Analysis of clinical manifestations and imaging features of bullous retinal detachment_Chinese Journal of Ocular Fundus Diseases

Authors：

Jin Enzhong , Ren Chi , Guo Yue , Yao Yuou , Qu Jinfeng ,  Zhao Mingwei

Department of Ophthalmology, Peking University People′s Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China;

Corresponding author：

Zhao Mingwei, Email: dr_zhaomingwei@163.com

Keywords：

Bullous retinal detachment; Central serous chorioretinopathy; Clinical features; Imaging features

DOI：

10.3760/cma.j.cn511434-20230215-00062

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Objective To investigate and analyze the clinical manifestations and imaging features of the eyes with bullous retinal detachment. Methods Retrospective case series study. Eleven eyes of 11 patients with bullous retinal detachment diagnosed in Department of Ophthalmology, Peking University People's Hospital from July 2015 to September 2021 were enrolled. There were 10 males and 1 female, with the mean age of (39.27±6.81) years. All patients had monocular bullous retinal detachment, with mean duration ranged from 3 months to 14 years. The basic information and medical history of all patients were collected. All patients underwent best corrected visual acuity (BCVA), indirect ophthalmoscopy, color fundus photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and B-scan ultrasonography. BCVA was performed using a standard logarithmic visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. The clinical data and imaging features of BCVA, OCT, FFA and ICGA were retrospectively analyzed and summarized. Results The mean logMAR BCVA of the 11 eyes was 0.91±0.45. Nine patients had bilateral disease, but bullous retinal detachment occurred in only 1 eye, and CSC manifestations were present in the contralateral eye. Six patients had received systemic or topical hormone therapy prior to onset. Yellowish-white material was observed in 6 eyes and retinal folds were observed in 5 eyes. OCT examination showed serous retinal detachment in the macular area with granular or patchy hyperreflective signals in the subretinal area in all eyes, and a few granular hyperreflective substances in the neuroretina in 6 eyes. Neuroretina cystoid degeneration was observed in 6 eyes, adhesion between the detached neuroretina and retinal pigment epithelial (RPE) was observed in 6 eyes, RPE tear was observed in 6 eyes, and different forms of retinal pigment epithelial detachment (PED) were observed in 6 eyes. FFA showed multiple fluorescence leakage spots in 10 eyes, and the average number of fluorescence leakage spots in all eyes was 3.82±2.44. There were multiple diffuse RPE lesions in 9 eyes. The results of ICGA examination showed that choroidal vessels were dilated and multiple hyperfluorescent leaks were observed in all eyes. B-scan ultrasonography examination of all affected eyes showed retinal detachment. Retinal reattachment can be achieved at (2.0±1.0) months after photodynamic therapy (PDT), while SRF can be completely absorbed at (2.36±0.81) months. The mean logMAR BCVA can be improved to 0.50±0.33, and no recurrence was found in the follow-up period up to 6 months. Conclusions Bullous retinal detachment is often associated with the use of hormones, while yellow-white material in the subretina and hyperreflective material in the OCT are common. It is characterized by neuroretina cystoid degeneration in the macular area, adhesion between the neuroretina and RPE, RPE tear and PED, with multiple fluorescence leakage spots and diffuse RPE lesions. PDT is an effective treatment for bullous retinal detachment.

Citation： Jin Enzhong, Ren Chi, Guo Yue, Yao Yuou, Qu Jinfeng, Zhao Mingwei. Analysis of clinical manifestations and imaging features of bullous retinal detachment. Chinese Journal of Ocular Fundus Diseases, 2023, 39(4): 282-289. doi: 10.3760/cma.j.cn511434-20230215-00062 Copy

