Extensive Serous Retinal Detachment Research Articles

Bilateral Extensive Serous Retinal Detachment in a Patient with Multiple Myeloma

Purpose: To describe a case of bilateral serous retinal detachment in a patient with multiple myeloma.Case summary: A 75-year-old woman presented with sudden-onset of reduced visual acuity in both eyes which had begun 2 days prior. Initial ophthalmological assessment revealed that visual acuities were 0.03 in the right eye and 0.05 in the left eye. Optical coherence tomography indicated pronounced macular elevation and extensive subretinal fluid accumulation in the posterior pole of both eyes. Fluorescein angiography did not detect any significant vascular leakage. Blood tests showed an albumin level of 2.1 g/dL, and plasma protein electrophoresis revealed an M protein level of 0.19 g/dL. Multiple myeloma-related hypoalbuminemia and paraprotein were suspected. The patient's retinal statuses were closely monitored and compared with blood test outcomes. Over 2 months, there was significant improvement, characterized by decreasing macular elevation and reduction of subretinal fluid. This progress was sustained thereafter. Plasma protein electrophoresis showed a gradual decline in paraproteins which coincided with the amelioration of serous retinal detachment.Conclusions: We encountered a case of acute and extensive serous retinal detachment in both eyes of a patient with multiple myeloma. When fluorescein angiography does not definitively show vascular leakage, light chain deposition disease-related serous retinal detachment should be considered. In such instances, it is important to address and monitor the underlying multiple myeloma.

Iodine-125 plaque brachytherapy for diffuse choroidal hemangioma.

To report 6 cases of diffuse choroidal hemangioma (DCH) in children treated with iodine-125 plaque brachytherapy at a single tertiary care center. Retrospective case series. Six pediatric patients diagnosed with DCH were included in the study. Pre-plaque visual acuity (VA) ranged from 20/150 to no light perception (NLP). All patients had extensive serous retinal detachment at presentation. An iodine-125 radioactive plaque was placed on the affected eye to administer a dose of 34.2-42.1 Gy to the tumor apex over a median of 4 days. Tumor regression and subretinal fluid resolution were observed in all eyes within 17 months of treatment. Visual acuity improved in 2 patients. Radiation-induced cataract and subretinal fibrosis were documented in 1 case, and 1 patient developed radiation retinopathy. No patients developed neovascular glaucoma within a follow-up range of 12-65 months. Iodine-125 plaque radiotherapy is an effective option for DCH, although there is a risk for radiation-induced complications.

Management of primary choroidal lymphoma presenting as extensive serous retinal detachment and salmon patch of bulbar conjunctiva: a case report

BackgroundWe describe the outcome of ultra-low-dose radiotherapy plus intravitreal methotrexate and rituximab injections for a patient with primary choroidal lymphoma who presented with nodular conjunctival salmon patches and extensive serous retinal detachment.Case presentationA 34-year-old Iranian man presented with a nodular patch of bulbar conjunctiva in the right eye, and 1+ vitritis. A nearly complete shallow serous retinal detachment, retinal folds, and multifocal yellow choroidal infiltrates were seen during a fundus examination of the right eye. Enhanced depth imaging optical coherence tomography revealed macular retinal folds and an uneven, undulating, “seasick” appearance of the choroidal surface with choriocapillaris compression, intraretinal and subretinal fluid, and clusters of optically dense material at the outer retinal level. An incisional biopsy of the conjunctival lesion confirmed the diagnosis of primary choroidal lymphoma with epibulbar involvement. The patient was treated with ultra-low-dose “boom-boom” radiation (4 Gy delivered in two fractions over two consecutive days) as well as intravitreal methotrexate and rituximab injections. After a year, the lesions had completely disappeared, with no adverse effects or recurrence.ConclusionUltra-low-dose (boom-boom) radiotherapy combined with intravitreal chemotherapy and/or immunotherapy may be an effective treatment for primary choroidal lymphoma with anterior epibulbar extension and diffuse subretinal fluid with favorable response and minimal side effects.

