Subfoveal Serous Retinal Detachment Associated with Distant Branch Retinal Vein Occlusion

Abstract

Purpose: : To study the pathophysiology of the subfoveal serous retinal detachment (SRD) observed in eyes with distant branch retinal vein occlusion (BRVO).

Methods: : We retrospectively reviewed the medical records of 10 patients (10 eyes) with distant BRVO that were examined using spectral-domain optical coherence tomography (OCT).

Results: : Distant BRVO was observed in the inferior area in 4 eyes, in the superior area in 5 eyes, and in the nasal area in 1 eye. The fovea was not directly affected with retinal hemorrhage, macular edema, or ischemia resulting from BRVO. However, the visual acuity was moderately disturbed (median, 0.65; range, 0.2-0.9 according to the Landolt chart). Seven eyes showed hard exudate around the fovea. OCT examinations showed SRD under the fovea in 9 eyes. Of these 9 eyes, 1 showed extensive subfoveal SRD that was connected to the area affected with BRVO through the subretinal space. In the remaining 8 eyes, however, OCT showed focal subfoveal SRD without subretinal connections to the area affected with BRVO. However, all these eyes show marked retinal swelling in the outer retina, especially in the outer plexiform layer. In 4 eyes, detailed OCT examinations showed a small break on the external surface of the neurosensory retina that connects the swollen outer retina with the underlying SRD. All eyes showed hyperreflective foci in the outer retina, most frequently along the inner boundary of the outer plexiform layer. SRD was regressed spontaneously in 3 eyes and 6 eyes showed regression of SRD immediately after the application of focal laser photocoagulation for distant BRVO.

Conclusions: : Distant BRVO was often accompanied with focal SRD beneath the fovea. The leakage from the retinal capillaries affected with BRVO travelled via the outer plexiform layer and caused SRD under the fovea through the break of the outer boundary of the neurosensory retina.

Keywords: vascular occlusion/vascular occlusive disease • macula/fovea • retinal detachment