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Background: The purpose of the study is to compare visual acuity, complications and outer retinal integrity following subretinal fluid (SRF) drainage from the peripheral retinal breaks (PRBs) versus posterior retinotomy (PR) versus perfluorocarbon liquid (PFCL) for macula-off rhegmatogenous retinal detachments (RRDs) at 2 years post-surgery., Methods: Retrospective analysis of 300 consecutive patients with primary RRD undergoing 23-gauge pars plana vitrectomy with SRF drainage through (1) PRB (n=100), (2) PR (n=100) or (3) with PFCL (n=100). Primary outcomes were visual acuity (best-corrected visual acuity (BCVA)) and complications (cystoid macular oedema (CMO) and epiretinal membrane (ERM)). Secondary outcomes were discontinuity of the external limiting membrane (ELM), ellipsoid zone (EZ) and interdigitation zone (IDZ) at 2 years post-surgery., Results: Mean (±SD) logMAR BCVA at 24 months was better in the PRB compared with PR and PFCL, with PFCL having the worst BCVA (PRB 0.5±0.6; PR 0.7±0.5; PFCL 0.9±0.7, p=0.001). CMO was higher with PFCL (PRB 29.7%; PR 30.2%; PFCL 45.9%, p=0.0015) and ERM formation was higher in PR (PRB 62.6%; PR 93.0%; PFCL 68.9%, p=0.002). There were no differences in ELM or EZ discontinuity. However, IDZ discontinuity was higher in PFCL (PRB 34%; PR 27%; PFCL 46%, p=0.002) at 2 years., Conclusions: Visual acuity was worse and discontinuity of the IDZ and CMO was greater in eyes with PFCL-assisted drainage compared with PRB or PR. Drainage technique may impact long-term visual acuity and photoreceptor integrity., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

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.)

Purpose: To determine whether fluid-fluid exchange (endodrainage) or external needle drainage can result in retinal displacement following minimal gas vitrectomy (MGV) with no fluid-air exchange for rhegmatogenous retinal detachment repair., Methods: Two patients with macula-off rhegmatogenous retinal detachment underwent MGV with and without segmental buckle. First case had MGV with segmental buckle (MGV-SB), along with endodrainage, whereas the second case had MGV only with external fluid drainage. At the completion of surgery, the patient was immediately log rolled to face down for 6 hours followed by positioning to the break., Results: Both patients achieved retinal reattachment, and postoperative widefield fundus autofluorescence imaging demonstrated a low-integrity retinal attachment with retinal displacement., Conclusion: Iatrogenic fluid drainage techniques, such as fluid-fluid exchange or external needle drainage during MGV (without fluid-air exchange), may result in retinal displacement. Allowing the retinal pigment epithelial pump to reabsorb the fluid naturally may reduce the risk of retinal displacement., Competing Interests: Dr. R.H. Muni is a consultant and receives research funding from Novartis, Bayer, Roche, and Alcon, none of which are relevant to this work. Drs. A. Bansal, W. Wei Lee, and L.C. Escaf declare no conflicts of interest.

Purpose: To describe the pathophysiology of secondary macular hole (MH) in rhegmatogenous retinal detachment (RRD)., Methods: A retrospective cohort of 360 consecutive primary fovea-off RRDs presenting to St. Michael's Hospital, Toronto, from January 2012 to September 2022 were included. Preoperative OCT was assessed for bacillary layer detachment (BALAD) abnormalities. Histological sections of normal eyes were assessed to inform OCT interpretations. Primary outcome measure was the progression of BALAD to full-thickness MH (FTMH)., Results: Of the 360 patients, 22.5% (n = 81) had BALAD abnormalities at presentation. Eight percent (29/360) had associated MH, of which 79.3% (23/29) were a BALAD-lamellar hole and 20.7% (6/29) were FTMH. After reattachment, 62% of MHs persisted (18/29), of which 83% (15/18) had BALAD-lamellar holes that subsequently progressed to FTMH in a mean of 8.1 ± 3.2 days. BALAD-lamellar holes had significantly worse postoperative visual acuity (P < 0.001) when compared with other BALAD abnormalities (58/81) or with the rest of the cohort (279/360). OCT spectrum from BALAD to FTMH includes (1) cleavage planes extending from Henle fiber layer into the BALAD; (2) central outer nuclear layer thinning; (3) Müller cell cone loss with tissue remnants at the foveal walls; (4) retinal tissue operculum close to BALAD-MH; and (5) progressive thinning or degradation of the posterior band of BALAD-lamellar hole leading to FTMH. Histological specimens identified foveal regions of low mechanical stability., Conclusions: BALAD plays a crucial role in the pathophysiology of MH in RRDs, which forms owing to sequential changes in four critical areas: RPE-photoreceptor interface, myoid zone, Henle fiber layer, and Müller cell cone with surrounding tissue. Timely management of fovea-off RRD with BALAD may be prudent to avoid the progression to BALAD-lamellar hole, subsequent FTMH, and worse functional outcomes.

