Whitish Outer Retinal Spots in Retinal Detachment: Longitudinal Follow-up, Multimodal Imaging, and Clinical Utility

Purpose: To characterize the poorly understood phenomenon of whitish outer retinal spots that occasionally appear in retinal detachment (RD).Design: Retrospective, consecutive case series.Subjects: Patients with RDs that had ophthalmoscopically visible whitish outer retinal spots.Methods: All RDs with whitish outer retinal spots identified by one examiner over a 4-year interval were identified, and records were retrospectively reviewed.Main Outcome Measures: Clinical and surgical observations, photography, and OCT.Results: Whitish outer retinal spots were visualized in 51 occurrences of RDs: 45 in rhegmatogenous retinal detachments (RRDs), 5 in tractional RDs, and 1 in exudative RD. In RRDs, the spots usually formed an arcuate band located between the causative retinal break and the attached retina. However, 6 RRDs had spots located between a peripheral gutter of subretinal fluid and attached retina. In 11 eyes, the spots were observed to appear over time or to propagate to areas of detached retina more distal to the break. The spots corresponded to hyperreflective foci in the ellipsoid/interdigitation layers on OCT. The spots were isofluorescent on fluorescein angiography. The average duration of symptoms before surgical repair was 27.7 days. In 7 of 23 eyes surgically repaired by the author, the distribution of the spots assisted in localizing an occult retinal break. The spots sometimes appeared or persisted in areas of residual subretinal fluid but invariably resolved after retinal reattachment.Conclusions: Whitish outer retinal spots can occur in all types of RD, not just RRDs. Observation of the spots can help date an RD as subacute and should prompt surgery. Because the spots occur in distributions that reflect the path of spread of subretinal fluid, their position can be used to localize causative retinal breaks. Ophthalmology Retina 2022;6:469-477 2022 by the American Academy of Ophthalmology