A mathematical determination of foveal attachment in primary rhegmatogenous retinal detachment when obscured by bullous retina
Tóm tắt
In primary rhegmatogenous retinal detachment (RRD), the foveal attachment is an important prognostic factors for post-operative vision. When the fovea is obscured by the RRD, its attachment status is considered uncertain. Using a model of the reduced emmetropic and − 10 dioptre myopic eye and the physical properties of the detached retina, we aimed to mathematically ascertain if it is clinically possible for the fovea to be attached while it is obscured by the primary RRD. With the patient upright, a primary RRD due to a 12 o’clock break directly above the fovea was considered. Mathematically, once the trough of the RRD touches the visual axis the edge of the RRD nearest to fovea is
$$2.77\,{\text{mm}}$$
away from fovea in emmetropic eye and
$$2.89\;\,{\text{mm}}$$
in myopic eye. When the RRD reaches the fovea, its trough is
$$2.20{\text{ mm}}$$
below the visual axis in emmetropic eye and
$$2.29{\text{ mm}}$$
in myopic eye. However, in vivo the RRD makes an acute angle with the retinal pigment epithelium and the corrugation of the retina in RRD shortens the retina. When these in vivo constraints are considered, in both of the above situations the fovea will be detached. If the fovea is obscured by an RRD, the fovea is very likely to be detached. In idiomatic terms, if the fovea cannot be seen, the fovea cannot see. This is an important clinical diagnosis for appropriate triage of the patient.
Tài liệu tham khảo
Mitry D, Charteris DG, Yorston D, Siddiqui MA, Campbell H, Murphy AL, et al. The epidemiology and socioeconomic associations of retinal detachment in Scotland: a two-year prospective population-based study. Invest Ophthalmol Vis Sci. 2010;51(10):4963–8.
Ghazi NG, Green WR. Pathology and pathogenesis of retinal detachment. Eye. 2002;16(4):411–21.
Michels RG, Wilkinson CP, Rice TA. Michels retinal detachment. 2nd ed. St. Louis: Mosby, cop; 1997.
Lai CT, Kung WH, Lin CJ, Chen HS, Bair H, Lin JM, et al. Outcome of primary rhegmatogenous retinal detachment using microincision vitrectomy and sutureless wide-angle viewing systems. BMC Ophthalmol. 2019;19(1):230.
Taylor E, Jennings A. Calculation of total retinal area. Br J Ophthalmol. 1971;55(4):262–5.
Pope JM, Verkicharla PK, Sepehrband F, Suheimat M, Schmid KL, Atchison DA. Three-dimensional MRI study of the relationship between eye dimensions, retinal shape and myopia. Biomed Opt Express. 2017;8(5):2386–95.
Hostovsky A, Trussart R, AlAli A, Kertes PJ, Eng KT. Pre-operative optical coherence tomography findings in macula-off retinal detachments and visual outcome. Eye. 2021;35(12):3285–91.
Mané V, Chehaibou I, Lehmann M, Philippakis E, Rothschild PR, Bousquet E, et al. Preoperative optical coherence tomography findings of foveal-splitting rhegmatogenous retinal detachment. Ophthalmologica. 2021;244(2):127–32.
Heath H, Beck TC, Foulds WS. Chemical composition of subretinal fluid. Br J Ophthalmol. 1962;46(7):385–96.
Stefánsson E, Wilson CA, Lightman SL, Kuwabara T, Palestine AG, Wagner HG. Quantitative measurements of retinal edema by specific gravity determinations. Invest Ophthalmol Vis Sci. 1987;28(8):1281–9.
Donati S, Caprani SM, Airaghi G, Vinciguerra R, Bartalena L, Testa F, et al. Vitreous substitutes: the present and the future. Biomed Res Int. 2014;2014:351804.