Resolution Of Exudative Retinal Detachment Research Articles

Orbital cellulitis with exudative retinal detachment: A rare finding

Abstract Orbital cellulitis is a rare cause of exudative retinal detachment (ERD). We hereby present a case of orbital cellulitis associated with ERD from North India. A 42-year-old man presented with features of orbital cellulitis in the left eye for 3 days. An ERD lesion was found in the superior-temporal quadrant of the retina of the same eye. Investigations were performed; however, the cause of orbital cellulitis could not be found. Systemic antibiotics were started, leading to improved orbital cellulitis and resolution of ERD. Orbital cellulitis can be treated with systemic antibiotics. The cure of underlying disease leads to the resolution of ERD.

Sudden Vision Loss Secondary to Optic Nerve Infiltration as a Presenting Symptom of Metastatic Lung Adenocarcinoma

To report a rare case of left-sided metastatic optic nerve infiltration and right-sided choroidal mass with exudative retinal detachment caused by EGFR exon 19 deletion positive non-small-cell lung adenocarcinoma that responded to targeted therapy with osimertinib (EGFR-TKI). Our patient demonstrated an excellent response with reduced size of the metastatic choroidal mass of the right orbit and improved visual acuity, in addition to systemic disease control. A 66-year-old male patient with a history of diabetes mellitus, hypertension, and tobacco use presented with sudden vision loss in the left eye secondary to optic nerve infiltration and subacute vision loss in the right eye secondary to exudative retinal detachment from a choroidal metastasis. He was found to have a right lung mass, multiple metastatic pulmonary nodules, and liver and bone metastases. Biopsy from a mediastinal lymph node confirmed the diagnosis of metastatic lung adenocarcinoma. He was found to have exon 19 deletion on next-generation sequencing. We treated him with local radiation therapy to the left eye and systemic osimertinib (EGFR-TKI). To our knowledge, our case is the first report of a patient who initially presented with acute vision loss and was found to have metastatic retrobulbar optic nerve infiltration in one eye and metastatic choroidal lesion with exudative retinal detachment in the fellow eye secondary to lung adenocarcinoma. Due to the rarity of this condition, literature regarding effective treatment is scarce. Our patient demonstrated significant improvement in visual acuity and resolution of exudative retinal detachment in the right eye following osimertinib treatment and radiation therapy to the left eye. Further investigation into the role of tyrosine kinase inhibitors and radiation therapy in treating intraocular metastasis involving the optic nerve is needed.

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.

Intravitreal dexamethasone implant (Ozurdex®) for exudative retinal detachment after proton beam therapy for choroidal melanoma.

To evaluate the efficacy and safety of intravitreal 0.7-mg dexamethasone implant (DEX-I) (Ozurdex®) in the treatment of extensive exudative retinal detachment (RD) associated with uveal melanoma treated using proton beam therapy (PBT). Data from 10 patients with exudative RD after PBT treated with intravitreal injection of 0.7-mg DEX-I were reviewed retrospectively. The main outcome measures were resolution of exudative RD, visual acuity, and safety profile. Mean age was 55.6 years (range 34-85). Mean time between PBT and DEX-I was 12.4 months (range 3-25). Mean follow-up was 9.9 months (range 4-15). Intravitreal Ozurdex® reduced exudative RD in 7 cases (70%) on average 3.1 months after injection with complete resolution of RD in 6 of these (60%). For half of the patients, their level of vision remained stable; the other half experienced a deterioration in visual acuity at the end of follow-up. No adverse effects were observed. In this small case series, treatment with intravitreal DEX-I reduced exudative RD in the majority of cases and had an acceptable safety profile.

Advanced Coats' disease treated with intravitreal bevacizumab combined with laser vascular ablation.

