Morphologic Stages of Rhegmatogenous Retinal Detachment Assessed Using Swept-Source OCT

• Published in: Ophthalmology retina Vol. 7; no. 5; p. 398
• Main Authors: Martins Melo, Isabela, Bansal, Aditya, Naidu, Sumana, Oquendo, Paola L, Hamli, Hesham, Lee, Wei Wei, Muni, Rajeev H
• Format: Journal Article
• Language: English
• Published: United States 01-05-2023
• Subjects: Fovea Centralis - pathology; Humans; Prospective Studies; Retina - pathology; Retinal Detachment - diagnosis; Retinal Detachment - pathology; Retinal Detachment - surgery; Tomography, Optical Coherence - methods; Rhegmatogenous retinal detachment, Stages of retinal detachment, Retinal morphology, OCT, Photoreceptor degeneration
• ISSN: 2468-6530
• DOI: 10.1016/j.oret.2022.11.013

To describe the sequential morphologic changes after rhegmatogenous retinal detachment (RRD) utilizing a novel, objective, and clinically relevant staging system based on swept-source OCT (SS-OCT) and determine its association with the duration of fovea-off and postoperative visual acuity (VA).
Prospective cohort study.
Consecutive patients with primary fovea-involving RRD referred to St. Michael's Hospital, Toronto, Canada, from January 2020 to April 2022.
All patients underwent SS-OCT and ultrawide-field SS-OCT at baseline. Primary RRDs with breaks above the 8- and 4-o'clock meridians were included. Patients with vision loss for ≥ 3 months, proliferative vitreoretinopathy grade C or worse, a demarcation line, previous vitrectomy, or other retinal pathology were excluded. The staging was based on an assessment of outer retinal morphology on successive SS-OCT scans from the peripheral break to the most posterior aspect of the RRD, following its direction of progression.
Sequential outer retinal morphologic changes observed using SS-OCT and associated VA at 3 months after surgery.
Forty-nine eyes were included. The mean age (standard deviation [SD]) was 61.2 (15.2) years. The mean presenting logarithm of the minimum angle of resolution (SD) acuity was 1.09 (0.75). All stages observed on a high-definition horizontal 51-line scan were reported. Outer retinal changes occurred in 5 stages: (1) separation of the neurosensory retina from the retinal pigment epithelium (42/49, 85.7%); (2) thickening of inner and outer segments of photoreceptors (45/49, 91.8%); (3) outer retinal corrugation formation: (3a) low-frequency (44/49, 93.6%) and (3b) high-frequency outer retinal corrugations (42/49, 85.7%); (4) loss of the definition of outer retinal corrugations, with concurrent thickening of inner and outer segments (26/49, 53.1%); and (5) patchy (moth-eaten) or complete loss of inner and outer segments (17/49, 34.7%). The mean duration of fovea-off by stage in the parafovea (SD) was 2 (1.4), 2.3 (1.2), 11.4 (8.1), and 12 (13.3) days for stages 3a, 3b, 4, and 5, respectively. There was a statistically significant association between increasing stage of RRD and longer duration of foveal involvement (P = 0.001) and, most importantly, between increasing stage and worse VA at 3 months after surgery (P = 0.011).
This novel staging system describes the sequential morphologic changes in RRD using SS-OCT. Increasing stage of RRD was associated with worse VA at 3 months after surgery.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.