Exudative Retinal Detachment Research Articles

THERAPEUTIC OUTCOMES AFTER ENDORESECTION OF COMPLEX RETINAL CAPILLARY HEMANGIOBLASTOMA.

To evaluate the anatomical and functional outcomes after endoresection of complex retinal capillary hemangioblastoma (RCH). Retrospective case series of 12 patients (13 eyes), all treated with pars plana vitrectomy, endodiathermy of feeding and draining vessels, endoresection of RCH and silicone oil injection. The mean age at the time of surgery was 32.5 ± 15.9 years. The mean follow-up duration after initial surgery was 50.5 ± 49.4 months. Indications for surgery included RCH with associated complications such as tractional retinal detachment in five eyes (38%), exudative retinal detachment in four eyes (31%), and combination of tractional retinal detachment and exudative retinal detachment in four eyes (31%). The dimensions of the resected RCHs were as follows: >3.0 mm in seven eyes (54%), >3.5 mm in three eyes (23%), and >4.0 mm in three eyes (23%). No tumor was located closer than 10 mm to the optic nerve or fovea. Anatomical success after initial surgery was 92%. One eye had a second vitreoretinal procedure owing to recurrent RD. The mean preoperative Snellen visual acuity was 20/303. The mean Snellen visual acuity at the final visit was 20/73. At the final visit, visual acuity had improved in seven eyes (54%), and six eyes (46%) were stable. Short-term complications included recurrent proliferative vitreoretinopathy in one eye (8%), transient ocular hypertension requiring topical antiglaucoma treatment in four eyes (31%), and long-term complications included progression of cataract in seven eyes (54%). Combined pars plana vitrectomy, endodiathermy of feeding and draining vessels, endoresection of RCH, and silicone oil injection may be an effective treatment option for complex RCH, achieving high anatomical success and stable or even improved visual acuity, acceptable rates of disease- and treatment-related complications, and minimal need for retreatment.

Just another metastatic carcinoid tumour to the uveal tract

We describe the clinic, image, and histopathologic features of a well differentiated neuroendocrine carcinoma (carcinoid tumour) metastatic to choroid and ciliary body in a 52-year-old Mexican Mestizo man. The ophthalmologic examination showed an inferior choroidal mass accompanied by exudative retinal detachment. Ultrasound B-Scan study revealed a diffuse thickened choroid with overlying serous retinal detachment, ultrasound A-Scan revealed a high internal reflectivity solid lesion. Ultrasound biomicroscopy (UBM) evidenced a dome shaped ciliary body mass, presumptive diagnosis was uveal tract metastatic disease. Scleral flap choroidal incisional biopsy was performed. Microscopic evaluation demonstrated a hypercellular lesion replacing choroid, composed by cohesive oval-round cells with finely granular chromatin arranged in organoid pattern. Immunohistochemical reactions were Pankeratin AE1/AE3 (+), Cytokeratin CK5/6 (+), Chromogranin A (+), Ki67 (20%), typical well differentiated neuroendocrine carcinoma (carcinoid tumour) was diagnosed. Patient had a mediastinal carcinoid diagnosed 3 years earlier. Metastatic cancer to the eye is perhaps the leading cause of intraocular tumour, despite this fact metastases are rarely seen by the ophthalmologist while the patient is alive. Intraocular metastasis should be considered in the presence of ciliary body or/and choroidal amelanotic or pigmented mass and serous retinal detachment in a patient with history of carcinoid tumor, althought its low frequency (2.2%).

Actualización sobre el manejo del tumor vasoproliferativo

Case reportHere we report a 19-year-old female patient who presented a vasoproliferative tumour. It caused complications, such as epiretinal membrane, macular oedema, vitreous haemorrhage, and exudative retinal detachment. The patient was treated with 3 injections of intravitreal bevacizumab, an intravitreal dexamethasone implant, tocilizumab, and double freeze-thaw cryotherapy. DiscussionTherapeutic options are: observation, if it is small, if it is a peripheral lesion, and if there seems to be no threat to vision. If it requires treatment, laser photocoagulation, intravitreal bevacizumab, trans-conjunctival cryotherapy, transpupillary thermotherapy, photodynamic therapy, brachytherapy plaques and surgery are the different options available. Recently, tocilizumab and intravitreal dexamethasone implants have been reported to be beneficial.

