Exudative Retinal Detachment Research Articles

Management of persistent exudative retinal detachment: exploring etiology and surgical outcomes.

This report aims to present the causes, clinical features, and surgical outcomes of persistent exudative retinal detachment (ERD) in a single tertiary referral center experience. We retrospectively analyzed 48 patients who underwent vitreoretinal intervention for persistent ERD between 2017 and 2024. The study assessed patient demographics, underlying causes of ERD, the success rate of surgical interventions, and postoperative visual outcomes. Of the 2040 eyes with retinal detachment treated at our center, 48 (2.35%) were diagnosed with ERD. Coats disease was the most frequent underlying cause, identified in 18 (37.5%) of ERD cases. Choroidal hemangioma (n = 6, 12.5%) and nanophthalmos (n = 5, 10.4%) were the next most common etiologies. The study population comprised 48 patients (30 males and 18 females) with a mean age of 37.48 years (range, 4-88 years). The mean best-corrected visual acuity remained stable from baseline to follow-up. The recurrence rate following primary surgery was 29.2%. Patients underwent a mean of 1.75 ± 1.00 surgeries. Globe preservation was achieved in 44 eyes (91.7%), while phthisis bulbi developed in 4 eyes (8.3%). Vitreoretinal surgery may be considered as a salvage procedure in cases where persistent ERD threatens the posterior pole. In our study, Coats' disease, choroidal hemangioma, and nanophthalmos were identified as the most common etiologies associated with persistent ERD. Surgical intervention has the potential to preserve vision, but the high recurrence rate necessitates a cautious approach and the possibility of multiple surgeries.

Pachychoroid as a Risk Factor for Exudative Retinal Detachment After Panretinal Photocoagulation: A Report of Two Cases

Pachychoroid as a Risk Factor for Exudative Retinal Detachment After Panretinal Photocoagulation: A Report of Two Cases

Bilateral exudative retinal detachment with subretinal light-chain protein in a patient with multiple myeloma -case report-

BackgroundExudative retinal detachment in patients with multiple myeloma is exceedingly rare. Only two Cases are known to us. We successfully identified light-chain proteins in subretinal fluid, allowing for a more precise understanding of the pathogenesis of this complication.Case presentationA 68-year-old patient presented with bilateral exudative retinal detachment. The visual impairment was reported one day after stem cell mobilization by granulocyte-colony stimulating factor (G-CSF) and the additional administration of Plerixafor. The symptoms began during stem cell apheresis. The patient underwent surgical treatment for both eyes through vitrectomy and silicone oil tamponade. Light-chain proteins were detected in the collected subretinal fluid through electrophoresis in one eye.ConclusionsWe successfully identified light-chain proteins in subretinal fluid, allowing for a more precise understanding of the pathogenesis of this complication. The pathomechanism likely involves damage to the outer blood-retina barrier due to the deposition of light-chain proteins. Whether mobilization of bone marrow cells with Plerixafor led to a breakdown of the outer blood-retina barrier in these patients is a topic for discussion and has to be considered in the use of Plerixafor.

Advances in the Study of the Pathogenesis of Vogt-Koyanagi-Harada Syndrome.

Vogt-Koyanagi-Harada syndrome (VKHS) is a common type of uveitis characterized by the invasion of melanocyte-rich tissues. In recent years, the incidence of VKHS has been increasing yearly, and its specific pathogenesis has not yet been elucidated. However, its pathogenesis has been a hot topic of research. The clinical course of VKHS is characterized by the early involvement of the posterior segment of the eye, including exudative retinal detachment, optic papillitis, bilateral diffuse chorioretinitis, etc. If treated improperly or with delayed treatment, the inflammation may gradually spread to the anterior segment of the eye, leading to vision loss or even vision. This study examines the pathogenesis of VKHS. It reviews the progress of research on the pathogenesis of VKHS, which will help to improve the understanding of VKHS and provide a reference for subsequent studies.

Choroidal metastases with exudative retinal detachment as the initial presentation of disseminated lung adenocarcinoma: photo essay.

Choroidal metastases with exudative retinal detachment as the initial presentation of disseminated lung adenocarcinoma: photo essay.

