Whitish Spots May Point to Causative Breaks in Retinal Detachment

Whitish outer retinal spots in patients with retinal detachment (RD) occur in distribution patterns that reflect the path of the spread of subretinal fluid, which can help physicians localize the causative retinal breaks, according to a case series report published in Ophthalmology Retina.

All patients (N = 47) who had RD with whitish spots between 2017 and 2021 at the Bascom Palmer Eye Institute in the United States were included in the study. Patient records were retrospectively reviewed for optical coherence tomography (OCT) data and outcomes.

Patients had a mean age of 49.8 ± 19.6 years, 27 were men, 20 women, and mean preoperative visual acuities were 20/157 ± 20/126 to hand motions.

Whitish outer retinal spots were visualized in 48 eyes with 51 occurrences. Most RDs (71%) involved the macula and 88% associated with rhegmatogenous retinal detachments (RRDs).

The whitish outer retinal spots were documented among 33 of the 51 occurrences with color or pseudocolor fundus. Spots were more easily visualized on near infrared and red-free fundus photographs than color or pseudocolor images.

Most spots appeared as an arcuate band of spots within the detached retina, usually between the causative break and detached retina and occasionally were clustered at one clock-hour from the RRD. Few eyes (13%) presented with the spots between the peripheral gutter of SRF and the attached retina. After surgery, some eyes (n = 8) developed spots in areas of residual subretinal fluid or persisted to propagate distally in areas with residual subretinal fluid.

Symptoms lasted an average 27.7 (SD, 29.0) days prior to surgery. Patients underwent scleral buckle (46%), pars plana vitrectomy (17%), or combined procedures (38%). The single-operation anatomic success rate was 91.4%. During the operation, the distribution of whitish outer retinal spots aided in localizing the occult retinal break.

Postoperative visual acuity at a mean follow-up of 14.0 months was 20/58 (SD, 20/42; P =.0002) hand motions.

“The major contribution of the current study is the characterization of the spatial relationships between causative retinal breaks and the distribution of whitish outer retinal spots in RRDs. Identifying the spots and understanding these spatial relationships can enable the surgeon to suspect the presence of an occult break and then localize and treat it” according to the report

This study was limited by the small sample size, the retrospective design, and by the fact that multiple surgeons performed the operations.

The study’s author reports that with careful ophthalmoscopy, RD with whitish outer retinal spots should prompt surgery and the localization of the spots can help identify an occult retinal break.

“The spots are relatively short-lived and so the only areas of retina that also have the spots must have detached near-simultaneously. If whitish outer retinal spots are present in an RRD, one can draw a straight line that bisects the band/cluster of spots and is perpendicular to the posterior, leading edge of detachment. The line should traverse the posterior pole and terminate at opposite ends of the ora serrata,” the study author explains.

Disclosure: The study author declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Russell JF. Whitish outer retinal spots in retinal detachment: longitudinal follow-up, multimodal imaging, and clinical utility. Ophthalmol Retina. 2022;S2468-6530(22)00039-2. doi:10.1016/j.oret.2022.01.017