Retinal granular cell tumor: a case report

BackgroundTo report a rare case of granular cell tumor invading the retina.Case presentationA 56-year-old female complained of blurred vision for 2 weeks in her left eye. An irregular-shaped retinal mass in the inferonasal and extending to the optic disc accompanied by dense exudation and extensive serous retinal detachment was observed. Several intravitreal bevacizumab injections were ineffective for stabilizing retinal exudation and intraocular pressure (IOP). Vitrectomy was performed to re-attach the retina and obtain a tumor biopsy specimen. Histopathological analysis revealed that the intraocular mass was a granular cell tumor. Immunohistochemical studies demonstrated that the tumor was positive for S100 and CD68, focal positive for neurofilaments, but negative for ERG and HMB-45. Local recurrence and distant metastasis were not found, but visual acuity had worsened to no light perception at the last visit due to uncontrolled intraocular pressure and retinal exudation after the surgery.ConclusionsGranular cell tumor is a rare benign neoplasm, but it can lead to devastating visual loss if it invades the retina adjacent to the optic nerve head.

The efficacy of cryotherapy in one case of retinal vasoproliferative tumor.

Retinal vasoproliferative tumor (VPT) is uncommon retinal lesion, classified as primary (idiopathic) or secondary. Retinal VPT has a predilection for the peripheral inferior temporal quadrant of the retina and may be unilateral or bilateral. It can lead to decrease vision due to intraretinal or subretinal exudation, neovascularization, retinal detachment, vitreous hemorrhage, preretinal fibrosis, macular edema and epiretinal membrane formation. Different modalities have been used to treat this tumor including clinical observation, pars plana vitrectomy, cryotherapy, laser photocoagulation, brachytherapy and radiotherapy. The authors describe a case of idiopathic retinal VPT associated with extensive serous retinal detachment and point out the importance of diagnosis and the effectiveness of cryotherapy.

Extensive Serous Retinal Detachment after Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

Copyright © 2016 The korean retina society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 맥락막혈관병증에 대한 광역학 치료 후 발생한 광범위 장액망막박리 Extensive Serous Retinal Detachment after Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

PRESUMED SYMPATHETIC OPHTHALMIA AFTER SCLERAL BUCKLING SURGERY

To report an unusual case of sympathetic ophthalmia after successful scleral buckling surgery. The authors reported the clinical manifestation, ocular and systemic workup, and outcome of a 23-year-old woman who presented with reduced vision 3 weeks after successful scleral buckling surgery. Slit-lamp examination showed a mild anterior chamber and vitreous reaction. Fundus examination showed extensive serous retinal detachment in both eyes. Systemic workup was negative for extraocular disease. The patient was treated with intensive systemic steroid and azathioprine. The inflammation was controlled and serous detachment resolved. Sympathetic ophthalmia can occur after successful scleral buckling surgery.

