Subclinical Retinal Detachment Research Articles

Unique Optical Coherence Tomography Imaging in Spontaneous Closure of Full Thickness Macular Hole Post Laser Photocoagulation

Purpose: To study events in spontaneous full thickness macular hole (FTMH) closure following laser photocoagulation (LP). Methods: Retrospective case study of a patient of spontaneous FTMH closure documented by SD-OCT following laser. Results: A 51-year-old lady presented with FTMH and a subclinical retinal detachment (RD) in her right eye. LP for subclinical RD was done and surgery for FTMH was advised. On day of surgery, repeat SD-OCT showed spontaneous closure of FTMH with an outer retinal defect, following which surgery was abandoned. Conclusion: Spontaneous PVD induction relieves antero-posterior traction and Inner limiting membrane (ILM) micro breaks relieves tangential traction, which can result in spontaneous closure of FTMH.

Retro-mode scanning laser ophthalmoscopy in evaluation of peripheral retinal lesions.

To study the diagnostic potential of retro-mode scanning laser ophthalmoscopy (RM-SLO) for evaluation of peripheral retinal lesions. Based on the results of indirect ophthalmoscopy, in this study, we included asymptomatic subjects with lattice retinal degeneration, retinal break, or subclinical retinal detachment and subjects without any peripheral retinal lesions. All participants' fundus periphery was examined with RM-SLO over 360° for the presence of peripheral retinal lesions in a masked fashion. Detection rate for retinal breaks and detachments were compared between indirect ophthalmoscopy and RM-SLO. Twenty-six subjects (52 eyes, 15 males and 11 females, 34.8 ± 11.8 years) were included in the peripheral retinal lesion group and 25 individuals (50 eyes, 10 males and 15 females, 42.8 ± 14.5 years) were included in the group without peripheral retinal lesions. Among the patients with peripheral retinal lesions detected with indirect ophthalmoscopy in at least one eye, RM-SLO categorized 20.7% (p = 0.031) more eyes as having subclinical asymptomatic retinal detachment or at least one retinal break. Additionally, RM-SLO demonstrated 55.0% (p = 0.001) more subclinical retinal detachments and 31.5% (p = 0.002) more asymptomatic retinal breaks. RM-SLO showed high potential in diagnosing peripheral retinal lesions and may be a useful additional diagnostic tool for the patients who demonstrate peripheral retinal lesions with indirect ophthalmoscopy.

Scanning Outside the Box: Utilizing Peripheral OCT to Differentiate Subclinical Retinal Detachment, Retinoschisis, and White Without Pressure

Introduction: No physician wants to misdiagnose a patient with retinal detachment, creating a low threshold for referral of suspicious peripheral retinal lesions. Conditions such as eripheral retinoschisis and white without pressure (WWOP) can raise alarm in the clinical examination for possible subclinical retinal detachment (SCRD). Utilization of optical coherence tomography (OCT) may be used to obtain images of the peripheral retina, and can aid in the differentiation of SCRD from the less ominous presentations of peripheral retinoschisis and WWOP. Case Series: This case series will explore peripheral OCT findings in each of these conditions and help the practitioner to use this valuable tool to improve patient care. Discussion: Peripheral OCT imaging can be used to help differentiate the findings of SCRD, retinoschisis, and white without pressure. This is important as SCRD typically requires treatment, while retinoschisis and white without pressure can be monitored. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/retinal-arterial-macroaneurysm-a-brief-review) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

Demarcation Laser Photocoagulation for Subclinical Retinal Detachment: Can Progression to Retinal Detachment Be Prevented?

