Optical Coherence Tomography Features in Fovea-Off Exudative vs Rhegmatogenous Retinal Detachment

Purpose: To describe the optical coherence tomography (OCT) features that can differentiate eyes with fovea-off exudative retinal detachment (ERD) vs rhegmatogenous retinal detachment (RRD), with particular attention to outer retinal corrugations (ORCs).

Design: Multicenter, retrospective cross-sectional study.

Methods: Multicenter, retrospective cross-sectional study of patients diagnosed with unilateral or bilateral fovea-off ERD or primary, acute, fovea-off RRD between 2016 and 2021. This study was performed with the approval from the Research Ethics Board at the University of Toronto and was conducted in accordance with the Declaration of Helsinki. Patients with any ERD etiology and evidence of extensive, bullous fovea-off detachment and in the RRD group: consecutive patients with acute, primary fovea-off RRD with good quality baseline SD-OCT imaging were included. Patients with exudative choroidal neovascularization from any etiology, optic nerve pit, significant media opacity, or OCT images with poor quality or low signal strength were excluded. Primary outcome was to describe the morphological features of the macula using SD-OCT in patients diagnosed with ERD vs RRD, with specific interest in ORCs.

Results: One hundred sixty-one eyes (51 ERD and 110 RRD) of 154 patients were included. Fifty-one eyes with ERD presented with 1 of 15 etiologies. ERD were associated with a greater risk of having hyperreflective dots in the outer retina (92.2% vs 74.5%, P = .009), hyperreflective material and dots in the subretinal fluid (72.5% vs 34.5%, P < .001), internal limiting membrane and inner retinal undulations (70.6% vs 39.4%, P < .001), and retinal pigment epithelium undulations (44.9% vs 6.4%, P < .001) compared to RRD. RRD was associated with a greater risk of outer retinal corrugations (80% vs 0%, P < .001), intraretinal fluid (90.9% vs 41.2%, P < .001) and ellipsoid zone thickening (90% vs 66.7%, P < .001) compared to ERD.

Conclusion: The presence of ORCs are highly specific for RRD and absent in ERD. This is likely related to differences in the pathophysiology of the diseases process, specifically the content of the subretinal fluid. Understanding the differences in OCT morphological features of ERD vs RRD may aid with diagnosis and management.