Author’s Disclosure Block: Miguel Cruz Pimentel, none; Suellen Demian, none; Shiva Sabour, none; Rajeev Muni, Consultant- Alcon, Apellis, AbbVie, Bayer, Bausch Health, Roche; Financial Support (to institution) - Alcon, AbbVie, Bayer, Novartis, Roche.

Abstract Body
Purpose: To assess the status of peripheral vitreous attachments around retinal tears in the context of rhegmatogenous retinal detachment. Methods: Prospective study conducted at St. Michael’s Hospital in Toronto, Canada. Approval was obtained from the Research Ethics Board, and 50 patients who provided informed consent for pneumatic retinopexy and subsequent imaging were prospectively followed with ultra-widefield imaging and swept-source OCT (SS-OCT) (Optos Silverstone, Optos, PLC; Dunfermline, UK). Static and dynamic assessment of the peripheral vitreous in the location of retinal tears was carried out. Results: All patients (50/50) presented with cystoid changes in the anterior portion of peripheral retinal tears. All patients had posterior vitreous detachment confirmed by the presence of a Weiss ring and the separation of posterior hyaloid attachment from the optic disc and central macula on SS-OCT. Imaging analysis revealed vitreous adhesion only to the free flap and the anterior portion of the retinal tear. The anterior and posterior edges of the peripheral tears showed reattachment and resolved cystoid changes after reattachment with pneumatic retinopexy. Retinopexy after laser application was observed to maintain adhesion among the posterior and anterior portions of retinal tears in all cases (50/50) at day 1,2, week one and month 1. Dynamic video assessment of vitreous traction and subretinal fluid in the area of the peripheral break was conducted in a subset of the patients (5/50), highlighting vitreous adhesion at the anterior portion of the tear that was overcome by laser retinopexy treatment. Conclusion: This is the first prospective study to dynamically assess in-vivo peripheral vitreous adhesion around peripheral retinal tears in RRD. We consistently found that the anterior flap of the tear exhibits peripheral vitreous attachment. The longitudinal evaluation demonstrates that this anterior traction can successfully be overcome with laser retinopexy in the setting of pneumatic retinopexy. Removal of vitreous traction is not a necessity in retinal detachment repair.