Bilateral Serous Macular Detachment in a Patient With Nephrotic Syndrome

Bilge, Ayşe Dolar; Yaylalı, Sevil Ari; Yavuz, Şadan; Şimşek, İlke Bahçeci

doi:10.1097/icb.0000000000000487

Cited by 11 publications

(9 citation statements)

References 8 publications

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“…These alterations would lead to secondary retinal pigment epithelium (RPE) dysfunction accounting for subretinal detachments and impaired photoreceptor outer segment phagocytosis leading to hyperautofluorescent subretinal material accumulation. The nephrotic syndrome could also have a role in the choroidal changes and subretinal detachments through a modification of the oncotic pressure [12,[17][18][19]. By restoring the plasmatic protein balance and decreasing amyloid deposits, the initiation of the first chemotherapy cycles led to the healing of the nephrotic syndrome and the resorption of the subretinal fluid.…”

Section: Discussionmentioning

confidence: 99%

Progressive chorioretinal involvement in a patient with light-chain (AL) amyloidosis: a case report

2020

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Background: To report an unusual case of light-chain (AL) amyloidosis with progressive bilateral chorioretinal abnormalities documented with short-wavelength autofluorescence, SD-OCT, fluorescein and indocyanine green angiography. Case presentation: Case report of a forty-three-year-old male patient with kappa AL amyloidosis. The patient presented with rapidly progressing pigmented and hyperautofluorescent drusenoid deposits in both eyes, associated with central serous retinal detachments, a pachychoroid and choriocapillaris enlargement. The general assessment revealed a renal failure symptomatic of a nephrotic syndrome, associated with proteinuria composed mainly of free kappa light chains. A kidney biopsy confirmed the diagnosis of kappa AL amyloidosis. Chemotherapy was quickly started. During remission, the extension of drusenoid deposits on the fundus was stopped and a disappearance of the subretinal fluid on SD-OCT was observed. Conclusions: AL amyloidosis is an insidious and potentially fatal condition. This case is one of the first to document the rapid progression of fundus alterations and their stabilization after disease remission. Identifying these specific fundus abnormalities is essential to avoid diagnosis wandering and therapeutic delay.

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Section: Discussionmentioning

confidence: 99%

Progressive chorioretinal involvement in a patient with light-chain (AL) amyloidosis: a case report

2020

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“…In this review, we focus on the management of ME and, in particular, on current data of studies and clinical trials about drugs that are under investigation or have already been evaluated in ME management. Although several diseases could lead to the development of ME (that is, DR 1 , RVO 2 , uveitis 3 , Irvine–Gass postoperative ME 18 , idiopathic macular telangiectasia type 1 and 2 19, 20 , perifoveal exudative vascular anomalous complex 21 , paclitaxel-induced maculopathy 22 , MEK inhibitor–associated maculopathy 23 , hypoproteinemia 24 , paracentral acute middle maculopathy 25 , and central serous chorioretinopathy 26 ), we will discuss the management of the major causes of ME, including DR, RVO, and uveitis.…”

Section: Introductionmentioning

confidence: 99%

Emerging therapies in the management of macular edema: a review

et al. 2019

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Macular edema (ME) is a major complication of several vascular and inflammatory retinal diseases. Multiple mechanisms are implicated in its development and lead to visual impairment that could be reversible (the acute stages) or not reversible (long-standing ME). For this reason, an effective approach to the treatment of ME is of paramount importance in order to prevent irreversible damage of visual function. In this review, we discuss the management of ME and, in particular, current data of studies and clinical trials about drugs that have already been evaluated or are under investigation in the management of ME. Although several diseases could lead to the development of ME, we focus on the three main causes: diabetic retinopathy (DR), retinal vein occlusion (RVO), and uveitis. The introduction into clinical practice of anti-vascular endothelial growth factor injections (ranibizumab and aflibercept) and dexamethasone implants has revolutionized the treatment of ME secondary to DR and RVO. However, new drugs are needed in the treatment of resistant forms of ME secondary to DR and RVO. A fluocinolone acetonide implant has been approved by the US Food and Drug Administration for the treatment of diabetic ME but not for RVO. Furthermore, brolucizumab and abicipar pegol have been shown to be effective in preliminary studies and have the chance to be approved soon for diabetic ME treatment. In ME secondary to uveitis, a crucial role is played by corticosteroids and non-biologic immunomodulatory drugs. However, several new biologic agents are under investigation in different clinical trials and could be important new therapeutic options in cases with a low response to first-line therapy. However, only a few of these drugs will enter the market after proving their safety and efficacy. Only after that will we be able to offer a new therapeutic option to patients affected by uveitic ME.

