RETINAL OPTICAL COHERENCE TOMOGRAPHY IMAGING BIOMARKERS: A Review of the Literature.

PURPOSE: The aim of this literature review was to summarize novel optical coherence tomography (OCT) imaging biomarkers that have recently been described in the literature and are frequently encountered clinically. METHODS: The literature was reviewed to identify novel OCT biomarkers reported to date. A descriptive summary of all terms and representative illustrations were provided to highlight the most relevant features. RESULTS: Thirty-seven OCT terminologies were identified. The vitreomacular interface disorder group included the four stages of epiretinal membrane, macular pseudohole, tractional lamellar hole (LH), degenerative LH, cotton ball sign, and foveal crack sign. The age-related macular degeneration group included outer retinal tubulation, multilayered pigment epithelial detachment, prechoroidal cleft, onion sign, double-layer sign, complete outer retinal atrophy, complete retinal pigment epithelium and outer retinal atrophy, and reticular pseudodrusen. The uveitic disorder group consisted of bacillary layer detachment, syphilis placoid, rain-cloud sign, and pitchfork sign. The disorders relating to the toxicity group included flying saucer sign and mitogen-activated protein kinase (MEK) inhibitor-associated retinopathy. The disorders associated with the systemic condition group included choroidal nodules and needle sign. The pachychoroid spectrum group included pachychoroid and brush border pattern. The vascular disorder group included pearl necklace sign, diffuse retinal thickening, disorganization of retinal inner layers, inner nuclear layer microcysts, hyperreflective retinal spots, paracentral acute middle maculopathy, and acute macular neuroretinopathy. The miscellaneous group included omega sign (ω), macular telangiectasia (type 2), and omega sign (Ω). CONCLUSIONS: Thirty-seven OCT terminologies were summarized, and detailed illustrations consolidating the features of each biomarker were included. A nuanced understanding of OCT biomarkers and their clinical significance is essential because of their predictive and prognostic value.

Applications of the Guarded-Needle External Drainage Technique in Vitreoretinal Surgery.

PURPOSE: To describe the surgical technique using the guarded-needle external drainage for a wide variety of applications in vitreoretinal surgery. METHODS: A step-by-step procedure and a surgical video using the guarded-needle external drainage technique are presented. In addition, a series of representative cases with wide-ranging diagnoses who underwent the technique is reviewed. DESCRIPTION AND TECHNIQUE: The guarded-needle using a 27-gauge thin-walled TSK needle (TSK Laboratory International) and a trimmed 70 buckle sleeve are connected to the active extrusion tubing of the vitrectomy machine. External drainage is performed by actively aspirating subretinal fluid using low active vacuum. The guarded-needle external drainage technique is used in cases with bullous detachments, and small and anterior breaks, when performing scleral buckle, for prevention of underfill when using oil tamponade in cases with choroidal effusion, addressing subretinal gas/air, lysing a subretinal band, draining a suprachoroidal hemorrhage, for diabetic tractional retinal detachments, detachments with no definitive break, and subretinal biopsy in exudative detachments. CONCLUSION: The guarded-needle external drainage has a wide range of applications in vitreoretinal surgery.

Binocular visual function and fixational control in patients with macular disease: A review.

For normally sighted observers, the centre of the macula-the fovea-provides the sharpest vision and serves as the reference point for the oculomotor system. Typically, healthy observers have precise oculomotor control and binocular visual performance that is superior to monocular performance. These functions are disturbed in patients with macular disease who lose foveal vision. An adaptation to central vision loss is the development of a preferred retinal locus (PRL) in the functional eccentric retina, which is determined with a fixation task during monocular viewing. Macular disease often affects the two eyes unequally, but its impact on binocular function and fixational control is poorly understood. Given that patients' natural viewing condition is binocular, the aim of this article was to review current research on binocular visual function and fixational oculomotor control in macular disease. Our findings reveal that there is no overall binocular gain across a range of visual functions, although clear evidence exists for subgroups of patients who exhibit binocular summation or binocular inhibition, depending on the clinical characteristics of their two eyes. The monocular PRL of the better eye has different characteristics from that of the worse eye, but during binocular viewing the PRL of the better eye drives fixational control and may serve as the new reference position for the oculomotor system. We conclude that evaluating binocular function in patients with macular disease reveals important clinical aspects that otherwise cannot be determined solely from examining monocular functions, and can lead to better disease management and interventions.

