Retinal Detachment, Exudative Workup

  • Author: Lihteh Wu, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 23, 2010
 

Laboratory Studies

  • Although the diagnosis of an exudative retinal detachment can usually be made clinically, the underlying etiology may be difficult to elucidate. Laboratory examinations under these circumstances are warranted.
    • Venereal Disease Research Laboratory (VDRL) test and fluorescein treponema antibody (FTA) test
    • Antineutrophil cytoplasmic antibodies
    • Erythrocyte sedimentation rate
    • Rheumatoid factor
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Imaging Studies

  • Ultrasound is a useful adjunct when the media is hazy. It can detect choroidal thickness, the presence or absence of choroidal masses, the size and location of choroidal masses, and scleral thickness. Peripheral annular choroidal detachments are seen in nanophthalmos and uveal effusion syndrome.
  • Fluorescein angiography is a useful adjunct to identify areas of leakage in central serous chorioretinopathy, Vogt-Koyanagi-Harada syndrome, and Coats disease.[1]
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Histologic Findings

The histopathologic findings are similar to those of a RRD with loss of photoreceptor outer segments acutely and chronic changes exemplified by retinoschisis, cysts, and RPE proliferation. Other findings include massive leakage into the retina and subretinal space.

In the acute uveitic phase of Vogt-Koyanagi-Harada syndrome, an eosinophilic exudate containing proteinaceous material is found in the subretinal space that is not usually present in the convalescent and chronic recurrent phases of the disease.[2]

Biochemical analysis of subretinal fluid in Coats disease reveals high levels of protein, albumin, and cholesterol in combination with nearly normal levels of other biochemical components suggesting entrapment of larger molecules in the subretinal space with equilibrium of smaller molecules, probably by active transport of the RPE.

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Contributor Information and Disclosures
Author

Lihteh Wu, MD  Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, 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, Pan-American Association of Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Coauthor(s)

Teodoro Evans, MD  Retina Fellow, St Michael's Hospital, University of Toronto, Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

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, and South Carolina Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

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

Disclosure: Nothing to disclose.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians & Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

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

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

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, and Pan-American Association of Ophthalmology

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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