Objectives:To describe results of demarcation laser photocoagulation in preventing progression of subclinical retinal detachment (SCRD).Materials and Methods:Twenty-one eyes of 20 patients with SCRD were included. All patients underwent a complete ophthalmological examination, spectral-domain optical coherence tomography, and color fundus photography. Ages at initial diagnosis ranged between 18 and 75 years (mean: 57.3±16.2 years). Patients followed for at least 6 months were included in the study. Periodic retinal examinations were performed over follow-up periods of 6-55 months using Goldmann three-mirror contact lens and sometimes semilunar mirror lens with scleral indentation.Results:Twelve patients (60%) were female, eight (40%) were male. The mean follow-up period was 24.3±15.2 months (6-55 months). Three (14.3%) eyes were pseudophakic. One patient was affected bilaterally, with both eyes each containing two separate areas of involvement. The SCRD was in the upper quadrant of 18 eyes (85.7%) and the lower quadrant in 3 eyes (14.3%), and was located in the temporal region 10 eyes (47.6%), the nasal quadrant in 4 eyes (19.1%), and in the upper quadrant (temporal-nasal) in 7 eyes (33.3%). Six eyes (28.6%) were found to have myopia greater than -3.0 diopters. Progression to clinical retinal detachment was observed in 4/21 SCRD eyes (19%). All eyes showing progression to clinical retinal detachment had >-3.0 diopter myopia and multiple retinal tears located in the upper quadrant.Conclusion:Demarcation laser photocoagulation should be kept in mind as a first-line treatment for eyes with SCRD. Laser photocoagulation is vital in preventing progression to rhegmatogenous retinal detachment in most patients. After this treatment, these patients should be followed closely.

Swept-Source OCT Analysis of the Margin of Choroidal Coloboma: New Insights

To study the retinal architecture and vitreoretinal interface at the edge of choroidal coloboma using swept-source OCT. Prospective observational case series at a tertiary eye care center. Patients with choroidal coloboma treated at an ophthalmology department and fulfilling the inclusion criteria of the study. Swept-source OCT was carried out in 30 eyes of 20 patients with choroidal coloboma. The primary objective was to describe the OCT features at the margin of the coloboma. Swept-source OCT of the coloboma margin revealed new features in addition to the previously described findings. Two types of transition from normal retina into intercalary membrane (ICM) were noted: abrupt (73.33%) and gradual (26.67%). Outer retinal layers (interdigitation zone and ellipsoid zone) terminated at a variable distance before the retinal pigment epithelium in 56.67% of eyes. Cystic spaces in the ICM (46.67%), schisis-like spitting of the ICM (30%), and breaks in the ICM (6.67%) were seen as well. Subclinical retinal detachment (RD) was also noted in 1 eye. The peculiar features noted at the vitreoretinal interface included vitreous attachment at the coloboma margin (23.33%), vitreous condensation (6.67%), and hill like projections of ICM into the vitreous cavity (26.67%). In the region of the coloboma, sclera and Tenon's capsule could also be analyzed as a hyperreflective lamellar structure and an irregularly arranged less hyperreflective structure. Swept-source OCT of the coloboma margin revealed various new features in addition to those described previously. The detection of subclinical RD or early termination of outer retinal layers in selected cases may be helpful in guiding new management protocols.

Laser Retinotomy with “Ultra Q Reflex” System for the Prevention of Rhegmatogenous Retinal Detachment due to the Peripheral Horseshoe Tears

Purpose. To evaluate laser retinotomy efficacy in the retinal detachment (RD) due horseshoe tear prevention. Patients and methods. 57 eyes of 54 patients with subclinical retinal detachment due to the peripheral horseshoe retinal tear were enrolled. 26 eyes of 25 patients of main group undergone combined laser technology included a barrier retinal photocoagulation of the local detachment zone, accompanied with deffered Nd:YAG laser retinotomy. The barrier retinal photocoagulation alone was performed on 31 eyes of 29 patients in control group to compare postoperation results. The assessment of the peripheral vitreoretinal interface was carried out by fundus ultrasound scanning, multispectral scanning laser imaging and spectral optical coherence tomography. The efficacy of the laser treatment was estimated by local retinal detachment height and area changes, while the safety was estimated by intra- and post-op complications rate. All patients were examined at the baseline, 1 week, 1, 3, 6 and 12 month follow-up. Results. Both main and control groups undergone barrier laser photocoagulation with complete round demarcation of subclinical local retinal detachment. All twenty five patients of main group achieved successful laser resection of retinal horseshore flap without any evidence of clinically significant complications. YAG-laser retinotomy in patients with retinal horseshoe tear resulted in decreased values of local retinal detachment height and area (in 40 and 38% respectively, p < 0.05). At the 12-month follow-up full retinal adhesion has been achieved in 15 eyes (58%), while partial adhesion has been observed in 7 eyes (27%). Obtained data were significantly lower compared with control group where some sings of retinal detachment progression were appeared (in 11 and 4% respectively, p > 0.05). No evidence of clinically significant complications after laser treatment has been revealed. Conclusions. The obtained data have demonstrated the efficacy and the safety of laser retinotomy in traction component reducing and consequent risk of retinal detachment minimising.

