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

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 tears/holes and 14.5% (20/138) had lattice degeneration. UWF-SS-OCT impacted management and was useful in determining the presence or absence of vitreoretinal traction with retinal holes or tears. It was also helpful in differentiating retinal detachment, schisis-detachment and retinoschisis in cases where it was not apparent clinically. There were also several novel findings such as vitreous adhesion at the posterior border of a retinal dialysis. UWF-SS-OCT was performed longitudinally before and immediately following laser retinopexy (n=22) and cryopexy (n=4). Microstructural changes were consistent with chorioretinal adhesion immediately following laser versus postprocedure day 6 following cryopexy. CONCLUSION: Single-capture UWF-SS-OCT enabled novel insights in RRD and associated peripheral vitreoretinal pathology.