Serous Detachment Research Articles

Acute central serous chorioretinopathy after prolonged application of topical minoxidil: A case report and review of the literature

We report a case of a young man aged 38 years who complained of seeing a black spot in front of his left eye Oculus sinister (OS) for 5 days. He had been applying minoxidil topically for the treatment of androgenic alopecia for 8 months. Both eyes’ Oculus uterque (OU) anterior segments were within normal limits. The OS posterior segment showed subretinal fluid (SRF) in association with a serous pigment epithelium detachment (PED). He was diagnosed with acute central serous chorioretinopathy (CSCR) secondary to the prolonged use of topical minoxidil. He was advised to cease minoxidil application as a first line of treatment. He followed up for 3 months, the SRF was observed to decrease at every follow-up, and the best-corrected visual acuity (BCVA) improved from 6/9, N6 to 6/6, N6. CSCR associated with topical minoxidil use is a rare entity, and a treating dermatologist must counsel the patient regarding the same while initiating the treatment.

Bilateral acute retinal necrosis with choroidal detachment

A 42-year-old man with history of topiramate intake presented with sudden diminution of vision. He was diagnosed with bilateral panuveitis with retinitis and serous choroidal detachment, with ultrasound biomicroscopy revealing ciliary body effusion. Systemic investigations were negative for immunosuppression. Topiramate was stopped and the patient was started on oral valacyclovir and oral steroids 48 h after antiviral therapy. The patient responded well to the treatment leading to resolution of retinitis as well as choroidal detachment. This is a unique case of bilateral acute necrotizing retinitis and choroidal detachment, in which early recognition and prompt treatment led to a favorable outcome.

Non-Neovascular Subretinal Fluid with Serous Retinal Pigment Epithelial Detachment: Wait or Treat

Introduction: To describe the course of subretinal fluid (SRF) in eye with serous pigment epithelial detachment (serous PED) in the absence of macular neovascularization (non-neovascular AMD). Method: This is a retrospective case study included one eye with non-neovascular SRF associated with serous PED. Swept source optical coherence tomography (SS-OCT) and optical coherence angiography (OCTA) were obtained at baseline and follow up with qualitative and quantitative analysis of macula, pigment epithelial detachment (PED), subretinal fluid (SRF) and the presence or absence of macular neovascular membrane (MNV) in addition to other multimodal imaging modalities like fluorescein angiography (FA) and fundus auto fluorescence (FAF). Results: Our 66-year-old female has presented with left serous (PED) with apical (SRF) and no MNV on OCTA with baseline best corrected vision (BCVA) in Log MAR = 0.5. The SS-OCT, OCTA, and BCVA were stable over the initial five-month follow-up observation period with no MNV (non-neovascular SRF). One month later, the patient received an intravitreal anti-VEGF injection outside our clinic. 1-month post-outside clinic anti-VEGF injection, SS-OCT showed a small RPE tear with flattening of RPE detachment and preservation of BCVA =0.5. In the 3rd month post-outside clinic anti-VEGF injection, the SS-OCT showed slight flattening of RPE detachment with an obvious increase in SRF, still negative MNV on the OCTA associated with a drop in BCVA to 0.3. The decision was made to give the patient an initial three loading doses of aflibercept injections .The SS-OCT post 2nd aflibercept injection showed complete resolution and drying out of SRF, with an improvement of BCVA to 0.5. we continue completing the loading phase and then the patient was placed on treat and extend regimen (T&E). After the fifth aflibercept injection, the PED was completely flattened with appearance of MNV on OCTA after resolution of SRF. Conclusion: Many published studies provide preliminary data about non-neovascular AMD with SRF. SRF could be present in the absence of MNV due to RPE decompensation or RPE pump failure. However, the non-neovascular SRF could be transformed with time into a neovascular one with the presence of MNV. Multimodal imaging approach is essential in differentiating non-neovascular versus neovascular SRF and avoiding unnecessary antiVEGF injections.

Predicting central choroidal thickness from colour fundus photographs using deep learning.

