Macular Neurosensory Detachment Research Articles

Warfarin, Winter, and Central Serous Chorioretinopathy

Central serous chorioretinopathy(CSC) is a retinal disease characterised by diminition of vision and neurosensory macular detachment. Here we present a rare case of a 50-year-old male with a history of deep vein thrombosis, who developed CSC after warfarin intake plus his two episodes of CSC developed in susequent winter seasons.

Correlation Between Warfarin, Winter, and Central Serous Chorioretinopathy

Central serous chorioretinopathy (CSC) is a retinal disease characterised by diminition of vision and neurosensory macular detachment. A rare case of a 50-year-old man with a history of deep vein thrombosis is presented here, who developed CSC after warfarin intake plus his two episodes of CSC developed in susequent winter seasons.

A study on use of adjuvant therapy of steroid and antibiotics in treatment of unilateral retinitis following typhoid fever in a medical college in Kuppam

Purpose: To compare the efficacy of adjuvant therapy of topical steroids eye drops with oral antibiotics and monotherapy of oral antibiotics in a typhoid fever associated retinitis. Materials and Methods: The study was conducted on a 30yr old male who presented to our OPD with decreased vision in left eye and was followed up for 1 month. Results: A 30yr old male patient presented to our OPD with decreased vision with left eye with history of typhoid fever for a duration of 4 weeks and was treated successfully. His BCVA was 6/6 in Right Eye and 6/36 in Left Eye. Fundus examination revealed multiple whitish ill defined lesions suggestive of retinitis lesions which was noted superiorly to the disc which was associated with macular neuro-sensory detachment and blurring of disc margins in the left eye. Significant improvement in BCVA was observed with adjuvant therapy of topical steroids with antibiotics over a period of 1 month. Diagnosis of post typhoid immune mediated retinitis was made with good resolution following treatment. Keywords: Post typhoid retinitis, Immune mediated retinitis, Post fever retinitis.

Macular neurosensory retinal detachment associated with topiramate use

Abstract A 36 year-old woman with idiopathic intracranial hypertension was treated with topiramate and acetazolamide. The patient was followed-up for 2 years, with a relationship between neurosensory detachments and topiramate being established, with recurrences after the introduction of topiramato and improvement after its withdrawal. These findings point topiramate as a possible cause of the clinical picture. Topiramate may cause retinal and macular neurosensory detachments. Although the ciliochoroidal effusion cases caused by this drug are well-known, its retinal side effects are less common. As it is a widely used drug, neurologists and ophthalmologists should be aware of its possible ocular side effects.

UNDERDIAGNOSED OPTIC DISK PIT MACULOPATHY: Spectral Domain Optical Coherence Tomography Features For Accurate Diagnosis.

To report a cohort with optic disk pit maculopathy (ODPM) presenting with neurosensory macular detachment that were initially misdiagnosed and mistreated; and to describe structural features on spectral domain optical coherence tomography in misdiagnosed and all other consecutive cases of ODPM. Multicenter international retrospective cohort study. 59 eyes from 59 patients with ODPM. 1) Proportion of patients with ODPM initially misdiagnosed, inaccurate diagnosis and treatment. 2) Morphologic features on spectral domain optical coherence tomography: other causes of subretinal and/or intraretinal fluid, inner/outer retinoschisis, communication with optic disk pit, and retinal pigment epithelium alterations. 3) Visual and anatomical outcomes 6 months after proper treatment. Fifteen patients (25.4%) with ODPM were correctly diagnosed initially and those were significantly younger than misdiagnosed cases (age 33.8 ± 15.2 vs. 58.7 ± 15.8 years, P < 0.0001). Forty of forty-four misdiagnosed eyes (90.9%) were treated for their presumed diagnosis before referral. Eyes with initial misdiagnosis had significantly more outer retinoschisis at baseline (88.4 vs. 40.0%, P = 0.0002) and more retinal pigment epithelium alterations (90.0 vs. 27.3%, P < 0.0001) 6 months after proper treatment. Optic disk pit maculopathy is an underdiagnosed entity and can mimic other causes for subretinal fluid. Awareness and identification of pertinent spectral domain optical coherence tomography features can help avoid inappropriate and delayed treatment.