Intravitreal Injection and Prophylactic Laser Treatment in Pediatric Vitreoretinal Pathologies

Vascular endothelial growth factor (VEGF) is an important mediator of pathological neovascularization and vascular permeability of the eye. The increasing use of intravitreal therapies targeting VEGF has revolutionized the treatment of pediatric vitreoretinal diseases. Laser photocoagulation is the standard treatment method for retinopathy of prematurity. The aim is to ablate the avascular peripheral retina, but ablation of the peripheral retina with traditional laser therapy is destructive, causes complications, and does not prevent all vision loss, especially in cases of retinopathy of prematurity affecting zone 1 of the eye. In Coats disease, retinal telangiectasias are treated early with laser photocoagulation, but with ischemia, high levels of VEGF in the ocular fluid may contribute to increased permeability of telangiectatic blood vessels, leading to lipoprotein leakage and subsequent exudative retinal detachment. Therefore, anti-VEGF has been recommended as adjuvant therapy in the treatment of Coats disease. In this review, intravitreal injection and prophylactic laser treatment applications in Retinopathy of Prematurity and Coats Disease are mentioned.

“Managing choroidal metastasis in a male patient with breast carcinoma”: A case report with review of literature

The purpose of this study was to report a rare case of male breast carcinoma with choroidal metastasis and to review the best possible management options. A 72-year-old man, a case of breast carcinoma, was noted to have choroidal metastasis 1-year posttreatment. Fundus examination revealed multiple yellow-white prominent masses arising from the choroid associated with exudative retinal detachment involving the macula. He was managed with intensity-modulated radiotherapy in both eyes over 10 days. Three months posttreatment, the choroidal metastasis showed regression. This case emphasizes on the need of an appropriate dilated ophthalmoscopic examination and detailed screening in all cases of breast cancer, aiding in early, prompt diagnosis and in formulation of an efficient management protocol.

Lens-Sparing Perfluoro-Octane-Assisted External Drainage of Total Exudative Retinal Detachment in Coats' Disease.

Lens-Sparing Perfluoro-Octane-Assisted External Drainage of Total Exudative Retinal Detachment in Coats' Disease.

Nodular posterior scleritis mimicking melanotic choroidal melanoma: A diagnostic dilemma.

To report a case of atypical nodular posterior scleritis mimicking as a melanotic choroidal melanoma. Descriptive case report. A 38-year-old female presented with sudden onset diminution of vision, severe pain and redness in her right eye. She was diagnosed to have choroidal melanoma in her left eye one year ago and underwent enucleation. On examination, conjunctiva was injected in right eye with cells in anterior vitreous face (AVF). Fundus examination revealed a large pigmented choroidal mass temporal to macula with exudative retinal detachment. Systemic evaluation and multimodal imaging ruled out the possibility of a choroidal melanoma or metastasis, with a presumptive diagnosis of nodular posterior scleritis. Three cycles of intravenous methyl prednisolone (IVMP) with a tapering dose of oral corticosteroids showed drastic improvement in symptoms with resolution of choroidal mass - further confirming the diagnosis. In cases of choroidal mass with an inflammatory component, a trial of steroids is worthwhile to prevent clinical misjudgement and devastating treatment outcomes including enucleation.

Optical Coherence Tomography Features in Fovea-Off Exudative vs Rhegmatogenous Retinal Detachment

