title: Novel microarchitectural dynamics in rhegmatogenous retinal detachments identified with intraoperative optical coherence tomography.
abstract: OBJECTIVE
  To evaluate ultrastructural macular changes during rhegmatogenous retinal detachment repair using intraoperative optical coherence tomography (iOCT).
  
  
  METHODS
  A multisurgeon, single-center consecutive case series of 9 eyes undergoing surgical repair for macula-involving rhegmatogenous retinal detachment with iOCT imaging using a custom microscope-mounted spectral domain OCT system. All patients underwent combined vitrectomy/scleral buckle repair. Imaging characteristics were analyzed, including persistence of subclinical intraoperative subretinal fluid and architectural changes associated with intraoperative maneuvers. Clinical characteristics were analyzed.
  
  
  RESULTS
  Nine eyes of nine patients were identified that underwent iOCT imaging during macula-involving rhegmatogenous retinal detachment repair. Persistent subclinical subretinal fluid was identified in 100% of eyes after perfluoro-n-octane instillation. Significant alterations to the foveal architecture were detected with iOCT in 100% of cases. Three foveal configurations were noted based on iOCT findings. Stage 1 was characterized by a small area of subfoveal hyporeflectivity (3/9 eyes), Stage 2 had prominent subretinal hyporeflectivity and foveal thinning with indeterminate macular hole (MH) formation (3/9 eyes), and Stage 3 demonstrated definitive full-thickness MH (3/9 eyes). No eyes were noted to have a MH preoperatively or in the immediate postoperative period. One Stage 3 eye developed a full-thickness MH 7 months postoperatively. Stage 3 configuration was associated with poorer final postoperative visual acuity (P = 0.009).
  
  
  CONCLUSIONS
  Microarchitectural changes occur during intraoperative repair of retinal detachments, including significant alterations in foveal configuration and persistent subretinal fluid. These features may help to prognosticate outcomes. These findings also suggest a possible novel mechanism for postrhegmatogenous retinal detachment MH formation.
authors.affiliation: Ophthalmic Imaging Center, Cleveland Clinic Foundation, Cole Eye Institute, 9500 Euclid Ave., Cleveland, OH 44195, USA. ehlersj@ccf.org
authors.forename: Justis P
authors.initials: JP
authors.lastname: Ehlers
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Ohr
authors.forename: Peter K
authors.initials: PK
authors.lastname: Kaiser
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Srivastava
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D008266:Macula Lutea / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D012163:Retinal Detachment / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012591:Scleral Buckling / Q000379:methods; D041623:Tomography, Optical Coherence / Q000379:methods*; D014821:Vitrectomy / Q000379:methods