Area Of Serous Retinal Detachment Research Articles

Fundus Autofluorescence and Optical Coherence Tomography Characteristics in Different Stages of Central Serous Chorioretinopathy.

Objective To describe the morphological changes on fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT) imaging at different chronicity of central serous chorioretinopathy (CSC). Methods This cross-sectional study included patients with CSC of different chronicity. Changes in FAF scans and morphological changes on SD-OCT were evaluated and compared at different stages of CSC. Results Sixty-nine patients were enrolled in the study, with a mean age of 52.1 ± 11.8 years. A distinct hypoautofluorescence (AF) pattern was observed at the leakage point in acute CSC (100%). The leakage site was indistinguishable in 48% of the patients with late-chronic CSC. The majority of acute CSC patients showed hyper-AF in the area of serous retinal detachment (SRD), which persisted in the early-chronic stage of CSC. In late-chronic CSC, many cases of hypo-AF (22.2%) and mixed-pattern AF (14.8%) were observed. SD-OCT revealed evolving features of retinal pigment epithelium (RPE) abnormalities in a time-dependent manner: from peaked PEDs in acute CSC to low-lying PEDs in early-chronic CSC and, eventually, flat, irregular PEDs in late-chronic CSC. The average thickness of the photoreceptor layer (inner and outer segment; IS/OS) was 79 μm in the acute group and 55.2 μm in the chronic group. The photoreceptor layer (IS/OS) height was positively associated with visual acuity (p=0.002). Conclusion Different stages of CSC present different patterns on FAF and SD-OCT imaging. Chronicity of CSC can be estimated using specific features in these images. Photoreceptor layer (IS/OS) height acts as a good and objective predictor of visual outcomes in CSC patients.

Acute exudative polymorphous paraneoplastic vitelliform maculopathy (AEPPVM) associated with choroidal melanoma

BackgroundTo report a case of acute exudative polymorphous paraneoplastic vitelliform maculopathy in a patient with a history of choroidal melanoma, with metastases to the pancreas, liver, and central nervous system.Case presentationA 63-year-old patient, with a history of enucleation of the right eye due to choroidal melanoma, complained of progressive visual loss during a follow-up visit. Fundoscopic examination revealed multiple small areas of serous retinal detachment scattered throughout the posterior pole and ancillary tests confirmed the diagnosis of acute exudative polymorphous paraneoplastic vitelliform maculopathy (AEPPVM). Screening for systemic metastases showed pancreatic, hepatic, and central nervous system involvement.ConclusionsWe describe a rare case of acute exudative polymorphous paraneoplastic vitelliform maculopathy, which should be considered in patients with or without a history of melanoma, who have vitelliform retinal detachments. Nevertheless, no previous reviews of literature have shown a correlation between AEPPVM and pancreatic metastasis.

Short-duration multiple-session subthreshold micropulse yellow laser (577 nm) for chronic central serous chorioretinopathy: results at 3 years.

To review the 3-year follow-up results of subthreshold micropulse yellow laser (SMYL) delivered by a short-duration multiple-session method for treatment of chronic central serous chorioretinopathy (CSC). A total of 27 eyes from 27 patients with chronic CSC available for 3 years of follow-up were enrolled in this retrospective and interventional study. Patients were treated with 577-nm SMYL photocoagulation at a 15% duty cycle over multiple sessions, with low power ranging from 200 to 400 mW that was increased in 100 mW increments according to resolution of subretinal fluid at monthly follow-up. Laser titration was not performed. A treatment duration of 20 ms rather than the conventional duration (100-300 ms) was applied over the area of retinal pigment epithelium leakage and all areas of serous retinal detachment, including the fovea. The mean follow-up period was 3.7 ± 0.8 years (range, 3-6 years). A total of 22 out of 27 eyes (81.5%) including six cases of recurrence during the follow-up period exhibited complete resolution of subretinal detachment at final follow-up, whereas only five eyes (15.5%) had either a partial or null response to SMYL treatment. The baseline best-corrected visual acuity was 0.26 ± 0.24 logarithm of the minimum angle of resolution (logMAR), which was improved to 0.08 ± 0.15 logMAR at 1-year (p = 0.005) and 3-year (p = 0.01) follow-up. The central macular thickness at baseline was 389.6 ± 103.4 μm, which was changed to 197.2 ± 40.0 μm (p < 0.001) at 1-year follow-up, 196.4 ± 40.2 μm (p < 0.001) at 3-year follow-up. Short-duration multiple-session SMYL therapy may be effective for long-term treatment of chronic CSC.