SUTURELESS CLOSURE OF 23- AND 25-GAUGE LEAKING SCLEROTOMIES WITH THE SCLERAL NEEDLING TECHNIQUE.

PURPOSE: To describe and evaluate the efficacy of a novel technique, scleral needling (SN), for securing 23- and 25-gauge leaking sclerotomies in microincision vitrectomy surgery. METHODS: A retrospective comparative review of consecutive cases of 23- and 25-gauge pars plana vitrectomy performed by a single vitreoretinal surgeon before the introduction of the SN technique (pre-SN; November 2016 to January 2017) and after the introduction of the SN technique (post-SN; November 2017 to January 2018) was conducted. The SN technique was implemented as an alternative to suturing, using a 30-gauge needle inserted perpendicularly through the full thickness of the sclera adjacent to the scleral opening, with the needle then immediately removed and sclerotomy closure confirmed. RESULTS: A total of 203 eyes, 105 from pre-SN and 98 from post-SN, were included in the study. The number of eyes requiring suture closure was significantly reduced from 39% in the pre-SN group to 2% in the post-SN group (P < 0.001). The mean postoperative intraocular pressure and incidence of hypotony on Days 1 to 2, Days 3 to 20, and Days 21 to 50 was not significantly different between the pre-SN and post-SN groups. No major complications associated with the SN technique were noted during the study period. CONCLUSION: The SN technique is a safe and simple method for effectively securing leaking sclerotomies in microincision vitrectomy surgery.

MACULAR HOLE HYDRODISSECTION: Surgical Technique for the Treatment of Persistent, Chronic, and Large Macular Holes.

PURPOSE: To present a new technique, macular hole hydrodissection, that increases the likelihood of closure for challenging macular holes (MHs) with multiple risk factors. METHODS: A retrospective review of all consecutive eyes with idiopathic Stage 3 and 4 MHs that were either persistent (failed previous vitrectomy surgery), chronic (symptoms of central vision loss of ≥2 years or a clinical diagnosis for ≥1 year), and/or large (aperture diameter of ≥400 µm), having undergone the macular hole hydrodissection surgical technique between January 1, 2014, and May 1, 2017, from an institutional practice setting was conducted. This technique lyses retina-retinal pigment epithelium adhesions by injecting fluid into the MH and allows for successful closure as the mobile edges are then brought closer together. RESULTS: Thirty-nine eyes of 39 patients with mean MH aperture and base diameters of 549.1 ± 159.47 µm and 941.97 ± 344.14 were included. Complete anatomical closure was achieved in 87.2% (34/39) of MHs. Vision improvement was observed in 94.9% (37/39) and gain of ≥2 lines was achieved in 79.5% (31/39). Of the MHs that achieved anatomical success, 100% (34/34) had a Type 1 closure. The mean postoperative follow-up was 320.33 ± 269.04 days. CONCLUSION: The macular hole hydrodissection surgical technique improves anatomical and functional outcomes of persistent, chronic, and/or large MHs.

OUTCOMES OF PARS PLANA VITRECTOMY FOR MACULAR HOLE IN PATIENTS WITH UVEITIS.

