Bilateral Serous Retinal Detachment Research Articles

Erdafitinib-induced bilateral multifocal serous retinal detachments and severe dry eye related unilateral peripheral ulcerative keratitis in a patient with metastatic urothelial carcinoma

Background: A case of bilateral multifocal serous retinal detachments and dry eye complicated with unilateral peripheral ulcerative keratitis (PUK) during erdafitinib therapy is described. Case description: A 76-year-old male underwent a baseline examination two months after initiating 8 mg erdafitinib therapy (April 2023) due to metastatic urothelial carcinoma. Left subfoveal serous retinal detachment was observed initially but the treatment was resumed as he was asymptomatic. In May 2023, bilateral multifocal subretinal fluid pockets were identified, and the patient was still asymptomatic. However, in June 2023 he complained of bilateral redness and a stinging sensation in his right eye. Bilateral severe dry eye and right PUK were diagnosed. He was prescribed dexamethasone eye drops and sodium hyaluronate artificial tears for both eyes. One week later corneal staining decreased, and progression of PUK ceased. Erdafitinib therapy was discontinued in June 2023 due to the planned transurethral prostatectomy. By July 2023, after discontinuation of the drug and administration of the topical treatment, the dry eye improved and the PUK became inactive. There was also resolution of subretinal fluid pockets in the right eye and a reduction of subretinal fluid pockets in the left eye. After the reinitiation of erdafitinib therapy, serous retinal detachments recurred in both eyes in September 2023, but both corneas remained stable with topical low-dose dexamethasone, cyclosporine-A and artificial tear usage. Conclusion: Erdafitinib therapy may lead to concurrent anterior and posterior segment complications. Multidisciplinary monitoring is crucial for patients undergoing erdafitinib therapy to prevent possible visual disturbances.

Vogt-Koyanagi-Harada Disease Presented with Bilateral Optic Disc Edema

Vogt-Koyanagi-Harada (VKH) disease is a multisystem inflammatory disease that occurs when body tissues including melanocytes are damaged by autoimmunity. The typical symptoms of VKH are bilateral multifocal uveitis and serous retinal detachment. Our patient was misdiagnosed as idiopathic intracranial hypertension because there were no other characteristic neurological symptoms other than bilateral optic disc edema. However, intracranial pressure was normal and pleocytosis was found, so VKH disease could be diagnosed. Bilateral optic disc edema may be a initial manifestation of VKH disease.

Bilateral Extensive Serous Retinal Detachment in a Patient with Multiple Myeloma

Purpose: To describe a case of bilateral serous retinal detachment in a patient with multiple myeloma.Case summary: A 75-year-old woman presented with sudden-onset of reduced visual acuity in both eyes which had begun 2 days prior. Initial ophthalmological assessment revealed that visual acuities were 0.03 in the right eye and 0.05 in the left eye. Optical coherence tomography indicated pronounced macular elevation and extensive subretinal fluid accumulation in the posterior pole of both eyes. Fluorescein angiography did not detect any significant vascular leakage. Blood tests showed an albumin level of 2.1 g/dL, and plasma protein electrophoresis revealed an M protein level of 0.19 g/dL. Multiple myeloma-related hypoalbuminemia and paraprotein were suspected. The patient's retinal statuses were closely monitored and compared with blood test outcomes. Over 2 months, there was significant improvement, characterized by decreasing macular elevation and reduction of subretinal fluid. This progress was sustained thereafter. Plasma protein electrophoresis showed a gradual decline in paraproteins which coincided with the amelioration of serous retinal detachment.Conclusions: We encountered a case of acute and extensive serous retinal detachment in both eyes of a patient with multiple myeloma. When fluorescein angiography does not definitively show vascular leakage, light chain deposition disease-related serous retinal detachment should be considered. In such instances, it is important to address and monitor the underlying multiple myeloma.