1.	Kaye R, Chandra S, Sheth J, et al. Central serous chorioretinopathy: an update on risk factors, pathophysiology and imaging modalities[J/OL]. Prog Retin Eye Res, 2020, 79: 100865[2020-05-11]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(20)30037-9. DOI: 10.1016/j.preteyeres.2020.100865.
2.	Gass JD. Bullous retinal detachment. An unusual manifestation of idiopathic central serous choroidopathy[J]. Am J Ophthalmol, 1973, 75(5): 810-821. DOI: 10.1016/0002-9394(73)90887-8.
3.	Sahu DK, Namperumalsamy P, Hilton GF, et al. Bullous variant of idiopathic central serous chorioretinopathy[J]. Br J Ophthalmol, 2000, 84(5): 485-492. DOI: 10.1136/bjo.84.5.485.
4.	Balaratnasingam C, Freund KB, Tan AM, et al. Bullous variant of central serous chorioretinopathy: expansion of phenotypic features using multimethod imaging[J]. Ophthalmology, 2016, 123(7): 1541-1552. DOI: 10.1016/j.ophtha.2016.03.017.
5.	Daruich A, Matet A, Marchionno L, et al. Acute central serous chorioretinopathy: factors influencing episode duration[J]. Retina, 2017, 37(10): 1905-1915. DOI: 10.1097/IAE.0000000000001443.
6.	van Rijssen TJ, van Dijk EHC, Yzer S, et al. Central serous chorioretinopathy: towards an evidence-based treatment guideline[J/OL]. Prog Retin Eye Res, 2019, 73: 100770[2019-07-15]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(18)30094-6. DOI: 10.1016/j.preteyeres.2019.07.003.
7.	Khairallah M, Kahloun R, Tugal-Tutkun I. Central serous chorioretinopathy, corticosteroids, and uveitis[J]. Ocul Immunol Inflamm, 2012, 20(2): 76-85. DOI: 10.3109/09273948.2011.650776.
8.	Sartini F, Menchini M, Posarelli C, et al. Bullous central serous chorioretinopathy: a rare and atypical form of central serous chorioretinopathy. A systematic review[J]. Pharmaceuticals (Basel), 2020, 13(9): 221. DOI: 10.3390/ph13090221.
9.	Gao T, Qu J, Xiao J, et al. Photodynamic therapy for bullous retinal detachment: a single-center experience of case series with a 6-month follow-up study[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(8): 1429-1439. DOI: 10.1007/s00417-018-4015-8.
10.	Nicholson B, Noble J, Forooghian F, et al. Central serous chorioretinopathy: update on pathophysiology and treatment[J]. Surv Ophthalmol, 2013, 58(2): 103-126. DOI: 10.1016/j.survophthal.2012.07.004.
11.	Schatz H, McDonald HR, Johnson RN, et al. Subretinal fibrosis in central serous chorioretinopathy[J]. Ophthalmology, 1995, 102(7): 1077-1088. DOI: 10.1016/s0161-6420(95)30908-6.
12.	Daruich A, Matet A, Dirani A, et al. Central serous chorioretinopathy: recent findings and new physiopathology hypothesis[J]. Prog Retin Eye Res, 2015, 48: 82-118. DOI: 10.1016/j.preteyeres.2015.05.003.
13.	Maruko I, Iida T, Ojima A, et al. Subretinal dot-like precipitates and yellow material in central serous chorioretinopathy[J]. Retina, 2011, 31(4): 759-765. DOI: 10.1097/IAE.0b013e3181fbce8e.
14.	Iida T, Yannuzzi LA, Spaide RF, et al. Cystoid macular degeneration in chronic central serous chorioretinopathy[J]. Retina, 2003, 23(1): 1-7; quiz 137-138. DOI: 10.1097/00006982-200302000-00001.
15.	Piccolino FC, De La Longrais RR, Manea M, et al. Posterior cystoid retinal degeneration in central serous chorioretinopathy[J]. Retina, 2008, 28(7): 1008-1012. DOI: 10.1097/IAE.0b013e31816b4b86.
16.	Kang HG, Woo SJ, Lee JY, et al. Pathogenic risk factors and associated outcomes in the bullous variant of central serous chorioretinopathy[J]. Ophthalmol Retina, 2022, 6(10): 939-948. DOI: 10.1016/j.oret.2022.04.015.
17.	Mudvari SS, Goff MJ, Fu AD, et al. The natural history of pigment epithelial detachment associated with central serous chorioretinopathy[J]. Retina, 2007, 27(9): 1168-1173. DOI: 10.1097/IAE.0b013e318156db8a.
18.	Lim Z, Wong D. Retinal pigment epithelial rip associated with idiopathic central serous chorioretinopathy[J]. Eye (Lond), 2008, 22(3): 471-473. DOI: 10.1038/sj.eye.6703020.
19.	Parchand S, Gupta V, Gupta A, et al. Bilateral giant retinal pigment epithelial rip in idiopathic central serous chorioretinopathy[J]. Retina, 2011, 31(9): 1977-1978. DOI: 10.1097/IAE.0b013e31822352b9.
20.	Prünte C, Flammer J. Choroidal capillary and venous congestion in central serous chorioretinopathy[J]. Am J Ophthalmol, 1996, 121(1): 26-34. DOI: 10.1016/s0002-9394(14)70531-8.
21.	Burumcek E, Mudun A, Karacorlu S, et al. Laser photocoagulation for persistent central serous retinopathy: results of long-term follow-up[J]. Ophthalmology, 1997, 104(4): 616-622. DOI: 10.1016/s0161-6420(97)30262-0.
22.	Yannuzzi LA, Shakin JL, Fisher YL, et al. Peripheral retinal detachments and retinal pigment epithelial atrophic tracts secondary to central serous pigment epitheliopathy[J]. Ophthalmology, 1984, 91(12): 1554-1572. DOI: 10.1097/iae.0b013e3182434da4.
23.	Spaide RF, Hall L, Haas A, et al. Indocyanine green videoangiography of older patients with central serous chorioretinopathy[J]. Retina, 1996, 16(3): 203-213. DOI: 10.1097/00006982-199616030-00004.

