Abstract
ObjectivesTo determine the prevalence of serous retinal detachments (SRD) using optical coherence tomography (OCT) in a large database of patients with uveitis from a tertiary referral setting, to describe clinical features of patients with SRD, and to ascertain retinal architectural features found in association with SRD.Main outcome measuresPrevalence of SRD in uveitis patients imaged with OCT, correlation of visual acuity with SRD, anatomic subtypes of uveitis identified, and association of SRD with various subtypes of macular edema (focal and diffuse) and retinal architectural abnormalities.DesignRetrospective, single-setting cross-sectional study of all OCTs in a digital imaging base ordered on patients from a tertiary referral uveitis clinic between July 2006 and March 2008.ResultsSRD were identified in 17 of 111 uveitis patients (15 %) reviewed; bilateral SRD were found in 5 of 17 patients (29 %). Intermediate uveitis was the most common disease association (47 %), but other conditions identified included Vogt-Koyanagi-Harada syndrome, multifocal choroiditis/panuveitis, and sarcoidosis. Retinal architectural features identified in association with SRD included focal macular edema (59 %), diffuse macular edema (50 %), any intraretinal edema (77 %), both diffuse and focal macular edema (32 %), and retinal pigment epithelial alteration (27 %). Moderate or severe visual impairment, defined as visual acuity 20/50 or poorer was seen in 71 % of patients with SRD. Poorer visual acuity was correlated with increased central subfield thickness in patients with SRD (r 2 = 0.41, p < 0.001).ConclusionSRD were present in 15 % of the uveitis patients reviewed. Moderate to severe vision impairment was present in the majority of eyes (71 %) with SRD. Diffuse macular edema and focal cystoid macular edema were the OCT features most commonly associated with SRD. Intermediate and panuveitis were the most common anatomic sites of inflammation. A variety of pathogenic mechanisms, both inflammatory and non-inflammatory, may be involved in SRD in uveitis patients; identification of the precise mechanism is important for appropriate therapy.
Highlights
The term uveitis is used to describe a heterogenous group of inflammatory diseases having in common intraocularJ Ophthal Inflamm Infect (2012) 2:191–197 inflammation
To illustrate the spectrum of disease processes identified in this uveitis patient population, we have summarized four illustrative cases of patients identified in this series with serous retinal detachment (SRD) of varying etiologies, management strategies, and prognostic implications
We identified SRDs in 15 % of all patients with uveitis who underwent time-domain optical coherence tomography (OCT) imaging due to suspected macular pathology
Summary
The term uveitis is used to describe a heterogenous group of inflammatory diseases having in common intraocularJ Ophthal Inflamm Infect (2012) 2:191–197 inflammation. Our ability to resolve retinal architectural features has been revolutionized by the advent of optical coherence tomography (OCT), a highly sensitive method of obtaining cross-sectional imaging of the retina to diagnose, follow, and characterize macular edema in uveitis and other disease states. OCT is the most widely used modality for detecting macular disease [2,3,4,5]. With this improved ability to characterize macular ultrastructure, three subtypes of macular edema have been identified [3, 5]. The first two, diffuse and cystoid macular edema, are caused by intraretinal fluid accumulation in the neurosensory retina. Besides its presence in patients with macular edema, neurosensory retinal detachment may result from other mechanisms independent of inflammation-associated macular edema (e.g., choroidal neovascularization)
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