Peripheral Retinal Vascular Patterns in Patients with Rhegmatogenous Retinal Detachment in Taiwan

Abstract

This is an observational study of fluorescein angiography (FA) in consecutive patients with rhegmatogenous retinal detachment (RRD) in Changhua Christian Hospital to investigate the peripheral retinal vascular patterns in those patients. All patients had their age, sex, axial length (AXL), and refraction status (RF) recorded. According to the findings in FA of the peripheral retina, the eyes were divided into 4 groups: in group 1, there was a ramified pattern of peripheral retinal vasculature with gradual tapering; in group 2, there was an abrupt ending of peripheral vasculature with peripheral non-perfusion; in group 3, there was a curving route of peripheral vasculature forming vascular arcades or anastomosis; and in group 4, the same as in group 3, but with one or more wedge-shaped avascular notches. Comparisons of age, sex, AXL, and RF, association of breaks with lattice degeneration and retinal non-perfusion, surgical procedures utilized, and mean numbers of operations were made among the four groups. Of the 73 eyes studied, there were 13 eyes (17.8%) in group 1, 3 eyes (4.1%) in group 2, 40 eyes (54.8%) in group 3 and 17 eyes (23.3%) in group 4. Significant differences in age, AXL and RF, and association of retinal breaks to non-perfusion were noted among the four groups. Patients in group 1 had older ages, while younger ages were noted in groups 3 and 4. Eyes in group 1 had the shortest average AXL and were least myopic in contrast to the eyes in groups 3 and 4. Association of retinal breaks and retinal non-perfusion was significantly higher in groups 2, 3 and 4 than in group 1. In conclusion, peripheral vascular anomalies are common in cases with RRD. Patients with peripheral non-perfusion tend to be younger, with longer axial length and have the breaks associated with retinal non-perfusion.

Fig 1. Color and FA pictures of group 1 eyes.

(A) FA of an eye with group 1 retinal vasculature. Note there is a dichomatous ramified pattern of peripheral retinal vasculature with gradual tapering. Marked leakage is noted in the detached, peripheral retina. Area of peripheral retinal avascularity was noted, which was within 1mm in width. (B) Fundus photo of a lattice degeneration within the vascular zone in an eye with type 1 vascular pattern. (C) Fluorescein angiography of the lattice degeneration showing large vessels crossing over the lattice degeneration, with loss of the small vasculature within the area of lattice degeneration. Telangiectasia was noted at the peripheral retinal vasculature outside the area of lattice degeneration with normal dichomatous vascular pattern. Vascular leakage was noted at some parts of peripheral retinal vasculature and around the lattice degeneration. (D) Fundus photo of a lattice degeneration associated tear at the margin of vascular zone with type 1 vascular pattern. (E) Fluorescein angiography showing loss of small vasculature within the lattice degeneration and lack of vasculature peripheral to the lattice degeneration. Vascular anastomosis at inner margin of lattice degeneration and telangiectatic vessels within detached retina were also noted.

Fig 2

Color fundus and FA pictures of group 2 eyes (A) Fluorescein angiography of an eye with group 2 retinal vasculature. Note there is an abrupt cessation of temporal and lower peripheral retinal vasculature, leaving a wide area of peripheral non-perfusion. Marked leakage is noted at the temporal and lower detached retina. Some microaneurysms are noted in the nasal peripheral, attached retina. (B) Magnified color fundus showing lattice degeneration at temporal aspect in the same patient. (C) Fluorescein angiography at the same location showing the lattice degeneration situated just beyond the vascular cessation. Terminal dilatation, vascular tortuosity and telangiectatic vessels were also noted

Fig 3

Color fundus and FA photos of group 3 eyes (A) Fluorescein angiography of an eye with group 3 retinal vasculature. Note there is anastomosis at the temporal and lower peripheral vasculature, with a wide non-perfusion at the temporal and lower aspect being noted. Vascular leakage is noted at some parts of the inferior and peripheral detached retina. (B) Another eye with type 3 vascular pattern showing circumferential route of peripheral vasculature, with peripheral non-perfusion, telangiectatic vessels and marked leakage. (C) Another eye with type 3 vascular pattern showing circumferential route and anastomosing vasculature forming a vascular loop with non-perfusion within the loop. Vascular leakage and telangiectasia were also noted. (D) Fundus photo of an eye with type 3 vascular pattern showing multiple tears without lattice degeneration. (E) Fluorescein angiography of the same patient showing that all the tears are in the peripheral non-perfused retina.

Fig 4

Color fundus and FA photos of group 4 eyes (A) Fluorescein angiography of group 4 vasculature. There is a V-shaped notch at peripheral retina, with peripheral anastomosing vasculature. Non-perfusion areas are noted inside the vascular arch. Wide area of peripheral non-perfusion is noted outside the temporal notch. Marked vascular leakage is noted at temporal anastomosing vessels. (B) Fundus photo of an eye with type 4 vascular pattern showing a tear at the temporal detached retina and 2 breaks associated with lattice degeneration at temporal upper attached retina. (C) Fluorescein angiography of the same eye, showing an avascular notch at temporal aspect and anastomosing vasculature. The tear is within the vascular loop, where the retina is non-perfused. (D) Fundus photo of a horse-shoe tear in an eye with type 4 vasculature. (E) Fluorescein angiography at the same location showing 2 V-shaped notches of the avascular zone. The tear is within a vascular loop, where the retina was partially perfused. Marked leakage was noted at the anastomosing vasculature.