Importance: In-office suprachoroidal viscopexy (SCVEXY) is a minimally invasive technique for rhegmatogenous retinal detachment (RRD) repair that can be performed with no incision, no tamponade agent, and no positioning requirements. This technique has the potential to be a step forward in the armamentarium to treat RRDs., Objective: To describe in-office SCVEXY for RRD repair., Design, Setting, and Participant: In this single-case report with short follow-up, a man in his 50s with pseudophakia and recent visual loss presented to St Michael's Hospital, Unity Health Toronto, with a fovea-off RRD in the right eye, extending from 6 to 10 o'clock, with no visible causative retinal break., Exposure: Injection of suprachoroidal sodium hyaluronate, 1%, in the region of the suspected break, using a 30-gauge needle with a custom-made guard that exposed only 1 mm of the needle., Main Outcome and Measures: Ability to perform in-office SCVEXY and to obtain a visible choroidal indentation., Results: After the procedure, a dome-shaped choroidal convexity was present in the superior temporal area. The patient achieved macular reattachment in less than 24 hours with no postoperative abnormalities, such as outer retinal folds, residual subfoveal fluid, or retinal displacement, with rapid recovery of the outer retinal bands on optical coherence tomography. The optical coherence tomography scans acquired in the area of the choroidal convexity demonstrated the location of the viscoelastic material in the suprachoroidal space. Laser retinopexy was applied in the suspected region of the retinal tear, and the patient was able to resume normal activity immediately after the procedure with no restrictions., Conclusions and Relevance: Suprachoroidal viscopexy is feasible as an in-office technique to create a temporary choroidal buckle for RRD repair. It is a minimally invasive procedure with the potential to maximize anatomical outcomes of integrity and postoperative functional outcomes in RRD because its mechanism of action does not require drainage of subretinal fluid or intraocular gas tamponade. Nevertheless, this was a single-case report with short follow-up, which limits the ability to determine the procedure's benefits, potential adverse events, failure rates, and best-case selection. Further work is required to refine the procedure and assess its efficacy and safety.

Purpose: To assess the risk of retinal displacement after scleral buckle (SB) versus pars plana vitrectomy with SB (PPV-SB)., Design: Multicenter prospective nonrandomized clinical trial., Methods: The study took place at VitreoRetinal Surgery in Minneapolis, Minnesota, Sankara Nethralaya in Chennai, India, and St. Michael's Hospital in Toronto, Canada from July 2019 to February 2022. Patients who underwent successful SB or PPV-SB for fovea-involving rhegmatogenous retinal detachment with gradable postoperative fundus autofluorescence (FAF) imaging were included in the final analysis. Two masked graders assessed FAF images 3 months postoperatively. Metamorphopsia and aniseikonia were assessed with M-CHARTs and the New Aniseikonia Test, respectively. The primary outcome was the proportion of patients with retinal displacement detected with retinal vessel printings on FAF in SB versus PPV-SB., Results: Ninety-one eyes were included in this study, of which 46.2% (42 of 91) had SB and 53.8% (49 of 91) underwent PPV-SB. Three months postoperatively, 16.7% (7 of 42) in the SB group and 38.8% (19 of 49) in the PPV-SB group had evidence of retinal displacement (difference = 22.1%; odds ratio = 3.2; 95% confidence interval [CI], 1.2-8.6; P = 0.02) on FAF. The statistical significance of this association increased after adjustment for extent of retinal detachment, baseline logarithm of the minimum angle of resolution, lens status, and sex in a multivariate regression analysis (P = 0.01). Retinal displacement was detected in 22.5% (6 of 27) of patients in the SB group with external subretinal fluid drainage and 6.7% (1 of 15) of patients without external drainage (difference = 15.8%; odds ratio = 4.0; 95% CI, 0.4-36.9; P = 0.19). Mean vertical metamorphopsia, horizontal metamorphopsia (MH), and aniseikonia were similar between patients in the SB and PPV-SB groups. There was a trend to worse MH in patients with