Attached Hyaloid on OCT Foretells Fellow Eye’s Retinal Detachment Risk 

An attached hyaloid in the fellow eye of a patient with rhegmatogenous retinal detachment (RRD), observed via optical coherence tomography (OCT) during the initial evaluation, can help stratify the risk of sequential RRD, according to a study published in Ophthalmology. “In this setting, OCT may be helpful to guide patient risk counseling and education regarding return precautions when symptoms of [posterior vitreous detachment (PVD)] arise,” the authors explain.

This retrospective study included 1049 patients who were presented with RRD to a retina clinic in New York between May 2011 and January 2021. Of those, 582 eyes had initial, bilateral, standard 20×15° macular OCT images. The mean follow-up time was 5.7±0.3 years. 

In addition to monitoring for attached hyaloid, the study authors also collected, if available: lattice degeneration in either eye, refractive error, prior ocular laser procedures, lens status, and type of surgical intervention.

Overall, the incidence of sequential RRD was 14.6%. Out of the patients who underwent OCT imaging, 353 fellow eyes had attached hyaloid (51.7%), and 229 had PVD (39.3%). Subsequent RRD was developed in 28 eyes with attached vitreous (7.9%) and in 7 eyes with PVD (3.1%). 23.7% of the eyes with an initially attached vitreous and developed PVD during the study follow-up experienced RRD during vitreous separation. None of the remaining eyes, in which the vitreous remained attached throughout the follow-up (n=237), developed RRD.

The researchers report that both attached hyaloid on OCT and lattice degeneration were found to be significant risk factors for fellow eye RRD (P =.02 and P =.03, respectively). Lattice degeneration in the fellow eye carried a 50% increased risk, and attached hyaloid 160% increased risk. 

Within the phakic eyes with attached hyaloid that separated, 3 out of 16 eyes that underwent cataract surgery developed RRD, whereas 14 out of 77 phakic eyes that did not undergo surgery developed RRD (P >.99).

Excluding fellow eyes with RRD, the researchers found retinal tears in an additional 119 eyes. Of these, 21 eyes that had attached hyaloid on the initial visit developed retinal tears during vitreous separation (17.8%). 100 out of 240 eyes (41.6%) with lattice degeneration were treated with prophylactic laser retinopexy. Treated and untreated eyes developed RRD with a 14% and 15% frequency, respectively (P =.83).

Numerous baseline findings in the fellow eye may affect its risk of developing RRD, including: PVD status, presence or absence of retinal degeneration, family history of retinal detachment, and history of high myopia, the study authors explain. “Our results demonstrated that attached hyaloid on OCT and the presence of lattice degeneration were the only risk factors associated with a significantly increased relative risk of fellow eye RRD,” they conclude. “The utilization of OCT scans to assess the PVD status in fellow eyes of patients presenting with an RRD offers an opportunity to guide patient education and monitoring.”

The study limitations include its retrospective nature, a significant range of follow-up periods, and the unavailability of other possible risk factors for the development of RRD for many study eyes.