Biomechanical Predictors of Rhegmatogenous Retinal Detachment in Myopic Patients

• Autor(a) principal: Marques, João Heitor
• Data de Publicação: 2023
• Outros Autores: Baptista, Pedro Manuel, Marta, Ana, Sousa, Paulo, Pires, Saul, Meireles, Angelina, Ambrósio, Renato, Menéres, Pedro, Melo Beirão, João
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://doi.org/10.48560/rspo.28261
• topic: Artigos Originais

INTRODUCTION: The prevalence of myopia is expected to increase significantly in the following decades. Moreover, axial myopia is associated with rhegmatogenous retinal detachment (RRD), a major cause of visual impairment in these patients. RRD develops after the dynamic interaction between the vitreous and the retina. Axial length (AL) is a well-described risk factor, but alone is insufficient to predict RRD. The main aim of this study was to analyze, dynamically and in vivo, ocular biomechanics in high myopic patients with RRD. Our secondary outcome was to address demographic, biometric and biomechanical predictors of RRD. METHODS: Observational cross-sectional case-control study, set in the Surgical Retina Clinic, Ophthalmology Department, Centro Hospitalar e Universitário do Porto, Portugal, that included subjects with myopia and history of RRD in one eye (RRD group), together with a control group of age and AL-matched subjects with no history of retinal tear or RRD in any eye. In the RRD group, only the fellow non-RRD non-operated eye was included for analysis. Biomechanical assessment was performed with Corvis Scheimpflung Technology® (Oculus, Germany) and AL was measured with Anterion® (Heidelberg, Germany). RESULTS: This study included for analysis 34 subjects (17 eyes of 17 patients in each group). Age (p=0.959), AL (p=0.879) and intraocular pressure (p=0.489) were well matched between groups. A multivariable logistic regression confirmed an independent effect of A1 Deflection Amplitude (standardized coefficient = -1.096, Wald test p-value=0.027), HC time (-1.207, p=0.030), and height (1.554, p=0.030) on RRD, with an area under the curve in the ROC analysis for this model of 0.897. We found no association between biometric or biomechanical parameters and the characteristics of RRD or final best-corrected visual acuity. CONCLUSION: To our knowledge, this is the first study evaluating in vivo ocular biomechanics in the development of RRD. We observed that the eyes of patients with RRD have stiffer measured biomechanics when compared to controls. The different biomechanical behavior between the vitreous and the sclera (to which the retina is ultimately attached) results in higher shear stress at the vitreoretinal interface. We hypothesize that RRD develops in cases where this balance is disrupted by a stiff sclera on one side and a compact vitreous on the other. The association between body height and RRD may also relate to systemic genetically determined biomechanics.