CHOROIDAL CHANGES ASSOCIATED WITH SEROUS MACULAR DETACHMENT IN EYES WITH STAPHYLOMA, DOME-SHAPED MACULA OR TILTED DISK SYNDROME.

To study the relationship of choroidal abnormalities with serous retinal detachment (SRD) in eyes with staphyloma, dome-shaped macula, or tilted disk syndrome. Group 1, 28 eyes of 20 patients with staphyloma/dome-shaped macula/tilted disk syndrome associated with SRD was compared with Group 2, 30 eyes of 20 patients, with staphyloma/dome-shaped macula/tilted disk syndrome but without SRD. Radial and en-face optical coherence tomography and choroidal analysis were performed. Group 1 had a thicker mean subfoveal choroidal thickness (161 μm vs. 92 μm, P < 0.05) and a greater variation in choroidal thickness (112 μm vs. 76 μm, P > 0.05) compared with eyes of Group 2. Focal abrupt changes in choroidal thickness were more commonly seen in Group 1 versus eyes in Group 2 (90% vs. 30%, P < 0.05) and this area of abrupt change was located within or at the edge of the SRD in 64% of eyes. Large choroidal vessels (pachyvessels) (82% located within the area of SRD) were always associated with the presence of SRD. An abrupt transition in choroidal thickness may be involved in the pathogenesis of SRD. In some cases, a radial scan pattern may better demonstrate mild SRD, choroidal contours and the focal choroidal variations than horizontal or vertical raster scan patterns.

High-Resolution Imaging of Intraretinal Structures in Active and Resolved Central Serous Chorioretinopathy

PurposeTo improve our understanding of central serous chorioretinopathy (CSC), we performed an analysis of noninvasive, high-resolution retinal imaging in patients with active and resolved CSC.MethodsAdaptive optics scanning light ophthalmoscopy (AOSLO) and spectral-domain optical coherence tomography (SD-OCT) were performed on five subjects with CSC. A custom AOSLO system was used to simultaneously collect confocal and split-detector images. Spectral domain–OCT volume scans were used to create en face views of various retinal layers, which then were compared to montaged AOSLO images after coregistration.ResultsThree distinct types of intraretinal hyperreflective clusters were seen with AOSLO. These clusters had a well-demarcated, round, and granular appearance. Clusters in active CSC over areas of serous retinal detachment were termed type-1. They were found primarily in the outer nuclear layer (ONL) and were associated with large defects in the photoreceptor mosaic and ellipsoid zone. Clusters in areas where the retina had reattached were termed type-2. They also were located primarily in the ONL but showed stability in location over a period of at least 8 months. Smaller clusters in the inner retina along retinal capillaries were termed type-3.ConclusionsRetinal imaging in CSC using en face OCT and AOSLO allows precise localization of intraretinal structures and detection of features that cannot be seen with SD-OCT alone. These findings may provide greater insight into the pathophysiology of the active and resolved phases of the disease, and support the hypothesis that intraretinal hyperreflective foci on OCT in CSC are cellular in nature.

Fundus autofluorescence imaging patterns in central serous chorioretinopathy according to chronicity.