Maculopathy in Patients with Monoclonal Gammopathy of Undetermined Significance

To describe clinical findings, laboratory values, and treatment response of patients with monoclonal gammopathy of undetermined significance (MGUS) demonstrating neurosensory macular detachment. Retrospective case series. Seven eyes of 4 patients (3 men and 1 woman; age range, 60-81 years) with neurosensory macular detachment, treatment-resistant submacular fluid, and vitelliform material. We retrospectively reviewed the medical and ocular histories, ocular examination findings, retinal imaging, ocular disease course, and laboratory findings in 4 patients with submacular fluid associated with MGUS. Description of the macular findings and treatment courses of 4 patients diagnosed with MGUS maculopathy. Seven eyes of 4 patients demonstrated neurosensory macular detachment with treatment-resistant submacular fluid and vitelliform material. No eyes demonstrated signs of significant hyperviscosity retinopathy. Fluorescein angiography showed no definite leakage in any involved eye. Laboratory evaluation revealed immunoglobulin G MGUS in all 4 patients. All 4 patients were resistant to treatments aimed at resolving the subretinal fluid, including some combination of anti-vascular endothelial growth factor injections, photodynamic therapy, topical dorzolamide, oral dosing of eplerenone or acetazolamide, or some combination thereof. In 3 patients, MGUS underwent malignant transformation 24 to 144 months after diagnosis, in 1 patient to lymphoplasmacytic lymphoma and in 2 patients to multiple myeloma. The fourth patient showed no evidence of malignancy 8 years after diagnosis. Submacular fluid without fluorescein leakage and unresponsive to conventional treatment may suggest an underlying immunoproliferative disorder that we have termed monoclonal gammopathy of macular significance. Given the propensity for monoclonal gammopathy of macular significance to transform into malignant disease in our series, serum protein analysis should be considered in patients with neurosensory macular detachment not attributable to known causes.

Multimodal imaging findings in a case of severe Central Serous Chorioretinopathy in an uncomplicated pregnancy

BackgroundCentral Serous Chorioretinopathy (CSC) has been previously reported as an infrequent complication of pregnancy that usually resolves spontaneously after delivery, with minimal or no sequel. We report a case of a severe form of CSC in an uncomplicated pregnancy with extensive subfoveal exudates and severe permanent visual loss. Multimodal imaging techniques, including color and red-free photographs, near-infrared reflectance, fluorescein angiography, and spectral-domain optical coherence tomography, were performed and the findings were correlated to the changes in visual acuity.Case presentationA 35-year-old pregnant woman presented with loss of vision and metamorphopsia in her left eye. Fundus examination showed subfoveal severe exudation with a posterior pole serous detachment. Optical coherence tomography (OCT) showed macular neurosensory detachment with central highly reflective sub-retinal material. Multimodal fundus pictures and angiograms revealed distinct clinical features of the disease during both the acute and final phase. The disease spontaneously resolved after delivery with regression of the subretinal fluid and the disappearance of subfoveal exudates. Nevertheless, because of severe atrophic macular changes and subfoveal fibrosis, no improvement of visual acuity was noted.ConclusionSevere variants of CSC may also present in cases of uncomplicated pregnancy and result in a poor prognosis. Recognising these presentations of CSC is critical to avoid improper management. Multimodal imaging may help to clarify the diagnosis and highlight the clinical features.

Recurrent neurosensory macular detachment in carotid-cavernous fistula

Case reportA 46 year-old man was seen in the emergency department complaining of vision loss and exophthalmos in his right eye. He also complained of headache, diplopia of 4 months onset, and neurosensory detachment that resolved spontaneously the month before. The study revealed tortuous conjunctival and episcleral vessels and neurosensory macular detachment in his right eye. A carotid-cavernous fistula was confirmed by computed tomography angiography. The fistula closed spontaneously during the hospitalization. One month later, the neurosensory detachment disappeared again. DiscussionCarotid-cavernous fistula should be included in the differential diagnosis of neurosensory macular detachments. These neurosensory detachments can resolve spontaneously 11 the fistula is closed.

