Author: Aditya Bansal (Canada)
Co-authors: Wei Wei Lee, Tina Felfeli, Rajeev H Muni
Purpose
To assess the in vivo physiology of retinal reattachment in humans using swept-source optical coherence tomography (SS-OCT) in real-time.
Setting/Venue
A prospective consecutive case series of fovea-involving rhegmatogenous retinal detachment (RRD) undergoing pneumatic retinopexy (PnR) at St Michael's Hospital/Unity Health Toronto, Toronto, Canada between July 1, 2020 and September 30, 2020. This study was approved by the Research Ethics Board at St. Michael’s Hospital/Unity Health Toronto in Toronto, Canada, and adhered to the Declaration of Helsinki.
Methods
Fifteen consecutive patients with a single or multiple retinal break(s) within 3 clock hours in detached retina above the 8 and 4 o’clock meridians with any number, location and size of retinal breaks or lattice degeneration in the attached retina, proliferative vitreoretinopathy ≤ grade B, undergoing treatment with PnR were eligible for the study. All patients underwent PnR as described in the PIVOT randomized trial. SS-OCT was performed at presentation and every 2 hours for the first six hours after gas injection, at day 1, 2, 5, and at week 1, 2, 4 and 6 after PnR. The primary outcome was the longitudinal assessment of early post-operative SS-OCT to establish stages of reattachment.
Results
93.3% (14/15) achieved successful reattachment at the median follow-up duration of 13 weeks (IQR 7.5-18.0). Reattachment occurred in five specific stages: Stage 1, redistribution of fluid and approach of the neurosensory retina towards the retinal pigment epithelium (RPE) occurred in 100% (15/15). Stage 2, reduction in cystoid macular edema and improvement of outer retinal corrugations was achieved in 100% (15/15). Stage 3, initial contact of the neurosensory retina to the RPE occurred completely in 66.7% (10/15). Stage 4, deturgescence of the inner and outer segments of the photoreceptors occurred in 66.7% (10/15). Stage 5, recovery of photoreceptor integrity occurred in three specific sub-stages, 5A: external limiting membrane (ELM) recovery (10/15, 66.6%), 5B: ellipsoid zone (EZ) recovery (9/15, 60%), 5C: interdigitation zone (IDZ)/foveal bulge recovery (3/15, 20%). 20% (3/15) had delayed progression through Stage 2, characterized by the formation of outer retinal folds. Similarly, 33.3% (5/15) developed residual subfoveal fluid blebs (delayed progression to stage 3).
Conlusions
This study characterizes the in vivo physiology of retinal reattachment in humans using high-resolution SS-OCT that occurs in five specific stages. Delayed progression through certain stages was characterized by post-operative anatomic abnormalities such as outer retinal folds and residual subfoveal fluid blebs.
Financial Disclosure
None
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