Impact of Baseline Morphologic Stage of Rhegmatogenous Retinal Detachment on Post-operative Anatomical Outcomes

Theme: Retina*
What: Retina
Part of: Retina III: A Passionate Potpourri for Pinching Out Pathology / Rétine III: Pot-pourri passionné pour éliminer les pathologies
When: 6/2/2024, 11:15 AM - 12:45 PM
Where: Room | Salle 713 AB

Abstract

Purpose:  The previously described morphologic stages of rhegmatogenous retinal detachment on OCT allow for more objective treatment decision-making and may be valuable for accurate prognostication of treatment outcomes (1). In this study, we sought to assess whether the baseline morphologic stages of rhegmatogenous retinal detachment (RRD) are associated with postoperative optical coherence tomography (OCT) anatomic outcomes. Study design: This is a retrospective cohort study including consecutive patients with fovea involving RRDs who were referred to St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada, from January 2012 to September 2022. Patients were treated at the discretion of the same surgeon (R.H.M.) with either pneumatic retinopexy, pars plana vitrectomy (PPV), scleral buckle (SB) or combined PPV and SB, as per standard of care. Exclusion criteria included any prior macular pathology, vitrectomy, or recurrent RRD in the first 12 months post-treatment. Best corrected visual acuity (BCVA) was obtained at 3, 6 and 12 months post-operatively.  Methods: Patients with primary RRD were assessed for the morphologic stage of RRD according to baseline OCT as per Melo et al 2022 (1). Briefly, RRDs were divided into 5 stages: 1) Stage 1 was marked by dissociation of neurosensory retina layers, 2) Stage 2, the bacillar layer thickesn, leading to a hyperreflective homogenous line, 3) Stage 3 is marked by the appearance and abundance of retinal corrugations (ORCs) that are low frequency in the early phase (Stage 3a) and high frequency on the low phase (Stage 3b), 4) Stage 4, the continuous thickening of the bacillary layer leading to hyperreflective dots (HRDs) and loss of ORCs definition, 5) Stage 5, where the loss of both outer segment and inner segment layer of the photoreceptors occurs. Postoperative OCTs were graded at 3, 6 and 12 months for internal limiting membrane (ILM), ellipsoid zone (EZ) and interdigitation zone (IDZ) integrity, epiretinal membrane (ERM) presence and severity of residual subfoveal fluid. Results: 351 RRD patients were included in the study. Advanced baseline morphologic stages of RRD were significantly associated with a discontinuous ELM, EZ and IDZ at all time points postoperatively (p<0.001). On the contrary, early stages were more associated with subfoveal blebs of residual fluid (p<0.001). There was no association between presenting stage of RRD and ERM severity. However, late stages were associated with earlier development of ERM at 3 months (p=0.012). Finally, we found that ELM, EZ, or IDZ discontinuity on post-operative OCT was associated with BCVA outcomes post-operatively (p<0.001). Conclusion:  Increasing baseline morphologic stages of RRD are associated with worse recovery of outer retinal bands and faster development of ERM at 3 months postoperatively. The stages of RRD are novel prognostic biomarkers of postoperative photoreceptor integrity.

Presenter(s)

Presenting Author: Isabela Martins Melo

Additional Author(s):

Ahmed Elsehemy

Aurora Pekacu, Department of Ophthalmology, St Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.

Chris Zajner, Western University, London, ON.

Sumana Naidu, Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.

Rajeev Muni, Department of Ophthalmology, St Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Kensington Vision and Research Institute, Toronto, Ontario, Canada.

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