BILATERAL SEROUS RETINAL DETACHMENT AS OCULAR MANIFESTATION IN ACUTE LYMPHOBLASTIC LEUKEMIA: A CASE REPORT

Introduction : Acute lymphoblastic leukemia (ALL) is known to cause several ocular involvements. However, retinal detachment is a rare complication. This report aims to present unusual ocular manifestations in the form of bilateral serous retinal detachment in a pediatric patient.
 Case Illustration : An 11-year-old girl with a diagnosis of relapsed ALL and thrombocytopenia was referred to the Ophthalmology Department due to sudden blurred vision. The patient was undergoing chemotherapy on the third cycle due to the relapse. Visual acuity was 1/300 in both eyes. Fundus examination showed bilateral serous retinal detachment. No treatment in ophthalmology was given due to the unstable condition of this patient.
 Discussion : Up to 90% of all leukemia patients have fundus changes during the disease. The presence of unilateral or bilateral serous retinal detachment as a sign of choroidal infiltration may be one of the manifestations of acute leukemia, both as a primary sign and a relapse. Literature has shown that chemotherapy, radiation, and systemic prednisone would improve the visual acuity in these patients. However, in this case, when the patient is unstable and experiencing a series of complications, we decided that life-saving treatment comes first.
 Conclusion : The incidence of ocular involvements in ALL could be due to the treatment and the disease itself. Prompt recognition of disease led to early systemic treatment and restoration of visual function. The goal of sight-saving comes second after life-saving treatments.

EBV-Induced Inflammatory Chorioretinitis With Bilateral Retinal Serous Detachment in a Young Immunocompetent Patient

Epstein-Barr virus (EBV) infection is generally asymptomatic and persists throughout life. Ocular involvement is rare, observed in immunocompromised patients, particularly those infected with HIV, where retinal involvement may occur. Inflammatory chorioretinitis with bilateral retinal serous detachment is a rare entity in EBV infections. This case report describes inflammatory chorioretinitis with bilateral serous retinal detachment in an immunocompetent patient, resulting from Epstein-Barr virus (EBV) infection. Although ocular involvement by EBV is rare in immunocompetent patients, this case highlights the importance of considering this possibility. The patient was successfully treated with acyclovir, highlighting the potential efficacy of antivirals in these situations. This observation highlights the need for early detection to prevent irreversible ocular damage, despite the lack of standard diagnostic algorithms. Optimal clinical management of these cases remains a challenge, underlining the need for further research. Keywords: Epstein-Barr Virus Infections; Chorioretinitis; Retinal Serous Detachment; Acyclovir; Immunocompetent Patient Abbreviations: EBV: Epstein-Barr Virus, HIV: Human Immunodeficiency Virus, CMV: Cytomegalovirus, HSV: Herpes Simplex Virus, OCT: Optical Coherence Tomography

Philadelphia chromosome-positive acute lymphoblastic leukemia presenting with bilateral serous retinal detachment: A case report and review of the literature

We report a case who presented with bilateral serous retinal detachment (SRD) as the initial sign of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). A 49-year-old female presented with blurred vision. A colored fundus image of the patient revealed SRD around the posterior pole’s optic disc. Bone marrow aspiration showed infiltration with lymphoblasts. The patient was diagnosed with Ph+ ALL. SRD regressed in the color fundus image of the patient after induction chemotherapy and intrathecal methotrexate. The patient’s visual symptoms completely regressed. In conclusion, acute leukemia should be considered in the differential diagnosis of cases presenting with SRD.

Bilateral serous retinal detachment associated with end-stage renal disease

We present a 27-year-old female with chronic renal disease and history of congenital renal hypoplasia currently under peritoneal dialysis. She was referred for sudden vision loss. Best-corrected visual acuity was 20/200 in the right eye and counting fingers in the left eye. Examination revealed bilateral serous retinal detachment with macular involvement confirmed by optical coherence tomography. Blood laboratory workup was requested, and a presumptive diagnosis of serous retinal detachment associated with peritoneal dialysis was made. She was referred to a nephrologist for dialysis adjustment. One week later, vision improved to 20/25 bilaterally, with complete resolution of retinal detachment.

Bilateral, Simultaneous Central Serous Chorioretinopathy in Association With Oral Contraception Use.