The estimation of central choroidal thickness from colour fundus images can improve disease detection. We developed a deep learning method to estimate central choroidal thickness from colour fundus images at a single institution, using independent datasets from other institutions for validation. A total of 2,548 images from patients who underwent same-day optical coherence tomography examination and colour fundus imaging at the outpatient clinic of Jichi Medical University Hospital were retrospectively analysed. For validation, 393 images from three institutions were used. Patients with signs of subretinal haemorrhage, central serous detachment, retinal pigment epithelial detachment, and/or macular oedema were excluded. All other fundus photographs with a visible pigment epithelium were included. The main outcome measure was the standard deviation of 10-fold cross-validation. Validation was performed using the original algorithm and the algorithm after learning based on images from all institutions. The standard deviation of 10-fold cross-validation was 73 μm. The standard deviation for other institutions was reduced by re-learning. We describe the first application and validation of a deep learning approach for the estimation of central choroidal thickness from fundus images. This algorithm is expected to help graders judge choroidal thickening and thinning.

Distinct Pathways of Macular Atrophy in Type 3 Macular Neovascularization Associated With AMD.

To explore the occurrence of macular atrophy (MA) in eyes with age-related macular degeneration (AMD)-associated Type 3 macular neovascularization (MNV) treated with anti-vascular endothelial growth factor (anti-VEGF) therapy. Importantly, we aimed at describing the existence of separate pathways leading to MA. We analyzed 41 participants (41 eyes) with treatment-naïve Type 3 MNV who were followed up for a duration of 12months after beginning the anti-VEGF therapy. At the one-year follow-up visit, optical coherence tomography (OCT) scans were reviewed for the presence of MA. MA regions of interest (ROIs) were selected and traced back to their original dominant baseline lesion (i.e., precursor) through previous serially captured OCT scans. Baseline lesions included precursors associated with the development and exudation of MNV and causes external to the neovascularization itself. At the one-year follow-up visit, MA was graded to be present in 38 (92.7%) out of 41 eyes. These 78 MA ROIs were divided into two subgroups according to the precursor lesion, yielding a group of 53 MA lesions with precursors associated with the development and exudation of MNV (i.e., MA caused by physical harm from Type 3 neovessels, collapse of a serous pigment epithelium detachment, and fibrosis) and 25 MA regions with precursors external to the neovascularization itself (i.e., MA caused by drusen or subretinal drusenoid deposits). Eyes with Type 3 MNV are commonly complicated by MA and precursors of MA include causes associated with the development and exudation of MNV, as well as lesions unrelated to the neovascularization process itself.

Ayurvedic management of Dhumadarshi (central serous chorioretinopathy): A case report

Abstract Central serous chorioretinopathy (CSCR) is characterized by serous detachment of the neurosensory retina at the posterior pole with or without focal pigment epithelial detachment and altered retinal pigment epithelium. In most cases, treatment helps restore the vision, but no treatment could maximize the final visual gain. In Ayurveda, visual-related conditions are included in the Drishtigata Roga (diseases causing visual disturbance). CSCR based on clinical presentation can be categorized under Dhumadarshi. A 42-year-old female came to the outpatient department of Shalakya tantra with the complaint of dimness in vision in the left eye (OS: oculus sinister) for 2 days, along with a black spot in the center of her vision while walking. On examination, unaided distant visual acuity was 6/36 in the left eye (OS) and 6/9 in the right eye (OD: oculus dexter). On optical coherence tomography examination, it was diagnosed as a case of CSCR. Interventions included in this study were on an outpatient basis with the potential action of Shothahara (anti-inflammatory), Vatanulomana (pacification of obstructed Vata), Medhya (intellect enhancer), and Drishtiprasadana (enhancing eyesight). At the end of the consultation, the vision was restated to normal, and the accumulation of subretinal fluid was completely resolved. In conclusion, Ayurvedic intervention can aid in accelerating visual restoration and reducing accumulation of subretinal fluid.

CENTRAL SEROUS CHORIORETINOPATHY FOLLOWING ORAL USE OF TADALAFIL

Central serous chorioretinopathy (CSCR) is characterized by a localized serous detachment of the neuroretina (DSR), associated with detachments of the retinal pigment epithelium (RPE) at the posterior pole [1]and a leakage of fluid in the subretinal space. Pregnancy, Type A personality, and systemic corticosteroid therapy are the main risk factors for Central Serous Chorioretinopathy [ 2] We report the case of a patient who developed central serous chorioretinopathy following the oral intake of 20mg tadalafil erectile dysfunction, suggesting a possible involvement of phosphodiesterase type 5 inhibitors as a risk factor for central serous chorioretinopathy.

