Central Serous Retinopathy – May 2017

May 2017

HPI

41 year old man presented with decreased vision in the right eye that affects depth perception. It has fluctuated over the last 6 months.

Systemic Medical History

Hypertension controlled on amlopidine.

Ocular Exam

Vision was 20/25 and 20/20, right and left eyes respectively. Intraocular pressures, pupils, nerves and anterior segments were unremarkable. Fundus examination of the right eye revealed subretinal fluid under fovea and inferior macula with no associated hemorrhage or exudates (Figure 1). The left eye was unremarkable (Figure 2).

Figure1
Figure 1
Figure2
Figure 2

Differential Diagnosis

  • Exudative Retinal Detachment
  • Exudative Macular Degeneration
  • Cystoid Macular Edema
  • Diabetic Macular Edema
  • Central Serous Maculopathy
  • Retinoschisis
  • Hypotony

Further Testing

OCT: Showed subretinal fluid under and inferior to the fovea right eye and was normal in the left eye (Figures 3 & 4).

Figure3
Figure 3
Figure4
Figure 4

FA: Showed multiple areas of diffuse leakage in the right eye and one temporal area of leakage in the left eye (Figures 5 & 6).

Figure5
Figure 5
Figure6
Figure 6

Diagnosis

Based on the subretinal fluid and hot spots on FA, a diagnosis of central serous retinopathy was made. After verifying that the patient did not have associated risk factors of corticosteroid use the unpredictable course of the disease was discussed with the patient. Options, including observation and treatment with PDT, or rifampin. The patient elected to undergo treatment with PDT.

1 month after treatment: Vision returned to 20/20, both eyes. OCT showed resolution of the subretinal fluid.

Figure7
Figure 7

Discussion

Central serous chorioretinopathy (CSC) is a common idiopathic retinal disease characterized by central vision loss due to the leakage of fluid through the retinal pigment epithelium into the sub-retinal space leading to serous detachment of the neurosensory retina, serous pigment and epithelial detachments. It is most common in young men, although men and women of any age may be affected. There is association with exogenous corticosteroid use and high stress personalities, but these relationships are incompletely understood. The course of disease is highly variable. It is possible to have a single, mild, self-resolving episode with no permanent visual sequelae or recurrent, severe disease leading to permanent visual impairment.

In part, because of the variable course of the disease, many treatments have been tried, with variable success. Current options included photodynmic therapy (PDT) in which a special dye is injected into a vein that allows localized treatment with a laser into the eye at the site(s) of leakage. Other therapies that have shown success include rifampin, finestride and mifepristone.

References

Gemenetzi M, De Salvo G and Lotery AJ. Central serous chorioretinopathy: an update on pathogenesis and treatment. Eye 2010; 24:1743-1756

Steinle NC, Gupta N, Yuan A, et al. Oral rifampin utilisation for the treatment of chronic multifocal central serous retinopathy. British Journal of Ophthalmology 2012;96:10-13.

Moisseiev E, Holmes AJ, Moshiri A, Morse LS. Finasteride is effective for the treatment of central serous chorioretinopathy. Eye (Lond). 2016 Jun;30(6):850-6. doi: 10.1038/eye.2016.53. Epub 2016 Apr 8.

Nielsen, Jared S MD Jampol, Lee M MD. ORAL MIFEPRISTONE FOR CHRONIC CENTRAL SEROUS CHORIORETINOPATHY. Retina. 31(9):1928-1936, October 2011.

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