PurposeTo investigate the time-period characteristics associated with morphologic changes in central serous chorioretinopathy (CSC) using fundus autofluorescence (FAF).Patients and methodsRetrospective, cross-sectional observational case series. Patients were classified into three groups: acute and chronic according to the onset of subjective symptoms of 6 weeks and sequelae patients who have history and symptoms but no serous retinal detachment (SRD). We compared FAF images to obtain characteristic findings according to the chronicity.ResultsA total of 52 eyes were included in this study. Acute CSC eyes were characterized by decreased FAF intensity at the leakage point in 13/22 eyes (56.5%) and staining patterns with various levels of fluorescence signal (hyperautofluorescent (10 eyes, 43.5%), hypoautofluorescent (1 eye, 4.3%), and minimal changes (12 eyes, 52.2%)) in the area of SRD. In chronic CSC eyes, hyperautofluorescent (14 eyes, 63.6%) or minimal changes (8 eyes, 36.4%) were observed in the area of SRD. Discrete dots with increased FAF intensity were observed in chronic CSC eyes (P<0.001). Eyes with sequelae of CSC had mixed FAF patterns over areas of retinal pigment epithelium (RPE) atrophy in seven eyes (100%, P<0.001)) and descending tracts which showed various FAF intensities according to the RPE and photoreceptor status (P<0.001).ConclusionFAF imaging patterns in CSC eyes differ according to the course of the disease, reflecting RPE and outer retinal changes. Detailed investigation using FAF could help to estimate the duration of CSC and determine the proper treatment modality.

Nondamaging photothermal therapy for the retina: initial clinical experience with chronic central serous retinopathy.

To assess safety and clinical efficacy of the nondamaging photothermal therapy for the macula for the treatment of chronic central serous retinopathy. Sixteen eyes of 16 patients with persistent central serous retinopathy (>4 months of duration) were treated with the PASCAL Streamline) at 577-nm wavelength, using 200-μm retinal spot sizes. Using Endpoint Management Software, the laser power was first titrated for a barely visible burn with 15-ms pulses, which was defined as 100% pulse energy. Treatment was then applied over the area of serous retinal detachment and adjacent nonthickened retina, using 30% pulse energy with the spot spacing of 0.25 beam diameter. Changes in subretinal fluid, Early Treatment Diabetic Retinopathy Study best-corrected visual acuity, and central macular thickness were measured over 6 months of follow-up. Pretreatment and posttreatment fluorescein angiography and fundus autofluorescence were also assessed. On average, 532 spots have been applied per treatment. No visible laser marks could be detected by clinical observation, optical coherence tomography, fundus autofluorescence, or fluorescein angiography. On average, 12 Early Treatment Diabetic Retinopathy Study letters gain was achieved at 2 months and was sustained by 6 months (P < 0.001). Central macular thickness decreased from 350 μm to 282 μm (P = 0.004). Subretinal fluid completely resolved in 37% of the patients after first treatment, whereas 44% of the patients required retreatment after 3 months because of recurrent fluid or incomplete resolution. The remaining 19% of the patients received a second retreatment. By 6 months, in 75% of the patients, the subretinal fluid was completely resolved, whereas in 25%, there was some minimal fluid left. Photothermal therapy using 577-nm PASCAL laser with Endpoint Management graphic user interface was safe, and it improved visual acuity and resolution of subretinal fluid in chronic central serous retinopathy. Lack of tissue damage allows periodic retreatment without cumulative scaring, characteristic to conventional photocoagulation. This technique should be tested in the treatment of other macular disorders and may offer an alternative to conventional laser coagulation of the macula and to anti-vascular endothelial growth factor pharmacological treatments of macular diseases.

Aquaporin‐4 and potassium channel kir4.1 in amd and serous retinal detachment secondary to choroidal melanoma

AbstractPurpose Aquaporin‐4 (AQP4) and potassium channel Kir4.1 are normally expressed in retinal Müller glia, and play a major role in controlling retinal fluid and maintaining retinal integrity and function. We examined AQP4 and Kir4.1 distribution and expression in human eyes with late age‐related macular degeneration (AMD) or long‐term serous retinal detachment secondary to choroidal melanoma.Methods Paraffin sections of central and peripheral choroid/retina from young (&lt;40 years, n=5), aged (&gt;70 years, n=4) and AMD (&gt;70 years, n=5) human post‐mortem eyes, and whole human eyes with choroidal melanoma (n=5), were co‐immunolabelled with antibodies to AQP4, Kir4.1 and GFAP, and visualised using immunofluoresence and confocal microscopy.Results We found differential expression of AQP4 and Kir4.1 in detached retina of melanoma eyes, with upregulation of AQP4 and downregulation of Kir4.1 compared to unaffected eyes. This was most obvious in the retina overlying melanomas and in detached retina separated from underlying choroid. GFAP immunoreactitvity was upregulated in areas of serous retinal detachment, and retinal thinning; Müller cell processes extended along the anterior surface of melanomas. No apparent difference in distribution or expression of AQP4 or Kir4.1 was observed for retinas with late stage AMD compared to controls.Conclusion Decreased Kir4.1 expression in long term serous retinal detachment may be associated with Müller cell proliferative gliosis, as suggested in earlier animal studies. Increased AQP4 expression suggests efforts to restore retinal fluid balance in areas with photoreceptor degeneration and compromised outer blood‐retinal barrier. Support: NFMRI (MCM), Lions NSW Eye Eyebank

