Z HOT TOPIC Z 

Authors: Carolina L. M. Francisconi, Verena Juncal, Roxane J. Hillier, Tina Felfeli, Louis R. Giavedoni, David T. Wong, Alan R. Berger, Filiberto Altomare, Peter J. Kertes, Rahda P. Kohly, Rajeev H. Muni

Author Disclosure Block: C.L.M. Francisconi: None. V. Juncal: None. R.J. Hillier: None. T. Felfeli: None. L.R. Giavedoni: None. D.T. Wong: None. A.R. Berger: None. F. Altomare: None. P.J. Kertes: None. R.P. Kohly: None. R.H. Muni: None.

Abstract Body:

Purpose: To determine the baseline OCT features associated with poor visual outcomes following rhegmatogenous retinal detachment (RRD) repair in The Pneumatic Retinopexy versus Vitrectomy Outcomes Randomized Controlled Trial (PIVOT)trial.
Study Design: Post-hoc analysis of a randomized controlled trial.
Methods: PIVOT trial was a RCT that compared long-term outcomes of RRD repair in patients undergoing pneumatic retinopexy (PnR) vs. pars plana vitrectomy (PPV). Patients with 1-year follow-up from the PIVOT trial who had spectral-domain optical coherence tomography (OCT) at baseline were included in the study. We performed an analysis of the(SD-OCT)images from the participants with macula-off RRD. At baseline, microstructural retinal changes were assessed on serial cross-sectional SD-OCT scans of the macula. The following parameters were investigated by two independent masked graders with disagreement adjudicated by a third masked grader: subfoveal fluid height (SFH), intraretinal cysts, outer retinal folds (ORFs), and epiretinal membrane (ERM). SFH was further classified as high (>825um or the 50^thpercentile) or low (<825um). Visual acuity (VA) was assessed at 3 and 12 months using ETDRS visual acuity and metamorphopsia was assessed using M-charts scores at 12 months. Data is reported as median (interquartile range) unless otherwise specified.
Results: The study in­cluded 46 eyes of 46 patients. Mean age was 62±9.6, 30 (65%) of patients were phakic, and 22 (48%) were treated with PnR. Median ETDRS VA at 3 and 12 months was 71 (25) and 78 (13) letters, respectively. The M-charts scores for vertical metamorphopsia at 12 months were significantly higher in the group that presented ORFs at baseline (0.0 [0.0] vs. 0.2 [0.4]; p=0.013). The M-charts scores for horizontal metamorphopsia at 12 months were significantly higher in the group that presented with ERM at baseline (0.0 [0.2] vs. 0.5 [0.7]; p=0.029). Presence of intraretinal cysts did not influence VA or metamorphopsia. Presence of a SFH greater than 825um was associated with decreased VA at 3 (Beta -.420; p=0.004) and 12 months (Beta -.333; p=0.018). Multivariable linear regression analysis including baseline SFH and lens status demonstrated that a SFH greater than 825um was an independent risk factor for lower VA at 3 months (SFH: Beta -0.428, p=0.004).
Conclusions: The presence of ERM and ORFs at baseline were associated with higher horizontal and vertical metamorphopsia scores at 1 year post RRD repair, respectively. Additionally, the presence of a SFH greater than 825um was associated with lower VA scores at 3 and 12 months following RRD repair.