescent (20%). In all patients with a HLE preoperatively, the HLE resolved by the 1-month postoperative visit. A residual line of demarcation remained in 8 of the 12 eyes (67%). In group A eyes, postoperative granular autofluorescent changes were present in four of the nine (44%) eyes, and were associated with worse preoperative (P=0.04) and postoperative (P=0.09) visual acuity.

Conclusion: UAF imaging reveals abnormalities in RRDs that allow excellent demarcation of the extent of the retinal detachment and assist in preoperative characterization of the detachment and postoperative counselling.

Figures

Figure 1.
Figure 1.
A 64-year-old male patient with 3 days of symptoms presented with a fovea-involving RRD. (a) Preoperative ultra-wide-field colour fundus photograph of the left eye shows superotemporal macula-involving RRD with outer retinal corrugations and retinal breaks visualized temporally. (b) UAF of the left eye shows hypofluorescence over the bullous RD and a HLE. (c) Magnified AF image of the left macula shows the HLE in more detail (arrows). (d) Preoperative OCT shows CME in the outer nuclear layers and submacular fluid and undulations in outer retina (arrows). (e) Preoperative OCT of a horizontal scan showing similar changes as in panel (d). (f) Postoperative ultra-wide-field colour fundus photograph 1 month after the repair shows attached retina with residual C3F8 gas bubble superiorly and chorioretinal scarring temporally from intraoperative endolaser. (g) Postoperative AF image shows persistent line of demarcation in the macula and granular areas of AF in the macular areas in sites of prior detachment, magnified in panel (h) (arrows). (i) Postoperative OCT shows resolution of CME and outer retina corrugation but persistent disruption of the outer retina in some areas (arrows). The vision improved from finger counting preoperatively to 20/40 postoperatively.
Figure 2.
Figure 2.
(a) Preoperative wide-field colour image of a 50-year-old female patient with a RRD involving the fovea. The short arrow identifies the area of bullous retinal detachment readily identified with ophthalmoscopy. The long arrow identifies an area of shallow neurosensory detachment extending through the fovea. (b) Preoperative wide field AF image of the same patient demonstrating the area of bullous detachment as hypofluorescence (short arrow) and the HLE with the long black arrow, indicating the area of shallow neurosensory detachment. (c) Preoperative OCT image of the patient from panels (a) and (b). The boundary between detached and attached retina is readily identified. (d) One-month postoperative colour image demonstrating reattachment of the retina with laser chorioretinal scars in the superotemporal quadrant. (e) One-month peripheral AF image demonstrating the residual demarcation line (black arrow) and granular AF changes (white arrow) within the area of previously detached retina. (f) Postoperative OCT image of the patient. A white arrow on the infrared image highlights the boundary between attached and detached retina, preoperatively. The OCT shows disruption of the IS/OS junction in the region of previously detached retina (which showed granular changes with AF) and a white arrow shows the boundary. (g) Preoperative OCT image of a different patient (78-year-old male) with a macula-affecting retinal detachment. (h) Postoperative OCT image of the patient from panel (g), who demonstrated postoperative granular AF changes, demonstrating significant outer retinal disturbance. The outer retinal changes of the IS/OS junction appear similar to the subretinal or outer retinal deposits (white arrow).
Figure 3.
Figure 3.
A 46-year-old male patient presented with symptoms of flashes and floaters for 2 weeks and with a macula-sparing RRD of right eye. His presenting vision was 20/20. (a) The preoperative ultra-wide-field colour photo revealed a shallow RRD superotemporal to the macula. White arrows detail the extent of the RRD. (b) The preoperative UAF shows a transparent RRD and a lack of hypofluorescence over the RRD, with subtle hyperfluorescence over the RRD. Black arrows detail the extent of the RRD. (c) Patient was treated with a scleral buckle. One-month postoperative ultra-wide-field colour image demonstrates persistence of subretinal fluid superotemporally. The long arrows illustrate the extent of the subretinal fluid. The arrowheads illustrate the elevation from the scleral buckle. (d) Ultra-wide-field postoperative AF image shows more hyperfluorescent zone of subretinal fluid and clear demarcation from attached retina. Black arrows indicate the extent of the persistent subretinal fluid. The postoperative VA was 20/25.

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