PurposeTo describe the optical coherence tomography (OCT) features that can differentiate eyes with fovea-off exudative retinal detachment (ERD) vs. rhegmatogenous retinal detachment (RRD), with particular attention to outer retinal corrugations (ORCs). DesignMulticenter, retrospective cross-sectional study. MethodsMulticenter, retrospective cross-sectional study of patients diagnosed with unilateral or bilateral fovea-off ERD or primary, acute, fovea-off RRD between 2016 and 2021. This study was performed with the approval from the Research Ethics Board at the University of Toronto and was conducted in accordance with the Declaration of Helsinki. Patients with any ERD etiology and evidence of extensive, bullous fovea-off detachment and in the RRD group: consecutive patients with acute, primary fovea-off RRD with good quality baseline SD-OCT imaging were included. Patients with exudative choroidal neovascularization from any etiology, optic nerve pit, significant media opacity, or OCT images with poor quality or low signal strength were excluded. Primary outcome was to describe the morphological features of the macula using SD-OCT in patients diagnosed with ERD vs RRD, with specific interest in ORCs. Results161 eyes (51 ERD and 110 RRD) of 154 patients were included. Fifty-one eyes with ERD presented with 1 of 15 etiologies. ERD were associated with a greater risk of having hyperreflective dots in the outer retina (92.2% vs 74.5%, p=0.009), hyperreflective material and dots in the subretinal fluid (72.5% vs 34.5%, p<0.001), internal limiting membrane and inner retinal undulations (70.6% vs 39.4%, p<0.001), and retinal pigment epithelium undulations (44.9% vs 6.4%, p<0.001) compared to RRD. RRD was associated with a greater risk of outer retinal corrugations (80% vs 0%, p<0.001), intraretinal fluid (90.9% vs 41.2%, p<0.001) and ellipsoid zone thickening (90% vs 66.7%, p<0.001) compared to ERD. ConclusionThe presence of ORCs are highly specific for RRD and absent in ERD. This is likely related to differences in the pathophysiology of the diseases process, specifically the content of the subretinal fluid. Understanding the differences in OCT morphological features of ERD vs RRD may aid with diagnosis and management.

Highlights of ophthalmological manifestations in newly diagnosed acute leukemia: a correlation with hematological parameters

Acute leukemia is a hematological malignancy affecting different organ systems including the eye and orbit through direct infiltration of tissues or secondary to hematological abnormalities. Ophthalmological manifestations in acute leukemia are variable ranging from asymptomatic presentation to serious manifestations that can alter the disease course and treatment. The purpose of this study is to detect the incidence of different ophthalmological manifestations in newly diagnosed acute leukemia patients and to assess the relationship between ocular findings and hematological characteristics and the sequel of these neoplasms. A cross-sectional study with analytical components was conducted on 222 newly diagnosed acute myeloid and acute lymphoblastic leukemia patients who presented at Oncology Center Mansoura University (OCMU) between January 2022 and February 2023. All patients underwent a complete ophthalmic evaluation at Mansoura Ophthalmology Center (MOC). The mean age was 43.45 ± 17.35 years (range, 17–85), and M/F was 137 (61.7%)/85 (38.3%). One-hundred and forty-four (64.9%) had acute myeloid leukemia (AML), and 78 (35.1%) had acute lymphoblastic leukemia (ALL). Ophthalmic manifestations were detected in 96 patients (43.2%). Among them, 4 (1.8%) had poor visual acuity. Retinal hemorrhage (19.8%) and Roth spots (17.1%) were the most common ocular manifestations. Other ophthalmological manifestations observed were orbital involvement (3.2%), ocular motility issues (1.4%), subconjunctival hemorrhage (5.9%), conjunctival chemosis (0.9%),lid swelling (4.1%), lid ecchymosis (3.2%), lagophthalmos (0.5%), lid ptosis (1.8%), retinal venous congestion & tortuosity (4.1%), preretinal hemorrhage (3.2%), vitreous hemorrhage (3.2%), macular affection (2.3%), retinal infiltration (1.8%), exudative retinal detachment (ERD) (1.8%), cotton-wool spots (0.9%), retinal vein occlusion (0.5%), papilledema (2.8%), optic disc infiltration (1.8%), disc pallor (1.8%).AML patients were significantly associated with a higher frequency of ocular affection, retinal hemorrhages, and Roth spots (P 0.028, 0.003, and 0.046, respectively) compared to ALL patients. Retinal hemorrhage was statistically significantly associated with anemia (P 0.021). Ophthalmological manifestations of acute leukemia are heterogeneous; they can be detected at initial presentations or relapse. Some manifestations are asymptomatic, others can affect visual acuity or even alter the disease course. Cooperation between ophthalmologists and haemato-oncologists is crucial for recognizing ocular involvement and disease management.

