Pockets of Subretinal Fluid after Retinal Reattachment Surgery: New Insights with SD-OCT

Abstract

Purpose: : Pockets of retained subretinal fluid (SRF) were first described in five patients after scleral buckling surgery by Lobes and Grand in 1980. They noted yellow-orange, dome-shaped subretinal lesions without associated edema or changes to the overlying retina. We observed this same finding after retinal reattachment surgery using pneumatic retinopexy and pars plana vitrectomy. With the advent of SD-OCT, we are able to better characterize and more closely follow these lesions over time.

Methods: : A retrospective chart review of four patients with these clinical findings from three tertiary care eye centers was performed. All patients suffered rhegmatogenous retinal detachment (RRD) and underwent reattachment surgery. The average age at time of detachment was 60 years (range 56-62). Two patients had macula-on RRDs and two had macula-off bullous RDs. Two patients underwent cryotherapy with pneumatic retinopexy. Two patients had vitrectomy with fluid air exchange and endolaser, one of which was combined with scleral buckle. Post-operative fluorescein angiograms and optical coherence tomography scans were obtained.

Results: : Funduscopy showed several small, well-circumscribed, yellow subretinal lesions. OCT demonstrated dome-shaped pockets of SRF without intrinsic change to the overlying retina. There were hyper-reflective deposits adherent to the undersurface of the RD as shown by OCT. (see fundus photos and OCT scans).

Conclusions: : Yellow blebs of subretinal fluid may occur after pneumatic retinopexy and vitrectomy surgery for RRD. The slow reabsorption of subretinal fluid may be due to diffuse RPE dysfunction. The hyper-reflective deposits within the SRF on OCT most likely represent shed photoreceptor outer segments. These outer segments accumulate in the subretinal space along with proteinaceous fluid, thus providing the yellowish hue of these lesions. The long term anatomic and visual prognosis associated with these lesions is favorable.

Keywords: retinal detachment • retina • retinal pigment epithelium