![]() Computed tomography (CT) or magnetic resonance imaging (MRI) can provide similar information in cases in which an ultrasound examination cannot be performed because of lack of patient cooperation (e.g., in a child) or because pressure from the ultrasound probe has potential for damage to the eye (e.g., in posttraumatic cases). It may reveal the presence, location, and size of intraocular tumors show scleral or choroidal thickening in inflammatory disorders and display any coexisting choroidal detachment. Ultrasonography is helpful in eyes with both hazy and clear media. Ocular coherence tomography (OCT) can show subretinal fluid and cysts in choroidal neovascularization and, with enhanced depth imaging (EDI), can be instrumental in making the diagnosis of CSC if the choroidal layer is thickened. Indocyanine green (ICG) angiography may be useful in showing areas of increased choroidal vascular permeability in CSC or hyperfluorescent nodules with late hypofluorescence in polypoidal choroidal vasculopathy. In certain diseases, fluorescein angiography can be used to guide laser photocoagulation therapy. It can also help confirm various characteristic vascular changes of retinal diseases that can lead to exudative retinal detachments, such as leakage from macroaneurysms in Coats’ disease. Fluorescein angiography may demonstrate small foci of hyperfluorescence in cases of CSC or characteristic patterns of lacy hyperfluorescence in choroidal neovascularization from a variety of causes. Fundus examination demonstrates single or multiple dome-shaped retinal elevations, with larger detachments exhibiting the phenomenon of shifting subretinal fluid.įluorescein angiography can be instrumental in diagnosis if the subretinal fluid is clear and the detachment is not too bullous. The anterior segment examination will frequently reveal clues to the diagnosis, such as conjunctival and episcleral injection in scleritis or anterior chamber cell and flare in Vogt–Koyanagi–Harada (VKH) syndrome. The intraocular pressure can be decreased in the presence of ciliary body inflammation or detachment but is often normal. Visual acuity can vary from 20/20 in cases of central serous chorioretinopathy (CSC) to count fingers or worse in age-related macular degeneration with massive exudative detachment. The visual acuity depends on the chronicity and extent of the detachment as well as associated RPE and choroidal derangements. Photopsia may be present as well, but when this history is elicited, patients should be examined carefully for the presence of a retinal break. Patients present with a history of decreased visual acuity, visual field defects, metamorphopsia, or floaters. 30.2 Total exudative retinal detachment with loss of the red reflex and retina visible behind the lens in a patient with Coats’ disease. Note also the smooth, dome-shaped appearance and the absence of any retinal rugae. Fundus photograph taken with the patient in the upright position the subretinal fluid has mainly settled inferiorly from the effects of gravity. Exudative detachments of the retina frequently coexist with detachments of the choroid. In large exudative detachments, the subretinal fluid may shift to dependent areas of the fundus with changes in the patient’s head position. The height of the detachment can likewise vary, and in some severe cases, the retina may be visible just posterior to the lens ( Fig. Exudative detachments display a dome or convex configuration, and their lateral extent can vary greatly, from a few disc diameters to the entire retina. ![]() Such abnormalities are seen in a variety of disease states involving the RPE, Bruch’s membrane, choroidal vasculature, or the retina. ![]() Exudative detachments can develop in all age groups when defects occur in the normal mechanisms for clearance of subretinal fluid or when these mechanisms are overwhelmed by excessive exudation. They can be further differentiated from rhegmatogenous detachments by the lack of retinal folds or rugae on their surface ( Fig. Exudative or “serous” retinal detachments are characterized by separation of the neurosensory retina and RPE without the presence of a retinal break or vitreoretinal traction. ![]()
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