Evolution of Outer Retinal Folds Occurring after Vitrectomy for Retinal Detachment Repair

Abstract

PURPOSE.To assess the evolution of outer retinal folds (ORFs) occurring after repair of rhegmatogenous retinal detachment (RRD) using spectral domain-optical coherence tomography (sd-OCT) and fundus autofluorescence (FAF), and to discuss their pathogenesis.METHODS. Twenty patients were operated on with 25-gauge pars plana vitrectomy and 20% sulfur hexafluoride gas injection for primary macula-off RRD repair and were followed prospectively. Sd-OCT and FAF images were recorded at 1, 3 and 6 months postoperatively. RESULTS.ORFs appeared on sd-OCT as hyperreflective lesions consisting of folded inner segment/outer segment of photoreceptors band and external limiting membrane band. Corresponding lines of increased or decreased autofluorescence were observed on FAF. Over the follow-up, the thick hypoautofluorescent lines progressively evolved to thick hyperautofluorescent lines and to thin hyperautofluorescent lines and eventually disappeared. Concomitantly, OCT scans revealed that the corresponding hyperreflective lesions decreased in number, height, and size. In six cases FAF assessment at month 6 was precluded by cataract development.CONCLUSIONS. ORFs tend to resolve spontaneously within a few months from operation leaving no or subtle abnormalities at the level of the outer retinal layers. OCT is superior to FAF to follow the evolution of ORFs in phakic eyes. The following factors might be involved in ORFs pathogenesis: structural changes occurring in the detached retina, residual pockets of subretinal fluid after retinal reattachment, intravitreal gas, unintentional retinal translocation, and intraoperative or perioperative hypotony. (Invest Ophthalmol Vis Sci. 2012; 53:7928-7935) DOI:10.1167/iovs.12-10322 U ntil a few years ago, our understanding of the cellular events that occur when the retina and the retinal pigment epithelium (RPE) are detached or reattached derived solely from the study of experimental animal models 1-3 and from limited histopathologic reports of retinal detachments in humans. 4,5 The advent of spectral domain-optical coherence tomography (sd-OCT) has permitted, without invasive intervention, to acquire pathologic data in vivo showing that persistent foveal detachment, distortion, and disruption of outer retinal layers (ORLs) and macular folds are common findings following successful surgery for retinal detachment (RD). 6-14More recently, fundus autofluorescence (FAF), an imaging modality that relies primarily on the fluorescence generated from the bisretinoids of lipofuscin in retinal pigment epithelial cells, also has been used to investigate the morphologic and functional changes occurring after RD repair. Shiragami et al 13 showed that in patients with large, bullous RDs, shifting of the retina from its original position can frequently be observed after vitrectomy and is elegantly depicted by FAF. The mark of the displacement consists of lines of increased autofluorescence that closely reflect the calibre and orientation of the adjacent retinal vessels to which the lines are related (Fi...

Impact of Metamorphopsia on Quality of Life after Successful Retinal Detachment Surgery

“…ORFs are common findings in macula-off detachments, as shown by histology reports [32, 3] and OCT studies [12, 22, 34]. These outer retinal undulations might be secondary to intraretinal proliferation of nonneural cell types occurring within hours of the detachment [30, 31] and might also play a role in the formation of postoperative ORFs [12] (Fig.…”

“…ORFs appeared on SD-OCT as hyperreflective lesions consisting of a folded ellipsoid zone and external limiting membrane band. The pathogenesis of ORFs is probably multifactorial with several variables concurring with their formation [42]. Some postoperative ORFs, but not all, were clearly related to the presence of preoperative undulations seen on SD-OCT (Fig.…”

“…In addition, both the anatomical and functional changes observed at 6 months postoperatively may resolve with time. For instance, ORFs tend to resolve spontaneously within a few months, leaving no or subtle abnormalities at the outer retinal layers [12, 43]. Despite a narrow majority in right-eye dominance we were not able to establish a link between eye preference and severity of the metamorphopsia because of the amount of missing data.…”

Management of Intraoperative and Postoperative Complications During Vitrectomy for Retinal Detachment

“…Persistent foveal detachment, distortion, and disruption of outer retinal layers (ORFs) and macular folds are common fi ndings following successful surgery for retinal detachment [ 44 ]. ORFs tend to resolve spontaneously within a few months from operation leaving no or subtle abnormalities at the level of the outer retinal layers.…”

“…ORFs tend to resolve spontaneously within a few months from operation leaving no or subtle abnormalities at the level of the outer retinal layers. The following factors might be involved in ORFs pathogenesis: structural changes occurring in the detached retina, residual pockets of subretinal fl uid after retinal reattachment, intravitreal gas, unintentional retinal translocation, and intraoperative or perioperative hypotony [ 44 ]. ORFs must be differentiated from fullthickness retinal folds, which may become fi xed, may require further surgical intervention [ 45 , 46 ], and are associated with apoptosis and thinning of the photoreceptor layer within the fold [ 47 ].…”