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. 2023 Apr 1;43(4):670-678.
doi: 10.1097/IAE.0000000000003696.

BACILLARY LAYER DETACHMENT AND ASSOCIATED ABNORMALITIES IN RHEGMATOGENOUS RETINAL DETACHMENT

Isabela Martins Melo  1   2 , Aditya Bansal  1   2 , Wei Wei Lee  1   2 , Paola Lourdes Oquendo  1   2 , Hesham Hamli  1   2 , Rajeev H Muni  1   2   3   4
Affiliations

BACILLARY LAYER DETACHMENT AND ASSOCIATED ABNORMALITIES IN RHEGMATOGENOUS RETINAL DETACHMENT

Isabela Martins Melo et al. Retina. .

Abstract

Purpose: To describe bacillary layer detachment and related abnormalities of the foveal bouquet in rhegmatogenous retinal detachment and assess their impact on photoreceptor recovery and full-thickness macular hole formation, using optical coherence tomography.

Methods: Prospective cohort of 93 consecutive patients with fovea-off rhegmatogenous retinal detachment presenting to St. Michael's Hospital from January 2020 to April 2022, with gradable preoperative foveal optical coherence tomography.

Results: 23.7% (22/93) of patients had evidence of bacillary layer detachment and associated abnormalities. The mean fovea-off duration was 6.4 days (±5.6 SD). 86.4% (19/22) had foveal bacillary layer detachment, 15.8% (3/19) of which had cleavage planes extending from the outer nuclear layer into the myoid zone, and 14% (3/22) had an inner lamellar hole with a residual bridge of photoreceptor remnants (all of which progressed to full-thickness macular hole). Among patients with gradable optical coherence tomography at 3 months post-operatively, 80% (12/15) had ellipsoid zone discontinuity, which persisted in 41% (5/12) at 1 year.

Conclusion: Bacillary layer detachment was described for the first time in the setting of rhegmatogenous retinal detachment. This is hypothesized to occur from horizontal traction secondary to hydration/lateral expansion of the outer retina in the presence of the Müller cell cone scaffold. Bacillary layer detachment may render the fovea susceptible to further injury, possibly representing a pathophysiological basis for full-thickness macular hole formation in rhegmatogenous retinal detachment.

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