Muni Rajeev H, Darabad Masoud Norouzi, Oquendo Paola Lourdes, Hamli Hesham, Lee Wei Wei, Nagel Flavia, Bansal Aditya, Melo Isabela Martins, Ramachandran Arun
From the Faculty of Medicine (R.H.M.), University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences (R.H.M., P.L.O., H.H., F.N., A.B., I.M.M.), University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology (R.H.M., P.L.O., H.H., W.W.L., F.N., A.B., I.M.M.), St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Kensington Vision and Research Institute (R.H.M.), Toronto, Ontario, Canada.
Department of Chemical Engineering and Applied Chemistry (M.N.D., A.R.), University of Toronto, Toronto, Ontario, Canada.
Am J Ophthalmol. 2023 Jan;245:14-24. doi: 10.1016/j.ajo.2022.08.019. Epub 2022 Sep 5.
Outer retinal folds occur when outer retinal corrugations (ORCs) persist after retinal reattachment with worse functional outcomes. We investigate the pathophysiology of ORCs in vivo.
Prospective cohort study.
Patients with rhegmatogenous retinal detachment (RRD) presenting to St. Michael's Hospital, Toronto, Ontario, Canada, between August 2020 and February 2022 were assessed with swept-source optical coherence tomography (SS-OCT) and ultra-widefield SS-OCT for ORCs. Clinical characteristics of eyes with/without ORCs were compared. Mathematical models were used to deduce mechanical properties leading to ORCs.
Sixty-six patients were included. More than half (60.6%, 40/66) were fovea-off and 48.4% (32/66) had ORCs at presentation. All eyes (32/32) with ORCs had retinal pigment epithelium (RPE)-photoreceptor dysregulation for at least 2 days, defined as loss of RPE control with acute, progressive, and extensive RRDs. In all (34/34) eyes without ORCs the RPE was in relative control of the subretinal space with nonprogressive subclinical or small localized or resolving RRDs, or with RPE-photoreceptor dysregulation for fewer than 2 days. Mathematical models indicate that a modulus of elasticity of the outer retina relative to the inner retina of 0.05 to 0.5 leads to ORCs.
ORCs develop with (1) acute exposure of subretinal space to liquified vitreous, (2) for >2 days, that (3) overwhelms RPE capacity, leading to progressive and extensive RRD. Mathematical models suggest that a reduction in the modulus of elasticity of the outer retina occurs such that intrinsic compressive forces, likely related to progressive outer retinal hydration and lateral expansion, lead to ORCs. Understanding the pathophysiology of ORCs has implications for management.
视网膜复位后，当外层视网膜皱襞（ORC）持续存在且功能预后较差时，会出现外层视网膜折叠。我们在体内研究ORC的病理生理学。
前瞻性队列研究。
对2020年8月至2022年2月期间就诊于加拿大多伦多圣迈克尔医院的孔源性视网膜脱离（RRD）患者，采用扫频光学相干断层扫描（SS-OCT）和超广角SS-OCT评估ORC。比较有/无ORC眼睛的临床特征。使用数学模型推导导致ORC的力学特性。
纳入66例患者。超过一半（60.6%，40/66）为黄斑脱离，48.4%（32/66）在就诊时存在ORC。所有存在ORC的眼睛（32/32）均有视网膜色素上皮（RPE）-光感受器失调至少2天，定义为RPE控制丧失伴急性、进行性和广泛性RRD。在所有无ORC的眼睛（34/34）中，RPE对视网膜下间隙处于相对控制状态，伴有非进行性亚临床或小范围局限性或正在消退的RRD，或RPE-光感受器失调少于2天。数学模型表明，外层视网膜相对于内层视网膜的弹性模量为0.05至0.5会导致ORC。
ORC的发生与（1）视网膜下间隙急性暴露于液化玻璃体，（2）持续>2天，（3）超过RPE能力有关，导致进行性和广泛性RRD。数学模型表明，外层视网膜弹性模量降低，使得可能与外层视网膜渐进性水化和横向扩张相关的内在压缩力导致ORC。了解ORC的病理生理学对治疗具有重要意义。
