Surgical management for treatment-resistant cases of inflammatory exudative retinal detachment: Mission impossible?

Purpose: To report the outcome of surgical intervention for inflammatory, exudative retinal detachment (ERD). Methods: A retrospective analysis of eyes with ERD that underwent vitrectomy. Results: Twelve eyes (10 patients) with ERD, non?responsive to medical therapy, underwent vitrectomy. The mean age was 35.7 ± 17.7 years. Five eyes (42%) had Vogt–Koyanagi–Harada disease, three (25%) had presumed tuberculosis (TB), two (17%) pars planitis, and one (8%) had sympathetic ophthalmia. The mean time of vitrectomy was 6.76 ± 4.1 months after onset. Six (50%) eyes had a recurrence, two settled with medical treatment, and four underwent re?surgery. The mean follow?up was 2.7 years. At the last visit, 10 (83.3%) eyes had attached retina; the best?corrected visual acuity (BCVA) had reduced to 1.6 ± 0.7 logarithms of the minimum angle of resolution (logMAR) from 1.3 ± 0.7 at baseline. Conclusion: Vitrectomy in ERD can act as an adjuvant to conventional medical therapy and help maintain structural integrity. Early vitrectomy may help preserve visual function.

Exudative retinal detachment as an initial presentation of retinopathy of prematurity: Clinical profile and outcomes of a rare presentation

Purpose: To describe the clinical profile and treatment outcomes of infants with retinopathy of prematurity (ROP) presenting with isolated exudative retinal detachment (ERD). Methods: Retrospective interventional case series. Preterm infants diagnosed with ROP with ERD at presentation were included. All demographic details, clinical findings, and treatment given were documented. The anatomical outcome was categorized as good, fair, and poor. Refractive outcome was classified into mild, moderate, and severe according to spherical equivalent at the last visit. Results: Fifteen eyes (8 patients) were included. Mean gestational age was 31.3 weeks, and birth weight was 1462.6 g. All eyes presented with aggressive ROP. Patches of retinal edema in avascular retina were seen in all eyes. A total of 86.6% of eyes had vascular sclerosis while 86.6% of eyes had subretinal exudates. The anatomical outcome was good in all eyes. In addition, 40% of eyes had a mild refractive error. Conclusion: Exudative retinal detachment in ROP is rare. The use of unregulated oxygen can be a contributory factor. Vascular sclerosis is consistent with hyperoxia?induced retinopathy models. Retinal edema and subretinal exudates indicate disrupted inner and outer blood?retinal barrier. Treatment outcomes are good when diagnosed and treated in time.

An unusual case of multifocal central serous chorioretinopathy with low serum cortisol managed using eplerenone

In this report, we describe a rare case of a 44-year-old Asian male with acute central serous chorioretinopathy (CSC) with bullous exudative retinal detachment. Endocrinology evaluation revealed hypothalamic–pituitary–adrenal axis suppression with low serum cortisol. Furthermore, neuroimaging revealed the presence of a pituitary microadenoma. He was treated with systemic eplerenone and hydrocortisone. After 12 weeks, bullous detachment completely resolved. Our case is a unique description of acute CSC with underlying low serum cortisol levels that responded to treatment with mineralocorticoid antagonist. This case highlights the various endocrine abnormalities other than the raised serum cortisol that can occur in patients with CSC.

Rebound inflammation after an intravitreal injection in Vogt朘oyanagi朒arada syndrome

A 43-year-old male with chronic Vogt朘oyanagi朒arada syndrome (VKH) presented with subfoveal choroidal neovascular membrane (CNVM) in the right eye with no evidence of active inflammation. He underwent intravitreal bevacizumab and dexamethasone injections. Postinjection he developed fresh keratic precipitates and exudative retinal detachment (RD). He received two more bevacizumab injections with oral corticosteroids and immunosuppressants causing resolution of exudative RD with scarred CNVM. We report this case to highlight that intravitreal injection may act as a trigger for rebound inflammation in VKH patients and may require anti-inflammatory drugs to be started even in the absence of an active inflammation.

Retinoblastoma in an Older Child: A Case Report

@#Retinoblastoma is a rare intraocular malignant tumour more commonly seen in children below five years of age. We presented a rare case of retinoblastoma in an older child. A nine-year-old girl noticed that she had loss of vision OS following a fall at home. Her vision was 6/6 OD and only light perception OS. Examination of the left eye revealed an extensive exudative retinal detachment. Her right eye examination was unremarkable. CT scan showed a left eye intraocular mass with calcification. EUA revealed a mixed endophytic and exophytic mass with extensive exudative retinal detachment. Family members consented to left eye enucleation and histopathological report confirmed the diagnosis of retinoblastoma. Post enucleation, patient is doing well with a prosthetic eye. In conclusion, any unexplained visual loss in children regardless of age warrants a full ophthalmological examination as the possibility of retinoblastoma cannot be ruled out.

