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Aditya Bansal, Wei Wei Lee, Tina Felfeli, Rajeev H Muni; Real-Time In Vivo Assessment of Retinal Reattachment in Humans using Swept-Source Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3091.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the physiology of retinal reattachment in humans using swept-source optical coherence tomography (SS-OCT) in real-time.
A prospective cohort study of consecutive patients with fovea-involving rhegmatogenous retinal detachment undergoing pneumatic retinopexy (PnR). SS-OCT was performed at presentation and every 2 hours for the first six hours, at day 1, 2, 5, and at week 1, 2, 4, and 6 after PnR. The outcome was defined as the longitudinal assessment of early post-operative SS-OCT findings to determine the stages of retinal reattachment.
Fifteen eyes of 15 consecutive patients were included. All 15 patients (100%) achieved successful retinal reattachment with PnR. Reattachment occurred in five specific reproducible stages based on SS-OCT findings: Stage 1, defined as a redistribution of fluid and approach of the neurosensory retina towards the retinal pigment epithelium (RPE) occurred in 100% (15/15) of patients (Fig 1B, Fig 2B). Stage 2, characterized by a reduction in cystoid macular edema and improvement of outer retinal corrugations was also achieved in 100% (15/15) of patients (Fig 1C&D, Fig 2C). Stage 3, defined by the initial contact of the neurosensory retina to the RPE occurred completely in 66.7% (10/15) and incompletely in 33.3% (5/15) of patients (Fig 1E, Fig 2D). Stage 4, defined as a deturgescence of the inner and outer segments of the photoreceptors occurred completely in 66.7% (10/15) of patients (Fig 1F, Fig 2E). Stage 5, characterized by recovery of photoreceptor integrity occurred in three specific sub-stages, 5A: external limiting membrane (ELM) recovery (10/15, 66.6%) (Fig 2F), 5B: ellipsoid zone (EZ) recovery (7/15, 46.6%) (Fig 2G), 5C: interdigitation zone (IDZ)/foveal bulge recovery (3/15, 20%) (Fig 1G, Fig 2H). 20% (3/15) of patients had delayed progression through Stage 2 which led to the formation of outer retinal folds (Fig 2I). Similarly, 33.3% (5/15) of patients had delayed progression to Stage 3 and developed residual subfoveal fluid blebs (Fig 2J).
This study characterizes the in vivo physiology of retinal reattachment in humans using high-resolution SS-OCT. The reattachment process occurs in five specific and reproducible stages and delayed progression through certain stages can lead to post-operative anatomic abnormalities such as outer retinal folds and residual subfoveal fluid blebs.
This is a 2021 ARVO Annual Meeting abstract.
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