PURPOSE: Inflammatory macular hole is a rare complication of uveitis, and data on surgical outcomes of closure are scarce. The purpose of this study is to evaluate the anatomical and visual outcomes of conventional pars plana vitrectomy for patients with uveitis. METHODS: Noncomparative, interventional, and consecutive case series from 6 vitreoretinal surgical centers from 2007 to 2015. Twenty eyes of 19 patients were included with 4 patients separated as viral retinitis. The primary outcome was change in best-corrected visual acuity at Month 3. Secondary outcomes were closure of the macular hole and postoperative optical coherence tomography characteristics. RESULTS: All eyes underwent conventional three-port pars plana vitrectomy with indocyanine green-assisted internal limiting membrane peeling. Mean Snellen best-corrected visual acuity improved from 20/200 to 20/63 (P = 0.01 for a difference in logarithm of the minimum angle of resolution) at Month 3. Twelve (75%) of patients achieved 2 or more lines of visual acuity improvement by postoperative Month 3. Surgery resulted in decreased epiretinal membrane (P = 0.002), intraretinal fluid (P < 0.001), subretinal fluid (P = 0.029), central subfield thickness (P < 0.001), and central cube volume (P = 0.041). Surgical intervention achieved anatomical success, as measured by macular hole closure, in 13 (81%) of patients at postoperative Month 3. CONCLUSION: Patients with inflammatory macular hole respond well to conventional surgery, with good anatomical and visual acuity outcomes.

Fixation Stability and Viewing Distance in Patients with AMD.

PURPOSE: People with normal vision perform activities of daily living binocularly, while changing viewing distance frequently and effortlessly. Typically, in patients with age-related macular degeneration (AMD), fixation stability is recorded with monocular instruments at a fixed viewing distance (i.e. optical infinity) to determine the location and precision of the preferred retinal loci (PRLs)-the part of the functional retina that fulfills the role of a pseudo-fovea. Fixation stability recorded with these instruments has been related to performance on visual tasks at shorter viewing distances, although it is not known how viewing distance affects the precision of ocular motor control in these patients. This study examined whether viewing distance affects fixation stability during binocular and monocular viewing. METHODS: Thirty patients with bilateral AMD, 10 older controls, and 10 younger controls participated. Each patient's better eye (BE) and worse eye (WE) were identified based on their visual acuity. Fixation stability was recorded with a binocular eye-tracker at three viewing distances (40 cm, 1 m, 6 m) in binocular and monocular (with BE and with WE) viewing conditions. Fixation stability was evaluated with a bivariate contour ellipse area. RESULTS: For the AMD group, there was no effect of viewing distance on fixation stability, regardless of viewing condition (i.e. binocular, monocular with the BE or with the WE). The same pattern of results was found for the two control groups. CONCLUSIONS: Viewing distance does not affect fixation stability in patients with AMD. Fixation stability data recorded with an instrument at a fixed viewing distance can be related to performance on visual tasks at other viewing distances.

INDUCTION OF MACULAR DETACHMENT FOR THE TREATMENT OF PERSISTENT OR RECURRENT IDIOPATHIC MACULAR HOLES.

PURPOSE: To analyze the efficacy of induced macular detachment for the treatment of persistent or recurrent idiopathic macular holes after treatment with one or more standard pars plana vitrectomies (PPVs) with internal limiting membrane peeling. METHODS: This study is a retrospective consecutive case series of 10 patients who underwent a PPV with subretinal balanced salt solution injection from 2011 to 2014 to treat persistent or recurrent idiopathic macular holes. All patients had previously undergone PPV with internal limiting membrane peeling. Visual acuity, ocular examination findings, and optical coherence tomographic images were reviewed preoperatively and postoperatively to assess the anatomical and visual outcomes of this procedure. RESULTS: Nine of the 10 patients who underwent the procedure had closure of their macular holes postoperatively (90%) and remained closed 6 months postoperatively. Most patients reported a subjective visual improvement. A mean objective visual improvement of 16 letters (Early Treatment Diabetic Retinopathy Study, 0.324 logMAR) was seen between preoperative and 6-month postoperative assessments of all patients (pre = 1.490, post = 1.166; P = 0.022). Subgroup analysis of patients with successful closure revealed 20 letters of improvement (0.398 logMAR) in visual acuity (pre = 1.491, post = 1.093; P = 0.004). There were no intraoperative or postoperative complications. CONCLUSION: In eyes with persistent or recurrent idiopathic macular holes after standard PPV with internal limiting membrane peeling, repeat PPV with subretinal balanced salt solution injection to create a macular detachment may be a viable surgical treatment option. Our results show improved anatomical and visual outcomes postoperatively that compare favorably to other case series describing various surgical treatments for these challenging cases.