Double Layer Sign and Pigment Epithelial Detachment in Patients Treated with Subthreshold Laser for Central Serous Chorioretinopathy

Background and Objective Central serous chorioretinopathy (CSCR) is characterized by serous detachments of the central neurosensory retina. Besides, other alterations of the retinal pigment epithelium (RPE) of the focal detachment of the RPE can occur. We explored the frequency of RPE detachment and double layer sign in OCT in our patient population, the influence of subthreshold photocoagulation (ST-LP) on these parameters and the possibility of correlations with visual acuity. Materials and Methods We conducted a retrospective analysis of all patients who underwent ST-LP based on the diagnosis of CSCR in a German university eye clinic from 2009 to 2014. Measurements in OCT were performed regarding pigment epithelial detachment (PED) and double layer sign (DLS). Results 54 eyes of 49 patients were included in the study. The frequency of PEDs dropped from 66% of cases at baseline to 50% after 3 months. No significant differences in calculated areas of lift-off volume of PED were identified. The frequency of a DLS was significantly lower 8 weeks after ST-LP compared to baseline (63%, p<0.05), but not after 12 weeks. Conclusion We conclude that PEDs and DLS are common in CSCR. In this study, no convincing correlation can be identified between BCVA before ST-LP or at the last visit and different characteristics of PED as well as DLS. While the area of PED becomes smaller after ST-LP, the extent of the DLS seems to increase. Further prospective studies are required, and DLS with respect to the occurrence of CNV should also be given attention.

THE OPTICAL COHERENCE TOMOGRAPHY (OCT) IN A PATIENT WITH RETINOPATHY-ASSOCIATED ECLAMPSIA: WHAT TO EXPECT?

Introduction : Eclampsia is a common pregnancy complication, that has been associated with retinopathy. Screening of retinopathy in preeclampsia/eclampsia is essential for early detection and management. Various imaging modalities are used to diagnose retinopathy. However, because of the higher-resolution imaging demand, optical coherence tomography (OCT) suggests a better option. The present study aimed to report the OCT findings of retinopathy-associated eclampsia.
 Case Illustration : A 24-year-old pregnant woman in 27th-week gestation with eclampsia presented the new onset of bilateral sudden diminution of vision. The vision in her right eye was limited to hand movement and that in her left eye was light perception only. Clinical examination revealed Siegrist streaks, Elschnig spots, and flame shape hemorrhages. OCT of both eyes demonstrated subretinal fluid, intraretinal fluid, thickening of the retinal layer, also inner retinal hyperreflectivity. Two months after the follow-up, there was an improvement in the OCT findings and also in the visual acuity.
 Discussion : An increase in macular thickness could be a characteristic feature in the OCT of retinopathy- associated eclampsia caused by retinal arteriolar narrowing due to systemic hypertension and ischemia. Previous studies have demonstrated subretinal/intraretinal fluid with or without serous retinal detachment in preeclampsia. Following our case, we report subretinal fluid, intraretinal fluid in the outer plexiform layer with retinal detachment and macular edema. The subretinal fluid and serous detachment were most likely caused by the changes in the fluid and ion-transport function of the retinal pigment epithelium (RPE).
 Conclusion : OCT can provide valuable information for diagnosis and follow-up retinopathy in preeclampsia/eclampsia.

Management of Central Serous Chorioretinopathy (CSC) with Focal Laser Photocoagulation

Introduction : Central Serous Chorioretinopathy (CSC) is an idiopathic retinal disease, characterized by focal leakage from the choroidal vessels due to RPE changes resulted in serous detachment of the neurosensory retina. CSC is suspected to be a multifactorial disease. Treatment of CSC is indicated for cases with SRF persisting for more than 4 months, decreased visual acuity, history of recurrence or history of previous CSC in other side with poor visual outcome.
 Case Illustration : A 41-year-old man complained sudden blurry vision on left eye since 3 months ago, accompanied by decreased ability to see in the middle field. In the left eye there was decrease fovea reflex. Fundus Fluorescein Angiography showed Central Serous Chorioretinopathy (CSC). Laser Focal Photocoagulation was performed for a patient in this case.
 Discussion :
 Conclusion : Patient was treated with Laser Focal Photocoagulation and pharmacological acetazolamide with the aim of closing the leak in the RPE and increasing SRF absorption.

