Bacillary Layer Detachment after Photodynamic Therapy for Central Serous Chorioretinopathy.

Abstract

To report the clinical and optical coherence tomography (OCT) findings of a patient with chronic central serous chorioretinopathy (cCSC) who developed a short-term bacillary layer detachment after photodynamic therapy. A 56-year-old man presented with metamorphopsia and 20/100 visual acuity in his right eye. He was diagnosed with active, chronic central serous chorioretinopathy based on clinical findings and multimodal imaging. His visual problems and retinal findings persisted for three months before he was treated with half-fluence, half-dose verteporfin photodynamic therapy. The patient had a prominent decrease in his vision post-operatively. Two days after treatment, multimodal imaging showed a marked increase in exudation that merged preoperative neurosensory retinal detachments. A prominent subfoveal bacillary layer detachment was also present. The subretinal fluid and bacillary layer detachment resolved over the next eight weeks, with a return of visual acuity to its baseline level and normalization of retinal structures except for a small zone of subfoveal ellipsoid zone and interdigitation zone disruption. Half-fluence, half-dose verteporfin photodynamic therapy caused a fulminant increase in subretinal fluid and an associated subfoveal bacillary layer detachment. We hypothesize that cCSC-related chorioretinal dysfunction contributed to the severe PDT-induced local inflammatory reaction that caused the patient's bacillary layer detachment. Hyperacute choroidal exudation too fulminant for containment in subretinal space extended into and exceeded photoreceptor inner segment tensile strength, cleaving the myoid layer and/or dissecting it from the ellipsoid layer. This finding broadens the causality spectrum of bacillary layer detachments and vision losses that can follow photodynamic therapy.