Comment on: Traumatic central serous chorioretinopathy.

Abstract

Sir, We read with interest the article, “Traumatic central serous chorioretinopathy (CSR)” by Steeples et al.[1] The authors discuss a case of CSR that developed after blunt trauma to the eye, diagnosed with the help of fluorescein angiography and optical coherence tomography (OCT). There are few additional features in this interesting case that we wish to highlight. Figs. 2 and 4 are OCT images of the left eye of the patient pre- and post-resolution of the CSR. Although choroid cannot be seen completely in either, it definitely appears to be much thicker than the retina itself. Hyporeflective areas can be seen just below the retinal pigment epithelium layer in the OCT images, especially beneath the area of pigment epithelial detachment (PED) in Fig. 4b, which are possibly dilated choroidal vessels. These features are suggestive of the recently described entity “pachychoroid pigment epitheliopathy” (PPE) which is believed to be associated with a spectrum of diseases inclusive of CSR and polypoidal choroidal vasculopathy.[2] Furthermore, left eye shows multiple small PEDs which is another feature of PPE. It would be helpful if the choroidal thickness could be objectively determined. OCT images of the right eye may also help in this regard. History of CSR in the right eye of the patient, the presence of PED and possibility of PPE are tempting toward diagnoses of idiopathic CSR rather than traumatic CSR. Bilateral CSR has an incidence as high as 40%.[3] The only sign of trauma in the index eye is minimal uveitis (1+ cells). The trauma may have been coincidental. Rather, as the patient had low vision (history of retinal detachment surgery) in the right eye, CSR would have caused drop in visual acuity and predisposed the patient to blunt trauma. Therefore, it becomes necessary to know the actual events and nature of trauma. We hope our analysis adds value to the discussion and await the authors' response. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.