Laboratory Studies
Although the diagnosis of an exudative retinal detachment usually can be made clinically, the underlying etiology may be difficult to elucidate. Laboratory examinations under these circumstances are warranted, as follows:
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Venereal Disease Research Laboratory (VDRL) test and fluorescein treponema antibody (FTA) test
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Antineutrophil cytoplasmic antibodies
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Erythrocyte sedimentation rate
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Rheumatoid factor
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. [11] Ultra–wide-field fluorescein angiography is used to identify areas of peripheral retinal nonperfusion, allowing guidance of treatment. [12]
Optical coherence tomography (OCT) can be used for quantitative examination.
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 usually is not present in the convalescent and chronic recurrent phases of the disease. [13]
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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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.
