Long-term prognosis of eyes with tilted disc syndrome-associated serous retinal detachment

Abstract

Purpose : Serous retinal detachment (sRD) secondary to tilted disc syndrome (TDS) with inferior staphyloma is often refractory to any treatments including anti-vascular endothelial growth factor (VEGF) therapy and photodynamic therapy (PDT). The purpose of this study is to evaluate long-term prognosis of eyes with TDS-associated sRD by a multi-center survey.

Methods : Forty-eight eyes of 41 patients (14 men and 27 women) diagnosed as TDS-associated sRD with follow-up of 12 months or longer were retrospectively reviewed in 8 institutes. The eyes were investigated regarding intervention, best corrected visual acuity (BCVA), and change of sRD and central retinal thickness (CRT) on optical coherence tomography.

Results : The mean age was 64.2 years (range: 27-83) and the mean follow-up period was 3.3 years (range: 1.0-8.3). Sixteen eyes had no intervention, while 32 eyes had interventions including: anti-VEGF therapy (n=17), PDT (n=10), and combined therapy (n=5). The mean BCVA at the best point was 0.13 in the logarithm of minimal angle of resolution unit, significantly better than 0.26 at baseline but deteriorated to 0.27 at the last visit. The mean CRT was significantly improved from 296 µm at baseline to 241 µm at the last visit. sRD was remitting without relapsing in 14 eyes (29%), remitting-relapsing in 12 eyes (25%), and persisting in 22 eyes (46%). At the last visit, 21 eyes (44%) with anti-VEGF therapy (n=10), PDT (n=5), or no intervention (n=6) had no sRD, significantly improving the mean CRT (277 to 184 µm) and the mean BCVA (0.21 to 0.13) (P<0.05). In contrast, 27 eyes with sRD remaining at the last visit had neither improvement nor deterioration of BCVA and CRT. The eyes with intervention had no superior impacts on the mean BCVA, while the mean CRT was significantly improved from 326 µm at baseline to 246 µm at the last visit (p<0.01). The mean baseline CRT in the eyes without intervention was 234 µm, thinner than that with intervention. But, of these eyes, the eyes with visual improvement had the mean baseline CRT of 301 µm as thick as that in the eyes with intervention.

Conclusions : Independently of intervention, TDS-associated sRD was resolved in 44%, while anti-VEGF therapy and PDT had impacts to decrease CRT. The eyes with sRD remitting improved BCVA, while decrease of BCVA was not severe even in the eyes with sRD persisting. Eyes with visual improvement tended to have thick CRT.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.