Fellow Eye RRD Risk Stratified by Hyaloid Status on OCT at initial RRD Diagnosis
Samir N. Patel, MD
Retina Vitreous Consultants
Wallsh JO, Langevin ST, Kumar A, Huz J, Falk NS, Bhatnagar P. Fellow Eye Retinal Detachment Risk as Stratified by Hyaloid Status on Optical Coherence Tomography. Ophthalmology. 2023 Feb 9:S0161-6420(23)00105-7. doi: 10.1016/j.ophtha.2023.02.004. Epub ahead of print. PMID: 36773761.
In patients with a rhegmatogenous retinal detachment (RRD) in one eye, it is important to evaluate and monitor the fellow eye as there is an elevated risk for developing an RRD. Traditional risk factors that may alter risk of RRD development in the fellow eye may include PVD status, presence or absence of lattice degeneration, family history of retinal detachment, and/or history of high myopia. The rate of bilateral sequential RRD ranges from 10% to 40%, but there is little data available on how to stratify the risk of fellow eye RRD development. The close association of PVD development and RRD risk offers an opportunity to stratify RRD risk in the fellow eye by evaluating the hyaloid status on OCT at presentation.
In this retrospective, single center, consecutive cohort study over 10 years published in Ophthalmology by Wallsh et al., the authors evaluated clinical records of all patients presenting with RRD and reviewed OCT imaging to classify the hyaloid status at initial presentation. The patients were then followed for a mean of 5.7 years for RRD development in the fellow eye.
In total, 1049 patients with an RRD were identified, and the overall incidence of bilateral sequential RRD was 14.6%. Of the 1049 patients with an RRD, OCT imaging was available for 582 eyes (55%) at initial presentation. By OCT review at baseline, the hyaloid was attached in 353 (51.7%) fellow eyes whereas a PVD was noted in 229 (39%) of fellow eyes. During the follow up, a subsequent RRD occurred in 28 (8%) fellow eyes with an attached hyaloid compared to 7 (3%) fellow eyes with a PVD on presentation (p = 0.02). Furthermore, of the 353 eyes with an attached hyaloid at baseline, 116 (33%) developed a PVD during the study follow up with a 23.7% frequency of sequential RRD development.
Overall, retinal tears were noted in 119 (11%) fellow eyes (excluding fellow eyes with RRD) during follow-up. Furthermore, at PVD development in fellow eyes with an attached hyaloid at presentation, 21 (18%) eyes developed a retinal tear.
In terms of relative risk, the study found that an attached hyaloid on OCT of the fellow eye at initial RRD presentation to be a significant risk factor for RRD development in the fellow eye. They noted that lattice degeneration in the fellow eye conferred a 50% increased risk of fellow eye RRD, whereas an attached hyaloid on baseline OCT conferred a 160% increased risk of fellow eye RRD.
These results revealed an increased risk of fellow eye RRD in those with an attached hyaloid on OCT at presentation in comparison to those with a PVD at baseline. The use of OCT to assess the PVD status in fellow eyes of patients presenting with an RRD is a unique tool for patient education and subsequent clinical monitoring. Limitations of this study are inherent in the retrospective nature of the study. Most notably, not all 1049 eyes with initial RRD had baseline OCT imaging, which limited the size of the cohort for subsequent analysis. Furthermore, the follow up period were variable for each eye and a longer follow up until PVD development in all eyes would have been optimal to determine the true rate of sequential RRD.
In summary, this study emphasizes the use of OCT imaging at baseline RRD presentation to evaluate the fellow eye and assist in risk stratification for possible subsequent RRD development.
Obtain CME credit: https://www.evolvemeded.com/course/2135-39