Initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease presenting with unilateral exudative retinal detachment despite bilateral choroidal involvement

International Ophthalmology - To investigate the frequency of initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease presenting with unilateral exudative retinal detachment....     

Posterior scleritis with exudative retinal detachment

PURPOSE/METHODS: We report the findings in a patient who presented with exudative macular detachment and discuss the most useful ancillary test and the treatment of this uncommon illness. The diagnostic tests show the typical features of this pathology. RESULTS/CONCLUSIONS: The macular exudative retinal detachment is one of the most frequent features of the posterior scleritis. The case that we report has similar findings to other cases described in the literature. Posterior scleritis is an uncommon disease, but we must take it into account in the differential diagnosis of a macular exudative retinal detachment.     

Bilateral exudative retinal detachment in pregnancy

A case of bilateral exudative retinal detachment associated with otherwise normal pregnancy is presented. Similar cases, but associated with toxemia of pregnancy from the literature are discussed. As far as we know, this is first reported case where bilateral exudative retinal detachment presented in a normal pregnancy and the re-attachment started promptly after a normal, spontaneous delivery. The re-attachment was complete, and the visual acuity after one year was 20/20 o.u. This case supports earlier theories that hypertension is not the only cause of exudative retinal detachment during pregnancy.     

Posterior segment recurrences in Vogt-Koyanagi-Harada disease

Aim To describe the clinical profile, management, and outcome in seven patients with posterior segment recurrence in Vogt-Koyanagi-Harada (VKH) disease. Material and methods Retrospective chart review of all the patients of VKH disease presenting to our institute between 2001 and 2005 was carried out. Patients with a documented posterior segment recurrence during follow-up were included in this study. Their history, systemic associations, ocular findings, investigations, management strategies, and treatment response were noted. Results Out of 82 VKH patients screened, documented posterior segment recurrence was seen in seven patients who included five women and two men, with a mean age of 33.7 years (range 22–55 years). At onset, two patients had incomplete and five had probable VKH disease. At the time of recurrence, four patients were on maintenance dose (5–10 mg/day) of oral corticosteroid while the remaining three were off treatment. The mean interval between the primary episode and posterior segment recurrence was 33.7 weeks (range 16–52 weeks). All posterior segment recurrences were bilateral and were characterized by vitritis (eight eyes), papillitis (14 eyes), multiple yellow-white oval subretinal lesions (six eyes), and exudative retinal detachment (10 eyes). The recurrences were managed with oral corticosteroids (1.0–1.5 mg/day) and Azathioprine (2.0–2.5 mg/day). Subsequently, three patients experienced a second episode of posterior segment recurrence, which also responded to the corticosteroid–Azathioprine combination. Conclusions Recurrences in VKH disease may involve predominantly the posterior segment, and respond well to the standard treatment.     

Tomographic features of serous retinal detachment with multilobular dye pooling in acute Vogt-Koyanagi-Harada disease

PURPOSE: To clarify the morphologic background of serous retinal detachment with multilobular dye pooling on fluorescein angiography (FA) in acute Vogt-Koyanagi-Harada (VKH) disease. DESIGN: Retrospective uncontrolled case series. METHODS: setting: Institutional study. study population: Ten eyes of five patients aged 16 to 52 years (average age, 31 years) with VKH disease who presented with a serous retinal detachment. observation procedures: Clinical examination and optical coherence tomography (OCT). main outcome measures: Findings on OCT and FA. RESULTS: All eyes had multilobular dye pooling with a dark rim on late-phase FA. OCT revealed subretinal septa that divided the subretinal space into several compartments. The subretinal septum lay on the retinal pigment epithelium (RPE) in the foveal area, forming the posterior wall of the subfoveal compartment while it detached from the RPE in the perifoveal area, which served as a lateral wall between the subfoveal and perifoveal compartments. The dark rims of each area of subretinal dye pooling corresponded to the subretinal septa. Soon after steroid pulse therapy, the subretinal septa resolved completely in all eyes. CONCLUSION: Subretinal septa caused multilobular dye pooling in serous retinal detachment associated with acute VKH disease. We assume that the subretinal septa are comprised of inflammatory products such as fibrin, which immediately resolve after steroid pulse therapy.     

玻璃体手术结合光凝治疗伴视网膜脱离的晚期Coats'病

目的：评估玻璃体手术结合眼内电凝光凝治疗伴渗出性视网膜脱离的晚期Ｃｏａｔｓ’病的疗效。方法：采用玻璃体切割,视网膜切开内引流、电凝、光凝及过氟化碳液体应用,治疗伴渗出性视网膜脱离Ｃｏａｔｓ’病１６例（１６只眼）,随访６～２４个月（平均１６月）。结果：术后视网膜复位率（１５／１６）９３．２％。１６只眼均保持术前视力,眼压控制于正常范围。结论：本方地多数晚期Ｃｏａｔｓ’病有效,可以使视网膜复位,维持现     

A case of traction retinal detachment in a patient with Gaucher disease

Background: This is the first report of vitreous surgery for traction retinal detachment in a patient with type III Gaucher disease with multiple vitreous opacities.

