Exudative Retinal Detachment

Excerpt

In exudative retinal detachment, subretinal fluid accumulates without retinal breaks or tractional forces. The underlying cause is a blood-retinal barrier disruption. Processes that either actively or passively allow for excessive fluid accumulation in the subretinal space between the retinal pigment epithelium and neurosensory retina lead to retinal detachment. During a retinal detachment, the retina separates from the underlying retinal pigment epithelium and choroid, resulting in retinal ischemia and photoreceptor degeneration.

The subretinal space originates from the remnant of the embryonic optic vesicle. Retinal detachment is classified into three groups based on the etiology of subretinal fluid accumulation: rhegmatogenous, tractional, or exudative. Some cases may involve a combination of these categories. Rhegmatogenous retinal detachment occurs when retinal tears or holes allow fluid to seep into the subretinal space. Tractional retinal detachment happens when traction on the retina occurs due to fibrovascular proliferation over the retina, often resulting from ischemic or hypoxic stimuli or other factors.

No anatomical adhesion exists between the retinal pigment epithelium and the neurosensory retina. Neural cell adhesion molecules expressed on the apical surface of retinal pigment epithelial cells facilitate adhesion between the retinal pigment epithelium and photoreceptor cells. Various etiologic factors, including inflammation, idiopathy, infection, surgery, neoplasia, vascular issues, or drug effects, can trigger ischemic-hypoxic stimuli, compromising the integrity of the blood-retinal barrier.

Timely diagnosis and treatment offer the possibility of reasonably good vision in patients with exudative retinal detachment. Exudative retinal detachments are primarily managed medically. Surgical intervention with scleral buckling or vitrectomy is rarely considered, typically only if all medical interventions prove ineffective.