Rapid growth of choroidal melanoma during pregnancy*

Editor, A 29-week pregnant, 31-year-old woman presented with a superior juxtapapillary choroidal tumour (8 mm largest basal diameter (LBD) × 5 mm height) in her left eye with a visual acuity of 20/30 (Fig. 1A, B). The patient wanted to delay any treatment until delivery. Three months later (2 weeks after delivering a boy), the tumour size had increased to 13 mm × 12 mm. There was extensive serous retinal detachment and subretinal haemorrhage that reduced her visual acuity to detecting only hand motion (Fig. 1C, D). Pathology of enucleated eye confirmed choroidal melanoma of mixed cell type and fluorescence in situ hybridization for chromosome 3 indicated monosomy (ZytoVision, Bremerhaven, Germany). Immunohistochemistry indicated absence of both oestrogen (Thermo Scientific, SP1, 1:100) and progesterone receptors (Dako, PgR 636, 1:100). The mean microvascular density (MVD) from three most highly vascularized areas (CD34+) was 79 vessels/0.313 mm2. Using standard photographs for semiquantitative scoring system (Makitie et al. 2001), macrophage density (CD68+) was determined to be moderate. (A) Fundus photography of the left eye depicting a superior juxtapapillary choroidal mass with associated serous retinal detachment. (B) Ultrasonographic image of the tumour with medium internal reflection. The largest basal diameter (LBD) was 8 mm, and the height was 5 mm. (C) Fundus photography of the same eye taken 3 months later. Tumor size increased with the development of extensive serous retinal detachment and subretinal haemorrhage. (D) Ultrasonographic image of the enlarged tumour with 13 mm in LBD and 12 mm in height. Hyperreflective layer indicated by arrowhead represents subretinal haemorrhage. We suspected that male foetal cells from the maternal circulation participated in tumour angiogenesis; however, there was no Y chromosome detected in the tumour using a DNA quantification kit (Applied Biosystems, Foster city, CA, USA). The patient was monitored for 2 years and remains metastasis free. We assumed that the LBD represented both tumour length and width. Although it could have been coincidental, the growth of UM during pregnancy have been previously reported (Seddon et al. 1982), as has transformation of clinically stable choroidal nevus into melanoma during pregnancy (Shields et al. 1991). Despite suspicions that increased growth was the result of endocrine effects, we did not detect oestrogen or progesterone receptors, which is consistent with previous studies (Seddon et al. 1982). In addition to rising oestrogen and progesterone, secretion of melanocyte-stimulating hormone (MSH) also increases during pregnancy. MSH is responsible for hyperpigmentation in pregnant women, usually affecting the nipples, areola, and face. UM is of melanocytic origin, so it has the potential to respond to elevated MSH. During pregnancy, immunity is altered to favour type 2 helper cell pathway (Th2) over type 1 helper cell pathway (Th1)to tolerate the foetus. This Th1/Th2 imbalance could promote rapid tumour growth. Vascular changes are frequently observed during pregnancy because of increased blood volume and raised angiogenic factors from high demand of vascular placenta. Although these vascular changes can merely increase tumour oedema or subretinal exudation, they can promote tumour vascularity as well, which facilitates growth. MVD was relatively high in our case, considering median MVD of 40 vessels/0.313 mm2 for 134 UM in one series (Makitie et al. 1999). Tumour vascularity is also affected by foetal cell microchimerism; foetal progenitor cells can enter the maternal circulation, and a recent study reported that these cells engraft in maternal cutaneous melanoma and differentiate into endothelial cells (Nguyen Huu et al. 2009). However, we did not detect foetal cells in the tumour. Therefore, the mechanism for rapid growth of UM in our patient may be multifactorial, relating to complex endocrine signalling, altered immunity, and a favourable angiogenic environment. The cumulative mortality rate depends on the tumour size. We recommend that a newly diagnosed UM in pregnant state be re-examined in one month if the tumour is to be observed. Initiation of the treatment is warranted in rapidly enlarging tumours. Part of this work was presented at the International Congress of Ocular Oncology conference from the 8–12th of September 2009 in Cambridge, United Kingdom.

Circumscribed choroidal hemangioma.

Circumscribed choroidal hemangioma is an uncommon, benign vascular tumor manifesting as an orange-red mass in the posterior pole of the eye. Serous retinal detachment accounts for decreased vision in most patients. Diagnosis of this tumor is challenging with many patients initially misdiagnosed with choroidal melanoma or metastasis. Several ancillary tests such as ultrasonography, fluorescein angiography, indocyanine green angiography, and magnetic resonance imaging help differentiate this tumor from other simulating lesions. Asymptomatic lesions should be observed, but visually threatening or visually impairing lesions require treatment. Photodynamic therapy, laser photocoagulation, and transpupillary thermotherapy may be used for primary management of this tumor. Patients who fail to respond to previous treatment or those with extensive serous retinal detachment can be treated using radiotherapeutic modalities. Long interval between onset of symptoms and treatment, poor visual acuity at presentation, and presence of chronic retinal or retinal pigment epithelial changes are associated with poor long-term vision.

Lipid Exudation in Age-related Macular Degeneration

We reviewed the relationship between lipid exudation and subretinal neovascular membranes associated with age-related macular degeneration. The records of 500 consecutive patients with subretinal neovascular membranes caused by age-related macular degeneration were examined. Seventy-five patients (15%) (85 eyes) manifested lipid exudation in conjunction with subretinal neovascularization. Twelve patients (2.4%) (13 eyes) had a massive lipid exudative response with extensive serous retinal detachment (resembling Coats' disease). Of the 85 eyes with subretinal neovascular membranes and lipid exudation, 71 (84%) had a subretinal neovascular membrane that was classified as ill defined. Improvement of vision with or without treatment was seen in only 14 of these 85 eyes (16.4%). After comparing these 85 eyes to 94 eyes from 76 patients with age-related macular degeneration and subretinal neovascular membranes but no lipid exudation, we found that a subretinal neovascular membrane associated with lipid exudation was more likely to be ill defined (71 eyes [84%] vs 35 eyes [37%]; P = .0001), was more frequently associated with retinal pigment epithelial detachment (30 eyes [35%] vs 15 eyes [16%]; P = .0029), and was more likely not to have stabilization of visual acuity (14 eyes [16%] vs 31 eyes [33%]; P = .025).