This report describes a case of bilateral, simultaneous central serous chorioretinopathy (CSCR) in a young woman on oral contraceptive pills (OCP). A 21-year-old woman with a negative past medical history presented with sudden onset of bilateral decreased vision shortly after starting OCP. Comprehensive ocular examination revealed bilateral central serous chorioretinopathy (CSCR), confirmed on retinal optical coherence tomography (OCT) and intravenous fluorescein angiography. The patient was instructed to discontinue OCP, and three weeks later, there was complete resolution of the visual symptoms and of the bilateral serous retinal detachments, documented on OCT. [Ophthalmic Surg Lasers Imaging Retina 2024;55:96-99.].

Bilateral central serous retinal detachment in a patient with nephrotic syndrome: a case report

BackgroundThe aim of this report is to highlight the importance of considering nephrotic syndrome as a potential underlying cause of bilateral central serous retinal detachment in a patient with systemic lupus erythematosus and to underscore the significance of a comprehensive systemic workup in these patients.Case presentationA 19-year-old Iranian female patient with history of systemic lupus erythematosus presented with progressive vision loss and bilateral macular elevation. Ophthalmic examination revealed periorbital edema, chemosis, and subretinal fluid at the macula of both eyes. Optical coherence tomography confirmed the existence of subretinal fluid and serous detachment located at the macula of both eyes. On fluorescein angiography, there were no signs of subretinal leakage such as smoke stack sign or expansile dot in late phases. Laboratory tests detected hypoalbuminemia and significant proteinuria, leading to the diagnosis of nephrotic syndrome. Treatment with prednisolone and albumin infusion resulted in improved visual acuity and resolution of subretinal fluid.ConclusionNephrotic syndrome can be a rare underlying cause of bilateral central serous retinal detachment, and its association with systemic lupus erythematosus should be considered. Hypoalbuminemia in nephrotic syndrome alters fluid dynamics in the retina, contributing to bilateral central serous retinal detachment. Early recognition and management of nephrotic syndrome are essential for vision recovery and preventing long-term complications.

A 66-year-old woman with two weeks of distorted vision in the left eye.

To report a case of concurrent melanoma metastasis to the orbit and MEK inhibitor-associated retinopathy. Case report of a 66-year-old female patient undergoing mutation targeted MEK-inhibitor treatment for metastatic melanoma with retinal manifestations. After initiating MEK-inhibitor therapy our patient presented with bilateral blurred vision. Clinical examination and OCT imaging revealed multifocal bilateral serous retinal detachments consistent with MEKAR. Extrafoveal subretinal fluid foci resolved after discontinuation of MEK-inhibitor therapy, but her foveal lesions persisted for over 18 months. Years after her initial evaluation for MEKAR, our patient developed metamorphopsia in the left eye resulting from chorioretinal folds secondary to intraconal orbital metastasis. MRI revealed additional intracerebral and lung metastases, and the patient expired in 2 months. We report a case of prolonged MEKAR with concomitant orbital metastasis from melanoma. Multimodal imaging in conjunction with history and clinical features allows for disease identification and monitoring.

A 48-year-old female with chronic, progressive bilateral vision loss and dyspnea.

To describe a unique case of isolated, bilateral serous retinal detachments associated with primary pulmonary arterial hypertension. Case report. A 48-year-old woman with primary pulmonary arterial hypertension presented with bilateral vision loss. She was found to have bilateral serous retinal detachments in the macula with accumulation of the fibrinous material. Optical coherence tomography demonstrated intraretinal and subretinal fluid, hyperreflective material in the subretinal space, and choroidal engorgement. Fluorescein angiography demonstrated pooling in the maculas, an area of blockage corresponding with the area of subretinal exudative material, and a petalloid pattern of leakage in the maculas without evidence of retinal vascular leakage. Her ocular symptoms improved with aggressive medical management of her pulmonary arterial hypertension with the addition of eplerenone. Primary pulmonary arterial hypertension results in chronically elevated systemic venous pressure, leading to both systemic and ocular symptoms. It is important to consider this systemic condition in the differential diagnosis of serous retinal detachments to provide adequate multidisciplinary management.

