Post-operative Photoreceptor Integrity and Anatomic Outcomes Based on Presenting Morphologic Stage of Rhegmatogenous Retinal Detachment

Abstract

Purpose: To evaluate outer retinal recovery on post-operative optical coherence tomography (OCT) based on presenting morphologic stage of rhegmatogenous retinal detachment (RRD). Methods: Retrospective cohort of consecutive primary fovea-involving RRDs, referred from January 2012-September 2022. Baseline OCTs were assessed for morphologic stage of RRD. Post-operative OCTs were graded at 3, 6 and 12 months for external limiting membrane (ELM), ellipsoid zone (EZ) and interdigitation zone (IDZ) discontinuity, epiretinal membrane (ERM) formation and severity, and residual subfoveal fluid. Results: 351 patients were included. Increasing baseline morphologic stage of RRD was significantly associated with ELM, EZ and IDZ discontinuity at all time points post-operatively(p<.001) and was shown to be an independent predictor of foveal photoreceptor integrity after adjusting for height of detachment, time to surgery and duration of fovea involvement(p<.001). Earlier stages were associated with subfoveal fluid(p<.001). There was no association between the stages of RRD and ERM severity. However, late stages presented with earlier development of ERM(p=.012). Conclusion: Increasing morphologic stage of RRD is associated with delayed recovery of outer retinal bands in the first year and faster development of ERM following RRD repair. Our results suggest that the stages may serve as a prognostic biomarker for postoperative photoreceptor recovery.