Materials and methods: A 16-year-old boy who was diagnosed with Gaucher disease at age two and was undergoing enzyme replacement therapy presented with numerous white opacities of varying sizes in the vitreous bodies of both eyes. Visual acuity was 20/40 in the right eye and 20/2000 in the left eye. The retina of the left eye was completely detached, and vitreous surgery was performed.

Results: Liquefaction of the vitreous body was advanced, and the central part of the vitreous cavity contained almost no vitreous humor. The macular region was successfully aspirated with a vitreous cutter to form a posterior vitreous detachment. From the optic disk to the nasal side, however, posterior vitreous detachment formation was prevented by strong adhesions between the retina and the vitreous body. The traction retinal detachment of the posterior fundus improved after vitreous body resection alone.

Conclusions: Traction retinal detachment may occur as a result of severe vitreous liquefaction in cases of Gaucher disease with numerous vitreous opacities.     

57例经玻璃体手术治疗的渗出性视网膜脱离临床分析

目的 总结玻璃体手术治疗的渗出性视网膜脱离患者的病因、手术指征及术后效果.设计 回顾性病例系列.研究对象 57例经玻璃体手术治疗的渗出性视网膜脱离患者.方法 回顾性分析相应的临床资料.主要指标 病因、手术指征及术后效果.结果 57例(62眼)渗出性视网膜脱离中Coats病23例(45.2%),为引起渗出性视网膜脱离的主要病因;其次为家族性渗出性玻璃体视网膜病变8例(12.9%)、葡萄膜炎7例(11.3%)、视网膜血管瘤7例(11.3%)、泡性视网膜脱离6例(9.7%)、眼内炎4例(6.5%)和视乳头小凹2例(3.2%).严重的渗出性视网膜脱离及并发增生性病变是进行玻璃体手术的指征.术后短期大部分患者可获有用视力;随访6个月以上者64.9%,渗出性视网膜脱离复发率为5.4%,大部分患者仍能保留有用的视力.结论 Coats病是引起渗出性视网膜脱离中需要采取玻璃体手术治疗的最主要原因.当渗出性视网膜脱离引起增生性病变、玻璃体积血或病变累及黄斑时是采取玻璃体手术的主要指征.手术可使大部分患者获得有用视力.(眼科,2008,17:52-55)     

Management of exudative retinal detachment in choroidal melanoma

Exudative retinal detachment is the most common source of visual loss associated with malignant melanoma of the uveal tract. Management has historically been conservative, leading to irreversible visual loss from photoreceptor damage during the several months needed for post-radiation resolution. The purpose of this paper is to describe timely vitreoretinal surgical intervention for exudative retinal detachments associated with choroidal melanomas. This was an interventional case series including six consecutive patients with malignant melanoma who experienced VA reduction secondary to associated exudative retinal detachment. Patients underwent complete ophthalmic evaluation and B-scan ultrasound. Treatment included proton-beam radiation or brachytherapy, prognostic transretinal tumour biopsy with 25-gauge vitrector and surgical treatment of exudative retinal detachment, including vitrectomy and drainage of subretinal fluid at the time of irradiation. Successful management of exudative retinal detachments associated with choroidal melanomas was observed in all cases, with significant restoration of vision. Steady regression of tumour thickness was noted clinically and ultrasonographically, without extrascleral extension or metastasis, and with no recurrence of exudative retinal detachment found over follow up. In the present study, the investigators have showed effective surgical treatment of exudative retinal detachment associated with malignant melanoma. These patients had significant restoration of vision, confirming that timely intervention of exudative retinal detachment associated with malignant melanoma can reverse visual loss in these patients. These findings are in contrast to previous reports of irreversible visual loss after exudative retinal detachments, and suggest that photoreceptor atrophy might play a role in visual loss associated with chronic exudative retinal detachments.     

Acute leukemia presenting as a unilateral exudative retinal detachment

The leukemias commonly involve the eyes and adnexae. It is unusual, however, for leukemia to present with visual complaints. Furthermore, there are only rare case reports of leukemic patients presenting with bilateral exudative retinal detachments. We report a unique case of a boy who presented with visual loss due to a unilateral exudative retinal detachment. A systemic evaluation discovered acute lymphocytic leukemia (ALL). There was rapid settling of the exudative detachment and improvement in vision while the patient received chemotherapy and radiotherapy for the ALL.     

Vitrectomy techniques in late-stage Coats'-like exudative retinal detachment

Retinal telangiectasia is the hallmark of Coats' disease. In the late stages, leakage from these abnormal vessels can result in a total, bullous exudative retinal detachment with cholesterol-laden subretinal fluid. Secondary angle-closure glaucoma may result in a blind and painful eye which may require enucleation or evisceration. Surgical reattachment of the retina and destruction of the retinal telangiectasia may preserve these eyes. We have found that vitrectomy, internal drainage of subretinal fluid and cholesterol, direct treatment of the retinal telangiectasia with intraocular diathermy and intravitreal gas or silicone oil injection are effective surgical techniques for salvaging these severely damaged eyes.