A series of atypical cases of exudative retinal detachment with diagnostic dilemma presenting to a rural eye care center in South India

Abstract Introduction: Retinal detachment results due to the accumulation of fluid in the subretinal space. Retinal detachment can be rhegmatogenous, exudative, or tractional detachment. Exudative detachment occurs due to various choroidal or retinal pathologies. We report a case series of exudative retinal detachment (ERD) with atypical presentation, who were diagnosed and treated in our retina clinic. The aim of our study was to stress on the timely etiological diagnosis in patients who present with ERD in achieving a good visual recovery. We also would like to emphasize thorough systemic evaluation in the management of such cases. Materials and Methods: In this case series, patients who presented to our institution with ERD underwent a comprehensive ocular and systemic evaluation in order to determine the underlying etiology. Results: Our study showed that inflammatory causes, whether infectious or noninfectious uveitic conditions and certain systemic conditions unrelated to uveitis can also cause ERD. Conclusion: A thorough examination of both ocular and systemic condition is crucial for identifying the cause of ERD, ultimately aiding in the preservation of vision. In addition, timely recognition and management of any underlying systemic conditions by the appropriate specialist can significantly decrease the morbidity and mortality in these patients. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.

Successful management of exudative retinal detachment in retinopathy of prematurity with sub-Tenon triamcinolone acetonide ınjection following laser photocoagulation: A case report

In this case report, we describe the successful treatment of exudative retinal detachment after laser photocoagulation with sub-Tenon’s injection of triamcinolone acetonide in a premature infant with retinopathy of prematurity (ROP). A preterm infant born at 25 weeks gestation and of weight 860 g was diagnosed with zone 2 stage 3 ROP with plus disease. Laser photocoagulation was performed to treat the active disease. After laser treatment, the infant developed exudative retinal detachment. To address the exudative retinal detachment, a sub-Tenon triamcinolone acetonide injection was administered. The procedure was well tolerated, and the patient showed rapid improvement in both clinical and imaging findings.

Exploring laser-induced acute and chronic retinal vein occlusion mouse models: Development, temporal in vivo imaging, and application perspectives.

Photodynamic venous occlusion is a commonly accepted method for establishing mouse models of retinal vein occlusion (RVO). However, existing model parameters do not distinguish between acute and chronic RVO subtypes. Large variations in laser energy seem to correlate with fluctuating retinopathy severity and high rates of venous recanalization during the acute phase, along with the variable levels of retinal perfusion during the chronic phase. After optimizing the modeling procedure and defining success and exclusion criteria, laser energy groups of 80mW, 100mW, and 120mW were established. Multimodal imaging confirmed that higher energy levels increased the incidence of retinal cystoid edema and intraretinal hemorrhage, exacerbated the severity of exudative retinal detachment, and reduced the venous recanalization rate. For the acute model, 100mW was considered an appropriate parameter for balancing moderate retinopathy and venous recanalization. Continuous imaging follow-up revealed that day 1 after RVO was the optimal observation point for peaking of retinal thickness and intensive occurrence of retinal cystic edema and intraretinal hemorrhage. After excluding the influence of venous recanalization on retinal thickness, acute retinal edema demonstrated a positive response to standard anti-vascular endothelial growth factor therapy, validating the clinical relevance of the acute RVO model for further study in pathogenic mechanisms and therapeutic efficacy. For the chronic model, the 120mW parameter with the lowest venous recanalization rate was applied, accompanied by an increase in both photocoagulation shots and range to ensure sustained vein occlusion. Imaging follow-up clarified non-ischemic retinopathy characterized by tortuosity and dilation of the distal end, branches, and adjacent veins of the occluded vein. These morphological changes are quantifiable and could be combined with electrophysiological functional assessment for treatment effectiveness evaluation. Moreover, the stable state of venous occlusion may facilitate investigations into response and compensation mechanisms under conditions of chronic retinal hypoperfusion.

Development of Vogt–Koyanagi–Harada disease-like uveitis during treatment by anti-programmed death-1 antibody: a case report

BackgroundSeveral immune checkpoint inhibitors (ICIs) have been linked to the occurrence of Vogt-Koyanagi-Harada disease (VKHD)-like uveitis. Among the ICIs, there has been no report of immune-related adverse events (irAEs) caused by a new programmed death protein-1(PD-1) monoclonal antibody (Toripalimab).Case presentationThis paper presents a case of VKHD-like uveitis that arose following Toripalimab therapy for urothelial cancer of the bladder, and the patient experienced symptoms 10 days after the final dosage of 20 months of medication treatment. This patient with bladder uroepithelial carcinoma had severe binocular acute panuveitis with exudative retinal detachment after receiving Toripalimab therapy. Binocular VKHD-like uveitis was suggested as a diagnosis. Both eyes recovered after discontinuing immune checkpoint inhibitors and local and systemic corticosteroid treatment.ConclusionsThis report suggests that VKHD-like uveitis can also occur in patients receiving novel PD-1 antibodies and the importance of paying attention to eye complications in patients receiving treatment over a long period.