Long-Term Outcomes of Total Exudative Retinal Detachments in Stage 3B Coats Disease

To evaluate the long-term outcomes of treatment of total exudative retinal detachments (ERDs) secondary to Coats disease (stage 3B) and the role of vitrectomy. Retrospective, observational case series. A total of 16 eyes in 16 patients undergoing treatment for total ERDs secondary to Coats disease with at least 5 years of follow-up. We reviewed the records of patients with stage 3B Coats disease. The interventions, including the timing of vitrectomy if used, and clinical course were recorded. The primary outcome measures were visual acuity at the most recent appointment, whether there was progression to neovascular glaucoma (NVG) or phthisis bulbi, and need for enucleation. All patients received ablative treatment (photocoagulation or cryotherapy), with 8 having scleral buckling (SB) and 6 having external drainage of subretinal fluid (XD). Of the 12 patients who had pars plana vitrectomy (PPV), 8 had early PPV (EV) in the first year after presenting, and 4 of 8 in the expectant management group had late PPV (late vitrectomy) at a mean of 4.3 years post-presentation for treatment of significant traction retinal detachment (TRD). The other 4 patients of 8 in the expectant management group did not require vitrectomy. Mean follow-up overall was 9 1/2 years. At the date of last follow-up, 50% had no light perception or light perception vision, which was consistent across the subgroups that underwent EV (4/8), late vitrectomy (2/4), or no PPV (2/4). A total of 4 of 16 patients had progression to NVG or phthisis, 1 of whom required enucleation. In this retrospective series of patients with Stage 3B Coats disease, ablative therapy with a combination of PPV, XD, or SB was effective in preventing progression to NVG or phthisis in the majority of patients, thus preserving the globe. Half of the patients (4/8) in this series who did not undergo PPV in the early vitrectomy group developed late-onset TRD, suggesting a possible role for early prophylactic vitrectomy with possible SB and XD; however, this is balanced by the other half (4/8) in the expectant management group who did not require any vitrectomy.

Selective photocoagulation in Coats disease: ten-year follow-up.

The diagnostic hallmark of Coats disease is development of "light bulb" telangiectasis in the retinal periphery, leading to posterior pole intraretinal and subretinal exudation. Even after complete obliteration of all abnormal vessels and resorption of all exudates, follow-up examinations are mandatory for several years. We retrospectively analyzed the charts, pictures and/or fluorescein angiographies of a series of 32 consecutive patients, in which the diagnosis of Coats disease was made. All patients underwent selective photocoagulation of the telangiectasis using a yellow-dye laser. Efficacy of treatment was monitored with drawings and/or fluorescein angiographies. All our patients had unilateral disease, with macular involvement and exudative retinal detachment. Visual acuity improved in one patient, decreased from light perception to blindness in another, and was unchanged in the remainder. This is the first report of anatomical benefits from treatment with a yellow-dye laser (i.e., selective photocoagulation without cryotherapy or drainage) despite the presence of a severe form of Coats disease. Our young Coats patients responded quickly to treatment. With successful obliteration of the abnormal vasculature, exudates began to absorb in about 4 to 8 weeks although, in some cases, 10 to 12 months were needed to obtain resolution of the exudative detachment. Poor visual outcome of 20/100 or worse was common. In Coats patients, the key issue is continuous control and long-term follow-up. (Eur J Ophthalmol 2002; 12: 501-5).

Solitary Retinal Capillary Hemangioma with Nonlipid Exudative Retinal Detachment

Solitary Retinal Capillary Hemangioma with Nonlipid Exudative Retinal Detachment

Oral Furosemide Therapy in Patients with Exudative Retinal Detachment Due to Hypertensive Retinopathy-IV