Hypercortisolism induced atypical central serous chorioretinopathy in pregnancy

Pregnancy can cause changes in the functioning of the eye in health and in disease, just as it modifies other non-reproductive systems of the body. Central serous chorioretinopathy (CSCR) is a relatively common retinal disease characterized by the accumulation of sub retinal fluid at the posterior pole of the fundus, creating a circumscribed area of serous retinal detachment. It typically affects young and middle-aged men with no previous medical and family history, and no systemic symptoms or signs. However, pregnancy, predisposed by endogenous hypercortisolism, probably represents a risk factor for central serous chorioretinopathy.1 Many cases of central serous chorioretinopathy have been described during or following treatment with glucocorticoids, administrated by any route, for various systemic or ocular conditions, when the CSCR is generally atypical, bilateral and has less male prelidiction.2 We present here the nuances of a case of a concomitant endogenous hypercortisolism (pregnancy) and exogenous hypercortisolism (treatment with oral corticosteroids) leading to a unilateral, atypical CSCR with sub retinal exudates in a 26 year old second gravida.

Dalen Fuch′s nodules and serous retinal detachment on optical coherence tomography in sympathetic ophthalmitis

Dear Editor, Sympathetic Ophthalmitis (SO) is a rare, diffuse granulomatous uveitis characterized by Dalen Fuchs (DF) nodules. We present a case of SO where DF nodules and serous retinal detachment have been documented by spectral domain optical coherence tomography (OCT). To the best of our knowledge there is only one published report of DF nodules imaged by OCT.[1] Till recently, the confirmation of DF nodules could only be done by Electron Microscopy of histopathological samples. A 28-year-old man sustained a penetrating injury to his left eye for which he underwent surgical repair at a local hospital. Two weeks later he presented with pain, redness and blurring of vision in his right eye. On examination, the best corrected visual acuity (BCVA) of right eye was 6/12p, N10 while the left eye had no perception of light. Slit lamp examination of right eye showed circumcorneal congestion, multiple fine keratic precipitates with 2+ cells and flare and retrolental cells. Fundus examination revealed three small yellowish-white lesions suggestive of DF nodules, temporal to the fovea with an area of bullous elevation measuring 3 disc diameters seen supero-temporal to the fovea. Examination of the left eye showed a 2 mm sutured corneal wound with 3+ cells and flare, a 6 mm non-reactive pupil and early cataract. Vascularized tissue was seen in the retrolental area and there was no view of the fundus. Ultrasound B scan showed total retinal detachment with diffuse choroidal thickening in the left eye. OCT of right eye showed a localized small area of disorganized retinal pigment epithelium (RPE) with trans-retinal hyperactivity suggestive of DF nodule [Figs. ​[Figs.11 and ​and2].2]. The nodule appeared to have caused dome shaped elevation and destruction of the pigment epithelium corresponding to the third type of DF nodule described by Reynard et al.[2] Extensive disintegration of RPE and choriocapillaries have been described by Gallagher et al.[3] but in our case, the destruction was more focal. However, these earlier descriptions of DF nodules based on electron microscopy of tissue samples, might be at variance with the findings on OCT. There was also a large area of serous retinal detachment [Fig. 3] as seen in the case series of Gupta et al.[4] temporal to the macula causing disruption of the normal photoreceptor layer. Intra ocular pressures measured 14 and 4 mmHg in the right and left eyes respectively. Figure 1 Optical coherence tomography of the right eye showing Dalen Fuchs Nodule (arrow) Figure 2 Optical coherence tomography of right eye: Retinal pigment epithelial surface map showing dome shaped elevations corresponding to the area of the Dalen Fuchs nodule (arrows) Figure 3 Optical coherence tomography of the right eye showing serous retinal detachment The patient was treated with topical steroids and cycloplegics in both eyes and with oral prednisolone 1 mg/kg which was tapered over a period of 2 months. After 2 weeks, his BCVA in the right eye was 6/6, N6 with a quiet anterior segment and fundus examination showed resolving DF nodules and serous detachments. Six weeks later, OCT showed complete resolution of DF nodules as well as the sub-retinal fluid with restoration of photoreceptors and inner and outer segments [Figs. ​[Figs.44 and ​and55]. Figure 4 and 5 Optical coherence tomography of right eye showing complete resolution of Dalen Fuchs nodule and serous retinal detachment SO is now rarely seen and so it is important for ophthalmologists to be aware of this dreaded complication. Early diagnosis and prompt treatment with systemic corticosteroids is absolutely necessary to prevent irreversible damage of the photoreceptor layer and to restore vision.[4] DF nodules can be clearly imaged by OCT which has emerged as an essential diagnostic tool in early detection, timely management and follow-up of patients with SO.[1]

