Martins Melo Isabela, Pecaku Aurora, Samet Saba, Oquendo Paola, Popovic Marko M, Demian Sue Ellen, Cruz-Pimentel Miguel, Muni Rajeev H
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.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Ophthalmol Retina. 2025 Apr 29. doi: 10.1016/j.oret.2025.04.017.
To characterize proliferative vitreoretinopathy(PVR) with swept-source optical coherence tomography(SS-OCT) in rhegmatogenous retinal detachment(RRD).
Prospective cross-sectional cohort study.
Consecutive primary RRDs presenting to St. Michael's Hospital from 2021 to 2023.
Ultra-widefield(UWF) fundus imaging was staged per the Retina Society 1991 PVR Classification and correlated with retinal microstructural changes assessed with SS-OCT.
SS-OCT findings in PVR.
100 patients were included. Patients with no signs of PVR or PVR A (49/100) were more likely to have a preserved bacillary layer on SS-OCT with low-amplitude outer retinal corrugations(ORCs) compared to the PVR B/C group. PVR B(retinal wrinkling/vessel tortuosity) was present in 24%(24/100) of cases, all of which had high-amplitude ORCs. PVR C (27/100) was clinically divided into patients with subretinal membranes(SR) [63%(17/27)] and patients with fixed retinal folds(IR)[37%(10/27)]. The SR subtype was associated with shallow, slowly progressive detachments. On SS-OCT, they had a thick hyperreflective membrane emanating from the retinal pigment epithelium and extending along the outer retinal surface, causing tractional folds of the outer retina in 47%(8/17) of cases and tractional bacillary layer detachment in 12%(2/17) of cases. Outer retinal thinning/atrophy was commonly observed in the SR subtype. Patients with the IR subtype had bullous detachments on fundus examination and extensive intra-retinal changes on SS-OCT. These had a thickened bacillary layer with high-amplitude ORCs with photoreceptor-photoceptor apposition within or between individual corrugations(fused ORCs). Significant pre-retinal membranes with loss of differentiation of the inner and outer retinal lamellae and distortion of underlying ORCs were observed.
Our study demonstrates imaging evidence of varying PVR morphology. The IR subtype occurs in bullous detachments with intrinsic retinal changes that span from fused and distorted corrugations to retinal thickening, pre-retinal membranes and loss of differentiation of retinal lamella. The SR subtype occurs in shallow, slowly progressive detachments, where the proliferation is associated with membranes emanating from the RPE, outer retinal thinning/atrophy and tractional outer retinal folds. We present a novel OCT classification of primary PVR, which varies based on RRD morphology. Pathological intraretinal apposition in ORCs may contribute to glial proliferation and subsequent intra-retinal and pre-retinal changes.
采用扫频光学相干断层扫描（SS-OCT）对孔源性视网膜脱离（RRD）中的增殖性玻璃体视网膜病变（PVR）进行特征描述。
前瞻性横断面队列研究。
2021年至2023年在圣迈克尔医院就诊的连续性原发性RRD患者。
根据视网膜协会1991年PVR分类对超广角（UWF）眼底成像进行分期，并与通过SS-OCT评估的视网膜微观结构变化相关联。
PVR的SS-OCT表现。
纳入100例患者。与PVR B/C组相比，无PVR体征或PVR A（49/100）的患者在SS-OCT上更有可能保留杆菌层，伴有低振幅视网膜外层波纹（ORC）。24%（24/100）的病例存在PVR B（视网膜皱襞/血管迂曲），所有这些病例均有高振幅ORC。PVR C（27/100）在临床上分为有视网膜下膜（SR）的患者[63%（17/27）]和有固定视网膜皱襞（IR）的患者[37%（10/27）]。SR亚型与浅的、缓慢进展的脱离相关。在SS-OCT上，它们有一层从视网膜色素上皮发出并沿视网膜外层表面延伸的厚高反射膜，47%（8/17）的病例导致视网膜外层牵引性皱襞，12%（2/17）的病例导致牵引性杆菌层脱离。视网膜外层变薄/萎缩在SR亚型中常见。IR亚型的患者眼底检查有大泡性脱离且SS-OCT上有广泛的视网膜内改变。这些患者的杆菌层增厚，有高振幅ORC，在单个波纹内或之间存在光感受器-光感受器贴附（融合的ORC）。观察到显著的视网膜前膜，伴有视网膜内外层板层分化丧失和下层ORC扭曲。
我们的研究展示了不同PVR形态的影像学证据。IR亚型发生于伴有内在视网膜改变的大泡性脱离中，这些改变范围从融合和扭曲的波纹到视网膜增厚、视网膜前膜和视网膜板层分化丧失。SR亚型发生于浅的、缓慢进展的脱离中，其中增殖与从视网膜色素上皮发出的膜、视网膜外层变薄/萎缩和牵引性视网膜外层皱襞相关。我们提出了一种基于RRD形态学的原发性PVR的新型OCT分类。ORC中的病理性视网膜内贴附可能导致胶质细胞增殖以及随后的视网膜内和视网膜前改变。
