Early Photoreceptor Alterations After Retinal Detachment Repair.

Purpose: The importance of outer retinal microstructure, specifically the external limiting membrane (ELM) and ellipsoid zone (EZ), was recently highlighted for visual recovery after rhegmatogenous retinal detachment (RRD). Quantitative assessment of the EZ/ELM reflectivity, termed the relative EZ reflectivity (rEZR), is a novel SD-OCT imaging biomarker for photoreceptor integrity. This study evaluates the rEZR's functional relevance after anatomically successful RRD repair, as well as its association with the surgical techniques. Methods: Patients with primary RRD, treated at the Department of Ophthalmology, University of Bonn/Germany between April 2021 and April 2023 and presenting to the six-week postoperative review with complete retinal reattachment, were identified. The rEZR (arbitrary units [AU]) was determined in the postoperative imaging data. Linear-mixed effect models, corrected for patient's age and preoperative macula-on/macula-off RRD situation, were applied to assess the association of the rEZR with the postoperative best-corrected visual acuity (BCVA) and with the previously applied surgical techniques. Results: A total of 187 patients with a median [interquartile range (IQR)] age of 70.0 [9.7] years (32.1% female) were included. Out of those, 91.4% (n = 171) underwent vitrectomy and 8.6% scleral buckling. Higher rEZR values were significantly associated with a better BCVA (coefficient estimate [CE] = 0.3009 [0.1620; 0.4398], P < 0.001) and scleral buckling (CE = 12.20 [0.33; 24.07], P < 0.044). Conclusions: This study supports the functional relevance of outer retinal impairment, as quantified by rEZR, and its association with surgery-related variables in the early postoperative period after RRD repair. Further research is needed to better understand the importance of longitudinal rEZR changes to finally achieve the best visual outcomes for RRD patients.