Update on pneumatic retinopexy.

PURPOSE OF REVIEW: Pneumatic retinopexy is an effective, cost-efficient procedure for retinal detachment repair. We review the history, indications, procedure, outcomes, economics, and trends regarding this in-office procedure. RECENT FINDINGS: Pneumatic retinopexy is classically performed in patients with small, superior retinal breaks, but these indications are expanding, with good results. Retinal reattachment rates with pneumatic retinopexy vary from 60% to 91% depending upon patient selection. Pneumatic retinopexy is less costly to perform than scleral buckling and pars plana vitrectomy and avoids many of the complications associated with these procedures. Despite these good results, recent data suggest that the use of pneumatic retinopexy is on the decline. SUMMARY: Recent review of the literature and our own personal experience using pneumatic retinopexy in selected cases of retinal detachment indicate that it is an effective and inexpensive procedure that avoids many of the complications that are associated with other retinal reattachment procedures.

Optimal Treatment of Retinal Vein Occlusion: Canadian Expert Consensus.

BACKGROUND: The availability of new therapeutic approaches, particularly intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapies, has prompted significant changes to the established treatment paradigms for retinal vein occlusion (RVO). Better visual outcomes and significantly lower rates of adverse events have been noted in multiple large randomized clinical trials and have led to a new standard of care for this sight-threatening condition. OBJECTIVE: To develop an expert consensus for the management of RVO and associated complications in the context of recent clinical evidence. METHODS: The development of a Canadian expert consensus for optimal treatment began with a review of clinical evidence, daily practice, and existing treatment guidelines and algorithms. The expert clinicians (11 Canadian retina specialists) met on February 1, 2014, in Toronto to discuss their findings and to propose strategies for consensus. RESULTS: The result of this expert panel is a consensus proposal for Canadian ophthalmologists and retina specialists treating patients presenting with RVO. Treatment algorithms specific to branch and central RVO (BRVO and CRVO) were also developed. CONCLUSIONS: The consensus provides guidelines to aid clinicians in managing RVO and associated complications in their daily practice. In summary, laser remains the therapy of choice when neovascularization secondary to RVO is detected. Adjunctive anti-VEGF could be considered in managing neovascularization secondary to RVO in cases of vitreous hemorrhage. Intravitreal anti-VEGF should be considered for symptomatic visual loss associated with center-involving macular edema on optical coherence tomography. Patients with BRVO and a suboptimal response to anti-VEGF could be treated with grid laser, and those with CRVO and an inadequate response to anti-VEGF may be candidates for intravitreal steroids.

Internal drainage for chronic macula-involving serous retinal detachment in idiopathic central serous chorioretinopathy.

Conventional treatment of idiopathic central serous chorioretinopathy (ICSC) consists of argon laser, photodynamic therapy, or observation. However, in cases of atypical bullous ICSC with exudative detachment preventing any laser therapy, a surgical approach with external drainage of fluid has been performed. We present a case of ICSC with persistent macula involving exudative retinal detachment without evidence of uveitis that responded favorably to internal drainage by vitrectomy along with a scleral buckle placement. Our case, treated with internal drainage, also demonstrated successful long-term reattachment of the serous retinal detachment without any additional complications from the surgery.

Long-term outcomes of noninfectious uveitis treated with systemic immunomodulatory therapy: a retrospective case series.

