Novel Staging System Describes Rhegmatogenous Retinal Detachment Morphology

A novel staging system can use swept-source optical coherence tomography (SS-OCT) to describe sequential morphological changes in patients with rhegmatogenous retinal detachment (RRD), according to research published in Ophthalmology Retina.

Researchers conducted the prospective cohort study between 2020 and 2022 and included 49 patients (mean age, 61.2 years) with primary fovea-involving RRD. Participants underwent evaluation with posterior pole and ultra-widefield-SS-OCT scans and investigators assessed sequential outer retinal changes on the basis of imaging findings and visual outcomes following surgical intervention.

Among the cohort, 79.6% of participants had fovea-off RRD, 20.4% had fovea-split RRD, 71.4% had phakia, 28.6% had pseudophakia, and mean visual acuity (VA) was 1.09 logarithm of the minimum angle of resolution (logMAR).

The investigators observed that eyes with RRD tended to progress from neurosensory retina separation from the retinal pigment epithelium (RPE) to loss of photoreceptors with a moth-eaten appearance of the outer retinal area with irregular edges.

Based on these trends, the investigators derived 5 progressive stages. Stage 1 involved separation of the neurosensory retina from the RPE (n=42). The patients who were not observed to have a stage 1 phenotype had RRDs that extended beyond the boundary of the scan. Stage 2 progression could be identified by a thickening of the photoreceptor layer (n=45). Stage 3 was stratified into 2 stages — 3A which showed low frequency outer retinal corrugations (ORCs; n=44) and stage 3B which demonstrated high frequency ORCs (n=42). Stage 4 was marked as a progressive loss of ORC definition with photoreceptor layer thickening (n=26). Stage 5 involved patchiness to complete loss of photoreceptors (n=17).

The average duration of foveal involvement was 2.6 days for stage 3A, 2.8 days for stage 3B, 8 days for stage 4, and 11.9 days for stage 5, according to the report. The duration of foveal involvement in the parafoveal region was 2, 2.3, 11.4, and 12 days for stages 3A, 3B, 4, and 5, respectively.

More advanced stages of progression involved worsening visual acuity. Mean visual acuity was 0.20 logMAR in eyes with stage 2 (n=1) or 3A (n=8), 0.32 logMAR in eyes with stage 3B (n=15), 0.78 logMAR in eyes with stage 4 (n=13), and 0.83 logMAR in eyes with stage 5 (n=6) RRD.

Significant associations between RRD staging with foveal involvement (F_[3,30], 6.30; P =.001) and VA (F_[3,39], 4.22; P =.011) were observed.

“We believe that this new staging system may allow clinicians to thoroughly consider the status of the retina on presentation and its potential impact on post-operative anatomical and functional outcomes,” according to the study authors. “[I]t may allow us to move beyond the simple dichotomy of fovea-on and fovea-off when making decisions regarding timing of intervention.”

Study limitations include a small sample size, single center design, and failure to consider different degeneration rates among photoreceptors, even within the same retinal region.