Widefield OCT Shows Effects of Rhegmatogenous Retinal Detachment Surgery

Single-capture ultra-widefield confocal scanning laser ophthalmoscope with integrated swept-source optical coherence tomography (UWF-SS-OCT) can provide clinically valuable information for rhegmatogenous retinal detachment (RRD) management, according to results of a study published in the British Journal of Ophthalmology.

This retrospective study evaluated UWF-SS-OCT data collected between December 2020 and February 2021 at the University of Toronto in Canada. Patients (N=101, mean age 56.6 years, 56.4% boys and men) with either RRD (56.5%), peripheral retinal pathology, or both, underwent UWF-SS-OCT using a customized protocol for dilation, examination, and imaging. Patients with active disease underwent serial imaging.

New or previously treated tears or holes were found in 31.1%, lattice degeneration in 14.5%, and degenerative retinoschisis in 7.2%. Included eyes had laser retinopexy (47.8%) and cryopexy (21.0%). Longitudinal UWF-SS-OCT was performed among patients before and after laser retinopexy (n=22), pneumatic retinopexy (n=16), and laser cryopexy (n=4).

For the laser retinopathy and cryopexy eyes, a UWF-SS-OCT performed 30 minutes after retinopathy found defined columnar bands of hyperreflectivity with margins extending through all retinal layers, disrupting retinal lamination. The retina adjacent to treated areas appeared normal while the treated areas had increased thickness with hyporeflective splitting of the outer nuclear layer (ONL) and disrupted retinal pigment epithelium (RPE).

At 3 to 4 days, the columnar bands and retinal lamination disruption persisted but the retinal thickness and ONL splitting were reduced. Choroidal thickness was increased, and the normal configuration was lost. At 1 week, researchers noted alternating thin/atrophic-treated areas which appeared undulating. From weeks 2 to 4, the laser treated areas appeared increasingly atrophic/thin.

Postcryopexy, at 24 hours imaging showed retinal thinning with loss of differentiation of normal retinal areas and hyper-reflectivity in all layers. Remnants of the atrophic retina were detached from remnants of the RPE. Between days 2 and 4, additional thinning to the retina with loss of differentiation of the retinal layers was noted. Choroidal vasculature appeared disorganized with a separation of the choroid from the sclera which was resolved by day 6.

Among 10 patients with retinoschisis, 6 were associated with retinal detachment. Three of the eyes with schisis-detachment were thought to not have detachment at the time of UWF-SS-OCT. Two of the 6 eyes had been diagnosed as routine rhegmatogenous retinal detachment at the time of UWF-SS-OCT.

In chronic RRD, UWF-SS-OCT found the pigmented demarcation line, indicating RPE proliferation.

The major limitations of this study were the small sample size and the retrospective design.

This study found that single-capture UWF-SS-OCT revealed novel insights and was clinically useful in the diagnosis and management of RRD.

Reference

Lee WW, Muni RH. Single-capture ultra-widefield guided swept-source optical coherence tomography in the management of rhegmatogenous retinal detachment and associated peripheral vitreoretinal pathology. Br J Ophthalmol. Published online May 30, 2022. doi:10.1136/bjophthalmol-2021-320149