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Exudative Retinal Detachment Treatment & Management

  • Author: Lihteh Wu, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 11, 2016
 

Medical Care

The medical and surgical treatments of exudative retinal detachments have to be tailored to the underlying condition.

Inflammatory conditions, such as scleritis and Vogt-Koyanagi-Harada syndrome, should be treated with anti-inflammatory agents.[5]

Tumors need to be treated accordingly. External beam radiation therapy or brachytherapy with a plaque may be used for choroidal melanoma. Metastatic lesions respond to chemotherapy or localized radiation therapy. Choroidal hemangiomas may respond to laser photocoagulation or plaque brachytherapy. Retinoblastomas may be shrunk with chemotherapy and then treated locally with heat, laser, or cryotherapy.

Infectious etiologies may respond to antibiotics.

Reports exist of patients with exudative retinal detachments secondary to chronic renal failure that have spontaneous retinal reattachment following renal transplant or renal dialysis.[6]

Anti-VEGF agents may play a role in the management of Coats disease.[1, 7, 8]

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Surgical Care

The medical and surgical treatments of exudative retinal detachments have to be tailored to the underlying condition.

Conditions with vascular anomalies, such as Coats disease, should be treated with laser, cryotherapy, or even vitrectomy to obliterate the vascular abnormalities. A retrospective case review of 8 eyes in 8 children with total or subtotal retinal detachment due to Coats disease demonstrated that transscleral drainage of subretinal fluid accompanied by anti-VEGF injection and laser photocoagulation appears to be successful in halting progression of advanced Coats disease with exudative detachment and is less invasive than conventional management.[9]

In nanophthalmos where the sclera is abnormally thick, vortex vein decompression with scleral windows and suprachoroidal fluid drainage is indicated.

Congenital anomalies, such as optic pits or colobomas, may respond to vitrectomy and endolaser techniques.

Central serous chorioretinopathy may respond to mild laser treatment of the focal areas that leak on fluorescein angiogram. Photodynamic therapy and micropulse laser have been used in cases of central serous chorioretinopathy that involve the fovea.[10]

 

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Consultations

Consult a vitreoretinal specialist early in the disease process. If immunosuppressive therapy is being considered, consultation with an immunologist or rheumatologist is highly recommended.

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Contributor Information and Disclosures
Author

Lihteh Wu, MD Asociados de Macula Vitreo y Retina de Costa Rica

Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Club Jules Gonin, Macula Society, Pan-American Association of Ophthalmology, Retina Society

Disclosure: Received income in an amount equal to or greater than $250 from: Bayer Health; Quantel Medical; Heidelberg Engineering.

Coauthor(s)

Dhariana Acón, MD Ophthalmologist, Caja Costarricense Seguro Social, Hospital de Guapiles, Costa Rica

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Steve Charles, MD Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, Retina Society, Club Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

V Al Pakalnis, MD, PhD Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, South Carolina Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Teodoro Evans, MD Consulting Surgeon, Vitreo-Retinal Section, Clinica de Ojos, Costa Rica

Disclosure: Nothing to disclose.

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An 8-year-old boy with Coats disease. Notice the macular exudation.
An 8-year-old boy with Coats disease. Notice the peripheral vascular dilatations. This patient underwent cryotherapy months before, and the exudative retinal detachment has basically disappeared.
 
 
 
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