Typhoid aftermath: presenting as vasculitis, neuroretinitis and macular neurosensory detachment

Systemic immune-mediated reactions are known to occur following typhoid illness. Vasculitis, neuroretinitis and macular neurosensory detachment are amongst the rarely documented aftermath of typhoid fever. A 32-year-old male came with complaints of decreased vision in both eyes with history of typhoid fever (treated adequately 4 weeks prior and declared cured 2 weeks prior to ocular manifestations) who was found to have vasculitis, neuroretinitis and neurosensory detachment at macula. His BCVA was 1/60 in right eye and 6/12 in left eye. The inflammation completely resolved and there was marked improvement in the visual acuity, 6/12 in right eye and 6/6 in left eye after treatment with oral steroids. Immune-mediated vasculitis and neuroretinitis, the ocular aftermath of typhoid fever responded well to oral steroids

Central serous chorioretinopathy in Benin City, Nigeria.

Central serous chorioretinopathy (CSCR) is a retinal cause of visual loss. The aim of this report is to describe the pattern of presentation of CSCR in patients presenting to a tertiary hospital in Nigeria within a specified period. The case folders of all patients in which a diagnosis of central serous retinopathy (CSR) was made from January 1, 2012 to December 31, 2014 were retrieved, data extracted and reviewed. There were a total of five patients within the study period made of four males and one female. There were two cases of bilateral CSCR and three cases of unilateral CSCR. There was a positive history of underlying anxiety or stress related conditions in all the patients. One patient with bilateral CSCR was on systemic prednisolone for arthritis. Confirmatory investigations were performed in all patients. Four patients had fundus fluorescein angiography which showed smoke stack and ink blot patterns in two patients, respectively. Two patients had optical coherence tomography showing macular neurosensory detachment, with one having associated pigment epithelial detachment. Vision improved in all patients with conservative management, reduction in anxiety/stress related activities and steroid use discontinuation in the patient with chronic steroid use. CSR has a favorable outcome with appropriate intervention.

Desprendimiento neurosensorial macular recurrente en fístula carótido-cavernosa

Case reportA 46 year-old man was seen in the emergency department complaining of vision loss and exophthalmos in his right eye. He also complained of headache, diplopia of 4 months onset, and neurosensory detachment that resolved spontaneously the month before. The study revealed tortuous conjunctival and episcleral vessels and neurosensory macular detachment in his right eye. A carotid-cavernous fistula was confirmed by computed tomography angiography. The fistula closed spontaneously during the hospitalization. One month later, the neurosensory detachment disappeared again. DiscussionCarotid-cavernous fistula should be included in the differential diagnosis of neurosensory macular detachments. These neurosensory detachments can resolve spontaneously 11 the fistula is closed.

A case of vasculitis, retinitis and macular neurosensory detachment presenting post typhoid fever.

BackgroundOcular and extraocular immune-mediated phenomena are known to occur following febrile illness. Vasculitis, retinitis and neurosensory detachment are not well-recognized sequelae of typhoid fever.FindingsWe report a case of vasculitis, retinitis and macular neurosensory detachment presenting post typhoid fever. A 27-year-old female presented with decreased vision in right eye with history of typhoid fever (treated adequately 6 weeks prior). Her best corrected visual acuity in right eye was 20/125, N36. Fundus showed a patch of vasculitis and retinitis superior to the disc associated with macular neurosensory detachment and disc pallor. With oral steroids, the inflammation resolved and visual acuity improved to 20/20 at 6 weeks.ConclusionsImmune-mediated vasculitis and retinitis following typhoid fever may respond well to systemic steroids.

Multimodal Imaging of Exudative Maculopathy Associated With Hand-Foot-Mouth Disease

A 31-year-old man presented with acute unilateral visual loss secondary to hand-foot-mouth disease (HFMD). Ophthalmic examination demonstrated best corrected visual acuity (BCVA) of 6/24 and a macular neurosensory detachment. He was diagnosed with unilateral acute idiopathic maculopathy (UAIM), and multimodality imaging was performed. No treatment was warranted. At 3 months, BCVA was 6/5 and funduscopy revealed a juxtafoveal scar. Based on the evidence of the association between HFMD and UAIM, the authors refer to this condition as exudative maculopathy associated with HFMD. Multimodality imaging during acute and convalescent phases is useful to study this disorder and raises questions about choroidal and bilateral involvement. Ophthalmologists should be aware of this and query about systemic signs and symptoms.