PurposeTo evaluate the impact of intravitreal bevacizumab combined with laser vascular ablation in the management of advanced Coats’ disease presenting with exudative retinal detachment.MethodsThis was a retrospective review of 24 children that presented with exudative retinal detachments associated with advanced Coats’ disease. Mean patient age was 62 months (range 9–160 months). Presenting signs included retinal detachment in 24 children (100%), vascular telangiectasia in 24 children (100%), and retinal ischemia in 24 children (100%). Twenty of 24 children presented with elevated, vascular leakage in the fovea (83%). Two children presented with sub-retinal fibrosis associated with presumed long-standing retinal detachment without evidence of rhegmatogenous retinal detachment. Ten patients exhibited vascular alterations in the periphery of the second eye without clinical evidence of exudation. All 24 children were treated with a large-spot-size diode laser directly to areas of abnormal telangiectatic vasculature. All 24 children received intravitreal bevacizumab injection.ResultsAll 24 children had resolution of exudative retinal detachment, ablation of vascular telangiectasia, and anatomic improvement of the retina. No child exhibited progressive retinal detachment and no eye required enucleation. No cases of neovascular glaucoma were seen. Fellow eyes with peripheral vascular alterations showed no progression to exudative vasculopathy during the observation period. Intravitreal bevacizumab injection was not associated with endophthalmitis or systemically-observed complications.ConclusionRepetitive intravitreal bevacizumab combined with laser vascular ablation may be utilized effectively for advanced Coats’ disease presenting with exudative retinal detachment.

Resolution of exudative retinal detachment and regression of retinal macrocyst post-laser in Coats disease

A 15-year-old boy presented with painless progressive blurring of vision in the right eye for 1 year in duration. His visual acuity in the right eye was hand movement. The right fundus showed presence of extensive subretinal exudates at the posterior pole and a retinal macrocyst at the temporal periphery. It was associated with exudative retinal detachment at the inferior periphery of the retina. Fundus angiography revealed telangiectatic retinal vessels at the superotemporal retina. Based on clinical and angiographic findings, a diagnosis of Coats disease was made. He was treated with retinal laser photocoagulation. There was resolution of the exudative retinal detachment, reduction of subretinal exudates, and regression of the retinal macrocyst with improvement of visual acuity to 1/60 post-laser therapy.

Intravitreal bevacizumab combined with plaque brachytherapy reduces melanoma tumor volume and enhances resolution of exudative detachment

BackgroundThe purpose of this study was to evaluate intravitreal bevacizumab as an adjuvant treatment to plaque brachytherapy in the treatment of choroidal melanoma.MethodsThis was a retrospective, consecutive study of 124 patients treated from 2007 to 2009 for choroidal melanoma with plaque brachytherapy. Patients were treated with I-125 plaque brachytherapy with 2 mm margins and 85 Gy to the tumor apex. Consecutive patients were injected intravitreally with 2.5 mg/0.1 mL bevacizumab at a site away from the primary tumor and immediately following plaque removal. Choroidal melanomas were observed using indirect ophthalmoscopy, wide-angle photography, and ultrasound. The main outcome measures were tumor volume, resolution of exudative retinal detachment, and visual acuity.ResultsOne hundred and twenty-four patients met our inclusion criteria and were included in the analysis. The mean patient age was 65.7 years, and the mean apical tumor height was 4.0 ± 2.7 mm and basal diameter was 12.7 ± 3.0 mm. Mean follow-up was 24 months. Prior to treatment, 100% of tumors had exudative retinal detachment, and pretreatment visual acuity was 20/55 (median 20/40). Tumor control was 100%, metastasis was 0% at last follow-up, and 89.8% had complete resolution of exudative retinal detachment, with a mean time to resolution of 3.36 months. At one month, 43% had complete resolution of exudative retinal detachment, which increased to 73% at 4 months. Visual acuity was 20/62 (median 20/40) at 4 months, with stabilization to 20/57 (median 20/40) at 8 months, 20/56 (median 20/30) at 12 months, and 20/68 (median 20/50) at 24 months. Tumor volume following combined therapy was shown to be reduced by 22.2% at 3 months, 28.9% at 6 months, 39.3% at 12 months, and 52.2% at 24 months (all P < 0.001). All patients tolerated the procedure well without systemic side effects.ConclusionIntravitreal bevacizumab may be used as an adjuvant agent following plaque brachytherapy. Treated choroidal melanomas show reduction in tumor volume as well as resolution of exudative retinal detachments.

