CHARACTERIZATION OF PERIPHERAL RETINAL DEGENERATIONS AND RHEGMATOGENOUS LESIONS USING ULTRA-WIDEFIELD SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY INTEGRATED WITH A NOVEL SCANNING LASER OPHTHALMOSCOPE

ABSTRACT Purpose: to evaluate the implementation of ultra-widefield swept-source optical coherence tomography (SS-OCT) in characterizing peripheral retinal degenerations and rhegmatogenous lesions, and to discuss its potential implications for clinical management decisions based on a case series. Methods We conducted a retrospective observational study on patients previously diagnosed with peripheral retinal degenerations and/or rhegmatogenous lesions, including retinal tears and holes, referred to the Eye Clinic, Careggi University Hospital, Florence (Italy) between October 2022 and October 2024. Each patient underwent a comprehensive ophthalmological examination, including slit-lamp biomicroscopy, dilated fundus examination with a Volk digital wide field lens, and multimodal imaging assessment with peripheral SS-OCT (Optos Silverstone). SS-OCT imaging was performed by two experienced ophthalmologists (DB, CN), specialized in retinal imaging acquisition. Typically, ultra-wide field 6 mm HD volume and 23 mm extended line OCT scans were captured, and several specific retinal areas were assessed using peripheral SS-OCT at the discretion of the photographer. We focused on evaluating the principal findings associated with peripheral degenerations and rhegmatogenous lesions, such as vitreoretinal attachment and traction, associated full-thickness retinal defects, and sub-retinal fluid, often challenging to be detected with indirect ophthalmoscopy. Additionally, we reported a cases series in which peripheral OCT findings supported or influenced clinical management decisions. Results A total of 107 eyes from 95 patients diagnosed with peripheral retinal degenerations and rhegmatogenous retinal lesions were scanned using the Silverstone platform. Forty-six men and 49 women were included in the study. The mean refraction (Spherical Equivalent) was −2.18 diopters (SD, ±2.5 diopters), with values ranging from -7.50 to 0. The median LogMar Best Corrected Visual Acuity (BCVA) was 0.0, and the average BCVA was 0.03 (standard deviation ±0.11). Ninety-one patients were phakic, while 4 patients were pseudophakic. One hundred and thirty lesions were successfully imaged with the Silverstone platform. Eighteen lesions were found in highly myopic eyes (> 6 diopters), and six were found in eyes with previous history of trauma. The most prevalent peripheral lesions were retinal tears (34 of 130 lesions) and lattice degeneration (25 of 130 lesions). Other commonly observed lesions included retinal holes (21 cases), retinal tufts (11 cases), peripheral retinoschisis (17 cases) and schisis/detachment (7 cases). Less common lesions observed were snail track degeneration (4 cases), white without pressure (4 cases) microcystic degeneration (2 cases), dialysis (2 cases), condensed vitreous (2 cases) and paving stone degeneration (1 case). Ultra-wide field SS-OCT imaging provided high-quality and clinically meaningful images of the peripheral retina and vitreoretinal interface, adding useful details regarding the ultrastructure of retinal peripheral degenerations, as the presence of full thickness retinal defects, the condition of the vitreous over these degenerations or the presence of subretinal fluid. In some cases, ultra-wide field SS-OCT imaging allowed us to detect specific findings that influenced or supported the clinical management, such as vitreous traction, everted edges and subretinal fluid associated to a peripheral hole, features that allowed the distinction of not atrophic holes from atrophic holes; or the presence of retinal detachment associated to a peripheral retinoschisis, not clinically evident in indirect ophthalmoscopy. Conclusions The characterization of specific peripheral retinal areas using ultra-wide field SS-OCT imaging may significantly enhance our understanding of retinal structures in peripheral degenerations and rhegmatogenous lesions. Further comprehensive studies are essential to correlate specific imaging characteristics with an increased risk of rhegmatogenous detachments and to determine whether peripheral OCT characterization can directly influence clinical management decisions.