Pigmentary lesions in eyes with rhegmatogenous retinal detachment with flap tears: a retrospective observational study

Abstract

We included 97 patients with unilateral rhegmatogenous retinal detachment (RRD) with posterior vitreous detachment who underwent vitrectomy, and examined pigmentary lesion (PL) characteristics around the sites of original tears using pre- and postoperative ultra-widefield scanning light ophthalmoscopy, green light fundus autofluorescence (FAF) imaging, and intraoperative digital video. If PL did not involve RRD, we used OCT to preoperatively assess any pathologic changes to the lesion. A total of 116 retinal tears (mean count, 1.2 ± 0.5; range, 1-4 per eye) were observed in the detached retina. Overall, 102 (88%), 63 (54%), 14 (12%), and 25 (22%) tears were accompanied by lattice degeneration (LD) or PL, both LD and PL, only LD, and only PL, respectively. In green FAF images, LD showed normal to mild-hyper fluorescence, whereas all PL showed hypofluorescence. On OCT, PL were located at the RPE level, while choroid abnormalities were unclear. In the retinal areas of 22 eyes, which were not affected by RRD, we observed PL without retinal tears; some were accompanied by vitreous traction and tractional retinal detachment. Pre-, intra-, and post-operative assessments of original flap tears suggested that PL might be a risk factor for RRD, developing alongside or separately from LD.

Figure 1

Lattice degeneration (LD) associated with rhegmatogenous retinal detachment (RRD) examined by pre- and postoperative ultra-widefield (UWF) color scanning light ophthalmoscopy (SLO). (A) LD without a pigmentary lesion (PL) in two representative cases. (B) LD with PL in two representative cases. The preoperative UWF images show the white vessels and retinal thinning within the LD lesions. White arrows indicate LD, and red arrowheads indicate PL.

Figure 2

Pigmentary lesion (PL) of eyes with rhegmatogenous retinal detachment (RRD) examined by pre- and postoperative ultra-wide field (UWF) scanning light ophthalmoscopy (SLO). (A) Pigmentary lesion (PL) without lattice degeneration (LD) in representative two RRD-eyes. The preoperative UWF-SLO images do not clearly show the PL. However, the postoperative UWF-SLO images show the PL in and behind the retinal tears, at the retinal pigment epithelial level. In the eyes, the retinal tears do not accompany the LD lesion. (B) PL without LD in other RRD-eyes. The pre- and postoperative SLO images show the PL. Red arrowheads indicate PL.

Figure 3

Green fundus autofluorescent (FAF) images of lattice degeneration (LD) and pigmentary lesion (PL). (A) and (B) LD in a non-detached retina of an eye with rhegmatogenous retinal detachment (RRD). The ultrawide field (UWF) scanning light ophthalmoscopy (SLO) image of LD (A). The green FAF shows normal to mild-hyper fluorescence in the LD lesion (B). White arrows indicate LD. (C)–(E) The PL seen in an original flap tear of another RRD-eye. The postoperative UWF SLO image shows the PL and retinal photocoagulation (PC) scars (C). The pre- and post-operative green FAF images of the PL in the original retinal flap tear, respectively (D, E). The PL shows hypofluorescence, which is distinguished from the appearances of the laser scars around the retinal tear. Red arrowheads indicate PL. Black arrowheads indicate PC scars.

Figure 4

Optical coherence tomography (OCT) images of pigmentary lesion (PL) at retinal areas that are not affected by rhegmatogenous retinal detachment (RRD). (A) The ultrawide field (UWF) scanning light ophthalmoscopy (SLO) image of PL. This retinal area is not affected by the RRD. (B) The OCT image of PL along the dotted arrow. Vitreous traction to the PL is seen. (C) The UWF SLO image of PL of other RRD-eyes. This retinal area is not affected by the RRD. (D) The OCT image of the PL along the dotted arrow. In addition to the vitreous traction (arrow), tractional retinal detachment and elevation of the retinal pigment epithelial level (red arrowhead) are seen.