Systemic Bevacizumab (Avastin) for Exudative Retinal Detachment Secondary to Choroidal Melanoma

To evaluate the safety and effect of systemic anti-vascular endothelial growth factor bevacizumab (Avastin) in treatment of exudative retinal detachment secondary to choroidal melanoma. Two patients were definitively treated with ophthalmic plaque radiation therapy and subsequently given 10 mg/kg intravenous bevacizumab every 2 weeks for 3 or 4 cycles. Complete resolution of the exudative retinal detachments occurred 1.2 months and 6.5 months after completion of systemic bevacizumab and 4.7 and 10 months after plaque therapy. The first patient's visual acuity improved from counting fingers at 1 foot to 20/80 (at 40 months), while his tumor regressed from 9.2 to 3.7 mm in apical height. The second patient's initial acuity was 20/20 and final acuity was 20/80 (at 35 months), while her tumor height regressed from 12.2 to 6.3 mm. No exudative retinal detachment, intraocular or systemic tumor recurrence was noted up to 40 and 35 months, respectively. Acute side effects of intravenous bevacizumab therapy included hypertension, headaches, and amenorrhea, which shortly resolved after completion of therapy. This pilot study suggests that systemic bevacizumab was associated with transient systemic effects as well as resolution of choroidal melanoma-related exudative retinal detachment.

Unusual rapid resolution of posttrabeculectomy exudative retinal detachment with only topical corticosteroid therapy in a case of nanopthalmos.

The purpose of this study was to report a case of nanophthalmos with unusual rapid resolution of exudative retinal detachment, which had developed the fifth day after filtering surgery with only topical corticosteroid therapy. Five days after an uncomplicated trabeculectomy for the management of glaucoma, the patient developed exudative retinal detachment. Without choroidal drainage and any other treatment, exudative retinal detachment started resolving in 2 days and disappeared in 2 weeks under only topical corticosteroid therapy. Topical corticoid therapy alone may be sufficient to achieve quick resolution of exudative retinal detachment secondary to glaucoma surgery in nanophthalmic eyes.

Predominant exudative retinopathy in incontinentia pigmenti and clinical course after peripheral laser photocoagulation

Dear Editor, Incontinentia pigmenti (IP) (Bloch-Sulzberger syndrome) is an X-linked condition with dermatological, dental, neurological and ocular abnormalities. Ocular abnormalities occur in 25–77% cases of IP.[1] The characteristic manifestation is a proliferative retinopathy which includes peripheral retinal vascular nonperfusion, preretinal neovascularization, preretinal or vitreous hemorrhage and infantile tractional retinal detachment.[2] In contrast, an early presentation of IP as predominant exudative retinopathy is not commonly reported.[3] We report a case of IP with predominant exudative retinopathy and successful resolution after laser photocoagulation. A 50-day-old female infant was referred for ophthalmology examination from pediatric neurology. The infant was born with an uneventful normal delivery at term and a birth weight of 3000 g. The infant had a vesicular rash on extremities at birth and seizures since second day of life. The infant was diagnosed as IP based on the typical skin lesions [Fig. 1a], magnetic resonance imaging (MRI) findings and pathological findings on skin biopsy.Figure 1: (a) Skin lesions on the trunk and the arm; (b) fundus right eye shows abnormally dilated and tortuous posterior pole vessels, exudative retinal detachment and multiple hemorrhages; (c) right eye, 1 month after laser with residual lipid exudates and nasal falciform fold; (d) right eye, 6 months after laser shows nasal falciform fold and submacular scar (arrow)On fundus examination of right eye, there were dilated and tortuous vessels with exudative retinal detachment at the posterior pole [Fig. 1b]. On indirect ophthalmoscopy with scleral indentation, there was 360° peripheral avascular retina with multiple preretinal hemorrhages. The left eye revealed dilation of posterior pole vessels, minimal exudation in posterior pole, few preretinal hemorrhages and peripheral avascular retina. In view of severe vascular abnormalities, the infant underwent bilateral laser photocoagulation of the entire peripheral avascular retina with diode laser (IRIS Medical Oculight SL, 810 nm infrared laser, Iris Medical Inc., Mountain View, CA, USA) (right eye 1123 spots, left eye 925 spots;400 msec, 400 mW). One-week post laser, there was reduction in vascular tortuosity and exudative retinal detachment in the right eye. There was complete resolution of exudative retinal detachment with a nasal falciform fold at 1-month follow-up [Fig. 1c]. The subretinal exudates resolved over a 3-month period with submacular scar. The left eye changes resolved completely without any sequelae. The infant shows a stable clinical course at 6 months [Fig 1d]. The present case had a predominant exudative response in contrast to the usual proliferative retinopathy seen in majority of cases of IP. These unusual findings are similar to a rare case described previously, which postulated these changes as an inflammatory chorioretinitis.[3] The exact etiology of these changes was unknown and the outcome not described. Subsequently, subretinal exudation containing melanin laden macrophages and lipofuscin was documented in eyes enucleated for total retinal detachment in IP.[4] The etiology of the neovascular retinopathy is more clear, which may result due to oxygen insufficiency caused by peripheral retinal non-perfusion.[2] The extensive exudation seen in the present case appears similar to other disorders like familial exudative vitreo-retinopathy and Coats disease with avascular retina and an abnormal capillary bed. Similar to these disorders, laser photocoagulation was successful in resolution of exudation. A previous study reports successful outcome after laser photocoagulation for proliferative retinopathy of IP.[5] In conclusion, exudative retinopathy in IP is uncommon and can be successfully treated with laser photocoagulation of peripheral avascular retina.