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

A Unique Case of Acute Deterioration in Visual Acuity: Vogt-Koyanagi-Harada Disease

Vogt-Koyanagi-Harada (VKH)disease is a chronic autoimmune inflammatorydisorderwithmultisystem involvement particularly involving the eye, skin, ear and brain. Our patient reported in the Ophthalmology OPD, CMH, Lahore, a 41-year-old female patient who presented with decreased visual acuity of 6/9 and 6/18 in her right and left eye respectively with intermittent tinnitus. Aslit lamp examination revealed bilateral paramacular choroiditis, more pronounced in the left eye. Fundoscopy showed the 'sunset glow fundus.' HerOCTshowedslightflattening ofthe foveal contourinthe left eye withgeneralized foveal thinning while the right eye had parafoveal thickening with a foveal lamellar hole. FFA showed a serous detachment in herleft eye.Adiagnosis of bilateral incomplete Vogt-Koyanagi-Harada syndrome was made as she tested negative for infectious diseases. She was started on an oral course of steroids initially but after persistent episodic exacerbations ciclosporin 75mg twice daily was started and regular 2 weekly follow-ups were advised. The mainstay of treatment for Vogt–Koyanagi–Harada disease is systemic corticosteroid therapy but the refractory cases get additional immunosuppressants like ciclosporin which was required in our patient as well. Keywords: Autoimmune, Fovea, Visual acuity.

Ab Externo Choroidal Fluid Drainage, Pars Plana Vitrectomy, and Endotamponade for the Management of Persistent Hypotony following Glaucoma Surgery.

Persistent severe serous choroidal detachment is a rare complication after glaucoma surgery. Surgical treatment with choroidal fluid drainage through a scleral incision is an option in these cases. Combining this procedure with pars plana vitrectomy and gas endotamponade has potential advantages. In the following, the perioperative course of this surgical option in a small cohort will be presented. This is a retrospective cohort study of the postoperative course of ab externo drainage of persistent serous choroidal detachment (≥4 weeks) in combination with pars plana vitrectomy and gas endotamponade in six eyes of six patients after exhausting all conservative treatment options. Inclusion criterion was persistent hypotony with severe serous choroidal detachment after intraocular pressure (IOP) lowering surgery due to medically uncontrolled glaucoma. Eyes were evaluated according to resolution of choroidal detachment, change in IOP and visual acuity (VA), postdrainage complications, and need for further surgeries. Before surgery, all patients presented with flat anterior chamber, decreased vision, and persistent choroidal detachment. The surgery itself was uneventful, but due to the complexity of the cases, tailoring the procedure to each patient's needs was required. Complete resolution of choroidal effusion was achieved by one month in 5 eyes and in 1 eye by month 3. There was an increase in average IOP from 5 (±2.1) mmHg before surgery to 11.3 (±3.7) mmHg and in VA from 1.7 (±0.8) to 1.2 (±0.6) logMAR. Five out of six patients required additional surgery, mainly to further increase the IOP even though choroidal detachment had already resolved. Ab externo choroidal fluid drainage combined with pars plana vitrectomy and gas endotamponade seems to be an effective and safe treatment option in persistent ocular hypotony. Although repeated surgeries might be necessary, large-scale prospective studies must be undertaken to provide corroborative evidence.

Comparison of switching treatment from ranibizumab to aflibercept and aflibercept to ranibizumab on serous pigment epithelial detachments due to age-related macular degeneration

Comparison of switching treatment from ranibizumab to aflibercept and aflibercept to ranibizumab on serous pigment epithelial detachments due to age-related macular degeneration

Longitudinal Follow-up after successful photodynamic therapy in two cases with unilateral choroidal hemangioma and serous macular detachment

Longitudinal Follow-up after successful photodynamic therapy in two cases with unilateral choroidal hemangioma and serous macular detachment

Acetazolamide –friend to foe

Bilateral acute angle closure attacks are rare and usually secondary to drugs or concurrent microspherophakia. Acetazolamide, a sulphonamide medication used in controlling intraocular pressure, is known to cause uveal effusion precipitating secondary acute angle closure attack. Here we report a well-documented case of concurrent bilateral angle closure with shallowing of the anterior chamber, supra-ciliary effusion, and serous and hemorrhagic choroidal detachment after administration of oral acetazolamide that resolved on withdrawing the insulting agent.