Bilateral choroidal metastases as presentation of dissemination of cutaneous malignant melanoma

AbstractPurpose To report the case of a patient with bilateral choroidal mestastases as the first sign of dissemination of cutaneous malignant melanoma.Methods A 47‐year‐old Caucasian male presented to our emergency department with rapid‐onset blurred vision in his right eye (RE). Ophthalmoscopic examination revealed multiple pigmented placoid lesions located in the posterior pole and half periphery of the retina of both eyes and a serous macular detachment in RE. Optical coherence tomography confirmed the macular neurosensory detachment in the RE Since clinical suspicion of choroidal metastases, we referred the patient to the Oncology Department for systematic study. After an exhaustive study, they concluded that it was a dissemination of a cutaneous malignant melanoma with bilateral choroidal metastases, liver and spleen metastases.Results The patient underwent palliative treatment with chemotherapy with improvement of the visual acuity and reduction of the macular neurosensory detachment in the RE. Nevertheless the patient died months later of the diagnosis of cutaneous melanoma dissemination.Conclusion Dissemination of cutaneous melanoma to the choroid is rare and is a major prognostic factor. In general the treatment of ocular metastases is palliative, because the presence of metastases indicates hematogenous spread of tumor. The objectives are therefore to maximize the quality of life and restore or preserve vision.

Optic Disc Tuberculoma in a Patient with Miliary Tuberculosis

A 27-year-old female, on anti-tubercular therapy for miliary tuberculosis for 1 week, presented with gradual diminution of right eye vision for 4 months. Right eye visual acuity was counting fingers at 15 cm. Right fundus showed a yellowish-white vascularized lesion, 4 disc diameters in size, overlying the optic disc and associated neurosensory macular detachment. The left eye was normal. A Mantoux test was negative. The authors diagnosed presumed optic disc tuberculoma in the right eye. Oral prednisolone in tapering doses was added to the anti-tubercular therapy. The optic disc lesion regressed with residual scarring and vision became 20/30 at 7 months.

Optic pit maculopathy after laser-assisted in situ keratomileusis

Case report: Optic disc pit is an embryological malformation of the optic nerve that occurs in less than one in 10000 people. It is 10%–15% bilateral, and 25% to 70% of patients develop a neurosensory macular detachment within the 2nd to 4th decade.Comments: We report a case of unilateral optic disc pit maculopathy 2 months after laser-assisted in situ keratomileusis (LASIK) revision.

Optical Coherence Tomography Findings in Ocular Decompression Retinopathy

Three days following trabeculectomy surgery, a 47-year-old woman experienced a decline in visual acuity to 20/400. Fundus findings were consistent with decompression retinopathy, and optical coherence tomography revealed macular thickening, cystoid macular edema, and neurosensory macular detachment. The foveal anatomy normalized following topical treatment, and visual acuity returned to 20/30 by 10 weeks postoperatively. Both macular detachment and cystoid macular edema may contribute to acute decline in visual acuity in decompression retinopathy. Optical coherence tomography facilitated the prompt detection of treatable pathology, which resolved following appropriate medical therapy.

Indocyanine Green Angiography for the Detection of Subretinal Nematodes in Diffuse Unilateral Subacute Neuroretinitis (DUSN)

Observational case-report on the clinical, fluorescein and indocyanine green angiographic findings in a patient with a presumed subretinal nematode. Retinography, angiography with sodium fluorescein and Indocyanine green were performed in a 45 year old man who presented with a neurosensory macular detachment. The lesion studied with fluorescein angiography was atypical for a choroidal neovascular membrane but suggestive of ocular cysticercosis. Additional indocyanine green angiography was therefore perfomed. Indocyanine green angiography could be a useful tool for the detection of subretinal nematodes.