Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Ophthalmol Retina. 2024 Jul;8(7):624-632. doi: 10.1016/j.oret.2024.01.014. Epub 2024 Jan 18.
To evaluate the association of baseline morphologic stage of rhegmatogenous retinal detachment (RRD) using OCT with postoperative anatomic and visual acuity (VA) outcomes.
Retrospective cohort study.
Consecutive primary fovea-involving RRDs referred from January 2012 to September 2022.
Patients with primary RRD and no prior macular pathology with gradable baseline OCT were assessed. Best-corrected VA (BCVA) was assessed at presentation and at 3, 6, and 12 months postoperatively. OCT scans were graded for parafoveal morphologic stage of RRD and foveal photoreceptor integrity.
Association of morphologic stage of RRD with 12-month BCVA.
Three hundred fifty-one patients were included. Sixty-eight percent (238/351) were male, the mean (standard deviation) age was 61.2 (± 12.8) years, and 59% (206/351) were phakic. Thirteen percent (47/351) presented in stages 1 and 2, 15% (54/351) in stage 3a, 36% (126/351) in stage 3b, 24% (83/351) in stage 4, and 12% (41/351) in stage 5. Increasing stage was associated with worse foveal photoreceptor integrity, reduced baseline BCVA and longer duration of central vision loss (P < 0.001). Mean (standard deviation) 12-month BCVA by stage was 0.77 (± 0.64) for stages 1 and 2, 1.00 (± 0.53) for stage 3a, 1.36 (± 0.55) for stage 3b, 1.33 (± 0.66) for stage 4 and 1.55 (± 0.47) for stage 5. Increasing stage was associated with reduced postoperative BCVA (P < 0.001) at all time points after adjusting for covariates. A subgroup analysis of acute detachments with retinal pigment epithelium-photoreceptor dysregulation demonstrated no difference in postoperative BCVA between stages 1, 2, and 3a. However, 12-month BCVA was significantly better in stages 1, 2, and 3a vs. stage 3b (P = 0.002) and stage 3a vs. 3b (P = 0.008).
This study validates the clinical relevance of a recently proposed OCT-based staging system for outer retinal morphologic changes over time in RRD. Postoperative BCVA was significantly reduced in patients with worse presenting stage at all time points. In acute RRDs, 12-month BCVA was significantly better in stages 1, 2, and 3a vs. stage 3b, which suggests early stages may have better retinal recovery compared with stage 3b or worse. Stage 3b may represent a critical point where substantial structural changes occur, leading to worse outcomes in acute RRDs. Patients presenting with fovea-involving RRDs in stages 1, 2, or 3a may benefit from more urgent intervention.
FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.
评估孔源性视网膜脱离（RRD）的基线形态学分期（使用 OCT 评估）与术后解剖和视力（VA）结果的相关性。
回顾性队列研究。
2012 年 1 月至 2022 年 9 月转诊的连续原发性累及黄斑的 RRD。
评估了原发性 RRD 且无先前黄斑病变且基线 OCT 可分级的患者。在就诊时和术后 3、6 和 12 个月评估最佳矫正视力（BCVA）。对旁中心形态学 RRD 分期和黄斑光感受器完整性进行 OCT 扫描分级。
RRD 形态学分期与 12 个月 BCVA 的相关性。
共纳入 351 例患者。68%（238/351）为男性，平均（标准差）年龄为 61.2（±12.8）岁，59%（206/351）为白内障。13%（47/351）为 1 期和 2 期，15%（54/351）为 3a 期，36%（126/351）为 3b 期，24%（83/351）为 4 期，12%（41/351）为 5 期。分期越高，黄斑光感受器完整性越差，基线 BCVA 越低，中心视力丧失时间越长（P<0.001）。按分期计算的 12 个月平均 BCVA 分别为 1 期和 2 期为 0.77（±0.64），3a 期为 1.00（±0.53），3b 期为 1.36（±0.55），4 期为 1.33（±0.66），5 期为 1.55（±0.47）。调整协变量后，所有时间点的术后 BCVA 均与分期降低相关（P<0.001）。对视网膜色素上皮-光感受器功能障碍的急性脱离亚组分析显示，1 期、2 期和 3a 期之间的术后 BCVA 无差异。然而，与 3b 期相比，1 期、2 期和 3a 期的 12 个月 BCVA 明显更好（P=0.002），与 3b 期相比，3a 期的 BCVA 更好（P=0.008）。
本研究验证了最近提出的基于 OCT 的 RRD 外视网膜形态随时间变化的分期系统的临床相关性。所有时间点的患者表现分期越差，术后 BCVA 明显降低。在急性 RRD 中，与 3b 期相比，1 期、2 期和 3a 期的 12 个月 BCVA 明显更好，这表明与 3b 期或更差的阶段相比，早期阶段可能有更好的视网膜恢复。3b 期可能代表发生大量结构变化的关键点，导致急性 RRD 的结果更差。患有 1 期、2 期或 3a 期累及黄斑的 RRD 的患者可能受益于更紧急的干预。
作者没有与本文讨论的任何材料有关的专有或商业利益。