Introduction: Hypertensive retinopathy is a condition characterized by a spectrum of retinal vascular signs in people with elevated blood pressure. This condition can be accompanied by exudative retinal detachment in hypertensive retinopathy grade IV. Furosemide is considered as a diuretic agent to force fluid absorption across the retinal epithelium. This is consistent with a model for ion transport in the isolated RPE, in which active furosemide-inhibitable transport of chloride from retina to choroid for a significant fraction of the short-circuit current. Objectives: To report the efficacy of oral furosemide in patients with exudative retinal detachment due to hypertensive retinopathy-IV. Case presentation: We reported two young patients, first patient with chronic kidney disease complained with decreased of visual acuity to 20/100 in the right and 20/200 in the left eye. The second patient with preeclampsia suddenly experienced bilateral visual loss to counting finger on both eyes. Those patients showed sub-retinal fluid, macular star and cotton wool spots in both retina. Macular edema was seen by optical coherence tomography (OCT) examination in both eyes. Both cases were diagnosed as hypertensive retinopathy grade IV with exudative retinal detachment. Oral furosemide 40 mg once a day was given. On the first patient visual acuity improve to 20/80 on both eyes and on the second patient visual acuity improve to 20/400 on both eyes. Ocular ultrasonography (USG) examination showed significant decrease of exudative retinal detachment with in the 17 days. Conclusion: Furosemide is diuretic agent and might be effective in resolution of exudative retinal detachment followed by improvement of visual acuities in patient with hypertensive retinopathy grade IV.

Diplopisiz Oküler Distopi ve Eksudatif Retina Dekolmanına Yol Açan Maksiller Sinüs Mukoseli

Mucocele is a cystic lesion occuring by the obstruction of drainage of normal paranasal sinus secretions due to infections, trauma, and rarely tumor. This lesion can impress to orbital contents by eroding orbital bone and it can be confused with malignant tumors. Most mucoceles originate from frontal and ethmoid sinuses, whereas maxillary and sphenoid sinus presentation is rare. In this case report we have presented a maxillary sinus mucocele case leading to asymptomatic inferior exudative retinal detachment and pushing up glob. A 43-year-old woman presented with swelling on her right malar region and lower eyelid lasting one year and increasing last three months. The patient had upward ocular dystopia and an exudative retinal detachment not extending the macula at the inferior retinal area in her right eye. She had diagnosed right maxillary sinus tumor suspicion by clinical examination and imaging methods. Operation was performed by the earnose-throat department. While ocular dystopia completely recovers, exudative retinal detachment was still present at the postoperative first day. As a result, maxillary sinus mucocele can lead to findings such as ocular dystopia without diplopia and exudative retinal detachment, and clinical signs may mimic the tumor.

Management of Retinal Diseases in Pregnant Patients.

Pregnancy leads to significant changes in the body, which potentially affect the retina. Pregnancy can induce disease, such as that seen in hypertensive retinopathy and choroidopathy. It can cause exudative retinal detachments in the HELLP syndrome (hemolysis, elevated liver enzymes and low platelets), disseminated intravascular coagulation (DIC), and thrombotic thrombocytopenic purpura (TTP), and provoke arterial and venous retinal occlusive disease. Pregnancy may also exacerbate pre-existing retinal disease, such as idiopathic central serous chorioretinopathy (ICSC) and diabetic retinopathy. Special consideration needs to be exercised when treating pregnant patients in choosing medications, as well as in selecting diagnostic modalities and surgical methods.

Intraocular metastasis: Comparison of clinical presentation with a known and unknown primary tumour

Abstract Objective The purpose of the present study is to review the frequency of intraocular metastases as first presentation of systemic disease, and to identify clinical and tumour characteristics. Methods Retrospective study of consecutive cases diagnosed of intraocular metastasis at a referral intraocular tumours unit between 1993 and 2014. General, epidemiological and ophthalmological characteristics were recorded. Results A total of 21 patients, with a mean age 62.7 years (31–89) were diagnosed with intraocular metastasis between 1993 and 2014. Both eyes were affected in 4 cases. Location was choroid in 20 cases. The intraocular tumour was the first manifestation of the systemic disease in 13 patients (61.9%). Primary tumour was breast in 47.6% and lung in 23.8%. Diagnosis of the primary tumour was performed by systemic studies, and only 1 patient required intraocular biopsy. Regarding the treatment, the majority of cases were controlled with systemic therapy, with 4 cases requiring additional external beam radiotherapy, and only one enucleation. No clinical differences were found between the cases with known and unknown systemic neoplasia, except in exudative retinal detachment, which was more frequent in the second group. Conclusions Although intraocular metastases are the most frequent intraocular tumour, they are not a frequent cause of consultation. In more than half of the cases it is the first presentation of unknown systemic neoplasia as a solitary non-pigmented intraocular mass. Early diagnosis is crucial to establish the appropriate treatment, preserve visual function, and improve the prognosis of the patient.

Retinal detachments in the pediatric population.

