Collaborative research will improve outcomes for retinal-detachment surgeries

Retinal detachment (RD) is a serious medical condition in which vision in an eye is partially or fully lost because of the separation of the retina from the retinal pigment epithelium (RPE). ChemE Professor Arun Ramchandran and Dr. Rajeev Muni, Vice Chair in the Department of Ophthalmology & Vision Sciences at U of T and an eye surgeon at St. Michael’s Hospital and Kensington Eye Institute, are collaborating to improve outcomes following surgeries that repair RDs.

Two of the common procedures used to treat RD include pars plana vitrectomy (PPV) and pneumatic retinopexy (PnR). Although most patients have a reattachment of the retina after one of these procedures, patients can suffer from a post-surgical visual disturbances or distortion. One potential adverse outcome after RD repair includes retinal displacement. This occurs when the retina is significantly displaced from its original position relative to the RPE.

“Retinal displacement can lead to the patient seeing objects as smaller or distorted in the operated eye and this can compromise the patient’s functional vision,” explains Muni. One study performed by the group revealed that 44% of PPV surgeries result in displacement, as compared to only 14% in PnR surgeries. The groups of Ramchandran and Muni are working together to understand how the type of ocular tamponade that is used during the procedure can impact the risk of retinal displacement. They have also expanded their work to explain the physiology of how corrugations in the retina can occur with RD and the potential implications of this.

“Lubrication stresses, fluid relocation in the sub-retinal region, and hydration induced swelling and corrugation of the retina are three mechanisms that have been explored in our work to explain the differences in the risk of displacement with PPV vs PnR,” say Ramchandran. “We have also been able to characterize abnormalities that occur in the retina at the time of RD (outer retinal corrugations); and based on mathematical models, have been able to shed light on their pathophysiology. This is critical as it has given us great insights on how the retina should be best reattached,” elaborates Muni.

Ramchandran and Muni have already published three papers regarding the mechanistic details of displacement with different types and sizes of tamponade, and they are anticipating one on corrugations and its implications for management. Additionally, the pair along with Muni’s colleague Dr. Hillier, have been invited to prepare a review paper for the highest impact journal in the field of Ophthalmology. Their research contributions will pave the path for significantly improving therapeutic strategies for RD. Specifically, creating new RD-repair techniques that reattach the retina as close as possible to its original status.

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