[Secondary retinal detachment accompanying intraocular tumors]

Aim of the study--the attempt to answer, what is the present incidence mechanism of arising, and what parameters can influence the development of secondary retinal detachment (s. r. d.) caused by intraocular choroidal tumor.

107 eyes of 105 consecutive patients aged 21 to 82 years (mean 62 years), diagnosed clinically as having choroidal malignant tumor, were evaluated. All patients were examined clinically including examination of anterior segment and fundus, ultrasonography and fluorescein angiography of the eye. Eyes qualified for enucleation were also examined histopathologically.

Out of all evaluated eyes s. r. d. was observed in 27 eyes (26 cases--25%). Exclusively in this group it occurred in 16 women (62%) and 10 men (38%). Right eye was involved in 10 cases, left eye in 15 and in 1 case both eyes were involved. The cause of s. r. d. was primary malignant choroidal tumor and in 3 cases--metastatic tumor. The therapy included brachytherapy, diode laser transpupillary thermotherapy (TTT), chemotherapy, local tumor excision and combined treatment. The s. r. d. was observed in cases of small tumors (2.77 mm) as well as very large ones (up to 11.56 mm). After therapy the detachment conceded in 10 eyes (37%). Analysis of clinical images, fluorescein angiograms and histopathological evaluation enabled better understanding of mechanisms leading to s. r. d.

1. In evaluated group the s. r. d. occurred more often in women (62%) than in men (38%). 2. Like intraocular tumors--it was seen more often in the left eye (59%) than in right one (41%). 3. The s. r. d. may occur in large tumors (over 6 mm) as well as in small ones (3 mm). 4. In case of large tumors the detachment has mainly "mechanical" character, however it may be also influenced by increased permeability of tumor vessels and impaired function of retinal pigment epithelium; the latter mechanism seems to play the main role in case of small tumors; in both cases the external retinal layer is damaged. 5. The most common cause of s. r. d. are tumors located in posterior pole (45%) and least frequently in upper-temporal quadrant (7%). 6. After brachytherapy, TTT or local tumor excision in selected cases s. r. d. may totally regress.