OBJECTIVE: To study the clinical characteristics and long-term outcomes of patients with noninfectious uveitis (NIU) who are treated with systemic immunomodulatory therapy (IMT). DESIGN: Retrospective case series. PARTICIPANTS: All consecutive cases of adults with NIU under the care of 5 uveitis subspecialty tertiary care clinics between 2010 to 2021 were included. METHODS: Patient outcomes were assessed at initial presentation and at the latest available follow-up. RESULTS: A total of 418 NIU patients receiving IMT therapy with a median age of 46.0 years and 59.3% female were identified. Each patient required an average of 1.4 agents until achieving an optimal response. Following initial treatment with prednisone, patients were most commonly initiated on methotrexate. The top 3 treatments with the highest proportion of optimal treatment response when taken alone or in combination with other agents were infliximab (79.3%), cyclosporine (75%), and adalimumab (70%). The strongest predictors for requiring a greater number of IMTs trialed were younger age, panuveitis, and a chronic or recurrent disease course. Multivariable linear regression analysis suggested that baseline visual acuity at diagnosis was the only significant predictor of final visual acuity (p < 0.001). CONCLUSIONS: NIU patients on IMT are often trialed on multiple therapeutic agents before achieving an optimal treatment response. Visual acuity at diagnosis is a predictor of final visual outcomes, whereas chronic or recurrent disease course, younger age, and panuveitis are predictors of requiring multiagent treatment regimens.

Characteristics of ocular hypertension and uveitic glaucoma among patients with noninfectious uveitis.

OBJECTIVE: Ocular hypertension and uveitic glaucoma are important downstream sequela of noninfectious uveitis (NIU). Herein, we describe the clinical outcomes of NIU cases with ocular hypertension and uveitic glaucoma. DESIGN: Retrospective cohort study. PARTICIPANTS: All adults (≥18 years) with NIU under the care of uveitis subspecialty tertiary care clinics between 2010 and 2021 were included. METHODS: The primary outcomes were baseline and final visual acuity. RESULTS: A total of 216 patients out of 914 (23.6%) cases with NIU had ocular hypertension or uveitic glaucoma over the study period. Of all patients with ocular hypertension or uveitic glaucoma, 46% were corticosteroid responders. Baseline and last median visual acuities were better for the ocular hypertension patients compared with patients with uveitic glaucoma (p < 0.001). A higher proportion of patients with uveitic glaucoma than patients with ocular hypertension required glaucoma surgery (p < 0.001). The regression analyses suggested that baseline visual acuity and anatomical classification are significant predictors of last visual acuity, whereas diagnosis of ocular hypertension versus uveitic glaucoma were significant predictors of requirement for glaucoma surgery (p < 0.001). CONCLUSION: A quarter of patients with NIU in this study developed ocular hypertension or uveitic glaucoma. Approximately half of the patients with ocular hypertension or uveitic glaucoma were deemed to be corticosteroid responders. Baseline and last visual acuity outcomes are better amongst ocular hypertension patients compared with those with uveitic glaucoma. Poor baseline visual acuity and panuveitis are predictors of worse vision at last follow-up. Additionally, diagnosis of uveitic glaucoma was a significant predictor of requirement for glaucoma surgery.

MACULAR HOLE HYDRODISSECTION TECHNIQUE WITH HUMAN AMNIOTIC MEMBRANE FOR REPAIR OF LARGE MACULAR HOLES.

PURPOSE: To describe a combined surgical technique using the macular hole hydrodissection (MHH) with human amniotic membrane for repair of large macular holes. METHODS: A step-by-step procedure and a surgical video using the combined MHH and human amniotic membrane technique are presented. DESCRIPTION AND TECHNIQUE: As the first step, the MHH separates the adhesions of the macular hole to the underlying retinal pigment epithelium with a soft-tipped cannula through proportional reflux followed by gentle passive aspiration. The human amniotic membrane graft is marked to identify the nonsticky epithelial side and ensure that the stromal layer (sticky and nonshinny) is facing downward toward the retinal pigment epithelium. The graft is then tucked into the space created with MHH between the macular hole edges and the retinal pigment epithelium with closed forceps to decrease the likelihood of the graft from dislocating postoperatively. CONCLUSION: The MHH in combination with the human amniotic membrane is a practical and effective technique for addressing challenging large macular holes.

