Exudative retinal detachment

Amer, Radgonde; Nalcı, Hilal; Yalçındağ, F Nilüfer

doi:10.1016/j.survophthal.2017.05.001

Cited by 61 publications

(50 citation statements)

References 440 publications

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“…Even in human serous detachments other than CSCR, where the distance between the photoreceptors and the RPE is greater, the retinal function is preserved after reattachment (Amer et al. ). It is therefore likely that our porcine results can be compared to serous detachments in humans, and that the retina tolerates both prolonged and great enlargements of the subretinal space.…”

Section: Discussionmentioning

confidence: 99%

Subretinal surgery: functional and histological consequences of entry into the subretinal space

Sørensen

2019

Acta Ophthalmologica

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Background and objectives: Gene-therapy, stem-cell transplantation and surgical robots hold the potential for treatment of currently untreatable retinal degenerative diseases. All of the techniques require entry into the subretinal space, which is a potential space located between the retina and the retinal pigment epithelium (RPE). Knowledge about obstacles and critical steps in relation to subretinal procedures is therefore needed. This thesis explores the functional and histological consequences of separation of the retina from the RPE, extensive RPE damage, a large cut in the retina (retinotomy) and RPE phagocytosis in a porcine model. Methods: Experiments were performed in 106 female domestic pigs of Danish landrace distributed over five studies. Under general anesthesia, different procedures for expansion of the subretinal space were conducted. Outcomes were visual function measured electrophysiologically with multifocal electroretinogram (mfERG) and retinal morphology examined histologically. Study I: The effect of anesthesia on mfERG was examined by repeated recordings for 3 hr in isoflurane or propofol anesthesia. Outcome was mfERG amplitude. Study II: Consequences of a large separation of the photoreceptors from the RPE were examined by injecting a perfluorocarbon-liquid (decalin) into the subretinal space. Two weeks after, in a second surgery, decalin was withdrawn. Outcomes were mfERG and histology 4 weeks after decalin injection. Study III: Extensive RPE damage was examined by expanding the subretinal space with saline and removing large sheets of RPE-cells through a retinotomy. Outcomes were mfERG and histology 2, 4 and 6 weeks after the procedure. Study IV: Consequences of a large retinotomy were examined by similar procedures as in Study III, but in study IV only a few RPE cells were removed. Outcomes were mfERG and histology 2 and 6 weeks after surgery. Study V: Clearance of the subretinal space was examined by injecting fluorescent latex beads of various sizes into the subretinal space. Outcome was histologic location of the beads at different time intervals after the procedure. Results: Study I: MfERG amplitudes decreased linearly as a function of time in propofol or isoflurane anesthesia. Duration of mfERG recording could be decreased without compromising quality, and thereby could time in anesthesia be reduced. Study II: MfERG and histology remained normal after reattachment of a large and 2-week long separation of the photoreceptors and RPE. Repeated entry into the subretinal space was well tolerated. Fluid injection into the subretinal space constitutes a risk of RPE-damage. Study III: Removal of large sheets of retinal pigment epithelial cells triggered a widespread rhegmatogenous-like retinal detachment resulting in visual loss. Study IV: A large retinotomy with limited damage of the RPE was well tolerated, and visual function was preserved. Study V: Subretinal latex beads up to 4 lm were phagocytosed by the RPE and passed into the sub-RPE space. Beads up to 2 lm travelled further through...

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Section: Discussionmentioning

confidence: 99%

Subretinal surgery: functional and histological consequences of entry into the subretinal space

Sørensen

2019

Acta Ophthalmologica

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“…When blood–retinal barrier is impaired by inflammation, infection, neoplastic diseases, and retinal vascular occlusive diseases, SRD subsequently occurs. [ 20 ] Several previous reports demonstrated post-natal SRD associated with PIH but the etiology remained unknown. [ 10 – 12 ] The clinical features of SRD associated with PIH are similar to those observed in VKH disease.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy-induced hypertension-related chorioretinitis resembling uveal effusion syndrome

Sato

Takeuchi²

2018

Medicine

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Rationale:Pregnancy-induced hypertension (PIH) is a major cause of maternal and fetal mortality. Hypertensive choroidopathy is a preliminary sign of vasogenic edema in the choroid, and is associated with PIH. Here, we report a post-natal case of PIH-related chorioretinitis with bilateral severe serous retinal detachment (SRD) resembling uveal effusion syndrome.Patient concerns:A 35-year-old woman was diagnosed with severe PIH at 37 weeks of pregnancy. She underwent an emergency cesarean delivery. Four days after delivery, she perceived a sudden decrease of vision. At presentation, fundus examination demonstrated bullous SRD and multiple white mottles in the posterior poles of both eyes. Optical coherence tomography (OCT) showed macula edema and retinal pigment epithelium (RPE) folds. Indocyanine green angiography (ICGA) demonstrated delayed filling of choroidal circulation in the early phase and multiple hyperfluorescent spots in the mid phase.Diagnoses:PIH.Interventions:Antihypertension treatment alone resulted in gradual resolution of the SRD.Outcomes:At 463 days after delivery, fundus photographs of both eyes showed leopard spots corresponding to hyperautofluorescent spots with dark rim observed on fundus autofluorescence images.Lessons:Ophthalmologists should be aware of PIH-related chorioretinitis with similar clinical manifestations as uveal effusion syndrome, and should treat with antihypertensive agents in cooperation with obstetricians.

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“…It is usually bilateral and tends to be diagnosed during the last trimester or shortly after delivery [ 13 ]. The main pathogenesis of this disease includes generalized vasoconstriction and choroidal ischemia affecting the retinal pigment epithelium, leading to a breakdown of the blood–retinal barrier and a leakage of proteins and fluid from the choriocapillaries into the subretinal space [ 14 ]. Focal ischemia caused by capillary obstruction is even more severe when associated to hemolysis of the red blood cells, such as the case of HELLP syndrome [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Focal ischemia caused by capillary obstruction is even more severe when associated to hemolysis of the red blood cells, such as the case of HELLP syndrome [ 13 ]. Patients usually have complete recovery of vision with complete resolution of RD within 2–12 weeks postpartum [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound assessment of visual loss during severe preeclampsia: a case report

et al. 2018

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Bilateral retinal detachments and cortical blindness are rare complications of preeclampsia and the association of the two pathologies is exceptional. We report the case of a preeclamptic patient who presented with an acute bilateral vision loss. Besides, her ocular ultrasound revealed bilateral retinal detachments and an elevated optic nerve sheath diameter. The patient underwent an urgent cesarean section. Subsequently, magnetic resonance imaging and ocular fundus examination confirmed the diagnosis.

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Exudative retinal detachment

Cited by 61 publications

References 440 publications

Subretinal surgery: functional and histological consequences of entry into the subretinal space

Subretinal surgery: functional and histological consequences of entry into the subretinal space

Pregnancy-induced hypertension-related chorioretinitis resembling uveal effusion syndrome

Ultrasound assessment of visual loss during severe preeclampsia: a case report

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