Fundus autofluorescence and optical coherence tomography findings in branch retinal vein occlusion.

Purpose. To describe the findings of fundus autofluorescence (FAF) and optical coherence tomography (OCT) in patients with branch retinal vein occlusion (BRVO). Methods. In this institutional, retrospective, observational case series, FAF was evaluated in 65 eyes with BRVO in 64 consecutive patients and compared with visual acuity, OCT findings, and other clinical observations. Results. Five types of autofluorescence appeared during the course of BRVO: (1) petaloid-shaped hyperautofluorescence in the area of macular edema and (2) hyperautofluorescence coincident with yellow subretinal deposits. (3) Diffuse hyperautofluorescence appeared within the area of serous retinal detachment (SRD) and OCT showed precipitates on the undersurface of the retina in 5/5 of these eyes (100%). (4) The area of vein occlusion showed diffuse hyperautofluorescence after resolution of the retinal bleeding. (5) Hard exudates exhibited hyper- or hypoautofluorescence. OCT indicated that most of the hard exudates with hyperautofluorescence were located on the retinal pigment epithelium. Conclusions. Hyperautofluorescence associated with subretinal fluid or hard exudate appeared in the subretinal space. This type of hyperautofluorescence may be attributed to blood cell or macrophages. FAF and OCT are noninvasive modalities that provide additional information regarding macular edema due to BRVO.

Retinal thickness and perimetric sensitivity in central serous chorioretinopathy

To investigate the relationship between anatomical changes and visual sensitivity in eyes with central serous chorioretinopathy (CSC). Twenty-one eyes with CSC were retrospectively studied using optical coherence tomography (OCT) retinal maps, line scan mode, and the Humphrey perimetry central 10-2 program. Total retinal thickness (TRT), including the neurosensory retina and subretinal fluid, correlated significantly with the sensitivity loss in the corresponding visual field in the central macula within a circle 6 mm in diameter. Differential analysis of the TRT, separating it into neurosensory retinal thickness (NRT) and subretinal thickness (SRT), revealed that only SRT correlated well with perimetric sensitivity at 1°, 3°, 5°, 7°, and 9° from the fovea along horizontal and vertical lines crossing at the fovea. Visual sensitivity measured with automated static perimetry is further attenuated by increasing distance between the photoreceptor and retinal pigment epithelium (RPE) in areas of serous retinal detachment in eyes with CSC.

