Outer retinal reflectivity and visual function loss after anatomically successful macula-off rhegmatogenous retinal detachment repair.

Rhegmatogenous retinal detachment (RRD) can cause permanent photoreceptor damage with subsequent vision loss, even after prompt repair. Here we compared photoreceptor structure in retinal areas with varying levels of residual visual function loss following anatomically successful macula-off RRD repair. Five eyes of four individuals (2 male, 2 female; ages 18-77 years) with successful macula-off RRD repair were included. Two were repaired via scleral buckle, one via vitrectomy, and two with both. Postoperative visual acuity measured 4-11 months after surgical repair ranged from 20/20 to 20/100. In each eye, areas of previously detached macula exhibited reduced or variable cone reflectivity on adaptive optics scanning light ophthalmoscopy (AOSLO) images. This was typically associated with reduced or variable inner segment/outer segment junction (IS/OS) band reflectivity on optical coherence tomography (OCT) images. Areas of the macula with reduced photoreceptor reflectivity also showed lower sensitivity on microperimetric testing. Despite anatomically successful repair, RRD results in photoreceptor changes, including reduced reflectivity of cone profiles and the IS/OS band that were associated with reduced macular sensitivity. As ophthalmologic imaging progresses towards higher resolution modalities, AOSLO may be useful in monitoring outcomes after RRD repair. Low cone reflectivity, cataract, high axial length, and poor visual fixation may be barriers to quantification of cone structure in this patient population.