Delayed macular hole formation after demarcation laser photocoagulation for subclinical retinal detachment

The purpose of this paper is to report a series of macular holes that developed after demarcation laser photocoagulation for subclinical retinal detachments. This observational case series consists of three eyes from three patients seen between 2005 and 2012. Delayed idiopathic macular hole formation occurred following demarcation laser photocoagulation for subclinical retinal detachment. Demarcation laser photocoagulation of subclinical retinal detachments may predispose to macular hole formation.

Imaging in vitreoretinal diagnostics

Imaging in vitreoretinal diagnostics

In vivo sectional imaging of the retinal periphery using conventional optical coherence tomography systems

Optical coherence tomography (OCT) has transformed macular disease practices. This report describes the use of conventional OCT systems for peripheral retinal imaging. Thirty-six eyes with peripheral retinal pathology underwent imaging with conventional OCT systems. In vivo sectional imaging of lattice degeneration, snail-track degeneration, and paving-stone degeneration was performed. Differences were noted between phenotypes of lattice degeneration. Several findings previously unreported in histopathology studies were encountered. Certain anatomic features were seen that could conceivably explain clinical and intraoperative behavior of peripheral lesions. Peripheral OCT imaging helped elucidate clinically ambiguous situations such as retinal breaks, subclinical retinal detachment, retinoschisis, choroidal nevus, and metastasis. Limitations of such scanning included end-gaze nystagmus and far peripheral lesions. This first of its kind study demonstrates the feasibility of peripheral retinal OCT imaging and expands the spectrum of indications for which OCT scanning may be clinically useful.

OPTICAL COHERENCE TOMOGRAPHY AFTER PARS PLANA VITRECTOMY FOR RETINAL DETACHMENT RELATED TO CHOROIDAL COLOBOMA

The purpose was to study the anatomical outcome of choroidal coloboma with retinal detachment managed by pars plana vitrectomy with silicone oil tamponade using optical coherence tomography. Six eyes of six patients with retinal detachment related to choroidal coloboma underwent pars plana vitrectomy with internal tamponade using silicone oil. Pre- and postoperative best-corrected visual acuities, intraocular pressure measurements, and intra- and postoperative complications were obtained. Color fundus photographs and optical coherence tomography images were taken at each follow-up. Patients were observed up to a mean of 14 months (range, 8-18 months). Silicone oil was removed in all eyes. In all patients who had undergone vitrectomy, the retina was completely reattached before and after silicone oil extraction. Postoperatively, best-corrected visual acuities improved in 5 patients and remained unchanged in 1 patient ranging from 20/200 to 20/40 at the last follow-up. Although the retina was reattached in all patients, the optical coherence tomography showed a persistent intercalary membrane detachment in 4 patients (67%). In 1 patient (16%), subclinical retinal detachment that did not increase during the follow-up after silicone oil removal was detected just beyond the margin of the coloboma. After vitrectomy and silicone oil removal, optical coherence tomography showed persistent detachment of the intercalary membrane in most patients. These findings emphasize the importance of sealing the junction between the intercalary membrane and extracolobomatous retina with a laser barrier.