retinal displacement versus those without retinal displacement (P = 0.067)., Conclusions: Scleral buckle is associated with less retinal displacement compared with PPV-SB, indicating that traditional PPV techniques cause retinal displacement. There is a trend toward increased risk of retinal displacement in SB eyes that underwent external drainage compared with SB eyes without drainage, which is consistent with our understanding that the iatrogenic movement of subretinal fluid, such as that which occurs intraoperatively during external drainage with SB, may induce retinal stretch and displacement if the retina is then fixed in the stretched position. There was a trend to worse MH at 3 months in patients with retinal displacement., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the role of en face OCT as a diagnostic tool for the detection of persistent subretinal fluid (PSRF) and outer retinal folds (ORFs) after successful rhegmatogenous retinal detachment (RRD) repair., Design: Observational post hoc analysis of 2 prospective surgical trials., Participants: All patients with gradable (signal strength ≥ 5 and no segmentation error) 6 × 6-mm 2 macular cube scans obtained using spectral-domain OCT (Carl Zeiss Meditec) between 1 and 2 months after surgery were included in this study., Methods: The scans were assessed for the presence or absence of PSRF or ORFs using en face OCT and cross-sectional B scans by 2 masked graders, with any disagreements adjudicated by a third senior masked grader., Main Outcome Measures: The sensitivity, specificity, and predictive accuracy (using area under the curve [AUC]) of en face OCT were compared with those of cross-sectional OCT, which is considered the gold standard., Results: Two hundred twenty-three patients were included in this study. The Cohen kappa between the graders in the diagnosis of PSRF and ORFs using en face OCT was 0.84 and 0.86, respectively. The sensitivity of en face OCT was 100% (95% confidence interval [CI], 100%-100%) in the diagnosis of PSRF and 98.8% (95% CI, 96.5%-101.1%) in the diagnosis of ORFs. Similarly, the specificity of en face OCT was 98.7% (95% CI, 96.8%-100.5%) and 84.2% (95% CI, 78.1%-90.2%) in the diagnosis of PSRF and ORFs, respectively. The AUC was 0.99 for PSRF and 0.91 for ORFs., Conclusions: En face OCT has good sensitivity, specificity, and predictive accuracy (using AUC) in the diagnosis of PSRF and ORFs. En face OCT is an efficient screening tool for postoperative anatomic abnormalities, such as PSRF and ORFs, after RRD repair., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To demonstrate how a small gas bubble injected into the vitreous cavity in pneumatic retinopexy for rhegmatogenous retinal detachment causes immediate displacement of subretinal fluid and to gain insights into the potential mechanism of retinal displacement., Methods: Three patients with rhegmatogenous retinal detachment who underwent pneumatic retinopexy were enrolled and prospectively followed. All patients underwent ultra-widefield fundus photography at baseline and at 1 to 2 minutes after intravitreal gas injection., Results: In all cases, the ultra-widefield fundus photograph demonstrated immediate displacement of subretinal fluid, suggesting that the buoyant force applied to the retina by the bubble was responsible for the displacement of subretinal fluid. The results were extrapolated to determine the buoyant force applied by a small and large gas bubble as in pneumatic retinopexy and pars plana vitrectomy. We determined that the buoyant force applied with a larger bubble in pars plana vitrectomy was substantially greater, and this may lead to retinal displacement., Conclusion: Intravitreal gas applies significant buoyant force to the detached retina and subretinal fluid that leads to substantial and rapid displacement of subretinal fluid. Understanding the affect of the buoyant force of the gas bubble on the detached retina can provide insight into possible mechanisms of retinal displacement., Competing Interests: R. H. Muni is a consultant, has participated in advisory boards, and receives research funding from Novartis, Bayer, and Allergan, none of which are relevant to this work. W. W. Lee, A. Ramchandran, H. Hamli, L. C Escaf, and A. Bansal declare no conflicts of interest.