PREOPERATIVE GAS FOR PARS PLANA VITRECTOMY: A SURGICAL TECHNIQUE FOR REPAIR OF RHEGMATOGENOUS RETINAL DETACHMENTS WITH MULTIPLE, LARGE, OR INFERIOR BREAKS.

PURPOSE: To describe the role of preoperative gas for pars plana vitrectomy (PGP) as an adjunct to surgical repair of rhegmatogenous retinal detachment (RRD). METHODS: This is a retrospective consecutive case series of all rhegmatogenous retinal detachments with multiple breaks in more than one quadrant, large breaks extending greater than one clock hour, and/or inferior breaks requiring PPV, who received intravitreal injection of sulfur hexafluoride (SF 6 ) or perfluoropropane (C 3 F 8 ) 1-2 weeks before PPV between 2016 and 2020 at a tertiary care center. RESULTS: A total of 109 eyes underwent the PGP technique, 73% of which had macular involvement. The rhegmatogenous retinal detachments on average involved 5.5 (SD 2.1) clock hours with inferior retinal breaks in 51%. Based on clinical examination, subretinal fluid was noted to be dissipated in parts of the detached retina before PPV in 57% of cases. The use of perfluorocarbon heavy liquid or posterior drainage retinotomy was required in 16% of cases. A 95% primary anatomical success rate was achieved over the median 177 (interquartile range 105-526) follow-up days. A final visual acuity of 20/50 or better was achieved in 65%. CONCLUSION: PGP as an adjunct to PPV may facilitate ease of surgery, as well as anatomical and functional success for rhegmatogenous retinal detachments with multiple, large, and/or inferior breaks.

Anatomical and functional outcomes of short-term DensironXTRA heavy silicone oil for rhegmatogenous retinal detachments: a comparative case series.

To assess the safety and efficacy of short-term DensironXTRA tamponade for repair of complicated rhegmatogenous retinal detachments (RRD). This is a retrospective consecutive case series of patients undergoing pars plana vitrectomy (PPV) with intravitreal DensironXTRA and a comparator group with gas (sulfur hexafluoride (SF6) or perfluoropropane (C3F8)) tamponades by a single surgeon between January 2017 and November 2020 at a tertiary care centre. A total of 121 eyes with DensironXTRA and 81 comparator eyes with a gas tamponade were included. The DensironXTRA group had a significantly higher number of cases with inferior breaks (82% vs. 48%; p < 0.0001) and a history of previous PPV for RRD (64% vs. 12%; p < 0.0001). DensironXTRA was removed after a median period of 70 (IQR: 48.5-105.5) days. There was similar anatomical success in both the comparator gas tamponade and DensironXTRA groups (98.8% vs. 97.5%, p = 0.6506). Although both groups experienced a significant improvement in visual acuity, this change was significantly higher in the comparator gas tamponade group versus DensironXTRA group (p = 0.0017). There was no significant change in IOP in the DensironXTRA group (mean difference - 0.7; 95% CI - 1.753 to 0.331, p = 0.1785). The rates of complications were low and not significantly different between the two groups. There was no evidence for central macular thinning with DensironXTRA compared to the contralateral eye without RRD as well as with DensironXTRA in situ versus after its removal. DensironXTRA is a promising short-term tamponade agent with good anatomical and functional outcomes and low rates of complications for the repair of complicated RRDs.

Prophylactic intraocular pressure lowering measures in anti-vascular endothelial growth factor therapy: A systematic review and meta-analysis.

