Abstract
Purpose :
OCT imaging of peripheral rhegmatogenous retinal lesions is rarely performed, leading to a significant knowledge gap. A systematic OCT analysis of peripheral retinal holes and breaks was performed.
Methods :
Retrospective, institutional, interventional, consecutive case series. All patients with rhegmatogenous pathology were imaged with wide-field OCT
Results :
A total of 107 eyes were included, 66 of which (61.7%) had retinal detachment. Four subtypes of rhegmatogenous lesions were identified: horseshoe break (Figure 1, A), operculated round hole (Figure 1, B), peripheral lamellar defect (Figure 1, C) and peripheral non-operculated hole (Figure 1, D). Horseshoe break was the commonest (73/107 eyes, 68.2%). It was larger (p<0.001), located at the posterior insertion of the vitreous base, with an anterior flap lifted due to vitreous traction, and with a posterior edge free from the vitreous. Operculated round hole (14/107 eyes, 13.1%) was smaller (p<0.001) and its borders were completely free from traction. It was located posteriorly to the vitreous base. The morphology of such lesion was similar to full-thickness macular hole (Figure 2, A), and they were stable over time. No retinal detachment was associated with operculated round holes alone, indicating that this may be a low-risk lesion. Non-operculated hole (17/107 eyes, 15.9%) was located in the far periphery, within the vitreous base, and it was the smallest lesion (p<0.001). Signs of strong vitreous adhesion and traction were noticed over the borders, which appeared lifted, even in the absence of posterior vitreous detachment (PVD). In some cases, the morphology of such lesion was comparable to vitreomacular traction syndrome (Figure 2, B). Peripheral lamellar defects (3/107, 2.8%) were partial thickness lesions located in the mid-periphery, associated with PVD.
Conclusions :
The similarities between rhegmatogenous defects and central tractional macular pathology may suggest common pathophysiological pathways. The role of vitreoretinal adherences and traction may be critical in the pathogenesis of all rhegmatogenous lesions. Vitreoretinal adhesion at the vitreous base may not be uniform.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.