Purpose: To describe the sequential morphologic changes after rhegmatogenous retinal detachment (RRD) utilizing a novel, objective, and clinically relevant staging system based on swept-source OCT (SS-OCT) and determine its association with the duration of fovea-off and postoperative visual acuity (VA)., Design: Prospective cohort study., Subjects: Consecutive patients with primary fovea-involving RRD referred to St. Michael's Hospital, Toronto, Canada, from January 2020 to April 2022., Methods: All patients underwent SS-OCT and ultrawide-field SS-OCT at baseline. Primary RRDs with breaks above the 8- and 4-o'clock meridians were included. Patients with vision loss for ≥ 3 months, proliferative vitreoretinopathy grade C or worse, a demarcation line, previous vitrectomy, or other retinal pathology were excluded. The staging was based on an assessment of outer retinal morphology on successive SS-OCT scans from the peripheral break to the most posterior aspect of the RRD, following its direction of progression., Main Outcome Measures: Sequential outer retinal morphologic changes observed using SS-OCT and associated VA at 3 months after surgery., Results: Forty-nine eyes were included. The mean age (standard deviation [SD]) was 61.2 (15.2) years. The mean presenting logarithm of the minimum angle of resolution (SD) acuity was 1.09 (0.75). All stages observed on a high-definition horizontal 51-line scan were reported. Outer retinal changes occurred in 5 stages: (1) separation of the neurosensory retina from the retinal pigment epithelium (42/49, 85.7%); (2) thickening of inner and outer segments of photoreceptors (45/49, 91.8%); (3) outer retinal corrugation formation: (3a) low-frequency (44/49, 93.6%) and (3b) high-frequency outer retinal corrugations (42/49, 85.7%); (4) loss of the definition of outer retinal corrugations, with concurrent thickening of inner and outer segments (26/49, 53.1%); and (5) patchy (moth-eaten) or complete loss of inner and outer segments (17/49, 34.7%). The mean duration of fovea-off by stage in the parafovea (SD) was 2 (1.4), 2.3 (1.2), 11.4 (8.1), and 12 (13.3) days for stages 3a, 3b, 4, and 5, respectively. There was a statistically significant association between increasing stage of RRD and longer duration of foveal involvement (P = 0.001) and, most importantly, between increasing stage and worse VA at 3 months after surgery (P = 0.011)., Conclusions: This novel staging system describes the sequential morphologic changes in RRD using SS-OCT. Increasing stage of RRD was associated with worse VA at 3 months after surgery., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2022 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To present a novel technique, minimal gas vitrectomy with scleral buckle, as a means of potentially minimizing retinal displacement compared with standard vitrectomy or vitrectomy/scleral buckle for select cases., Methods: A patient with right macula-off retinal detachment and retinal breaks at 7 o'clock and 10 o'clock underwent a 23-gauge pars plana vitrectomy, localization, and cryopexy of the breaks along with an inferior temporal segmental scleral buckle. No air-fluid exchange was performed. Suturing of sclerotomies, anterior chamber paracentesis of 0.3 mL, and intravitreal injection of 0.6 mL pure sulfur hexafluoride were then performed. The patient was advised to perform the steamroller maneuver with initial face-down positioning for 6 hours., Results: The patient achieved retinal reattachment, and postoperative wide-field fundus autofluorescence imaging demonstrated high-integrity retinal attachment with no retinal displacement., Conclusion: The minimal gas vitrectomy with scleral buckle technique has the potential to minimize retinal displacement in cases with inferior break(s) by using a small volume expansile gas tamponade and localized scleral buckle compared with standard vitrectomy or vitrectomy/scleral buckle with a full gas fill.

