First Author: Y.Alibet UKRAINE
Co Author(s): G. Levytska I. Levytskyy
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The aim of the study was to investigate the anatomical position of the ciliary body and the features of its morphological changes in rhegmatogenous retinal detachment (RRD)complicated by choroidal detachment (CD).
It is known that (RRD) in 0,5-4% of cases is complicated by (CD), hypotension and intraocular inflammation. An important role in the pathogenesis of the listed complications plays the disturbance of the ciliary body function, however, no description of its morphological features in the literature for this pathology.
This study involved 49 patients (49 eyes; age, 24 to 83 years) with RRD complicated by concomitant CD and intraocular inflammation. Exclusion criteria were history of previous ocular inflammatory diseases, ocular trauma or retinal surgery. All patients underwent standard ophthalmological examination including visual acuity assessment, biomicroscopy, ophthalmoscopy and ocular tonometry, ultrasound biomicroscopy (UBM) of the ciliary body, choroid and retina was performed. Ciliary body thickness (CBT) measurements were performed under cycloplegia with phenylephrine hydrochloride 10% and cyclopentolate hydrochloride 1%, at the four cardinal meridians (i.e., the superior, inferior, nasal, and temporal) of the both eyes. The CBT was measured between the ciliary processes located most closely to the scleral spur. We used the Quantel Medical Aviso UBM unit (Quantel Medical, Clermont-Ferrand, France) with a 50-MHz linear probe (axial resolution: 35 µm; lateral resolution: 60 µm).
Baseline UBM revealed ciliary body edema with detachment and extending from the ciliary body into the choroid in all patients. It is noteworthy that in this category of patients, ciliary detachment was characterized by the detachment of the pars plana only, whereas the attachment of the pars plicata to the sclera was maintained. Therefore, no connection was observed between the subchoroidal spaces and the anterior chamber, which is a feature that distinguishes the ciliary detachment from other pathology in the eye with RRD. The presence of all the ciliary body parts edema has been established. The particularity of the edema of the detached pars plana was the absence of an outer border, which was manifested by the presence of a multitude of oblique fibres. The study of the pars plicata is more informative due to the presence of a clear outer contour. The determination of the thickness between the ciliary tracts located closest to the scleral spur allows to exclude the possible variability of the localization of the pars plana in different quadrants, as well as in persons with different anterior/posterior diameter of the eye.
RRD associated with CD, is complicated by ciliary body edema and the detachment of the pars plana only. The particularity of the pars plana edema is the presence of many small oblique fibres with a lack of a clear outer boundary. The pars plicata keeps contact with the sclera, which allows to determine the CBT and prevents the communication of the subchoroidal space with the anterior chamber.