Ruthenium-106 Plaque Therapy for Diffuse Choroidal Hemangioma in Sturge-Weber Syndrome

Diffuse choroidal hemangiomas associated with Sturge-Weber syndrome (SWS) are classically treated with external beam radiotherapy (EBR), but there are a few reports usually of single cases indicating the usefulness of plaque therapy. We present our observations on two cases of diffuse choroidal hemangiomas with exudative retinal detachment associated with SWS treated with Ruthenium-106 plaque therapy. Outcomes included best-corrected visual acuity (BCVA) and regression in tumor thickness measured by ultrasonography. The initial BCVA of the affected eyes was counting fingers at 1 meter and light projection. Pretreatment tumors thickness was 3.5 mm and 4.7 mm. In a follow-up period of 18–24 months, significant reduction in thickness of choroidal hemangiomas up to 1.2 mm and 1.4 mm with prompt resolution of exudative retinal detachment was observed. BCVA achieved 20/200 and 20/400, respectively. The findings in this paper indicate that Ruthenium-106 plaque therapy is effective in treatment of diffuse choroidal hemangiomas associated with SWS.

Gamma Knife Radiosurgery for Choroidal Hemangioma

Patients with choroidal hemangioma (CH), a benign ocular hamartoma, frequently presents with visual disturbance as a result of exudative retinal detachment (RD), which originates in subretinal fluid accumulation. We report our experience using the Leksell Gamma Knife in the management of symptomatic CH. Seven patients with symptomatic CH (circumscribed form in 3 patients and diffuse form in 4) were treated with the Leksell Gamma Knife at our institution during a 7-year period. All patients presented with exudative RD involving the macula that resulted in severe visual deterioration. The prescription dose to the target margin was 10 Gy in all cases. The mean tumor volume receiving the prescription dose was 536 mm3 (range, 151-1,057). The clinical data were analyzed in a retrospective fashion after a mean follow-up of 34.4 months (range, 9-76). The resolution of exudative RD was achieved within 6 months, and the visual acuity of the affected eye had improved at the latest follow-up examination (p=.018) in all patients. No recurrence of exudative RD occurred. Thinning of the CHs was observed in most patients; however, symptomatic radiation toxicity had not developed in any of the patients. Symptomatic CHs can be safely and effectively managed with Gamma Knife radiosurgery using a marginal dose of 10 Gy.

