Abstract
Purpose :
To investigate the relationship between hyperreflective dots (HRDs) on optical coherence tomography (OCT) in primary rhegmatogenous retinal detachments (RRD) with preoperative clinical characteristics and assess their potential as a prognostic imaging biomarker for postoperative outcomes.
Methods :
This single-centered retrospective cohort study assessed 1,768 consecutive charts of primary fovea-off RRDs referred to St. Michael’s Hospital, Toronto, Canada between January 2012-September 2022. Only patients with gradable OCT at presentation were included. Exclusion criteria included re-detachments or any prior macular pathology. Visual acuity(VA) was obtained at baseline, 3, 6 and 12 months. Baseline foveal OCT scans were graded for the presence of HRDs in the outer retina, morphological stage of RRD in the parafovea (according to Melo et al. 2022) and foveal photoreceptor integrity. Epiretinal membrane(ERM) and cystoid macular edema(CME) were graded on postoperative OCTs.
Results :
A total of 353 consecutive patients were included, of which 30 were fovea split, and 323 were fovea off RRDs. The proportion of patients in Stages 1, 2, 3a, 3b, 4 and 5 was 2%(n=7), 13%(n=45), 15%(n=54), 35%(n=124), 23%(n=82) and 12%(n=41), respectively. The presence of HRDs was associated with reduced VA at 3, 6 and 12 months(p<0.001) after excluding patients with visually significant cataract. HRDs were also associated with height of foveal detachment, duration of central vision loss, and RRD extent(p<0.001). Increasing stage of RRD was also associated with HRDs(p <0.001). This finding was also significant whilst focusing only on the integrity of foveal photoreceptors(p <0.001). HRDs were neither associated with ERM formation post-operatively nor with its severity(p=0.278). However, they were associated with CME at 3 and 6 months postoperatively(p=0.018; p=0.006).
Conclusions :
HRDs have been hypothesized to consist of intraretinal inflammatory cells. We have found that HRDs were significantly associated with the morphologic stage, extent, duration, and height of the RRD preoperatively and with reduced VA and CME postoperatively. Our results suggest that HRDs are associated with outer retinal degeneration, as long-standing and extensive RRDs are more likely to present with HRDs. The association of HRDs with CME provides some insight on the possible importance of inflammatory processes in RRD pre and postoperatively.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.