Infrared and fundus autofluorescence imaging in eyes with optic disc pit maculopathy

To characterize the infrared (IR) and fundus autofluorescence (FAF) images of eyes with optic disc pit maculopathy. A retrospective non-comparative study of three patients with optic disc pit maculopathy who were followed by optical coherence tomography (OCT) and retinal angiography (Heidelberg retina angiograph 2) before and after vitreous surgery without laser photocoagulation. The areas of serous retinal detachment and inner retinal schisis were dark in the IR and FAF images preoperatively; and they changed to brighter areas following reattachment of the retina. There was an increase in the granular hyperfluorescence in the FAF images accompanied by an increase in the number of subretinal precipitates. OCT showed a thickening of the photoreceptor outer segments. The outer retinal layer defect initially appeared bright in the IR images and hypofluorescent or hyperfluorescent in the FAF images. The outer retinal layer defect became larger with a reduction of the outer retinal schisis and increased retinal detachment, but then became smaller with the resolution of the retinal detachment. All cases had a resolution or reduction of the retinal detachment and retinal schisis after the vitrectomy. The IR and FAF images in eyes with optic disc pit maculopathy reflect the changes in the inner and outer retinal layers corresponding with the stage of recovery of the disease.

Blue light and near-infrared fundus autofluorescence in acute Vogt–Koyanagi–Harada disease

Background/aimsTo investigate the characteristics of fundus autofluorescence (FAF) in acute Vogt–Koyanagi–Harada (VKH) disease.MethodsFAF photography with blue light (BL-FAF) and near-infrared light (NIR-FAF) was performed on 10 eyes of five patients...

Sympathetic ophthalmia manifesting with conjunctival chemosis

A 13-year-old girl was referred to us with the complaints of severe headache and decreased visual acuity (VA) in the right eye, of 1 week duration. She had a history of penetrating ocular trauma in the left eye 1 month earlier. Her best-corrected VA was counting fingers in the right eye and no light perception in the left eye. External examination revealed a massive inferior conjunctival chemosis bilaterally (Fig. 1a). Slitlamp examination of the right eye showed 0.5? cells, no corneal precipitates, and mild vitritis. There were a cloud cornea and an iris distortion, and no posterior segment structures were visible in the traumatized eye. Fundus examination of the right eye revealed focal yellow–white lesions at the level of the retinal pigment epithelium (RPE), multifocal serous retinal detachment (SRD), and hyperemic optic disc (Fig. 1b). Fluorescein angiography showed multifocal leaks at the level of the RPE with pooling of dye in the area of SRD (Fig. 1c). Ultrasonography of the right eye showed marked, diffuse choroidal thickening (3 mm), and diffuse retroscleral edema with T-sign in the peripapillary region (Fig. 1d). In the traumatized eye, there was choroidal and ciliary body detachment. Optical coherence tomography of the right eye showed SRD with subretinal septa. A diagnosis of SO was made, and the patient was treated with intravenous methylprednisolone (1 g/day for 3 consecutive days) followed by oral administration of prednisone (1.5 mg/kg). Three days after presentation, intraocular inflammation had improved and conjunctival chemosis had completely resolved. One week later, the chemosis had recurred and the SRD became more extensive and bullous. Cyclosporin (5 mg/kg/day) and then infliximab (5 mg/kg/ 0–2–4–8 weeks) were added. After a follow-up of 3 months, conjunctival chemosis had disappeared (Fig. 2a) and VA was 20/200. SRD had resolved, and there were subretinal fibrosis with RPE proliferation (Fig. 2b). Ultrasonography showed resolution of choroidal thickening and retroscleral edema (Fig. 2c). S. Attia S. Jenzeri I. Chtioui B. Jelliti S. Zaouali S. B. Yahia M. Khairallah (&) Department of Ophthalmology, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia e-mail: moncef.khairallah@rns.tn

Metástase de coróide simulando síndrome de efusão uveal: relato de caso

We report a case of choroidal metastasis simulating uveal effusion syndrome. This patient with uveal metastasis from lung carcinoma presented with decreased vision in the left eye. Fundoscopic examination revealed pigmentary clumping, multiple choroidal nodules and serous retinal detachment. Fluorescein angioraphy revealed a leopard spots pattern similar to uveal effusion syndrome. Ultrasound revealed the presence of choroidal nodules with moderate internal reflectivity, choroidal thickening and serous retinal detachment. Optical coherence tomography showed retinal pigment epithelium tear and hyper-reflective nodules within the choroid and areas of serous retinal detachment. Image investigation demonstrated the presence of a solitary pulmonary nodule at the left apical lung. Choroidal metastasis can lead to a scenario that simulates uveal effusion syndrome. This possibility must be considered when having an atypical uveal effusion symptomatoloy and a systemic screening for systemic cancer should be performed.

