Morphologic Stages of Rhegmatogenous Retinal Detachment Assessed Using Swept-Source OCT

Area of Science:

• Ophthalmology
• Retinal imaging
• Surgical outcomes

Background:

• Rhegmatogenous retinal detachment (RRD) is a sight-threatening condition requiring timely intervention.
• Accurate staging of RRD is crucial for predicting visual prognosis and guiding treatment.
• Current staging methods may lack objective, detailed morphologic assessment.

Purpose of the Study:

• To introduce a novel, objective staging system for RRD based on swept-source OCT (SS-OCT) findings.
• To describe the sequential morphologic changes in RRD using SS-OCT.
• To determine the association between RRD stage, duration of fovea-off, and postoperative visual acuity (VA).

Main Methods:

• Prospective cohort study of patients with primary fovea-involving RRD.
• Utilized SS-OCT and ultrawide-field SS-OCT for baseline imaging.
• Developed a 5-stage system based on sequential outer retinal morphology observed via SS-OCT, from peripheral break to posterior extent.
• Excluded patients with long-standing vision loss, advanced proliferative vitreoretinopathy, or prior ocular surgery.

Main Results:

• Forty-nine eyes were analyzed, with mean age 61.2 years and presenting VA 1.09 logMAR.
• Identified 5 distinct stages of outer retinal changes: retinal pigment epithelium separation, photoreceptor inner/outer segment thickening, low/high-frequency corrugation formation, loss of corrugation definition, and photoreceptor inner/outer segment loss.
• Mean fovea-off duration increased with stage (e.g., 2 days for stage 3a to 12 days for stage 5).
• A significant association was found between higher RRD stage and longer fovea-off duration (P=0.001) and worse 3-month postoperative VA (P=0.011).

Conclusions:

• The novel SS-OCT-based staging system accurately depicts sequential morphologic changes in RRD.
• Increasing RRD stage is significantly associated with prolonged fovea-off duration.
• Higher RRD stages predict worse visual acuity outcomes at 3 months postoperatively.