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“…Although Izeedini et al [ 2 ] and Blige et al [ 3 ] have reported on cases of SRD that were associated with nephrotic syndrome, these patients only exhibited SRD around the central fovea. Thus, our present case is unique in that the SRD with intraretinal edema was extensive enough to cover the entire posterior pole.…”

Section: Discussionmentioning

confidence: 99%

“…The main symptoms of nephrotic syndrome, which is a renal disease, include severe proteinuria, hypoalbuminemia, edema, and dyslipidemia [ 1 ]. There have also been a few reports of serous retinal detachment (SRD) being associated with nephrotic syndrome [ 2 , 3 ]. The mechanism of SRD is said to involve intratissue fluid retention due to systemic fluid overload and hypoalbuminemia.…”

Section: Purposementioning

confidence: 99%

A Case of Nephrotic Syndrome with Bilateral Serous Retinal Detachment and Shallow Anterior Chamber Associated with Ciliary Body Edema

Takai

Sakuma

Mashimo

et al. 2022

Case Rep Ophthalmol

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Nephrotic syndrome is a disease that causes fluid retention in the body due to loss of protein in the blood, which can lead to serous retinal detachment (SRD) in the macula. We report a case of severe SRD in both eyes and angle closure due to ciliary body edema caused by nephrotic syndrome. A 57-year-old man was admitted to the Department of Nephrology in our hospital for a thorough examination of his generalized edema. He was diagnosed with nephrotic syndrome but proved to be refractory to steroid treatment. Due to distortion symptoms in both eyes on the 30th day of hospitalization, the patient was referred to our department. Best-corrected visual acuity (BCVA) was 0.8 in the right eye and 1.0 in the left eye. Slit lamp examination and anterior segmental optical coherence tomography (OCT) showed shallow anterior chambers in both eyes. Fundus and macular OCT demonstrated severe SRD in the posterior pole of both eyes. After observing the presence of hypoalbuminemia, we considered the possibility of SRD and angle closure due to ciliary edema that resulted from the leaks associated with the nephrotic syndrome. Thereafter, ocular findings improved in conjunction with systemic symptom improvements associated with ultrafiltration and low-density lipoprotein apheresis. On the 60th day of hospitalization, his BCVA improved to 1.2 in both eyes, SRD disappeared, and the anterior chamber depth normalized. This case demonstrates the importance of recognizing SRD and angle closure associated with ciliary body edema as complications linked with nephrotic syndrome.

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Bilateral Serous Macular Detachment in a Patient With Nephrotic Syndrome

Abstract: In nephrotic syndrome cases especially with accompaniment of high blood pressure, fluid accumulation in the retina layer may occur. Serous macular detachment must be kept in mind when treating these patients.

Cited by 11 publications

References 8 publications

Progressive chorioretinal involvement in a patient with light-chain (AL) amyloidosis: a case report

Progressive chorioretinal involvement in a patient with light-chain (AL) amyloidosis: a case report

Emerging therapies in the management of macular edema: a review

A Case of Nephrotic Syndrome with Bilateral Serous Retinal Detachment and Shallow Anterior Chamber Associated with Ciliary Body Edema

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