|Year : 1982 | Volume
| Issue : 6 | Page : 565-567
Clinical evidence of serous or exudative retinal detachment
D P Ganguli
4, Maharaja Nanda Kumar Road, Calcutta-700 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ganguli D P. Clinical evidence of serous or exudative retinal detachment. Indian J Ophthalmol 1982;30:565-7
Incidence of serous or exudative retinal detachments are not very rare in a retina centre. Sometimes much confusion arises regarding exclusion of rhegmatogenous retinal detachment, particularly in apparently monocular affection. History of previous attack, bilaterality, shifting sign of subretinal fluid (SRF) due to high viscosity, sparing of extreme periphery and occasional presence of dustlike opacities due to inflammatory cells in the vitreous cavity , suggestive of serous retinal detachment. Absence of retinal break though suggestive of inflammatory origin, yet possibility of undetected tiny retinal break at the periphery is always there and presence of such break with a long standing retinal detachment may manifest shifting sign of SRF.
Fluorescein angiography  or fluorescein fundoscopy is a confirmatory evidence for the diagnosis of serous retinal detachment. Facility of fluorescein study is not available in many centres or even in teaching institutions of our country. Minute examination of both the eyes with direct or indirect ophthalmoscope even, had revealed some interesting clinical signs particularly in the fellow eye of apparently monocular affection which helped a lot to establish serous origin of the detachment.
| Materials and methods|| |
4 apparently monocular and 2 bilateral cases, included in study, were examined at the Retina Research Centre, Medical College, Calcutta-Routine laboratory investigations and systemic examinations were done. Fundus examination was done by direct, indirect ophthalmoscope and 3 mirror contact lens. Fluorescein fundoscopy was done in a few cases. Lumber puncture was not done in any of the cases.
| Observations|| |
Cases 1. P. Mukherjee, 38 MH with H/O DV R.E.-month O/E on 25.11.75 - Vision in R.E. 6/60, L.E. 6/6. R.E. Elevation of lower retina from 10 0' clock to 4 0' clock, 2 localised cyst like translucent retinal elevations of 1/2 dise size in supero-temporal quadrant between disc and macula and exudates behind the equator at 12 0' clock were visible, One ring like deep-seated retinal marking was visible at the maclau Subsequent examinations revealed rapid progression of retinal separation and within 3 weeks almost entire retina was elevated and cyst like retinal elevations were merged in the detached retina. L.F. 4 small brownish blister like retinal elevations of different sizes were visible near the post pole. One localized retinal oedematous area adjacent to the disc was also visible.
Case 2. Susil Mazumdar, 52 MH with H/O DV R.E,-2 months. Similar DV-8 yrs. back. O/E on 16.5.78. Vision R.E. 2/60 L.E. 6/9. R.E. 2/3 retina was elevated from the lower part. L,E. 2 small brownish blister like elevations above the fovea were vitible Fluorescein fundoscopy suggested pigment epithelial detachment.
Cases 3. Jatan Jana, 42 MH with H/O DV R.E.-3 months. O/E on 14.10.78. Vision R.E.-C.F.-3ft., L.E. 6/9.R.E.-2/3 retina was elevated from the lower part. L.E.-5 small brownish blister like retinal elevations of different sizes were visible supero-temporal to fovea. Fluorescein fundoscopy suggested pigment epithelial detachment.
Case 4. Digambar Panda, 33 MH with H/O DV L.E. - 4 months. O/E on 21.9.77. Vision R.E. 6/9, L.E. HM. R.E. 2 large translucent cyst like retinal elevations in the lower part were observed with pigment patches at 3 and 12 0' clock meridian between disc and macula. Fluorescein leakage were observed at the elevated areas. L.E.-Entire retina was elevated with pigment patches on the temporal side of the macula.
Case 5. Prabir Pal, 34 MET with H:/O DV R.E.-2 months and L.E.-15 days. O/E on 22.6.78. Vision B.E. 6/18. R.E. Lower half of the retina was elevated including the macula with white exudated on the temporal side of the macula. L.E. Infero-temp. quadrant of the retina was elevated with white exudate at the macula and 2 cyst like retinal elevations adjacent to fovea on the temporal side were observed.
Case 6. Lipi Ghatak, 34 FH with H/O DV in B.E.-7 days. O/ E on 17.4.76 Vision in B.E. 3/60. R.E. Entire retina was elevated except upper retinal periphery. One ring like deep seated retinal marking adjacent to fovea wasvisible. L.E. 2/3 retina was elevated in spidery manner with maximum elevation in the lower part in B.E.
| Discussion|| |
Serous retinal detachment is caused by leakage from choroidal or (less often) from retinal blood vessels 3sub , due to systemic or local factorst Systemic affection is usually bilateral. Clinical manifestation may be predominant in one eye and very minute affection in the fellow eve may be observed at some stage of affection, In cases of 1 to 4 major affection was limited to one eye characterised by massive serous retinal detachment and in the fellow eye of cases 1, 2 & 3 affection was very ill defined characterised by localised small blister like retinal elevations at the posterior pole, but, in case 4 manifertation was more marked by large cyst like translucent retinal elevations. Brownish blister like elevations were manifestations of serous pigment epithelial detachment  and cyst like translucent retinal elevations represented localised serous retinal detachment ,. Both forms were observed in case No. 1 (R & L).
Circular deep seated retinal markings a< were observed in case I (R) and 6 (R) clinically suggestive of cyst like elevation; preceding massive retinal detachments as wa;
observed in Case No. 5 (L) and oedematou area adjacent to the disc in case No. 1 (L, suggestive of very fine leakage of Bruch'; membrane and pigment epithelium.
| Summary|| |
Minute examinations of the detachmen cases with ophthalmoscope if reveal cyst o blister like retinal elevations or localises oedematous area in the fellow eye of apparen tly monocular affection, diagnosis of serou origin may be taken as certain. Circular deep seated retinal marking (S) if present in the detached retina in monocular or bilateral involvement, serous origin may be a possibility Retinal detachment surgery in such cases will be of no effect or even may be disastrous.
| References|| |
Schepens, C.L., 1966, Retinal Diseases, p. 324-333, Ed. by Samuel J. Kumura and Wayne M. Caygill. Lea and Febiger, Philadelphia.
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Gass, J.D.M., 1972, Retinal Congress, p. 182 - 201, Appleton Century Crofts, New Yotk.
Duke-Elder, S., 1967, System of Ophthalmol. 775. Henry Kimpton, London.
L'Esperance, F.A., 1975, ocular Photocoagulation, p. 180-180. C.V. Mosby Comp., Saint Louis.