In this review, we present a concise summary of the more commonly seen types of retinal detachments (RDs) that one can encounter in pediatric patients. A spectrum of diseases from rhegmatogenous RD in Stickler syndrome, Marfan syndrome, and choroidal coloboma to exudative RD in Coats disease, to tractional RD in persistent fetal vasculature, and combined RDs in familial exudative vitreoretinopathy are described with the management pearls for each.

Bilateral Choroidopathy, Nephritis and Hypertension in Systemic Lupus Erythematosus

A 18-year-old woman with systemic lupus erythematosus (SLE) presented with right sided migraine and blurred vision of the right eye. Ophthalmologic evaluation revealed multiple bilateral exudative retinal detachments, with increased choroidal thickness measured with optical coherence tomography (OCT). Acute renal dysfunction contraindicated fluorescein or indocyanine green angiography. The presence of choroidopathy was the first presentation of lupus nephritis. She was treated with corticosteroids and immunosuppressive agents with resolution of serous retinal detachments and complete remission of proteinuria and renal function. OCT may be a key exam for the early diagnosis of choroidopathy and implementation of appropriate therapeutic measures, necessary to prevent permanent damage.

Samoistne jednostronne wysiękowe odwarstwienie siatkówki jako pierwszy objaw raka płuca

Samoistne jednostronne wysiękowe odwarstwienie siatkówki jako pierwszy objaw raka płuca

Sympathetic ophthalmia associated with uncomplicated retinal detachment surgery in a young male: An uncommon entity

Sympathetic ophthalmia (SO) is a rare, bilateral granulomatous panuveitis of unknown etiology that follows accidental or surgical trauma to the uveal tissue of one eye. We describe an unusual case of an 11-year-old male patient who developed SO following retinal detachment (RD) repair in conjunction with pars plana vitrectomy in the right eye (RE). Twenty days following surgery, the patient presented with a recurrent RD in RE and bilateral multifocal exudative RDs, inflamed optic nerve with characteristic changes of SO detected by fluorescein angiography, and ultrasound B-scan in the left eye (LE). Aggressive and effective management with topical and systemic immunosuppressive agents permitted control of the disease with good visual outcome in LE.

Cataract development in children with Coats disease: risk factors and outcome

To describe the clinical features of cataract during the course of Coats disease and to determine its risk factors and effects on the long-term visual outcome. The medical records of consecutive patients with Coats disease followed for at least 2years were analyzed retrospectively. Ophthalmological examination, ancillary tests, and treatment modalities were reviewed. The time of cataract diagnosis and its management were recorded. Parameters influencing cataract development and final visual outcome were investigated using uni- and multivariate analysis. A total of 57 patients (mean age, 5.0±4.0years; 51 males) were included; cataract formation was observed in 16 (28%) during a mean follow-up of 7.1±3.7years. The mean time from diagnosis of Coats disease to cataract detection was 25±22months. Total white cataract developed in 12 patients (75%); posterior subcapsular cataract, in 4 (25%). Cataracts were surgically removed in 10 patients to improve fundus visualization and clinical follow-up. Presence of exudative retinal detachment at diagnosis was an independent risk factor for cataract formation (P=0.031). Cataract development was associated with more advanced disease stages (P<0.001). History of cataract was a significant predictor for worse final visual outcome (P<0.001), independent of disease stage (P=0.003) and presence of macular complication, such as atrophy, fibrosis, or tractional retinal detachment (P<0.001, adjusted R2=0.83). Cataract development is frequent in children with Coats disease and aggravates the visualprognosis. Exudative retinal detachment at diagnosis, present in more advanced disease stages, is an independent risk factor for cataract formation.

AAV8-antiVEGFfab Ocular Gene Transfer for Neovascular Age-Related Macular Degeneration.

Sustained suppression of VEGF is needed in many patients with neovascular age-related macular degeneration (NVAMD), and gene transfer of a VEGF-neutralizing protein is a promising approach to achieve it. Initial clinical trials testing this approach have shown encouraging signals, but evidence of robust transgene expression and consistent antiangiogenic and antipermeability activity has been lacking. In this study, we demonstrate expression of an anti-human VEGF antibody fragment (antiVEGFfab) after subretinal injection of AAV8-antiVEGFfab. In transgenic mice expressing human VEGF in retina (rho/VEGF mice), a model of type 3 choroidal neovascularization (NV), eyes injected with ≥1× 107 gene copies (GC) of AAV8-antiVEGFfab had significantly less mean area of NV than null vector-injected eyes. A dose-dependent response was observed with modest reduction of NV with ≤3× 107, >50% reduction with ≥1× 108 GC and almost complete elimination of NV with 3× 109 or 1× 1010 GC. In Tet/opsin/VEGF mice, in which doxycycline-induced high expression of VEGF leads to severe vascular leakage and exudative retinal detachment (RD), reduction of total RD by 70%-80% occurred with 3×109 or 1× 1010 GC of AAV8-antiVEGFfab, an effect that was sustained for at least a month. These data strongly support initiating clinical trials testing subretinal injection of AAV8-antiVEGFfab in patients with NVAMD.

