In Vivo Assessment of the Physiology Of Retinal Reattachment in Humans

Authors: Aditya Bansal, Wei Wei Lee, Tina Felfeli, Rajeev H. Muni.

Disclosure Block: A. Bansal: None. W. Lee: None. T. Felfeli: None. R.H. Muni: None.

Abstract Body:

Purpose: To assess the stages of retinal re-attachment using swept-source optical coherence tomography (SS-OCT) for rhegmatogenous retinal detachment (RRD).
Study Design: Prospective Cohort Study.
Methods: Patients with fovea involving RRD demonstrating a single retinal break or a group of breaks in detached retina within 3 clock hour above the 8- and 4-o’clock meridians, with any number, location, and size of retinal breaks or lattice degeneration in attached retina undergoing pneumatic retinopexy (PnR) were included in the study. All patients were imaged on SS-OCT using high definition (HD) horizontal 1 line spotlight scan (100x) and posterior pole (12X12 mm) cube 512X512. Imaging was done at day 0 (baseline and every 2 hours for the first six hours after gas injection), on days 1, 2, 5, and at weeks 1, 2, 4, and 6 post-procedure. Outcomes included SS-OCT changes after PnR for RRD in an attempt to determine the stages of retinal re-attachment.
Results: Fifteen eyes of 15 consecutive patients were included in the study. All fifteen eyes had successful retinal attachment (100%), with two eyes, required additional gas injection (double bubble). Retinal reattachment occurred with 5 specific reproducible stages on the basis of SS-OCT findings: Stage 0, Approach of neurosensory retina towards the retinal pigment epithelium (RPE) (15/15, 100%); Stage 1, Reduction of cystoid macular edema and/or improvement of outer retinal corrugations (15/15, 100%); Stage 2, Contact of the neurosensory retina to RPE (10/15, 66.66%); Stage 3, Deturgescence of inner and outer segments of photoreceptors (10/15, 66.66%); Stage 4: Recovery of Photoreceptors Integrity: 4A: External Limiting Membrane (ELM) (13/15, 86.66%), 4B: Elipsoid Zone(EZ) (8/15, 53.33%), 4C: Interdigitation Zone(IZ) (5/15, 33.33%); Stage 5: Reconstitution of foveal bulge (1/15, 6.66%). Five patients had residual subretinal fluid (SRF) in the subfoveal area and developed subretinal fluid blebs before reaching stage 2 with an arrest of the reattachment process. Three patients didn’t have complete resolution of outer retinal corrugations (Stage 1) before contact between the neurosensory retina and RPE (Stage 2) as a result ended up with formation of outer retinal folds (ORF).
Conclusions: This is the first in vivo assessment of the physiology of retinal attachment based on high-resolution SS-OCT. We have determined that the reattachment process occurs in 5 specific and reproducible stages. Anatomic abnormalities such as subretinal fluid blebs or outer retinal folds occur due to an arrest or delay at a specific stage in the reattachment process.