Neuroophthalmological findings of sarcoidosis and Vogt‐Koyanagi‐Harada syndrome

AbstractBesides common ocular manifestations neurologic involvement including optic nerve disease, cranial nerve palsies and disorders of the hypothalamus and pituitary gland was also identified in 12% of patients with sarcoidosis. Facial nerve palsy is the most common but usually self‐limited neurological manifestation. Optic nerve involvement is the most common neuroophthalmic manifestation. Papilledema, compressive, ischemic, or neuritic optic neuropathy due to granulamatous infiltration of any part of the optic nerve may be seen. Lacrimal gland involvement is also common and is usually asymptomatic. Extensive granulomas may lead to diplopia. Orbital symptoms may mimic other inflammatory syndromes. Like sarcoidosis Vogt‐Koyanagi Harada is a disorder characterized with bilateral, granulomatous panuveitis associated with central nervous system and auditory manifestations. At prodromal stage lumbar puncture reveals a pleocystosis, ultrasonography shows diffuse thickening of the choroid tissue. At this stage patients typically report severe headaches, nausea, meningismus, dysacusia, tinnitus, and may even have fever, orbital pain and photophobia. Prodromal phase usually lasts for several days, which may persist for several weeks. It is followed by acute uveitic phase, characterized by bilateral choroiditis, vitritis and papillitis. After that chronic phase is seen with vitiligo, poliosis and resolution of exudative retinal detachments. Neuroophthalmological manifestations may help in diagnosis of rare disorders like Sarcoidosis and VKH syndrome.

Resolution of Exudative Retinal Detachment From Retinal Astrocytoma Following Photodynamic Therapy

Resolution of Exudative Retinal Detachment From Retinal Astrocytoma Following Photodynamic Therapy

Rate of Resolution of Exudative Retinal Detachment After Plaque Radiotherapy for Uveal Melanoma—Correction

Rate of Resolution of Exudative Retinal Detachment After Plaque Radiotherapy for Uveal Melanoma—Correction

Rate of resolution of exudative retinal detachment after plaque radiotherapy for uveal melanoma.

To determine the clinical relevance of exudative retinal detachment (ERD) and the rate of ERD resolution after plaque radiotherapy of posterior uveal melanomas. Retrospective, nonrandomized study of 135 consecutive patients with posterior uveal melanoma treated by iodine 125 plaque radiotherapy. Extent of ERD and tumor thickness were assessed before radiotherapy and at postoperative follow-up visits. Local tumor control was assessed at each follow-up visit. An ERD was present in 71 patients (53%) and was a risk factor for local treatment failure (P =.03). The ERD resolved after radiotherapy in 59 (83%) of the 71 patients. The ERD resolved within 1 year in 64 patients (90%) (mean time to resolution, 5.6 months). The rate of ERD resolution correlated with the rate of decrease in tumor thickness (P =.004). The ERD did not resolve and the tumor thickness continued to increase in 5 patients, who required further intervention. A recurrent retinal detachment developed in 5 patients, who were diagnosed as having rhegmatogenous retinal detachment (3 patients) and lipid exudation secondary to tumor vasculopathy (2 patients). Two patients with local tumor recurrence did not develop a recurrent ERD. Local tumor control was achieved in 130 patients (96%). An ERD may be a risk factor for local failure after plaque radiotherapy for uveal melanoma. If an ERD does not resolve within 9 to 12 months of radiotherapy and the tumor is not regressing, treatment failure should be suspected. A recurrent ERD does not necessarily represent local tumor recurrence.

Bilateral Bullous Exudative Retinal Detachment in Renal Failure

Bilateral bullous exudative retinal detachment has been reported in patients with renal failure, but the etiology and appropriate treatment at this type of retinal detachment are debatable. We present our experience with a patient with renal failure and bilateral bullous exudative retinal detachment. His renal disease was membrano-proliferative glomerulonephritis, which is immunologically mediated. The etiology of exudative retinal detachment associated with renal failure is discussed, and the roles of hypertension, fluid retention, electrolyte imbalance and immune-comples deposition in the presence and resolution of exudative retinal detachment in the patient are investigated. Clinical study indicated that immune-comples deposition or hypertension or both might have been the cause of retinal detach-ment in this patient. The resolution of resolution of retinal detachment was correlated with correction of fluid reten-tion and dilutional hyponatremia, but unrelated to the level of blood pressure. The effect of systemic corticosteroid therapy remains unclear.