Surgical implications in exudative retinal detachment

Background Surgeries for retinal reattachment form the main stay of treatment for rhegmatogenous, tractional and combined retinal detachment. However, they do not form the first line of management in exudative retinal detachment. Massive exudative retinal detachment not responding to the conventional line of treatment or not permitting the performance of conventional line of treatment is chosen for surgical intervention. It is a mandatory prerequisite to identify the pre-existing factor that has been instrumental in the initiation of exudative retinal detachment (ERD). ERD occurs due to breakdown of the complex interactions of forces that maintain the normal apposition of the retina, RPE, Bruch’s membrane and choroid (Table 1). Failure of these forces, due to various causes enlisted below, potentially could lead to formation of fluid under the neurosensory retina. Central serous chorioretinopathy (CSCR) known to be a very common cause for localized ERD either in stressed males or patients who are on steroid medication for various ailments are potentially at risk for CSCR. This variety of CSCR is described as typical and is treated with lifestyle modification, avoiding steroids in all forms; focal laser photocoagulation is done to leak identified on fundus fluorescein angiogram for extrafoveal leaks and photodynamic therapy (PDT)/micropulse diode laser for subfoveal leak. When the fluid is non-resolving and retinal detachment is chronic and bullous, permanent damage to retinal pigment epithelium as well as outer retinal structures occurs and persistence of subretinal fibrin may lead to subretinal fibrotic scar formation. To avoid these complications, surgical intervention is planned after failure of conventional treatment. However, surgical treatment is never the first line of management in these conditions.