Chronic Retinal Detachment with Secondary Retinal Macrocyst and Peripheral Neovascularization

Purpose: To report the association of a retinal macrocyst with peripheral retinal neovascularization that occurred secondary to a chronic, subclinical rhegmatogenous retinal detachment and to illustrate the utility of wide-field fundus photography. Methods: Case Report Results: A 37 year-old male was diagnosed with chronic retinal detachment on routine eye examination. Further evaluation revealed intraretinal hemorrhages and a retinal macrocyst. Diagnosis was confirmed with wide-field fundus photography and fluorescein angiography. Surgery was recommended to repair the retinal detachment, to allow spontaneous resolution of the macrocyst. Conclusion: Chronic, subclinical retinal detachments may rarely be associated with retinal macrocysts and retinal neovascularization. This altered retinal morphology can be delineated on wide-field fundus imaging, which aids in diagnosis and management.

A clinical and optical coherence tomography study of choroidal colobomas

This paper reviews current understanding of coloboma of the choroid, as evaluated clinically and using optical coherence tomography. Studies of the margin of coloboma of the choroid with optical coherence tomography revealed several interesting features, including variability in transition from normal retina to intercalary membrane (gradual or abrupt), presence of subclinical retinal detachments, focal communications between the subretinal space and subintercalary membrane space in eyes with extra-colobomatous retinal detachments, and inward humping of the eye wall in some cases. Pathological studies have stressed the importance of the intercalary membrane and the margin of coloboma as barriers for occurrence of retinal detachments. Vitrectomy and silicone oil tamponade could correct these retinal detachments in a majority of cases. Optical coherence tomography can provide insight into pathology at the margin of the coloboma. Coupled with knowledge from histopathological studies, this information can guide the management of retinal detachments secondary to coloboma of the choroid with a high degree of success.

A Clinical and Optical Coherence Tomography Study of the Margins of Choroidal Colobomas

To describe the features at the margin of the choroidal colobomas as evaluated clinically and by optical coherence tomography (OCT). Prospective observational case series. Seventeen patients (30 eyes) that presented to the outpatient department of a tertiary care center. Clinical examination and OCT testing of the 30 eyes. Description of OCT features of the margin of the choroidal colobomas. Histologically, there is no normal choroid, retinal pigment epithelium, or retina overlying choroidal colobomas; rather, the overlying tissue is an extension of the retina called the intercalary membrane (ICM). In these patients, OCT showed that transition from normal retina to the ICM could be categorized as abrupt or gradual and also showed that the inner neurosensory retinal layers continued as the ICM, whereas the outer layers could not be traced beyond a point. In some cases with apparently attached retina, subclinical retinal detachments were identified along the margin of the coloboma. In cases with retinal detachment, OCT allowed for identification of the precise site of communication between the sub-ICM space and subretinal space at the locus minoris resistentiae. The margin of the choroidal coloboma, in some cases, showed the appearance of a hump owing to inward turning of the retinochoroidal layers with thickening of the layers at the margin. In small colobomas, OCT revealed the ICM thickness comparable to normal retina but showed structural alterations. Fundus lesions that were clinically labeled forme fruste of choroidal coloboma seemed to have normal retinal thickness and layering on OCT. In 1 patient, a temporal optic pit was associated with the forme fruste choroidal coloboma in 1 eye; the fellow eye had a typical choroidal coloboma. Optical coherence tomographic evaluation of the margins of choroidal colobomas helps in understanding the transition from retina to ICM, detects subclinical retinal detachments, and aids in identifying the site of communication between the sub-ICM space and the subretinal space in eyes with retinal detachment.

Structural features of attached retina in rhegmatogenous retinal detachments.

