Morphologic Features of Regulated vs. Dysregulated Rhegmatogenous Retinal Detachment Using Swept-Source Optical Coherence Tomography

• Published in: American journal of ophthalmology Vol. 268; pp. 19 - 28
• Main Authors: PECAKU, AURORA, NAIDU, SUMANA C., DEMIAN, SUEELLEN, PIMENTEL, MIGUEL CRUZ, MELO, ISABELA MARTINS, MUNI, RAJEEV H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2024
• Subjects: Retinal Morphology; Rhegmatogenous Retinal Detachment; Optical Coherence Tomography, Outer Retinal Corrugations, Regulated Rhegmatogenous Retinal Detachment, Dysregulated Rhegmatogenous Retinal Detachment
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2024.06.033

•Morphologic features of regulated and dysregulated retinal detachment (RD) differ.•Dysregulated RRDs are more likely to have outer retinal corrugations.•Regulated RRD occurs in young patients with retinal holes and attached hyaloid.•Dysregulated RRD occurs in patients with vitreous separation and horseshoe tears.•Understanding of the morphological differences in RRD has clinical implications. To describe varying morphological features of patients with RRD based on the extent of regulation of the subretinal space by the retinal pigment epithelium (RPE) pump using swept-source optical coherence tomography (SS-OCT). Prospective clinical cohort study.  Setting: St. Michael's Hospital, Toronto, Canada, from August 2020-August 2023. Participants: 120 consecutive eyes with primary RRD. Cohorts: Subclinical, non-progressive, localized RRD defined as regulated vs. acute, progressive, and extensive defined as dysregulated, assessed with SS-OCT. Main Outcome: Morphological features of regulated vs. dysregulated RRDs with SS-OCT. 19.2% (23/120) of RRDs were classified as regulated and 80.8% (97/120) were dysregulated. The mean age of patients with regulated RRDs was 37.1 years (±13.7 SD) vs. 62.6 years (±11.6SD) for patients with dysregulated RRDs (P < .001). The presence of outer retinal corrugations (ORCs) on OCT was observed in 4.3% (1/23) of regulated vs. 81.4% (79/97) of dysregulated RRDs (P < .001). CME was found in 41.6% (5/12) of regulated RRDs compared to 87.3% (83/95) of dysregulated RRDs (P < .001). ORC presence was an independent predictor of having a dysregulated RRD (P = .02, β = 6.6, 95% CI [1.3-33.2]) when controlling for age, sex, baseline VA, lens status, and RD extent. Among patients with regulated RRDs, 25.0% (3/12) were in Stage 2, 0% (0/16) in Stage 3A, 8.3% (1/12) in Stage 3B, 0% (0/16) in Stage 4, and 66.7% (8/12) in Stage 5. In patients with dysregulated RRDs, 14.7% (14/95) were in Stage 2, 15.7% (15/95) were in Stage 3A, 37.9% (36/95) in Stage 3B, 22.1% (21/95) in Stage 4, and 9.5% (9/95) in Stage 5 (P < .001). There are significant morphologic differences between regulated and dysregulated RRDs using SS-OCT. ORCs are present in almost all dysregulated cases but in a minority of regulated cases and they are an independent predictor of RPE-photoreceptor regulation status. Demographic and clinical features differentiate regulated and dysregulated RRD and understanding these differences has significant implications for optimal management and postoperative outcomes.