Pathophysiology of Outer Retinal Corrugations in Retinal Detachment

Abstract

Purpose : Outer retinal corrugations (ORCs) in rhegmatogenous retinal detachment (RRD) that do not fully resolve prior to reattachment may lead to the development of outer retinal folds which are associated with worse functional outcomes. The purpose of this study is to investigate the dynamic evolution of outer retinal corrugations (ORC) in vivo with optical coherence tomorgraphy (OCT) imaging.

Methods : Prospective cohort study. Eyes with RRD that underwent RRD repair were assessed longitudinally with multimodal imaging at baseline and at frequent intervals for up to 6 weeks post-operatively. The primary objective was to assess differences between RRD eyes with and without ORCs and to formulate a theory on the pathophysiology of ORCs by carefully observing the evolution and resolution of ORCs in vivo with OCT.

Results :
Fifty-seven eyes in 51 patients were assessed and followed. 34 participants were male with mean age of 60.9 (SD 7.77). 34 participants were phakic with baseline logMar visual acuity of 0.919 (SD=1.05). Mean duration of fovea-off of 6.88 days (SD=6.52) with 2.01 (SD=0.83) detached quadrants. 56.1% (32/57) of eyes had ORCs and 43.9% had no ORCs on presentation. All (100%) eyes with ORCs had complete and acute loss of RPE control with a larger extent of RRD (1 quadrant or more) and for a duration of more than 2 days. Although eyes without ORCs had subretinal fluid, the RPE was still in relative control of the subretinal space or the RRD had a duration of less than 2 days in all (100%) cases. This included 10 eyes with chronic non-progressive localized RRDs, 6 eyes with small localized acute RRDs, 5 eyes with residual displaced fluid following successful PnR or SB, and 4 eyes with larger acute RRDs of less than 2 days duration.

Conclusions : This prospective study describes a novel dynamic RPE-control theory of ORCs in RRD. The study demonstrates that more extensive RRD with loss of RPE-control for more than 2 days are more likely to develop ORCs. Clinical observations suggest that exposure of the outer retina to liquefied vitreous leads to the outer retina being more susceptible to deformation. Regaining RPE control following RRD repair results in a reversal of the ORCs. Understanding the pathophysiology of ORCs could lead to a modification of vitreoretinal surgical approach that allow ORCs to resolve prior to reattachment. The presence of ORCs is also suggestive of an open retinal break and absence of RPE control.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.