Purpose: To describe bacillary layer detachment and related abnormalities of the foveal bouquet in rhegmatogenous retinal detachment and assess their impact on photoreceptor recovery and full-thickness macular hole formation, using optical coherence tomography., Methods: Prospective cohort of 93 consecutive patients with fovea-off rhegmatogenous retinal detachment presenting to St. Michael's Hospital from January 2020 to April 2022, with gradable preoperative foveal optical coherence tomography., Results: 23.7% (22/93) of patients had evidence of bacillary layer detachment and associated abnormalities. The mean fovea-off duration was 6.4 days (±5.6 SD). 86.4% (19/22) had foveal bacillary layer detachment, 15.8% (3/19) of which had cleavage planes extending from the outer nuclear layer into the myoid zone, and 14% (3/22) had an inner lamellar hole with a residual bridge of photoreceptor remnants (all of which progressed to full-thickness macular hole). Among patients with gradable optical coherence tomography at 3 months post-operatively, 80% (12/15) had ellipsoid zone discontinuity, which persisted in 41% (5/12) at 1 year., Conclusion: Bacillary layer detachment was described for the first time in the setting of rhegmatogenous retinal detachment. This is hypothesized to occur from horizontal traction secondary to hydration/lateral expansion of the outer retina in the presence of the Müller cell cone scaffold. Bacillary layer detachment may render the fovea susceptible to further injury, possibly representing a pathophysiological basis for full-thickness macular hole formation in rhegmatogenous retinal detachment.

Purpose: Outer retinal folds occur when outer retinal corrugations (ORCs) persist after retinal reattachment with worse functional outcomes. We investigate the pathophysiology of ORCs in vivo., Design: Prospective cohort study., Methods: Patients with rhegmatogenous retinal detachment (RRD) presenting to St. Michael's Hospital, Toronto, Ontario, Canada, between August 2020 and February 2022 were assessed with swept-source optical coherence tomography (SS-OCT) and ultra-widefield SS-OCT for ORCs. Clinical characteristics of eyes with/without ORCs were compared. Mathematical models were used to deduce mechanical properties leading to ORCs., Results: Sixty-six patients were included. More than half (60.6%, 40/66) were fovea-off and 48.4% (32/66) had ORCs at presentation. All eyes (32/32) with ORCs had retinal pigment epithelium (RPE)-photoreceptor dysregulation for at least 2 days, defined as loss of RPE control with acute, progressive, and extensive RRDs. In all (34/34) eyes without ORCs the RPE was in relative control of the subretinal space with nonprogressive subclinical or small localized or resolving RRDs, or with RPE-photoreceptor dysregulation for fewer than 2 days. Mathematical models indicate that a modulus of elasticity of the outer retina relative to the inner retina of 0.05 to 0.5 leads to ORCs., Conclusions: ORCs develop with (1) acute exposure of subretinal space to liquified vitreous, (2) for >2 days, that (3) overwhelms RPE capacity, leading to progressive and extensive RRD. Mathematical models suggest that a reduction in the modulus of elasticity of the outer retina occurs such that intrinsic compressive forces, likely related to progressive outer retinal hydration and lateral expansion, lead to ORCs. Understanding the pathophysiology of ORCs has implications for management., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The management of rhegmatogenous retinal detachment has rapidly evolved over recent decades. A range of surgical techniques exist, all of which can achieve retinal reattachment in most cases. In recent years there have also been vast technical advances in retinal imaging that have introduced novel ways of visualizing and studying the retinal macro and microstructural anatomy following retinal detachment repair. Recent clinical trial data demonstrates that functional and patient-reported outcomes of retinal reattachment differ with surgical technique, accompanied by differences in anatomic biomarkers of retinal recovery or 'integrity'. We discuss recent insights into the physiology of retinal reattachment gleaned from multimodal imaging, which shed light on the pathophysiology of various post-operative anatomic abnormalities. The ideal scenario is to achieve retinal reattachment as soon as possible, without retinal displacement, outer retinal folds or discontinuity of the external limiting membrane, ellipsoid zone and interdigitation zone, with an intact foveal bulge. To this end, we present an in-depth contemporary account of current concepts and mechanisms involved during retinal reattachment surgery, supported by clinical data and mathematical modelling, awareness of which can help the vitreoretinal