Optical Coherence Tomography Biomarkers in Rhegmatogenous Retinal Detachment: A Narrative Review

Rhegmatogenous retinal detachment (RRD) is a vision-threatening retinal disorder in which successful anatomical reattachment does not always result in satisfactory functional visual recovery. Optical coherence tomography (OCT) has become an essential non-invasive imaging modality for evaluating retinal microstructure and identifying biomarkers associated with postoperative visual outcomes. This narrative review summarizes and critically evaluates current evidence regarding the prognostic significance of OCT biomarkers following RRD repair. Available studies indicate that primary outer retinal biomarkers, particularly the integrity of the ellipsoid zone (EZ) and external limiting membrane (ELM), are the most reliable predictors of postoperative best-corrected visual acuity. Preservation of these structures reflects photoreceptor viability and is strongly associated with improved visual recovery. Secondary biomarkers, including hyperreflective foci, intraretinal cystic changes, retinal folds, persistent subretinal fluid, and preretinal hyperreflective dots, provide complementary information regarding inflammatory activity, retinal remodeling, and postoperative complications such as epiretinal membrane formation. Although these biomarkers have considerable clinical value for prognostication, patient counseling, and postoperative monitoring, their interpretation is limited by heterogeneity among studies, differences in imaging protocols, and the lack of standardized assessment criteria. Future large-scale prospective studies are needed to validate OCT biomarkers and establish standardized approaches for their integration into routine clinical practice.