دورية أكاديمية
Impact of Baseline Morphologic Stage of Rhegmatogenous Retinal Detachment on Postoperative Visual Acuity.
| العنوان: | Impact of Baseline Morphologic Stage of Rhegmatogenous Retinal Detachment on Postoperative Visual Acuity. |
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| المؤلفون: | Martins Melo I; 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., Naidu S; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Pecaku A; 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., Zajner C; Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada., Bansal A; 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., Oquendo PL; 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., Lee WW; 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., Muni RH; 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; Kensington Vision and Research Institute, Toronto, Ontario, Canada. Electronic address: rajeev.muni@gmail.com. |
| المصدر: | Ophthalmology. Retina [Ophthalmol Retina] 2024 Jul; Vol. 8 (7), pp. 624-632. Date of Electronic Publication: 2024 Jan 18. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Published by Elsevier Inc. on behalf of American Academy of Ophthalmology Country of Publication: United States NLM ID: 101695048 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2468-6530 (Electronic) Linking ISSN: 24686530 NLM ISO Abbreviation: Ophthalmol Retina Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: New York, NY : Published by Elsevier Inc. on behalf of American Academy of Ophthalmology, [2017]- |
| مواضيع طبية MeSH: | Retinal Detachment*/surgery , Retinal Detachment*/diagnosis , Retinal Detachment*/physiopathology , Visual Acuity* , Tomography, Optical Coherence*/methods , Vitrectomy*/methods, Humans ; Male ; Retrospective Studies ; Female ; Middle Aged ; Postoperative Period ; Follow-Up Studies ; Aged ; Fovea Centralis/pathology ; Scleral Buckling/methods |
| مستخلص: | Purpose: To evaluate the association of baseline morphologic stage of rhegmatogenous retinal detachment (RRD) using OCT with postoperative anatomic and visual acuity (VA) outcomes. Design: Retrospective cohort study. Subjects: Consecutive primary fovea-involving RRDs referred from January 2012 to September 2022. Methods: 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. Main Outcome Measures: Association of morphologic stage of RRD with 12-month BCVA. Results: 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). Conclusions: 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. (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: OCT; Postoperative visual acuity; Retinal morphology; Rhegmatogenous retinal detachment; Stages of retinal detachment |
| تواريخ الأحداث: | Date Created: 20240119 Date Completed: 20240705 Latest Revision: 20240705 |
| رمز التحديث: | 20240706 |
| DOI: | 10.1016/j.oret.2024.01.014 |
| PMID: | 38242437 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 2468-6530 |
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| DOI: | 10.1016/j.oret.2024.01.014 |