surgeon achieve better post-operative outcomes. In this review we substantiate the case for a paradigm shift in rhegmatogenous retinal detachment repair; beyond the emphasis on single-operation reattachment rates, and instead striving to maximize functional outcomes using minimally invasive techniques. This can only be achieved if vitreoretinal surgeons embrace all of the available techniques, with individualized selection of surgical approach and the resolute goal of optimizing the 'integrity' of retinal reattachment., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Purpose: To compare visual acuity and photoreceptor integrity following pars plana vitrectomy with drainage from the peripheral retinal break(s) (PRB), posterior retinotomy (PR), or perfluorocarbon liquid (PFCL) for macula-off rhegmatogenous retinal detachment., Design: Retrospective consecutive interventional comparative clinical study., Methods: 300 consecutive patients (300 eyes) with primary macula-off rhegmatogenous retinal detachment underwent 23-gauge pars plana vitrectomy with subretinal fluid drainage through PRB (n = 100), PR (n = 100), or with PFCL (n = 100). Visual acuity and spectral-domain optical coherence tomography were performed preoperatively and at 3, 6, and 12 months postoperatively. Primary outcomes were visual acuity and discontinuity of the external limiting membrane, ellipsoid zone, interdigitation zone, and retinal pigment epithelium at 1 year., Results: Baseline characteristics were similar. Single-operation reattachment rates were as follows: PRB 86%, PR 85%, and PFCL 83% (P = .9). Mean (±SD) logMAR visual acuity at 1 year was greater with PRB and PR compared with PFCL (PRB 0.6 ± 0.5, PR 0.7 ± 0.6, PFCL 0.9 ± 0.6, P = .002). There was an association between drainage technique and discontinuity of the external limiting membrane (PRB 26%, PR 24%, PFCL 44%, P = .001), ellipsoid zone (PRB 29%, PR 31%, PFCL 49%, P < .001), and interdigitation zone (PRB 43%, PR 39%, PFCL 56%, P = .004). There was an association between drainage technique and risk of cystoid macular edema (PRB 28%, PR 39%, PFCL 46%, P = .003) and epiretinal membrane (PRB 64%, PR 90%, PFCL 61%, P < .001)., Conclusions: PFCL-assisted drainage is associated with worse visual acuity and greater risk of outer retinal band discontinuity and cystoid macular edema compared with PRB or PR. PR had a greater risk of epiretinal membrane compared with PRB and PFCL. PRB had the best outcomes overall. Drainage technique may impact long-term anatomic and functional outcomes., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: Suboptimal functional outcomes after rhegmatogenous retinal detachment (RRD) repair may be related to photoreceptor abnormalities, including alterations of the ellipsoid zone (EZ) that may not be apparent on cross-sectional optical coherence tomography (OCT). This study assessed EZ recovery using en face OCT after RRD repair and its association with visual acuity., Design: Post hoc analysis of a randomized controlled trial., Methods: Patients with macula-off RRD were monitored at 3, 6, 12, and 24 months postoperatively and annually thereafter. En face OCT of the EZ slab were analyzed. Hyporeflective areas were colocalized with EZ abnormalities on cross-sectional OCT B-scans and measured by 2 masked graders. Primary outcome was change in area of EZ hyporeflectivity from 3 to 24 months, and its association with Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity recovery was also assessed., Results: In total, 271 images of 61 patients were assessed. Mean area of hyporeflectivity significantly decreased from 3 to 24 months (-2.98 mm 2 ; 95% CI, 1.82-4.13 mm 2 ; P < .0001), with further reductions up to 4 years. Linear regression revealed an association between change in hyporeflective area and change in the ETDRS letter score from 3 to 24 months (β = -0.31, P = .009, R 2  = 14.8%) and between duration of macula-off and change in hyporeflective area from 3 to 24 months (β = -0.37, P = .018, R 2  = 13.7%)., Conclusions: En face OCT provides a novel biomarker for visualizing and quantifying EZ recovery after RRD repair that is associated with ETDRS visual acuity recovery. A steady decline in the area of EZ hyporeflectivity was observed over many years with delayed recovery in patients with longer duration of macula-off., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: To assess the incidence of postoperative outer retinal folds (ORFs) after pars plana vitrectomy (PPV) vs. pneumatic retinopexy (PnR) for rhegmatogenous retinal detachment (RRD) repair and to determine the association of ORFs with functional outcomes at 1 year., Design: Randomized controlled trial., Participants: Patients with primary macula-off RRD meeting the Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized (PIVOT) trial