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A. Simmons-Rear, S. Yeh, B. T. Chan-Kai, A. K. Lauer, C. J. Flaxel, J. R. Smith, J. T. Rosenbaum, E. Suhler; Characterization of Serous Retinal Detachments in Uveitis Patients With Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6186.
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Patients with uveitis may develop decreased visual acuity secondary to various macular pathologies including serous retinal detachments (SRD), macular edema (ME), and choroidal neovascular membranes (CNVM). SRDs have been observed in association with ME, but may also be found in specific uveitic syndromes such as Vogt-Koyanagi-Harada (VKH). Optical coherence tomography (OCT) provides a highly sensitive method of cross-sectional imaging of the retina. The purpose of this investigation was to ascertain the epidemiology of SRDs in uveitic patients, the OCT features of SRDs and the relationship to visual acuity (VA).
OCTs of uveitis patients seen at the Casey Eye Institute between 2006-2008 were reviewed for the presence of serous RDs. OCTs in which SRDs were identified were evaluated for retinal pigment epithelial (RPE) disruption, macular edema (diffuse or focal cystic) and central subfield thickness (CST). Medical records were reviewed for demographic information, VA, anatomic classification of uveitis, and secondary diagnosis.
18 of 111 patients (16.2%) who underwent OCT imaging were found to have SRDs on their initial OCT examination. 5 patients (28%) had bilateral SRDs. 14 patients (78%) were female. The mean age of patients was 39 years (range 9-64). Mean logMAR VA+/-SD was 0.63+/-0.74 (Snellen 20/84). Moderate visual impairment (VA between 20/40 and 20/200) was found in 9 eyes (39%) while severe visual impairment (VA <= 20/200) was observed in 4 eyes (17%). Mean CST was 494 µm (range 210-1718 µm). Anatomic diagnoses included intermediate uveitis (8), posterior uveitis (2), and panuveitis (8). Specific syndromes/etiologies identified included VKH (2), post-operative (2), sarcoidosis (1), acute posterior multifocal placoid pigment epitheliopathy (APMPPE, 1), corticosteroid-associated central serous retinopathy (CSR, 1), macular hypotony (1), and panuveitis-associated CNVM (1). 15 patients (83%) had associated macular edema (diffuse or focal) and 8 patients (47%) demonstrated RPE disruption or scarring. A significant relationship between at least moderate visual loss (VA 0.05, Fisher’s exact test).
Macular edema was associated with SRDs in the majority of patients in this series with intermediate uveitis comprising the greatest proportion (>40%) of these cases. Less frequent disease associations included APMPPE, CNVM, and CSR. Although a clear statistical relationship between VA and CST in SRDs associated with uveitis was not found, moderate and severe visual impairment may be found in greater than 50% of these patients.
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