To examine the thickness and structural features of the ophthalmoscopically normal-appearing, attached retina in rhegmatogenous retinal detachments by optical coherence tomography (OCT) and compare them with those of the fellow eye. Seventy eyes of 35 patients with rhegmatogenous retinal detachments were included in this study. The retinal detachments were not total. None of the patients had pathologic myopia or a history of ocular surgery. The fellow eyes were ophthalmoscopically normal and used as controls. Attached retinal sites of the eyes with a retinal detachment and the corresponding retinal sites of the fellow eyes were examined by OCT. Three OCT sections were taken from each eye, and thicknesses of three reflective zones corresponding to the inner part of the neurosensory retina (partial neurosensory retina), photoreceptor-photoreceptor outer segment, and total retinal thickness on each OCT section were measured and compared with those of the fellow eye. These three measurements were taken as the main outcome measures and performed on five different sites of each OCT section taken from each eye. The mean partial neurosensory retinal thickness of the attached retina in the eyes with a retinal detachment and the corresponding retinal sites in the fellow eyes was 172.74 +/- 14.23 microm and 170.60 +/- 16.51 microm, respectively. There was no statistically significant difference between these two values. The mean photoreceptor outer segment thickness of the attached retina in the eyes with a retinal detachment and the corresponding retinal sites in the fellow eyes was 62.74 +/- 12.02 microm and 58.23 +/- 15.14 microm, respectively. There was a statistically significant difference between these two values. The mean total retinal thickness of the still-attached retina in the eyes with a retinal detachment and the corresponding retinal sites in the fellow eyes were 293.23 +/- 27.87 microm and 277.06 +/- 19.12 microm, respectively. There was a statistically significant difference between these two values. The main difference between the two groups of eyes was at the level of the thickness of the black hyporeflective zone, corresponding anatomically to the photoreceptor and photoreceptor outer segment that enlarges in the retinal detachments. Therefore, there may be a subclinical retinal detachment or a global retinal relaxation even in the ophthalmoscopically normal-appearing, still-attached retina. This may be the underlying cause of preoperative and postoperative signs and symptoms. Additional studies are required to confirm these findings.

Subclinical retinal detachment resulting from asymptomatic retinal breaks: prognosis for progression and regression.

To give a more accurate epidemiologic description of subclinical retinal detachments and to learn their prognosis. Prospective, natural history cohort study. Seventeen patients, with 19 eyes involved with 22 separate areas of subclinical retinal detachment (SCRD). Ages at initial diagnosis ranged between 14 and 67 years. Periodic retinal examinations over follow-up periods of between 8 months and >33 years, using indirect ophthalmoscopy and scleral indentation, and sometimes slit-lamp vitreous examinations with Goldmann lens. Documentation with written descriptions and drawings of lesions and estimation of size and dimensions. The rate of progression to clinical retinal detachment (CRD), which involved 11% of eyes (2 of 18), was found to be exactly equal to the likelihood of spontaneous regression and disappearance, also found in 11% (2 of 18), without any treatment. The calculated incidence rate of progression to CRD was 0.008 (<1% per year). Also, myopic females were found to have a 4.7-times greater risk of subclinical retinal detachment developing than were males, P = 0.036. All of these findings are reported for the first time in the ophthalmic literature. Compared with symptomatic clinical retinal detachment, SCRD is much less threatening to the vision and the health of the eye. Therefore, SCRD does not require or justify routine treatment but should be reexamined at regular annual intervals or more frequently if changes are observed. If it definitely progresses to CRD, surgical treatment is justified.

Spontaneous regression and disappearance of subclinical rhegmatogenous retinal detachment

PURPOSE: To report spontaneous regression and disappearance of subclinical rhegmatogenous retinal detachment. METHODS: Case reports. RESULTS: Three separate areas of subclinical retinal detachment in two eyes of two patients were followed without treatment for 35 years (Case 1) and 28 years (Case 2). The three areas of subclinical retinal detachment spontaneously regressed and disappeared. There has been no recurrence of subclinical retinal detachment in Case 1 for 12 years and 14 years, and in Case 2 for 12 years. CONCLUSION: Subclinical retinal detachment can show spontaneous regression and disappearance as its natural outcome when observed without intervention.