Tuberculous ciliary body granuloma initially diagnosed as bullous retinal detachment: a case report

BackgroundOcular tuberculosis is a relatively rare extrapulmonary manifestation of tuberculosis. This vision-threatening disease is extremely challenging to diagnose, particularly because it can mimic other diseases. We report a case of tuberculous ciliary body granuloma initially diagnosed as bullous retinal detachment.Case reportA 52-year-old female presented with bullous retinal detachment in her left eye, and ultrasound biomicroscopy (UBM) verified the presence of a lesion with ciliary body granulomatous inflammation. The T-SPOT was positive, and the purified protein derivative (PPD) test was strongly positive (diameter of 20 mm). Following the administration of oral anti-tuberculosis regimen combined with prednisone, the retina gradually became reattached, the ciliary body granuloma became significantly reduced in size, and the visual acuity of the patient noticeably improved.ConclusionsTuberculous ciliary body granulomas can cause bullous exudative retinal detachment and can be diagnosed with UBM. Early and full-course anti-tuberculosis treatment (ATT) combined with corticosteroid therapy can improve the patient prognosis.

Visual Outcomes in Malignant Hypertensive Retinopathy Cases: A Clinical and Spectral Domain Optical Coherence Tomography Study.

Objective The objective is to correlate visual outcomes in malignant hypertensive retinopathy with changes in systemic causative factors and spectral domain optical coherence tomography (SD OCT) morphologic parameters. Materials and methods This is a prospective observational study including patients presenting within two weeks of acute rise of systolic blood pressure (SBP) ≥ 180 mm Hg or diastolic blood pressure (DBP) ≥ 120 mm Hg and with posterior segment involvement in both eyes. Baseline SBP, DBP, mean arterial pressure (MAP), best corrected visual acuity (BCVA), and SD OCT parameters such as central macular thickness (CMT), subfoveal choroidal thickness (SCT), and sub-retinal fluid (SRF) height were measured at presentation and followed monthly up to three months. These variables at baseline and three months were compared and correlated. Results Thirty-three patients (66 eyes) having malignant hypertension were included in the study. Diverse clinical presentations noted among patients were optic disc edema, hard exudates in the macula, peripapillary splinter hemorrhage, cotton wool spots, Elschnig spots, exudative retinal detachment, optic neuropathy, and severe exudative retinopathy. SD OCTshows hyperreflective dots and intraretinal fluid with or without SRF.At three months, the mean SBP, DBP, MAP, CMT, SRF, and SCT all decreased significantly from baseline (p<0.001). Changes in SBP, DBP, MAP, and SCT correlated significantly with changes in BCVA (p<0.001). Conclusion In malignant hypertensive retinopathy, macular edema with SRF is the major cause of mild-to-moderate decrease BCVA at presentation, but macular ischemia, exudative RD, and optic neuropathy can cause a significant decrease in vision. A decrease in SBP, DBP, MAP, and SCT correlatesignificantly with visual outcomes.

Ruthenium-106 (106Ru) plaque brachytherapy for treatment of circumscribed choroidal hemangioma.

