Medical Care
The medical and surgical treatments of exudative retinal detachments must be tailored to the underlying condition.
Inflammatory conditions, such as scleritis and Vogt-Koyanagi-Harada syndrome, should be treated with anti-inflammatory agents. [14]
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. [15]
Anti-VEGF agents may play a role in the management of Coats disease. [2, 16, 17]
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 or cryotherapy to obliterate the vascular abnormalities. If an exudative retinal detachment is present, surgical techniques such as drainage with or without vitrectomy have been recommended. [18] 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. [19]
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. [20]
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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An 8-year-old boy with Coats disease. Notice the macular exudation.
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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.