Bilateral multifocal serous retinal detachments after multiple trauma: a case report

We present a patient with bilateral multifocal serous retinal detachments after multiple trauma in a car accident without preceding corticosteroid treatment. A 37-year-old patient was admitted to our hospital after he had suffered multiple body injuries in a car accident. After being woken from an induced coma, he complained of blurry vision in his left eye, so he underwent a complete ophthalmic examination – several serous retinal detachments were found at the posterior pole of both eyes, along with thickened choroids. As there was no intraocular inflammation, accelerated hypertension or other changes indicating other causes of serous retinal detachments, and since we observed a steady spontaneous subretinal fluid resorption, we classified our case as an atypical central serous chorioretinopathy. Alternatively, serous retinal detachments could have occurred due to transient alterations in choroidal circulation following cerebral injury. In conclusion, this case report adds new data on the occurrence of serous retinal detachments and discusses their possible aetiology in the trauma setting. Care must be taken not to miss any other underlying pathology needing treatment.

Dose-Dependent and Reversible Serous Retinal Detachments in Fibroblast Growth Factor Receptor Inhibitor-Associated Retinopathy.

We report two cases of fibroblast growth factor receptor (FGFR) inhibitor-associated retinopathy, including the first case of Debio 1347 associated retinopathy manifesting with bilateral serous retinal detachments along the superotemporal arcades and a case of erdafitinib associated retinopathy manifesting with classic foveal serous retinal detachments. Both cases demonstrate a clear dose-dependent and reversible class effect likely secondary to downstream effects of FGFR inhibition on the MEK pathway, resulting in retinal pigment epithelial cell dysfunction, and may also involve additional mechanisms of cellular injury through inhibition of the PI3K/AKT/mTOR pathway. FGFR inhibitor-associated retinopathy appears to manifest differently among patients. [Ophthalmic Surg Lasers Imaging Retina 2023;54:368-370.].

Bilateral Serous Retinal Detachment as a Complication of HELLP Syndrome.

HELLP syndrome is a pregnancy complication, putting at risk the life of mother and child, characterized by high blood pressure, elevated liver enzymes and low platelets. Serous retinal detachment is a rare complication of pregnancy and may be associated with HELLP syndrome. One of the most common symptoms is a decrease in visual acuity. A rare case of bilateral exudative retinal detachment associated with HELLP syndrome is described in a 38-year-old woman a few hours after delivery. Optical coherence tomography (OCT) showed an amount of subretinal fluid and macular edema. Use of systemic corticosteroids and careful management of blood pressure led to early resolution of subretinal fluid and a good recovery of vision. Her final best corrected visual acuity was 1 (decimal notation) in both eyes at 2 weeks after delivery. These types of cases are rarely reported and highlight the importance of increasing awareness of this pathology among ophthalmologists.

PROBABLE VOGT-KOYANAGI-HARADA DISEASE: A CASE REPORT

Vogt-Koyanagi-Harada(VKH)diseaseisabilateralgranulomatouspanuveitis affecting young adults, withor without systemic manifestations. The prognosis of VKH disease is generally favorable, however the development of complicationscanleadto blindnessanddeafness.(1) In this case, we report a 22-year-old man who developed probable Vogt–Koyanagi–Haradadisease without any systemic symptoms, but with several risk factors for poor visual prognosisbeforetreatment,andwhowassuccessfullytreatedwithintensivecorticosteroidtherapy. Our aim is to describe a clinical case with bilateral serous retinal detachment that presumed asprobableVKHdisease.

A significant finding in acute lymphoblastic leukemia: bilateral serous retinal detachment

A significant finding in acute lymphoblastic leukemia: bilateral serous retinal detachment

Bilateral optic disc edema and serous retinal detachment as initial ocular manifestations of systemic lymphoma: A case report and literature review

Bilateral optic disc edema and serous retinal detachment as initial ocular manifestations of systemic lymphoma: A case report and literature review

MASSIVE BILATERAL SEROUS RETINAL DETACHMENT IN A YOUNG PATIENT WITH HYPERTENSIVE CHORIORETINOPATHY AND CHRONIC KIDNEY DISEASE.