To describe the clinical and imaging features of circumscribed choroidal hemangiomas (CCH) and their treatment outcomes with Ruthenium-106 (106Ru) plaque brachytherapy. Retrospective study of 24 patients (24 eyes) diagnosed with CCH and treated with 106Ru plaque between 2017 and 2022. Analysis included pre- and post-treatment clinical and imaging features such as tumor regression, reduction in height, subretinal fluid (SRF) resolution, and change in best-corrected visual acuity (BCVA). The mean age at presentation was 36 years (range, 16-57). The most common tumor location was the temporal quadrant (n = 19) with macular involvement (n = 13). Associated features were macular SRF (n = 22) and inferior exudative retinal detachment (n = 10). Nineteen of the 24 patients underwent primary treatment, whereas 5 patients underwent plaque as a salvage treatment. The mean tumor apex dose was 40 Gy. At a median follow-up of 7.5 months (range 3-65 months), 18 eyes showed complete regression, whereas 6 eyes showed partial regression. The mean height decreased from 4.8 (SD 1.28) mm at presentation to 2.5 (SD 1.63) mm. Median BCVA improved from logMAR 1.2 (IQR 0.4-2) at baseline to logMAR 1.05 (IQR 0.1-1.95) (p = 0.4). Complete resolution of the macula and tumor SRF was observed in 15 (68%) and 13 (57%) eyes, respectively. The radiation-related complications observed were radiation maculopathy (4 eyes), retinopathy (1 eye), and vitreous hemorrhage (1 eye). Ruthenium-106 plaque brachytherapy is effective for CCH (> 3 mm height) as a primary and salvage treatment for tumors unresponsive to other modalities.

Ruthenium-106 Plaque Brachytherapy for Circumscribed Choroidal Hemangioma: A Case Series and Review of Literature

Introduction: We aim to report the anatomical and functional outcomes of ruthenium-106 brachytherapy in the management of circumscribed choroidal hemangiomas (CCH). Methods: This is a single-center, retrospective case series including patients with unilateral symptomatic CCH treated with ruthenium-106 brachytherapy at the Cairo University Ocular Oncology Service. Patient records were analyzed for patients’ demographics, best corrected visual acuity (BCVA), tumor dimensions (thickness and largest base diameter), foveal subretinal fluid, radiation-related complications, and recurrence. Results: Seven patients were included in the study (including 6 males) with a mean age of 39.3 ± 15.4 years; ruthenium-106 plaque was used to deliver 50 Gray to the tumor apex. After a mean follow-up duration of 12.5 months, all patients had significant improvement in BCVA after treatment, mean tumor height decreased significantly from 4.76 ± 1.76 mm to 1.70 ± 1.2 mm (p value 0.01). The largest tumor base diameter also decreased significantly from 9.13 ± 2.68 mm to 4.65 ± 3.75 mm (p value 0.05). Subretinal fluid and exudative retinal detachment resolved in all patients, and no significant radiation-related complications were observed in any patient. None of the patients needed any further treatment or experienced recurrence within the follow-up period. Conclusion: Ruthenium-106 brachytherapy is an effective tool in the management of symptomatic CCH with a good visual prognosis and safety profile.

Visual outcome of cataract surgery in paediatric uveitis

1. To analyse the visual outcome in patients of paediatric uveitis who underwent cataract surgery; 2. To analyse the post-operative complications of cataract surgery in paediatric uveitis.Retrospective observational study was done on patients of uveitis who underwent cataract surgery. Patients who were under 18 years and co-operative for examination were included.They underwent Phacoaspiration with posterior chamber IOL implantation by a single surgeon after 3 months of activity free interval, BCVA(in Log MAR) in every follow up, anterior segment examination using slit lamp and posterior segment examination using IDO, post-operative complications and Intra ocular pressure was recorded using Noncontact tonometer.Uveitis was classified using the SUN classification of uveitis. Use of corticosteroids, biologics and immunosuppressive drug were collected at each visit. Total of 18 subjects diagnosed with cataract as a complication of uveitis &amp; undergone cataract surgery were studied (6 were females, 12 were males) 9 had anterior uveitis, 1had intermediate uveitis and 5 had pan uveitis. JRA (66.7%) was the most common cause identified. Improvement in vision from baseline was observed post-surgery at the end of first, third and 6th month which was statistically significant (P- Value &amp;#60;0.05). Average duration of disease before they underwent surgery was 18 months. Most common post op complication was posterior capsular opacification (50 %), others include secondary glaucoma (38.9), exudative retinal detachment (5.6%) and Vitritis (22.2%)Unlike adult uveitic patients, the surgical management of paediatric uveitic cataract is both challenging and controversial, and the surgery itself has been associated with poor visual outcomes. However, our study had shown that with implantation of IOL, good immunosuppressants and control of the disease can give these children a good visual outcome.