1. Kaye R, Chandra S, Sheth J, et al. Central serous chorioretinopathy: an update on risk factors, pathophysiology and imaging modalities[J/OL]. Prog Retin Eye Res, 2020, 79: 100865[2020-05-11]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(20)30037-9. DOI: 10.1016/j.preteyeres.2020.100865.
2. Gass JD. Bullous retinal detachment. An unusual manifestation of idiopathic central serous choroidopathy[J]. Am J Ophthalmol, 1973, 75(5): 810-821. DOI: 10.1016/0002-9394(73)90887-8.
3. Sahu DK, Namperumalsamy P, Hilton GF, et al. Bullous variant of idiopathic central serous chorioretinopathy[J]. Br J Ophthalmol, 2000, 84(5): 485-492. DOI: 10.1136/bjo.84.5.485.
4. Balaratnasingam C, Freund KB, Tan AM, et al. Bullous variant of central serous chorioretinopathy: expansion of phenotypic features using multimethod imaging[J]. Ophthalmology, 2016, 123(7): 1541-1552. DOI: 10.1016/j.ophtha.2016.03.017.
5. Daruich A, Matet A, Marchionno L, et al. Acute central serous chorioretinopathy: factors influencing episode duration[J]. Retina, 2017, 37(10): 1905-1915. DOI: 10.1097/IAE.0000000000001443.
6. van Rijssen TJ, van Dijk EHC, Yzer S, et al. Central serous chorioretinopathy: towards an evidence-based treatment guideline[J/OL]. Prog Retin Eye Res, 2019, 73: 100770[2019-07-15]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(18)30094-6. DOI: 10.1016/j.preteyeres.2019.07.003.
7. Khairallah M, Kahloun R, Tugal-Tutkun I. Central serous chorioretinopathy, corticosteroids, and uveitis[J]. Ocul Immunol Inflamm, 2012, 20(2): 76-85. DOI: 10.3109/09273948.2011.650776.
8. Sartini F, Menchini M, Posarelli C, et al. Bullous central serous chorioretinopathy: a rare and atypical form of central serous chorioretinopathy. A systematic review[J]. Pharmaceuticals (Basel), 2020, 13(9): 221. DOI: 10.3390/ph13090221.
9. Gao T, Qu J, Xiao J, et al. Photodynamic therapy for bullous retinal detachment: a single-center experience of case series with a 6-month follow-up study[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(8): 1429-1439. DOI: 10.1007/s00417-018-4015-8.
10. Nicholson B, Noble J, Forooghian F, et al. Central serous chorioretinopathy: update on pathophysiology and treatment[J]. Surv Ophthalmol, 2013, 58(2): 103-126. DOI: 10.1016/j.survophthal.2012.07.004.
11. Schatz H, McDonald HR, Johnson RN, et al. Subretinal fibrosis in central serous chorioretinopathy[J]. Ophthalmology, 1995, 102(7): 1077-1088. DOI: 10.1016/s0161-6420(95)30908-6.
