Retinal necklace: Chain of cysts in retinal detachment.

Case Report

A 30-year-old woman presented with a history of low vision in the left eye following trauma since childhood and recent onset pain. Visual acuity was 20/20 in the right eye and light perception in the left eye with inaccurate projection of rays.

On examination, there was media haze of 4+ in the left eye. Ultrasound B-scan revealed a total retinal detachment (RD) with multiple retinal cysts in chain giving an appearance of a necklace [Fig. 1]. No surgical intervention was planned as the patient refused surgery after explaining prognosis. Topical steroids and cycloplegics were started for symptomatic relief of pain.

Figure 1

Ultrasound B-scan showing total retinal detachment with multiple retinal cysts in chain giving an appearance of a necklace

Retinal cysts are indicators of long-standing rhegmatogenous RD and seen in up to 1%–3% of RDs.[12] They occur due to chronic degenerative cystic changes in the outer plexiform layer of the detached retina.[1] They may be associated with hemorrhage within the cyst.[3] Ultrasound typically depicts round-to-oval bifurcations in the continuity of the detached retina. Surgical management of RD associated with cysts is carried out similar to the management of RD without cysts, and no specific treatment is usually required for the management of the cysts as they tend to resolve spontaneously with successful surgery for retinal reattachment. Cysts interfering with retinal reattachment may require surgical or laser-assisted drainage.[14]

Conclusion

Detection of retinal cysts either on clinical examination or on ultrasound examination is important as it helps in prognostication (their presence suggests a long-standing RD).

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.