Report a case of hypertensive chorioretinopathy with massive bilateral serous retinal detachment in a young patient with chronic kidney disease. Observational case report. An 18-year-old man with Grade 5 chronic kidney disease, systemic high blood pressure, secondary acute pulmonary edema, and acute uremic syndrome was referred to our service complaining of bilateral decreased vision starting one week ago. The patient was treated at that moment with hemodialysis and losartan. At initial examination, the patient's blood pressure was 170/120 mmHg; dilated fundus examination evidenced optic disk edema, hypertensive chorioretinopathy, and massive serous retinal detachment with best-corrected visual acuity of hand motion in both eyes. The case was diagnosed as undertreated hypertension and was referred to the nephrologist for treatment adjustments. At 1-month follow-up, blood pressure was 160/90 mmHg; there was clinical improvement in both eyes but with ischemic sequelae. At the final follow-up 6 months later, blood pressure was 100/60 mmHg, best-corrected visual acuity was 20/80 in the right eye and count fingers at 2 min the left eye, and there was a complete resolution of the retinal serous detachment in both eyes. Patients with massive serous detachments due to systemic hypertension are atypical so it is of immense importance for the ophthalmologists to recognize the ocular manifestations of systemic diseases that put the patient's life at risk as in this case.

Prospective Study of Clinical Characteristics and Visual Outcome in Vogt–Koyanagi–Harada Syndrome in a Tertiary Eye Hospital in South India

Purpose: To describe the demographic pattern, clinical characteristics, treatment modalities, and visual outcome in Vogt–Koyanagi–Harada (VKH) disease patients observed at a tertiary eye care centre in South India. Methods: A prospective chart analysis of 38 patients with VKH disease. Results: Of the 38 VKH patients, 31 (81.6%) were female, the mean age was 39.8 years, and the median duration of symptoms was 10 days (range: 2 to 180 days). The most common ocular complaint was a defective vision (70 eyes or 92.1%). Extraocular manifestations were headache (13 patients or 34.2%) and tinnitus (4 patients or 10.5%). Twenty-four patients (63.2%) presented with bilateral panuveitis, and 12 patients (31.6%) had posterior uveitis. The most common posterior segment presentation included bilateral serous retinal detachment (100%), disc oedema (37 eyes or 48.7%), and vitritis (31 eyes or 40.8%). All patients (100%) were treated with oral and topical prednisolone, based on the ocular inflammation status, 9 patients (23.7%) required dexamethasone (intramuscular), 39 eyes (51.3%) required posterior subtenon triamcinolone, 16 patients (28.9%) required methotrexate, 1 (2.6%) required cyclophosphamide, 1 (2.6%) required azathioprine. At the final visit, the majority of the patients had statistically significant good visual outcomes. Conclusion: Prompt diagnosis and early initiation of treatment with systemic, local steroid and immunosuppressive therapy showed faster recovery with good visual outcome.

Suprachoroidal triamcinolone acetonide injection: a novel therapy for serous retinal detachment due to Vogt-Koyanagi Harada disease.

To assess the efficacy and safety of Suprachoroidal triamcinolone acetonide injection [SCTA] as an adjunctive therapy in management of Vogt-Koyanagi Harada [VKH] serous retinal detachment. Prospective parallel group study. 12 eyes of 6 patients with bilateral multiple serous retinal detachment of VKH in acute phase on systemic steroids. Each patient was received single SCTA injection (SCTA group, n = 6 eyes) and the other non-injected eye (Standard treatment group, n = 6 eyes), patients were followed for 1, 3, and 6 months to assess changes in best corrected visual acuity [BCVA], central foveal thickness [CFT] and intraocular pressure [IOP] between both groups. The primary end point was changes in BCVA from baseline till 6th months follow-up. Secondary end points were changes in CFT and IOP from baseline to 6 months of follow-up. BCVA at one and three months was significantly better in eyes received SCTA than in non-injected eyes (p-value = 0.026 for each). CFT at one and three months was significantly higher in non-injected eyes than in eyes received SCTA (p-value = 0.028 for each). IOP showed no significant differences between both groups. SCTA is an effective adjuvant treatment for VKH serous retinal detachment, without any serious ocular adverse effects or increase in IOP and causing significant reduction in CFT and rapid improvement in BCVA when combined with oral steroids.