Desprendimiento de retina exudativo como primera manifestación de una preeclampsia grave / Serous retinal detachment as a first sign of severe preeclampsia

El desprendimiento de retina exudativo es una causa poco común de pérdida visual en la preeclampsia. Su patogenia no es del todo conocida, aunque la isquemia coroidea pudiera jugar un papel fundamental. Existen pocos casos reportados en la literatura y la mayoría hace referencia a casos aislados o series cortas de casos. Presentamos el caso de una primigesta de 34 años en el tercer trimestre de embarazo con un desprendimiento de retina exudativo bilateral. La sintomatología visual fue la primera manifestación de una preeclampsia que terminó en cesárea de urgencia. La clínica oftalmológica se resolvió de forma espontánea a las dos semanas de la cesárea(AU)

Exudative retinal detachment is an uncommon cause of loss of visual acuity in preeclampsia. Its pathogenesis is not fully understood, but choroidal ischaemia is known to play a key role. Few cases have been reported, and most of these refer to isolated cases or short series of cases. We describe the case of a primigravida aged 34 years, in the third trimester of pregnancy, with bilateral exudative retinal detachment. The visual symptoms were the first manifestation of preeclampsia, which finally required an emergency caesarean section. The retinal detachment resolved spontaneously within two weeks of the caesarean section(AU)

Syphilitic uveitis: 3 cases report / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To evaluate the clinical manifestations and visual outcome of syphilitic uveitis patients. ·METHODS: Case series of three patients with syphilitic uveitis were managed in Hospital USM.·RESULTS: Three patients were diagnosed to have uveitis secondary to syphilis. All three patients were not known to have syphilis prior to presentation but had positive history of sexual promiscuity.Allpatients presented with progressive blurring of vision for average of one-month duration. Two of them had association with fever,ocularpainandfloaters.Visualacuityat presentation ranged from 6/12 to hand movement. Mild anterioruveitis( non-granulomatous),vitritisand papillitis were present in all the patients. First patient had multifocal chorioretinitis with exudative retinal detachment. The second patient presented with exudative retinaldetachmentwhilethethirdpatienthad chorioretinitis only. All the patients were treated with intramuscular benzyl-penicillin 2.4 MU weekly for 4 weeks and two of them received oral doxycycline 200mg twice daily for 3 months. The uveitis responded well to the treatment and two of them showed dramatic visual improvement from 6/120 to 6/21 and 6/12 to 6/6. The one with worse outcome was confirmed to have positive retroviral.·CONCLUSION: Ocular syphilis presented here as non granulomatous inflammation associated with exudative retinal detachment, Final visual outcome is generally good despite slow improvement after treatment.

Acute Lymphoblastic Leukemia Manifesting as Acute Vogt-Koyanagi-Harada Disease

We describe a case of bilateral exudative retinal detachment associated with prodromal symptoms simulating the presentation of acute Vogt-Koyanagi-Harada disease that was eventually diagnosed as acute lymphoblastic leukemia. A 42-year-old man presented with sudden visual loss in both eyes for two weeks. He complained of intermittent headache, neck stiffness and tinnitus for a month. His best-corrected visual acuities were 20/200 in both eyes. Fluorescein angiography, optical coherence topography and indocyanine green angiography featured bilateral serous retinal detachments. A clinical diagnosis of incomplete type Vogt-Koyanagi-Harada disease was considered. However, complete blood cell count showed a marked increase in the number of white blood cells and bone marrow examination revealed precursor B cell lymphoblastic leukemia. The patient started on induction chemotherapy. A week later, his best-corrected visual acuities were 20/25 and the serous retinal detachments were nearly absorbed in both eyes. Bilateral exudative retinal detachment associated with neurologic and auditory abnormalities may be a presenting sign of acute lymphoblastic leukemia. Clinicians should be aware of the possibility of leukemia in such patients.

