Rhegmatogenous retinal detachment masquerading as exudative
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Uveitis and retina specialists must routinely classify retinal detachments (RD) into rhegmatogenous or serous (exudative) processes. Due to contrasting clinical signs, typical presentations are not particularly challenging to differentiate. Rhegmatogenous RDs are associated with anterior vitreous pigmented cell and non-shifting sub-retinal fluid. In non-infectious uveitis, serous RDs may result from severe inflammation, typically at the level of the choroid, with resultant shifting subretinal fluid. This is a retrospective case report illustrating the diagnostic and therapeutic challenges associated with a chronic rhegmatogenous retinal detachment masquerading as a severe panuveitis with intense anterior chamber inflammation.

A 26-year-old male presented with features of unilateral panuveitis: hypotony, anterior segment inflammation (posterior synechiae and anterior chamber cell with fibrin clumping), diffuse choroidal thickening, and retinal detachment. Laboratory investigations for infectious or rheumatologic processes were negative, and empiric systemic corticosteroid therapy was unsuccessful. This prompted suspicion for an alternate primary etiology, and pars plana vitrectomy revealed small retinal breaks as the underlying cause of the retinal detachment and inflammation.

Rhegmatogenous retinal detachments are a known cause of intraocular inflammation. Nevertheless, it remains a challenge to recognize retinal breaks in this setting, particularly with robust anterior segment inflammation and posterior findings resembling severe exudative uveitis. Being aware of this unique presentation may prevent delays in diagnosis and have important prognostic implications.

Source: https://www.sciencedirect.com/science/article/pii/S2451993618303025