Acute intraocular pressure (IOP) elevation following repeat intravitreal anti-vascular endothelial growth factor (VEGF) injections (IVI) may pose a risk to the integrity of the retinal nerve fiber (RNFL). This meta-analysis investigates the role of IOP-lowering interventions such as an anterior chamber paracentesis (ACP) and IOP-lowering medications on the IOP in patients undergoing IVIs. MEDLINE, EMBASE, and the Cochrane Library were searched up to February, 2021. Studies investigating IOP-lowering interventions in patients undergoing IVI versus controls were included. The primary outcome was the IOP in the short- and long-term post-IVI. Secondary outcomes were changes in the RNFL thickness and best corrected visual acuity (BCVA). ACP at time of anti-VEGF injection significantly lowered IOP immediately post anti-VEGF (WMD: -27.98 mm Hg, P < 0.001). Patients in the ACP group also had significantly thicker RNFL compared to control (WMD: 2.07 um, P < 0.00001) at median follow-up of 16.5 months. IOP-lowering medications (on the day of injection or in the long-term) significantly reduced IOP up to 30 minutes after injection (WMD: -3.31 mm Hg, P = 0.003). This effect was statistically significant between the 2 arms up to 1 month follow-up. There was no difference in BCVA in intervention versus controls. ACP reduces immediate IOP spikes post-IVI and preserves the RNFL in the short- and longterms IOP-lowering medications also reduce IOP spike, with limited data on RNFL thickness.

Prognostic Features of Preoperative OCT in Retinal Detachments: A Systematic Review and Meta-analysis.

TOPIC: To evaluate the prognostic association between preoperative features seen on OCT imaging and postoperative visual acuity (VA) outcomes in rhegmatogenous retinal detachments (RRDs). CLINICAL RELEVANCE: Currently, there is limited literature on the prognostic value of preoperative RRD OCT features. METHODS: A literature search was conducted on Ovid MEDLINE, Ovid Embase, and Cochrane CENTRAL from inception to September 15, 2022. A meta-analysis was performed using a random-effects model. Quality of studies and evidence were assessed using the Joanna Briggs Institute tools and the Grading of Recommendations, Assessment, Development and Evaluation framework, respectively. RESULTS: A total of 1671 eyes of 1670 patients from 29 observational studies were included. Of these, 89% of eyes had a macula-off RRD at presentation. The mean average duration of detachment was 15 ± 10 days. Most eyes (62%) underwent pars plana vitrectomy. Six preoperative OCT features were analyzed: height of retinal detachment (HRD) at the fovea, central macular thickness (CMT), disruption of the ellipsoid zone (EZ) and/or external limiting membrane (ELM), intraretinal cystic cavities (ICCs), outer retinal corrugations (ORCs), and macular detachment. A greater HRD was weakly associated with postoperative VA (Pearson correlation r = 0.35; 95% confidence interval [CI], 0.20-0.48; P < 0.01), and there was no change in this association throughout the postoperative follow-up period. The CMT was not associated with postoperative VA. Eyes with disruption of the EZ and/or ELM had a postoperative VA worse by 0.35 logarithm of the minimum angle of resolution (logMAR) (95% CI, 0.15-0.54; P < 0.01) or 3 Snellen lines. Eyes with ICCs had a postoperative VA worse by 0.14 logMAR (95% CI, 0.01-0.26; P < 0.01) or 2 Snellen lines. Eyes with ORCs did not have a significantly different postoperative VA than eyes without ORCs. Eyes with macular detachment had a postoperative VA worse by 0.15 logMAR (95% CI, -0.31 to 0.00; P = 0.02) or 2 Snellen lines. Overall, the quality of studies ranged from moderate to good (73%-100%). All associations had a low quality of evidence, with CMT being of very low quality. CONCLUSION: Despite the low quality of evidence, a greater HRD, disruption of the EZ and/or ELM, presence of ICCs, and macular detachment were associated with a poor postoperative VA. We propose a standardized nomenclature for consistency and accuracy in reporting preoperative RRD OCT features for future studies. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.