Rajeev H. Muni

Pathophysiology of outer retinal corrugations: Imaging dataset and mechanical models

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This article presents high-resolution swept-source optical coherence tomography (SS-OCT) imaging data used to elaborate a mechanical model that elucidates the formation of outer retinal corrugations (ORCs) in rhegmatogenous retinal detachments (RRD). The imaging data shared in the repository and presented in this article is related to the research paper entitled “Outer Retinal Corrugations in Rhegmatogenous Retinal Detachment: The Retinal Pigment Epithelium-Photoreceptor Dysregulation Theory” (Muni et al., AJO, 2022). The dataset consists of 69 baseline cross-sectional SS-OCT scans from 66 patients that were assessed for the presence of ORCs and analyzed considering the clinical features of each case. From the 66 cases, we selected SS-OCT images of 4 RRD patients with visible ORCs and no cystoid macular edema (CME) to validate the mechanical model. We modelled the retina as a composite material consisting of the outer retinal layer (photoreceptor layer) and the inner retinal layer...

En Face Optical Coherence Tomography in Diagnosis of Persistent Subretinal Fluid & Outer Retinal Folds after Rhegmatogenous Retinal Detachment Repair

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Purpose To evaluate the role of en face optical coherence tomography (OCT) as a diagnostic tool for the detection of persistent subretinal fluid (PSRF) and outer retinal folds (ORF) following successful rhegmatogenous retinal detachment (RRD) repair. Design Observational post hoc analysis of two prospective surgical trials. Participants All patients with gradable (signal strength ≥ 5 and no segmentation error) 6x6 mm macular cube scans using spectral-domain OCT (SD-OCT) (Carl Zeiss Meditec, Jena, Germany) obtained between 1 and 2 months postoperatively were included in this study. Methods Scans were assessed for the presence or absence of PSRF or ORFs using en face OCT and cross-sectional B scans by two masked graders with any disagreements adjudicated by the third senior masked grader. Main Outcome Measure Sensitivity, specificity and predictive accuracy {using area under curve (AUC)} of en face OCT in comparison to cross-sectional OCT as the gold standard Results Two hu...

Morphologic Stages of Rhegmatogenous Retinal Detachment Assessed with Swept-Source Optical Coherence Tomography

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Purpose: To describe the sequential morphological changes following rhegmatogenous retinal detachment (RRD), utilizing a novel, objective, and clinically relevant staging system based on swept-source optical coherence tomography (SS-OCT) and determine its association with duration of fovea-off and postoperative visual acuity. Design: Prospective cohort study. Subjects: Consecutive patients with primary fovea-involving RRD referred to St. Michael's Hospital, Toronto, Canada, from January 2020-April 2022. Methods: All patients had SS-OCT and ultra-widefield SS-OCT at baseline. Primary RRDs with breaks above 8 and 4 o'clock were included. Patients with vision loss≥3 months, PVR≥grade B, demarcation line, previous vitrectomy or other retinal pathology were excluded. Staging was based on the 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 measure...

Persistent subfoveal fluid in pneumatic retinopexy versus pars plana vitrectomy for rhegmatogenous retinal detachment: posthoc analysis of the PIVOT randomised trial

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Purpose To assess the incidence of persistent subfoveal fluid (PSFF) in pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) following rhegmatogenous retinal detachment (RRD) repair and to determine its association with functional outcomes. Methods Posthoc analysis of the PIVOT randomised trial. Eyes with gradable en face and cross-sectional spectral-domain optical coherence tomography (SD-OCT) scans at 1–2 months postoperatively were included. Primary outcome was the proportion of patients with PSFF following PnR versus PPV at 1–2 months postoperatively. Secondary outcomes included association of PSFF with Early Treatment Diabetic Retinopathy Study (ETDRS) letter score at 3, 6 and 12 months and metamorphopsia score (MCHARTs) at 12 months. Results Of 176 participants enrolled in PIVOT, 158 (89.8%) had gradable SD-OCT scans. Intergrader agreement was 0.870 (Cohen’s kappa). The incidence of PSFF was 16% (13/81) following PnR and 10.4% (8/77) following PPV (p...

Single-capture ultra-widefield guided swept-source optical coherence tomography in the management of rhegmatogenous retinal detachment and associated peripheral vitreoretinal patholog

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Background/Aim To assess the utility of single-capture ultra-widefield confocal scanning laser ophthalmoscope with integrated swept-source optical coherence tomography (UWF-SS-OCT) in the management of rhegmatogenous retinal detachment (RRD) and associated peripheral pathology. Methods 138 eyes of 101 consecutive patients with RRD and/or associated peripheral pathology at a vitreoretinal practice in Toronto, Canada between December 2020 and February 2021 that had UWF-SS-OCT with interpretable scans were included. A 200 degree fundus photograph was used to navigate a built-in 100 kHz UWF-SS-OCT to image pathology with a high-density 23 mm line scan and/or volume scan. Main outcomes were the microstructural details of the RRD and/or associated peripheral pathology and longitudinal assessment of response to laser retinopexy and cryopexy with UWF-SS-OCT. Results 56.5% (78/138) of eyes had prior or current RRD (6 eyes had combined retinoschisis detachment), 31.1% (43/138) had retinal tea...

