From the Department of Ophthalmology and Vision Sciences, University of Toronto (A.P., S.C.N., S.D., M.C.P., I.M.M.), Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto (A.P., S.C.N., S.D., M.C.P., I.M.M.), Toronto, Ontario, Canada.
From the Department of Ophthalmology and Vision Sciences, University of Toronto (A.P., S.C.N., S.D., M.C.P., I.M.M.), Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto (A.P., S.C.N., S.D., M.C.P., I.M.M.), Toronto, Ontario, Canada; Kensington Vision and Research Institute (A.P., S.C.N., S.D., M.C.P., I.M.M.), Toronto, Ontario, Canada.
Am J Ophthalmol. 2024 Dec;268:19-28. doi: 10.1016/j.ajo.2024.06.033. Epub 2024 Jul 6.
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).
Prospective clinical cohort study.
Setting: St. Michael's Hospital, Toronto, Canada, from August 2020-August 2023.
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.
Morphological features of regulated vs. dysregulated RRDs with SS-OCT.
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).
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.
利用扫频源光学相干断层扫描（SS-OCT）描述视网膜色素上皮（RPE）泵对视网膜下空间调节程度不同的孔源性视网膜脱离（RRD）患者的不同形态特征。
前瞻性临床队列研究。
地点：加拿大安大略省多伦多市圣迈克尔医院，时间：2020 年 8 月至 2023 年 8 月。
120 例原发性 RRD 连续眼。亚组：亚临床、非进行性、局限性 RRD 定义为调节，急性、进行性和广泛定义为失调，使用 SS-OCT 评估。
SS-OCT 评估调节与失调 RRD 的形态特征。
19.2%（23/120）的 RRD 为调节性，80.8%（97/120）为失调性。调节性 RRD 患者的平均年龄为 37.1 岁（±13.7 SD），失调性 RRD 患者的平均年龄为 62.6 岁（±11.6 SD）（P <.001）。在外视网膜波纹（ORC）OCT 上观察到，4.3%（1/23）的调节性 RRD 存在，81.4%（79/97）的失调性 RRD 存在（P <.001）。调节性 RRD 中发现 CME 占 41.6%（5/12），而失调性 RRD 中发现 CME 占 87.3%（83/95）（P <.001）。ORC 存在是 RRD 失调的独立预测因素（P =.02，β=6.6，95%CI [1.3-33.2]），同时控制年龄、性别、基线 VA、晶状体状态和 RD 范围。在调节性 RRD 患者中，25.0%（3/12）为 2 期，0%（0/16）为 3A 期，8.3%（1/12）为 3B 期，0%（0/16）为 4 期，66.7%（8/12）为 5 期。在失调性 RRD 患者中，14.7%（14/95）为 2 期，15.7%（15/95）为 3A 期，37.9%（36/95）为 3B 期，22.1%（21/95）为 4 期，9.5%（9/95）为 5 期（P <.001）。
使用 SS-OCT 观察到调节性和失调性 RRD 之间存在显著的形态差异。ORC 几乎存在于所有失调性病例中，但在少数调节性病例中存在，它们是 RPE-感光细胞调节状态的独立预测因子。人口统计学和临床特征可区分调节性和失调性 RRD，了解这些差异对最佳管理和术后结果具有重要意义。
