Exclusion criteria were previous vitreoretinal surgery, age under 10, inability to consent and pregnancy.Ī pre-operative baseline ophthalmic examination was recorded. Recruitment criteria included patients undergoing vitreoretinal surgery for primary RRD between January 2015 and July 2017. Before enrolling in this study, informed consent was obtained from all patients. This prospective observational cohort study was approved by the National Health Service Research Ethics Service (12/WM/0330) and adhered to the tenets of the Declaration of Helsinki. In this study, changes in visual function, assessed by best corrected visual acuity (BCVA) and perimetric retinal sensitivity, were studied in parallel with changes in outer retinal thickness, as a function of photoreceptor loss after RRS. Cone ellipsoid zone thickness changes on OCT have also been associated with visual acuity 12 months post-RRS. Ĭlinically, the mean ONL thickness has been used as a global measure of photoreceptor degeneration in operated and un-operated retinae, as well as foveal cone density. Vitreous levels of pro-apoptotic molecules intercellular adhesion molecule-1 (ICAM-1), induced by Fas ligation, and monocyte chemoattractant protein-1 (MCP-1) are also upregulated after RRS. Subretinal caspase-8 and -9 levels increase as the area of detachment increases in human RRD and TUNEL-positive nuclei are detected in the ONL 1–7 days after RRD, which are changes that suggest photoreceptors degenerate by apoptosis. In human studies, evidence for photoreceptor degeneration after RRS includes thinning of the outer nuclear layer (ONL), reduced cone mosaic density and suppression of genes regulating photoreceptor function. Īfter reattachment, retinal function is impaired by altered synaptic connectivity in the outer plexiform layer, imperfect photoreceptor outer segment regeneration, failed reconstitution of the RPE cone sheath and scarring within the retina. In animal models of RRD, photoreceptor death occurs as early as 12 h peaking around 2–3 days. ![]() ![]() ![]() ĭuring RRD, separation of the retina from the retinal pigmented epithelium (RPE) leads to outer retinal ischaemia and isolation from the underlying choroidal blood supply. The visual outcomes of macula-off RRD in which the fovea is detached are worse than those of macula-on detachment in which the fovea is still attached, with 28% and 68% achieving 6/12 vision or better at 3 months, respectively. The visual impairment that ensues after retinal reattachment surgery (RRS) is linked to multiple factors including proliferative vitreoretinopathy, duration of the RRD, pre-operative visual acuity, patient age, post-operative complications such as cataract, and foveal involvement of the detachment. There are significant geographical variations in the incidence of rhegmatogenous retinal detachment (RRD) of between 6.3 and 17.9 per 100,000 of population.
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