Physiology of retinal reattachment in humans: Swept source optical coherence tomography imaging data supporting a novel staging system

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This article presents high-resolution swept source optical coherence tomography (SS-OCT) imaging data used to describe the physiology of retinal reattachment in humans. SS-OCT imaging was performed at baseline and every 2 h for the first 6 h and at frequent intervals thereafter up to 6 weeks following the injection of intravitreal gas in eyes undergoing pneumatic retinopexy for rhegmatogenous retinal detachment. Imaging data presented in this article is related to the research paper titled “ Real-Time in Vivo Assessment of Retinal Reattachment in Humans using Swept-Source Optical Coherence Tomography” (Bansal et al., 2021). SS-OCT images were assessed longitudinally and used to devise a novel staging system that describes the physiology of retinal reattachment. Multiple examples of each stage and the transition from one stage to the next are provided. SS-OCT images were also assessed to determine the timing associated with each stage, and the anatomic abnormalities, such...

Longitudinal Assessment of Ellipsoid Zone Recovery using En Face Optical Coherence Tomography after Retinal Detachment Repair

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Purpose Suboptimal functional outcomes following rhegmatogenous retinal detachment (RRD) repair may be related to photoreceptor abnormalities including alterations of the ellipsoid zone (EZ) which may not be apparent on cross-sectional optical coherence tomography (OCT). This study assessed EZ recovery using en face OCT following RRD repair and its association with visual acuity. Design Post hoc analysis of a randomized controlled trial. Methods Patients with macula-off RRD were followed at 3, 6, 12 and 24 months post-operatively and annually thereafter. En face OCT of the EZ slab were analyzed. Hyporeflective areas were co-localized with EZ abnormalities on cross-sectional OCT B-Scans and measured by two masked graders. Primary outcome was change in area of EZ hyporeflectivity from 3 to 24 months and its association with ETDRS visual acuity recovery was also assessed. Results 271 images of 61 patients were assessed. Mean area of hyporeflectivity significantly decreased from 3 to 24...

Response to Comment on “Real-Time In Vivo Assessment of Retinal Reattachment in Humans Using Swept-Source Optical Coherence Tomography”

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We observed that retinal reattachment mediated by the retinal pigment epithelium (RPE) occurs in 5 specific stages and 20% of patients had delayed progression through Stage 2, characterized by outer retinal folds (ORFs). 1 dell'Omo et al hypothesized that “persisting undulations play a role in the formation of pockets of subretinal fluid, later evolving into ORFs” 2 . We demonstrated how improvement of outer retinal corrugations (ORCs) occurs during the slow and natural reattachment process mediated by the RPE in Stage 2 and how if parts of the retina remain in Stage 2 without sufficient improvement of ORCs while adjacent areas progress to Stage 3, then an ORF may develop. We also observed that “formation of pockets of subretinal fluid” were likely not involved in the pathophysiology of ORFs. 1,2 ( Read Full Article )

Real-Time In Vivo Assessment of Retinal Reattachment in Humans using Swept-Source Optical Coherence Tomography

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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 undergoing pneumatic retinopexy (PnR). SS-OCT was performed at presentation and frequent intervals immediately following PnR. Primary outcome was longitudinal assessment of early post-operative SS-OCT to establish stages of reattachment. Results 93.3% (14/15) achieved successful reattachment at the median follow-up duration of 13 weeks (IQR 7.5-18.0). Reattachment occurred in five specific stages: Stage 1, redistribution of fluid and approach of the neurosensory retina towards the retinal pigment epithelium (RPE) occurred in 100% (15/15). Stage 2, reduction in cystoid macular edema and improvement of outer retinal corrugations was achieved in 100% (15/15). Stage 3, initial contact of the neurosensory retina to the RPE...

Retinoschisis Detected With Handheld Spectral-Domain Optical Coherence Tomography in Neonates With Advanced Retinopathy of Prematurity

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Objectives  The recent development of handheld spectral-domain optical coherence tomography (HHSD-OCT) has enabled us to obtain high-resolution retinal scans of premature infants with retinopathy of prematurity (ROP). The purpose of this study is to document HHSD-OCT findings in laser-treated neonates with progressive ROP. Methods  This is a retrospective consecutive case series of 3 patients with progressive ROP despite laser photocoagulation. All patients were transferred from peripheral neonatal intensive care units (NICUs) to the Children's Hospital Los Angeles. All patients had a complete ocular examination, fundus photography, fluorescein angiography, and HHSD-OCT. Results  All 3 patients had active progressive ROP despite prior laser photocoagulation. Of the 6 eyes, 1 was excluded from the study because it had an exudative retinal detachment following laser photocoagulation. Retinal detachment was not detected on clinical examination in the 5 remaining eyes, although there wa...

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