Morphologic Features and Implications of Regulated versus Dysregulated Rhegmatogenous Retinal Detachment Using Swept-Source Optical Coherence Tomography

Theme: Retina*
What: Posters
Part of: Poster Presentations / Présentations d'affiches | Break in the Exhibition Hall / Pause dans la salle d’exposition
When: 6/1/2024, 10:30 AM - 11:15 AM
Where: Exhibition Hall | Salle d'exposition

Abstract

 

Purpose: To describe the varying morphological features of patients with rhegmatogenous retinal detachment (RRD) based on the extent of regulation of the subretinal space by the retinal pigment epithelium (RPE) pump in humans in vivo, based on high-resolution swept-source optical coherence tomography (SS-OCT).

Design: Prospective cohort study.

Methods: Primary RRDs referred to St. Michael’s Hospital, Toronto, Canada were included. All patients underwent SS-OCT and ultra-widefield SS-OCT at baseline. Dysregulated RRDs were characterized as acute, progressive, and extensive. In contrast, regulated RRDs were defined as localized, non-progressive, slowly progressive, or subclinical RRDs. Foveal scans were examined for the presence of outer retinal corrugations (ORC), cystoid macular edema (CME), bacillary layer detachment and associated pathologies, and hyperreflective dots. The stage of RRD on SS-OCT was determined based on the staging system developed by Melo et al.

 

Results: 122 eyes were included. 21.3% (26 /122) of RRDs were classified as regulated, while 78.7% (96/122) were dysregulated. The mean age of patients with regulated RRDs at baseline was 43.9 years (±18.4 SD) versus 62.9 years (±12.7SD) for patients with dysregulated RRDs (P<0.001). Among regulated RRDs, 61.5% (16/26) were fovea-involving compared to 97.9% (94/96)  in the dysregulated group (P< 0.001). The mean baseline LogMAR was 0.6 (±0.6) versus 1.2 (±0.7) (P<0.001) for regulated versus dysregulated, respectively. In the patients with causative break identified, horseshoe tears were absent in all patients (0%;0/26) with regulated RRDs and observed in 87.3%(48/55) of patients with dysregulated RRDs (P< 0.001). Atrophic or small retinal holes were detected in all cases of (100%, 18/18) of regulated RRDs vs 12.5% (7/55) in the dysregulated ones (P<0.001). The presence of outer retinal corrugations (ORC) on OCT was observed in 3.8%(1/26) of regulated vs 84.4% (81/96) of eyes in the dysregulated RRD group (P<0.001). Cystoid macular edema (CME) was found in 50.0% (8/16) of eyes with regulated RRD compared to 87.2% (82/94) of eyes with dysregulated RRD (P<0.001). Among patients with regulated RRDs, 31.3% (5/16) were predominantly in Stage 2, 0% (0/16) in Stage 3A, 6.3% (1/16) in Stage 3B, 0% (0/16) in Stage 4, and 62.5% (10/16) in Stage 5. In patients with dysregulated RRDs, 14.9% (14/94) were in Stage 2, 16.0% (15/94) in Stage 3A, 38.3% (36/94) in Stage 3B, 23.4% (22/94) in Stage 4, and 7.4% (7/94) in Stage 5 (P<0.001).

Conclusions: There are significant morphologic differences between regulated and dysregulated RRDs using SS-OCT. In particular, ORCs are present in almost all dysregulated cases but a minority of regulated cases. The type of causative break, demographic, and clinical features differentiate regulated and dysregulated RRD, and these factors may have substantial implications for optimal management

Presenter(s)

Presenting Author: Aurora Pecaku

Additional Author(s):

Sumana Naidu, University of Toronto

Isabela Martins Melo, University of Toronto

Rajeev Muni, University of Toronto

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