Delayed absorption of subretinal fluid after scleral buckling procedures: the significance of subretinal precipitates. 1978

D M Robertson

A delay in absorption of subretinal fluid after surgical repair for rhegmatogenous retinal detachment beyond 6 weeks was recognized in 39 of 575 consecutive cases undergoing scleral buckling procedures. The most common preoperative condition that was identified in these eyes was large clumps of cells on the undersurface of the detached retina. These cream-colored aggregates appeared similar to mutton-fat keratic precipitates and are referred to as subretinal precipitates. Most likely caused by aggregates of macrophages, they were present in 12 percent of the overall series of cases; subretinal precipitates also were recognized and documented before operation in nearly half of the eyes with delayed fluid absorption, a relationship that is highly significant in statistical analysis (P less than 0.001). On recognizing them before operation, the clinician can expect that approximately a fourth of the eyes will have fluid persisting beyond 6 weeks from the time of surgical repair until complete absorption. A second relatively common condition associated with delayed absorption of fluid that could be recognized in advance of surgical treatment was a long-standing peripheral (usually inferior) retinal detachment, which typically spared the macula, was associated with demarcation lines, and was caused by round atrophic holes with or without lattice degeneration. The presence of demarcation lines (reflecting relatively long-standing retinal detachment) was also positively correlated with delayed fluid absorption (P less than 0.02). Other conditions associated with delayed absorption of fluid included detachments of long-standing duration by history (especially when associated with previous unsuccessful efforts to repair the retina), vitreoretinal traction, and conditions whereby the choriocapillaris-retinal pigment epithelial complex and been significantly disturbed. Such conditions included hemorrhage into the subretinal space as a complication of surgical relase of subretinal fluid, previous retinal surgery, and possibly heavy treatment with cryopexy, especially when associated with exudative detachment. An analysis of subretinal fluide from 39 eyes showed a positive relationship between protein concentration and duration of the detachment but no relationship to a variety of other factors, including the presence of subretinal precipitates. Commonly identified cellular structures in the subretinal space consisted of pigmentladen macrophages. When studied by electron microscopy, some of these were thought to have originated from the retinal pigment epithelium.

UI MeSH Term Description Entries
D008264 Macrophages The relatively long-lived phagocytic cell of mammalian tissues that are derived from blood MONOCYTES. Main types are PERITONEAL MACROPHAGES; ALVEOLAR MACROPHAGES; HISTIOCYTES; KUPFFER CELLS of the liver; and OSTEOCLASTS. They may further differentiate within chronic inflammatory lesions to EPITHELIOID CELLS or may fuse to form FOREIGN BODY GIANT CELLS or LANGHANS GIANT CELLS. (from The Dictionary of Cell Biology, Lackie and Dow, 3rd ed.) Bone Marrow-Derived Macrophages,Monocyte-Derived Macrophages,Macrophage,Macrophages, Monocyte-Derived,Bone Marrow Derived Macrophages,Bone Marrow-Derived Macrophage,Macrophage, Bone Marrow-Derived,Macrophage, Monocyte-Derived,Macrophages, Bone Marrow-Derived,Macrophages, Monocyte Derived,Monocyte Derived Macrophages,Monocyte-Derived Macrophage
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D011506 Proteins Linear POLYPEPTIDES that are synthesized on RIBOSOMES and may be further modified, crosslinked, cleaved, or assembled into complex proteins with several subunits. The specific sequence of AMINO ACIDS determines the shape the polypeptide will take, during PROTEIN FOLDING, and the function of the protein. Gene Products, Protein,Gene Proteins,Protein,Protein Gene Products,Proteins, Gene
D012163 Retinal Detachment Separation of the inner layers of the retina (neural retina) from the pigment epithelium. Retinal detachment occurs more commonly in men than in women, in eyes with degenerative myopia, in aging and in aphakia. It may occur after an uncomplicated cataract extraction, but it is seen more often if vitreous humor has been lost during surgery. (Dorland, 27th ed; Newell, Ophthalmology: Principles and Concepts, 7th ed, p310-12). Retinal Pigment Epithelial Detachment,Detachment, Retinal,Detachments, Retinal,Retinal Detachments
D002449 Cell Aggregation The phenomenon by which dissociated cells intermixed in vitro tend to group themselves with cells of their own type. Aggregation, Cell,Aggregations, Cell,Cell Aggregations
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D005122 Exudates and Transudates Exudates are fluids, CELLS, or other cellular substances that are slowly discharged from BLOOD VESSELS usually from inflamed tissues. Transudates are fluids that pass through a membrane or squeeze through tissue or into the EXTRACELLULAR SPACE of TISSUES. Transudates are thin and watery and contain few cells or PROTEINS. Transudates,Exudates,Transudates and Exudates,Exudate,Transudate

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