12. Daruich A, Matet A, Dirani A, et al. Central serous chorioretinopathy: recent findings and new physiopathology hypothesis[J]. Prog Retin Eye Res, 2015, 48: 82-118. DOI: 10.1016/j.preteyeres.2015.05.003.
13. Maruko I, Iida T, Ojima A, et al. Subretinal dot-like precipitates and yellow material in central serous chorioretinopathy[J]. Retina, 2011, 31(4): 759-765. DOI: 10.1097/IAE.0b013e3181fbce8e.
14. Iida T, Yannuzzi LA, Spaide RF, et al. Cystoid macular degeneration in chronic central serous chorioretinopathy[J]. Retina, 2003, 23(1): 1-7; quiz 137-138. DOI: 10.1097/00006982-200302000-00001.
15. Piccolino FC, De La Longrais RR, Manea M, et al. Posterior cystoid retinal degeneration in central serous chorioretinopathy[J]. Retina, 2008, 28(7): 1008-1012. DOI: 10.1097/IAE.0b013e31816b4b86.
16. Kang HG, Woo SJ, Lee JY, et al. Pathogenic risk factors and associated outcomes in the bullous variant of central serous chorioretinopathy[J]. Ophthalmol Retina, 2022, 6(10): 939-948. DOI: 10.1016/j.oret.2022.04.015.
17. Mudvari SS, Goff MJ, Fu AD, et al. The natural history of pigment epithelial detachment associated with central serous chorioretinopathy[J]. Retina, 2007, 27(9): 1168-1173. DOI: 10.1097/IAE.0b013e318156db8a.
18. Lim Z, Wong D. Retinal pigment epithelial rip associated with idiopathic central serous chorioretinopathy[J]. Eye (Lond), 2008, 22(3): 471-473. DOI: 10.1038/sj.eye.6703020.
19. Parchand S, Gupta V, Gupta A, et al. Bilateral giant retinal pigment epithelial rip in idiopathic central serous chorioretinopathy[J]. Retina, 2011, 31(9): 1977-1978. DOI: 10.1097/IAE.0b013e31822352b9.
20. Prünte C, Flammer J. Choroidal capillary and venous congestion in central serous chorioretinopathy[J]. Am J Ophthalmol, 1996, 121(1): 26-34. DOI: 10.1016/s0002-9394(14)70531-8.
21. Burumcek E, Mudun A, Karacorlu S, et al. Laser photocoagulation for persistent central serous retinopathy: results of long-term follow-up[J]. Ophthalmology, 1997, 104(4): 616-622. DOI: 10.1016/s0161-6420(97)30262-0.
22. Yannuzzi LA, Shakin JL, Fisher YL, et al. Peripheral retinal detachments and retinal pigment epithelial atrophic tracts secondary to central serous pigment epitheliopathy[J]. Ophthalmology, 1984, 91(12): 1554-1572. DOI: 10.1097/iae.0b013e3182434da4.
23. Spaide RF, Hall L, Haas A, et al. Indocyanine green videoangiography of older patients with central serous chorioretinopathy[J]. Retina, 1996, 16(3): 203-213. DOI: 10.1097/00006982-199616030-00004.

Chinese Journal of Ocular Fundus Diseases

Analysis of clinical manifestations and imaging features of bullous retinal detachment

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