Efficacy and Safety of Oral Eplerenone in Acute Central Serous Chorioretinopathy: A Randomised Controlled Study

Introduction: Acute Central Serous Chorioretinopathy (CSCR) is an important form of acquired maculopathy that usually presents as localised serous detachment of the neurosensory retina. Although, the disease is typically self limiting over a period of 2-3months, a percentage of patients ultimately develop chronic RPE changes. Eplerenone, a potential Mineralocorticoid Receptor (MR) antagonist, may play a role in regulating choroidal vascularity and modifying the disease in chronic CSCR. Aim: To assess the safety and efficacy of oral eplerenone medication in acute CSCR. Materials and Methods: This was a randomised controlled trial that included 162 eyes of 162 patients with acute CSCR. Patients were divided into two groups– Group-A, which received oral Eplerenone, and Group-B, which received Placebo therapy. Each group comprised 81 eyes. Best Corrected Visual Acuity (BCVA), Central Macular Thickness (CMT), and serum potassium (K+) levels were measured at baseline and monthly intervals for three consecutive months. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) Statistics version 20 software (IBM Corp., Armonk, NY, USA). A p-value less than 0.05 was considered statistically significant. Results: The differences in CMT in Group-A and Group-B were 279±56.41µm and 207±68.88 µm (p<0.01) at the end of the first month and 361±33.56 µm and 278±46.27 µm at three months (p<0.01), respectively. The average BCVA improvement in Group-A and Group-B was 6.05 lines and 4.21 LogMAR lines, respectively, at the conclusion (p=0.002). Deterioration to chronicity was seen in 3.7% of the eyes in Group A and 17.3% of the eyes in Group B. The increase in Serum K+ at three months was 0.61±0.27 mg/dL in Group-A and 0.1±0.21 mg/dL in Group-B (p=0.03). Conclusion: Eplerenone is a safe and effective first-line treatment option for acute CSCR, leading to faster and higher resolution with protection from progression to chronicity.

Ayurveda holistic management of acute unilateral central serous chorioretinopathy with pigmentary epithelial detachment: A case report

Abstract Central serous chorioretinopathy (CSCR) is characterized by localized serous detachment of neurosensory retina secondary to leakage of fluid from choriocapillaris, accumulating under the macula, with or without pigmented epithelial detachment. A 30-year-old male presented with complaints of sudden painless diminished vision and floaters in the right eye for 5 days. The patient had no previous history of any ocular disease and no significant systemic illness. The visual acuity as per LogMAR was 0.5 in the right eye and 0 in the left eye. The fundus examination showed round elevated detachment around the macula, which was confirmed by optical coherence tomography, showing neurosensory detachment due to serous fluid accumulation under the macula along with small pigmentary epithelial detachment. Management was done on an outpatient basis over 2.5 months, which included both internal and topical interventions along with Yoga therapy. The disease was resolved in 2.5 months with complete resolution of serous fluid. The visual acuity was brought back to normal, that is, LogMAR 0. CSCR cases can be successfully treated with an Ayurvedic holistic approach, and they respond better when treated at an early stage. These practices can be considered as an alternative.

Vitreomacular traction in diabetic retinopathy.

Vitreomacular traction (VMT) has unique presentations in eyes with diabetic retinopathy (DR). This study aimed to investigate the characteristics and clinical course of VMT in DR. A retrospective case series. Thirty eyes from 30 patients with DR and concurrent VMT were retrospectively enrolled. Baseline and final best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) characteristics were reported. Linear regression models were used to analyze the correlating factors for visual outcome. Of the 30 eyes, a thickened posterior hyaloid membrane was noted in all cases and multi-layered traction from different directions in 14 eyes (46.7%). Twenty-one eyes (70%) had tractional macular retinoschisis, seven (23.3%) had foveal detachment, five (16.7%) had a lamellar macular hole, and three (10%) had a full-thickness macular hole, including two with macular hole retinal detachment. Three eyes had spontaneous release of the VMT within 3 months of observation. For the remaining 27 eyes receiving operations, the VMT, full-thickness macular hole, and serous foveal detachment all resolved postoperatively with residual macular schisis in 6 eyes (22.2%) only. None of the baseline OCT characteristics were associated with postoperative BCVA (P > .05). VMT in DR had a thickened posterior hyaloid, and many of them had multi-layered traction and/or concurrent macular retinoschisis. Lamellar macular hole, full-thickness macular hole, or concurrent retinal detachment may also occur. Spontaneous resolution of VMT rarely occurred, and those who underwent operation for VMT had improved vision and macular structures with resolution of the macular hole and retinal detachment.

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.