Retinal Breaks and Rhegmatogenous Retinal Detachment in Association with Branch Retinal Vein Occlusion

To report the incidence and clinical characteristics of retinal breaks and/or rhegmatogenous retinal detachment (RRD) in patients with branch retinal vein occlusion (BRVO). We reviewed the clinical records of 230 eyes of 214 patients with BRVO and identified eyes with retinal breaks and/or RRD. Patients had at least 6 months of follow-up. Seven of 230 eyes (3%) had retinal breaks and 3 eyes (1.3%) had RRD. One of the eyes with RRD had subclinical retinal detachment. All 7 eyes had ischemic disease documented by fluorescein angiography. Two of 7 eyes had concurrent retinal neovascularization. Four eyes with breaks, but without RRD, and the eye with subclinical RRD were managed by argon green laser. Two eyes with RRD were managed successfully with scleral buckling surgery and postoperative supplemental argon green laser. The mean follow-up period was 14.8 +/- 8.3 months. Patients with BRVO should be monitored closely for possible retinal break formation and RRD development.

What happens to untreated asymptomatic retinal breaks, and are they affected by posterior vitreous detachment?

Objective The purpose of the study was to ascertain the natural consequences of asymptomatic retinal breaks and to learn what effects, if any, the occurrence of posterior vitreous detachment (PVD) has on such breaks. Design This was a cohort study of consecutive asymptomatic phakic patients, all of whom had asymptomatic retinal breaks, observed without treatment over periods of 1 to 33 years (average, 11 years). Participants There were 196 patients with 235 involved eyes. Intervention Periodic clinical examinations, including binocular indirect ophthalmoscopy with scleral indentation on all eyes and posterior vitreous examination on 50 eyes, were performed. Results In the total study period, one small peripheral retinal detachment developed, without symptoms, from a previous subclinical detachment over a period of 14 years. Nineteen eyes (8%) originally had or developed 22 areas of subclinical detachment, 2 of which were treated because of moderate extension, even though remaining subclinical and without symptoms. Ten eyes encountered acute PVDs, which caused symptomatic retinal tears in three eyes, one of which also had a clinical retinal detachment. Of the 50 asymptomatic eyes examined with Goldmann lens and slit lamp, 12 (24%) were found to have an existing PVD, which had not led to any complication of the previous retinal breaks in any eye. Conclusions Asymptomatic retinal breaks discovered in phakic primary eyes do not show any significant tendency toward clinical retinal detachment, with the exception of a few of those cases that progress to subclinical retinal detachment. It is only some of these, comprising 1% to 2% of the total group, that may justify treatment. Posterior vitreous detachment coexists safely with asymptomatic retinal breaks in phakic primary eyes and shows no tendency to provoke complications to pre-existing breaks at the time of its occurrence.

Prophylaxis of retinal detachment.

Prophylactic treatment of retinal breaks can only be justified if the risk of complications from treatment is lower than the risk of breaks leading to clinical retinal detachment. Recommendations for prophylaxis should be based on results from valid controlled studies and not merely on traditional high-risk associations between certain risk factors and clinical retinal detachment. Present evidence supports prophylactic treatment of all symptomatic tractional tears; and is suggestive for the treatment of large, symptomatic operculated tears, high-risk fellow eyes of nontraumatic giant retinal breaks, retinal breaks with subclinical retinal detachments threatening progression, and retinal breaks before cataract surgery. Support for prophylactic treatment of asymptomatic retinal breaks in aphakic and pseudophakic eyes with or without an intact posterior capsule is at best, equivocal. Asymptomatic retinal breaks in phakic eyes with lattice degeneration, high myopia, and fellow eye detachments show no significant benefit from prophylaxis and should be followed without treatment.

Clinical and Histologic Effects of Extreme Intraocular Hypothermia

Rabbit eyes in which vitrectomy was performed underwent three hours of hypothermic perfusion with either 22 C or 2 C lactated Ringer's solution. Clinical, electroretinographic, fluorescein angiographic, histologic, and ultrastructural examinations were performed. No changes were noted in eyes cooled with 22 C fluid. Reversible lens opacities, equivocal electroretinographic changes, and subclinical retinal detachments were found in the eyes cooled with 2 C fluid. Extreme cooling of eyes is not advisable, although temperatures of 22 C are well tolerated.