Serous retinal detachment secondary to choroidal osteoma successfully treated with transpupillary thermotherapy.

To report a case of serous retinal detachment (SRD) associated with choroidal osteoma successfully treated with transpupillary thermotherapy (TTT). A 21-year-old woman presented with a 1-month history of blurred vision in the right eye. Visual acuity was 20/50 in the right eye and 20/20 in the left eye. Fundus examination of the right eye revealed a suprapapillary choroidal osteoma associated with SRD extending to the macula. Fluorescein angiography showed diffuse mottled hyperfluorescence of the tumor associated with a moderately leaking area at its inferior border within the area of SRD. There were neither obvious features of choroidal neovascularization nor typical focal retinal pigment epithelial leaks. TTT, applied to the leaking area in one session using an 810-nm diode laser, resulted in resolution of subretinal fluid and subsequent improvement in visual acuity to 20/25. TTT can be considered as treatment for patients with choroidal osteoma complicated by SRD.

Choriorétinopathie séreuse centrale et maladies systémiques : deux cas observés sous corticothérapie

Introduction Central serous chorioretinopathy is an uncommon retinal disease, whose pathogenesis is largely unknown. It is characterized by an accumulation of subretinal fluid at the posterior pole of the fundus, creating a circumscribed area of serous retinal detachment. It manifests generally as a visual loss or an abnormal colour vision. It is often idiopathic but may also be associated with numerous pathological situations, with frequent exposure to corticosteroids. Exegesis We report on two patients with central serous chorioretinopathy. The first female patient had been treated with steroids for a systemic lupus erythematosus for fifteen years, and the second male patient had been treated with steroids for an idiopathic hypereosinophilic syndrome for a few months. Visual loss led to a diagnosis of central serous chorioretinopathy. Lowering of steroids doses was followed by a clinical improvement in both cases. Conclusion Similarly to cataract or glaucoma, central serous chorioretinopathy belongs to the potential ocular side-effect of steroid treatment, and thus deserves to be known by internists.

Evaluation of central serous chorioretinopathy with optical coherence tomography

PURPOSE: To evaluate central serous chorioretinopathy with optical coherence tomography during the acute phase and after resolution of the acute phase. METHODS: In a prospective study, 23 consecutive eyes of 23 patients (19 men, four women; mean age ± SD, 46.0 ± 8.1 years; range, 29 to 60 years) with central serous chorioretinopathy were examined with optical coherence tomography during the acute phase and after resolution of the retinal detachment. After the initial examination, the patients were reexamined for 3 to 6 months (mean, 4.7 ± 1.1 months). Cross-sectional retinal images through the center of the fovea were obtained from all eyes by optical coherence tomography. The retinal thickness at the center of the fovea was measured. The difference between the retinal thickness during the acute phase and after resolution of the retinal detachment was statistically analyzed using the Wilcoxon test. We also examined a grayish-white lesion that corresponded to the leakage point in fluorescein angiography in four eyes. RESULTS: In the acute phase, neurosensory retina was thickened within the area of serous retinal detachment in all 23 eyes. The detached retina was thicker than the reattached retina after resolution of the retinal detachment in all eyes. The retinal thickness at the center of the fovea during the acute phase (range, 157 to 236 μm; mean ± SD, 196.9 ± 22.6 μm) was significantly thickened compared with that after resolution (range, 105 to 152 μm; mean ± SD, 124.8 ± 10.7 μm; P <.0001, Wilcoxon test). In the acute phase, areas of low reflectivity localized within the detached retina were observed in 18 of the 23 eyes. In the area of the grayish- white lesion, optical coherence tomography showed a moderately reflective mass bridging the detached neurosensory retina and retinal pigment epithelium in the four eyes; the outer layer of the detached retina was more highly reflective in these eyes. The retinal pigment epithelium was focally detached beneath the subretinal reflective mass in three of the four eyes. CONCLUSIONS: In all eyes studied, neurosensory retina was thickened within the area of serous retinal detachment in the acute phase of central serous chorioretinopathy. The grayish-white lesion seems to be a fibrinous exudate that accumulates in the subretinal space and infiltrates into the outer retina.