A Case of Retinal Contusion Combined Exudative Retinal Detachment Causing Delayed Visual Disturbance

PURPOSE: To report a case of retinal contusion with the complication of exudative retinal detachment causing delayed visual disturbance. CASE SUMMARY: A 28-year-old man presented with visual disturbance of the left eye. Three days prior, a soccer ball hit him on his left eye, and he visited a local clinic. His visual acuity was 0.9. Fundus examination revealed a lesion of the macula, which was diagnosedas retinal contusion. Two days later, visual acuity decreased to 0.3 and he was referred to us. At presentation, his visual acuity was 0.125. A gray to white lesion around the superotemporal vascular arcade, and exudative retinal detachment involving the fovea associated with the lesion were found. Subretinal fluid collection was confirmed with optical coherence tomography (OCT). Fluorescein angiography showed diffuse leakage over the contusion, and fluorescein was pooled in the detached area. At 15 days, subretinal fluid was resolved on OCT and vision was improved to 0.8. CONCLUSIONS: We suggest that leakage from the contusion caused delayed exudative retinal detachment and decrease of visual acuity. Visual acuity improved with resolution of the subretinal fluid. Though the visual acuity was good in spite of a severe retinal contusion on the perifoveal area, the possibility of exudative retinal detachment and delayed visual disturbance shoud be considered.

Choroidal Detachment in a Patient with Myelodysplastic Syndrome

PURPOSE: After myelodysplastic syndrome is transformed to acute leukemia, the patient condition worsens rapidly. The authors experienced a case of choroidal detachment in a patient with myelodysplastic syndrome and report this case with literature review. METHODS: A 59-year-old man with myelodysplastic syndrome was admitted because of systemic illness. After examination, he was diagnosed with acute leukemia transformation. During admission, he experienced visual acuity decrease in the right eye. Ophthalmic examination showed annular choroidal detachment, exudative retinal detachment, and narrow anterior chamber angle. Orbital CT showed anterior rotation of the lens-iris diaphragm, thickened choroids, and slightly enhanced ocular soft tissue. RESULTS: Despite medical treatment including carbonic anhydrase inhibitor for about 2 weeks, the ophthalmic finding was not quite subsided, so surgical treatment was arranged. However, the systemic illness aggrevated abruptly, and the patient died about 1 month after medical treatment.

Experimental Exudative Retinal Detachment in Albino Rats

To establish animal model of exudative retinal detachment in Sprague Dawley albino rats and to elucidate the possible role of retinal vein in the induction of exudative retinal detachments, rose bengal photosensitive dye was injected intravenously and argon laser was applied. In group A(10 eyes), laser was applied on intervascular retinal areas linearly. In group B (12 eyes), laser was applied on major retinal veins. In group C(4 eyes), laser was applied on major retinal arteris. In group D(3 eyes), laser was applied on major retinal veins without rose bengal dye and in group E(26 eyes), only the rose bengal dye was perfused. And in group F(3 eyes), normal eyes were fixed for negative controls. Exudative bullous retinal detachment occurred only in group B and these resutls were confirmed in histological examinations. In control groups (D and E), tissue injuries were not found. In conclusion, exudative retinal detachment could be induced by occlusion of retinal veins in albino rats and the abnormalities of retinal venous blood flow were required for the induction of exudative retinal detachment.

57 cases of exudative retinal detachment treated with vitrectomy / 眼科

Objective To review the causes of exudative retinal detachment(ERD),indications of vitrectomy for ERD and its outcomes.Design Retrospective case series.Participants 57 patients with ERD received vitrectomy in EENT Hospital,Fudan Uni- versity.Methods A retrospective analysis of clinical records were conducted.Main Outcome Measures Etiology,vitrectomy indica- tions and its outcomes.Results 57 cases(62 eyes)with ERD received vitrectomy.The disease distribution of vitrectomy were Coats dis- ease in 23 cases(45.2%),familial exudative vitreoretinopathy in 8 cases(12.9%),uveitis in 7 cases(11.3%),retinal hemangioma in 7 cases(11.3%),bullous retinal detachment in 6 cases(9.7%),endophthalmitis in 4 cases(6.5%)and pit of optic nerve in 2 cases(3.2%). Severe ERD and proliferative change were major indication for treatment with vitrectomy.During follow-up period,most patients gained useful vision in early stage.Follow up rate of 6 months or more was 64.9%.The recurrence of ERD was 5.4% and most patients also gained useful vision.Condusion Coats disease is the prominent cause of being treated with vitrectomy in ERD.When proliferation or vitreous hemorrhage happens or macula is involved,vitrectomy should be performed.Most patients can gain useful vision after vitrecto- my.(Ophthalmol CHN,2008,17:52-55)