Cross-Sectional and En Face Optical Coherence Tomography of Outer Retinal Morphological Changes Following Retinal Detachment Repair

Purpose: To characterize short-term outer retinal changes in silicone oil-filled eyes after primary macula-involving rhegmatogenous retinal detachment (RRD) repair using en face and cross-sectional optical coherence tomography (OCT), and to examine the association of outer retinal features, including foveal ellipsoid zone rosettes (FEZRs), with 12-week postoperative best-corrected visual acuity (BCVA). Methods: This prospective observational study included 35 patients with primary macula-involving RRD who underwent pars plana vitrectomy with silicone oil tamponade with follow-up at 3, 6, and 12 weeks. BCVA, external limiting membrane (ELM)/ellipsoid zone (EZ) integrity, persistent subretinal fluid (PSRF), outer retinal folds (ORFs), and FEZR were evaluated. Results: Mean BCVA improved from 1.96 logMAR at baseline to 0.64 logMAR at 12 weeks, with progressive restoration of foveal ELM/EZ integrity. En face OCT showed high agreement with cross-sectional OCT for PSRF and ORF detection. PSRF was detected in 25.7%, ORFs in 5.7%, and FEZR in 22.9% of eyes; FEZR were more frequent in eyes with poor 12-week visual outcomes. Conclusion: Cross-sectional and en face OCT provided complementary information on early outer retinal remodeling after RRD repair with silicone oil tamponade. Progressive ELM/EZ restoration was associated with better 12-week BCVA, whereas FEZR presence was associated with worse 12-week BCVA. These findings support further prospective evaluation of FEZR as a potential early negative prognostic imaging marker.