{Reference Type}: Journal Article
{Title}: Morphologic Features of Regulated vs. Dysregulated Rhegmatogenous Retinal Detachment Using Swept-Source Optical Coherence Tomography.
{Author}: Pecaku A;Naidu SC;Demian S;Pimentel MC;Melo IM;Muni RH;
{Journal}: Am J Ophthalmol
{Volume}: 268
{Issue}: 0
{Year}: 2024 Jul 6
{Factor}: 5.488
{DOI}: 10.1016/j.ajo.2024.06.033
{Abstract}: <B>OBJECTIVE: </B>To describe varying morphological features of patients with RRD based on the extent of regulation of the subretinal space by the retinal pigment epithelium (RPE) pump using swept-source optical coherence tomography (SS-OCT).<BR><B>METHODS: </B>Prospective clinical cohort study.<BR><B>METHODS: </B> Setting: St. Michael's Hospital, Toronto, Canada, from August 2020-August 2023.<BR><B>METHODS: </B>120 consecutive eyes with primary RRD. Cohorts: Subclinical, non-progressive, localized RRD defined as regulated vs. acute, progressive, and extensive defined as dysregulated, assessed with SS-OCT.<BR><B>RESULTS: </B>Morphological features of regulated vs. dysregulated RRDs with SS-OCT.<BR><B>RESULTS: </B>19.2% (23/120) of RRDs were classified as regulated and 80.8% (97/120) were dysregulated. The mean age of patients with regulated RRDs was 37.1 years (±13.7 SD) vs. 62.6 years (±11.6SD) for patients with dysregulated RRDs (P < .001). The presence of outer retinal corrugations (ORCs) on OCT was observed in 4.3% (1/23) of regulated vs. 81.4% (79/97) of dysregulated RRDs (P < .001). CME was found in 41.6% (5/12) of regulated RRDs compared to 87.3% (83/95) of dysregulated RRDs (P < .001). ORC presence was an independent predictor of having a dysregulated RRD (P = .02, β = 6.6, 95% CI [1.3-33.2]) when controlling for age, sex, baseline VA, lens status, and RD extent. Among patients with regulated RRDs, 25.0% (3/12) were in Stage 2, 0% (0/16) in Stage 3A, 8.3% (1/12) in Stage 3B, 0% (0/16) in Stage 4, and 66.7% (8/12) in Stage 5. In patients with dysregulated RRDs, 14.7% (14/95) were in Stage 2, 15.7% (15/95) were in Stage 3A, 37.9% (36/95) in Stage 3B, 22.1% (21/95) in Stage 4, and 9.5% (9/95) in Stage 5 (P < .001).<BR><B>CONCLUSIONS: </B>There are significant morphologic differences between regulated and dysregulated RRDs using SS-OCT. ORCs are present in almost all dysregulated cases but in a minority of regulated cases and they are an independent predictor of RPE-photoreceptor regulation status. Demographic and clinical features differentiate regulated and dysregulated RRD and understanding these differences has significant implications for optimal management and postoperative outcomes.