Impact of Baseline Morphologic Stage of Rhegmatogenous Retinal Detachment on Post-operative Visual Acuity

To evaluate the association of baseline morphologic stage of rhegmatogenous retinal detachment (RRD) using optical coherence tomography (OCT) with postoperative anatomic and visual acuity (VA) outcomes. Retrospective cohort study. Consecutive primary fovea involving RRDs referred from January 2012-September 2022. Patients with primary RRD and no prior macular pathology with gradable baseline OCT were assessed. Best-corrected VA (BCVA) was assessed at presentation, 3, 6 and 12 months postoperatively. OCTs were graded for parafoveal morphologic stage of RRD and foveal photoreceptor integrity. Association of morphologic stage of RRD with 12-month BCVA. 351 patients were included. 68%(238/351) were male, mean age of 61.2(±12.8) years, and 59%(206/351) were phakic. 13%(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 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 RPE-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). 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.