Panretinal Photocoagulation: A Review of Complications

ABSTRACT Panretinal photocoagulation (PRP) is a mainstay of therapy for retinal ischemic disease. The procedure involves creating thermal burns in the peripheral retina leading to tissue coagulation, the overall consequence of which is improved retinal oxygenation. While highly effective, there have been concerns historically regarding the anatomic effects and visual complications following PRP, the most common of which include choroidal effusions, exudative retinal detachments, macular edema, visual field deficits, and night vision defects. The occurrence of these complications is closely tied to laser parameters such as increased duration and power and intensive treatment in a single sitting, all of which cause increased dispersion of thermal energy within the retina and choroid. The advent of newer laser delivery systems, such as the multispot pattern laser, has greatly mitigated but not eliminated these issues. The following article reviews the most common complications following PRP treatment, including reported occurrences, inciting factors, and underlying pathophysiology.

Unilateral Adult Xanthogranulomatous Infiltration of the Conjunctiva, Limbus and Sclera Leading to a Combined Ophthalmic Artery and Central Retinal Vein Occlusion.

Objective:To describe the features of a female patient with a biopsy-proven xanthogranulomatous infiltration of the conjunctiva, limbus and sclera who had an exudative retinal detachment, combined ophthalmic artery and central retinal vein occlusion unilaterally.Method:A-53-year old otherwise healthy woman presenting with a painful visual loss in her right eye underwent an ophthalmic examination, meticulous systemic work-up and histopathologic assessment.Results:Ophthalmic examination revealed multiple subconjunctival masses, upper limbal infiltrations, trace cells in the anterior chamber, pale looking posterior fundus, 360 degree scattered retinal hemorrhages and marked exudative retinal detachment in her right eye. Left eye was completely normal.A biopsy taken from one of the subconjunctival masses demonstrated a diffuse infiltration of the histiocytes and this was interpreted as a xanthogranulomatous infiltration with the help of immunohistochemical staining techniques.Conclusion:Present case is the only reported adult case with xanthogranulomatous-like infiltration of the eyeball featuring both anterior and posterior segment involvement without any concomitant major systemic disturbances.

Panuveitis simulating ocular Behçet’s in cases of chronic myelogenous leukaemia in remission

We report two patients with chronic myelogenous leukaemia (CML) in remission phase who developed panuveitis simulating Behçet’s disease. A 26-year-old man presented with bilateral panuveitis (hypopyon in the right eye,...

Gene Therapy Restores Mfrp and Corrects Axial Eye Length

Hyperopia (farsightedness) is a common and significant cause of visual impairment, and extreme hyperopia (nanophthalmos) is a consequence of loss-of-function MFRP mutations. MFRP deficiency causes abnormal eye growth along the visual axis and significant visual comorbidities, such as angle closure glaucoma, cystic macular edema, and exudative retinal detachment. The Mfrprd6/Mfrprd6 mouse is used as a pre-clinical animal model of retinal degeneration, and we found it was also hyperopic. To test the effect of restoring Mfrp expression, we delivered a wild-type Mfrp to the retinal pigmented epithelium (RPE) of Mfrprd6/Mfrprd6 mice via adeno-associated viral (AAV) gene therapy. Phenotypic rescue was evaluated using non-invasive, human clinical testing, including fundus auto-fluorescence, optical coherence tomography, electroretinography, and ultrasound. These analyses showed gene therapy restored retinal function and normalized axial length. Proteomic analysis of RPE tissue revealed rescue of specific proteins associated with eye growth and normal retinal and RPE function. The favorable response to gene therapy in Mfrprd6/Mfrprd6 mice suggests hyperopia and associated refractive errors may be amenable to AAV gene therapy.