criteria who were randomly assigned to undergo PPV or PnR., Methods: Post hoc analysis of the PIVOT trial. The incidence and quantitative morphologic features of ORFs were assessed using en face and cross-sectional OCT at 1 month postoperatively by 2 masked graders. The ETDRS letter score was measured and quantitative assessment of metamorphopsia was performed at 1 year., Main Outcome Measures: Proportion of patients with ORFs at 1 month postoperatively among those who underwent PPV versus PnR. The secondary outcomes included the association of ORFs with visual acuity (ETDRS letter score) and metamorphopsia via metamorphopsia charts at 12 months postoperatively., Results: Of 176 participants enrolled in PIVOT, 88 were macula-off RRDs. Of them, 94.3% (83 of 88) underwent postoperative OCT scans that were gradable at month 1, 93.2% (41 of 44) in the PPV group and 95.5% (42 of 44) in the PnR group. The incidence of ORF formation was 34.1% (14 of 41) in the PPV group and 14.3% (6 of 42) in the PnR group (P = 0.034). The ETDRS letter score at 1 year was 65.7 ± 6.6 letters in patients with ORFs vs. 75.1 ± 1.4 letters in those without ORFs (difference = 9.4 letters, 95% confidence interval [CI] = 7.5-11.3, P = 0.047). Among patients in the PPV group alone, the mean ETDRS letter score at 1 year in patients with ORFs was 62.8 ± 24.7 letters, compared with 75.4 ± 9.2 letters in patients without ORF formation (difference = 12.6 letters, 95% CI = 0.05-24.59, P = 0.04). Horizontal and vertical metamorphopsia scores were similar in patients with and without ORFs: horizontal, 0.35 ± 0.12 vs. 0.29 ± 0.07 (difference = 0.06, 95% CI = 0.01-0.11, P = 0.69); vertical, 0.25 ± 0.07 vs. 0.29 ± 0.07 (difference = 0.04, 95% CI = 0-0.08, P = 0.60). There was a negative correlation between the closest distance of an ORF from the fovea and vertical metamorphopsia score (r = -0.507, P = 0.045)., Conclusions: There is greater risk of developing ORFs after PPV compared to PnR for primary RRD. Outer retinal folds at 1 month are associated with significantly worse ETDRS visual acuity letter scores at 1 year., (Copyright © 2021 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the in vivo physiology of retinal reattachment in humans using swept-source optical coherence tomography (SS-OCT) in real time., Design: Prospective case series., Methods: Fifteen consecutive patients with fovea-involving rhegmatogenous retinal detachment were undergoing pneumatic retinopexy. SS-OCT was performed at presentation and frequent intervals immediately after pneumatic retinopexy. The primary outcome was longitudinal assessment of early postoperative SS-OCT to establish stages of reattachment., Results: Most patients (93.3%, 14/15) achieved successful reattachment at the median follow-up duration of 13 weeks (interquartile range 7.5-18.0). Reattachment occurred in 5 specific stages: 1) redistribution of fluid and approach of the neurosensory retina toward the retinal pigment epithelium occurred in 100% (15/15); 2) reduction in cystoid macular edema and improvement of outer retinal corrugations was achieved in 100% (15/15); 3) initial contact of the neurosensory retina to the retinal pigment epithelium occurred completely in 66.7% (10/15); 4) deturgescence of the inner and outer segments of the photoreceptors occurred in 66.7% (10/15); and 5) recovery of photoreceptor integrity occurred in 3 specific substages: 5A) external limiting membrane recovery (10/15, 66.6%); 5B) ellipsoid zone recovery (9/15, 60%); and 5C) interdigitation zone/foveal bulge recovery (3/15, 20%). Twenty percent (3/15) had delayed progression through stage 2, characterized by formation of outer retinal folds. Similarly, 33.3% (5/15) developed residual subfoveal fluid blebs (delayed progression to stage 3)., Conclusions: This study characterizes the in vivo physiology of retinal reattachment in humans using high-resolution SS-OCT that occurs in 5 specific stages. Delayed progression through certain stages was characterized by postoperative anatomic abnormalities. Am J Ophthalmol 2021;221:•••-•••. © 2021 Elsevier Inc. All rights reserved., (Copyright © 2021 Elsevier Inc. All rights reserved.)

We describe a rare case of scleral buckle (SB) infection with Serratia species. A 48-year-old male with a history of retinal detachment repair with scleral buckling presented with redness, pain, and purulent discharge in the left eye for 4 days. Conjunctival erosion with exposure of the SB and scleral thinning was noted. The SB was removed and sent for culture. Blood and chocolate agar grew Gram-negative rod-shaped bacillus identified as Serratia marcescens. On the basis of the susceptibility test results, the patient was treated with oral and topical antibiotics. After 6 weeks of the treatment, his infection resolved. [ABSTRACT FROM AUTHOR]