Exudative Retinal Detachment

Excerpt

Accumulating excessive fluid in the subretinal space between the retinal pigment epithelium (RPE) and neurosensory retina leads to retinal detachment (RD). The subretinal space is the remnant of the embryonic optic vesicle. Depending on the etiology which leads to subretinal fluid accumulation, retinal detachment is divided into three categories- rhegmatogenous, tractional, or exudative retinal detachment.

There may be a combination of these categories in some cases. Rhegmatogenous retinal detachment occurs when there are retinal tears or holes leading to fluid seeping into the subretinal space. Tractional retinal detachment occurs when there is traction on the retina due to fibrovascular proliferation over the retina resulting from ischemic or hypoxic stimuli or other causes.

Exudative retinal detachment occurs when excessive subretinal fluid accumulates in the absence of any retinal breaks or tractional forces. Exudative retinal detachment occurs due to disruption of the integrity of the blood-retinal barrier.

There is no anatomical adhesion between the retinal pigment epithelium and the neurosensory retina. The apical surface of the retinal pigment epithelial cells expresses neural cell adhesion molecules, which create adhesion between retinal pigment epithelium and photoreceptor cells.

Any etiologic factor, whether inflammatory, idiopathic, infectious, surgical, neoplastic, vascular, or drug-induced, can induce ischemic-hypoxic stimuli, leading to the loss of integrity of the blood-retinal barrier.

If diagnosed and treated on time, reasonably good visual acuity can be recovered in patients with exudative retinal detachment. Based on the cause of exudation, exudative retinal detachment is mainly managed on medical lines. Very rarely, if all medical interventions fail, a surgical line of management with scleral buckling or vitrectomy surgery may be considered.