Central serous chorioretinopathy misdiagnosed as posterior uveitis and the vicious circle of corticosteroid therapy

Abstract

Purpose:To determine the proportion of patients with central serous chorioretinopathy (CSCR) mistaken for posterior uveitis and to identify the deleterious consequences.Methods:Charts of 1,657 patients admitted in the section of inflammatory eye diseases at the Center for Ophthalmic Specialized Care (COS) in Lausanne, Switzerland from 1995 to 2013 were reviewed. CSCR cases misdiagnosed as posterior uveitis or those with superimposed disease due to steroid therapy for uveitis were studied. Delay in diagnosis, specific erroneous uveitis diagnosis and evolution of the disease were also evaluated. Retrospectively, the most useful means for a correct diagnosis of CSCR were the original fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) when available.Results:Out of a total of 1,657 patients, 15 (0.9%) cases with CSCR were identified. These included 12 subjects misdiagnosed as posterior uveitis and 3 uveitis subjects with superimposed CSCR following corticosteroid therapy for uveitis. The presentation of the disease was largely influenced by improper and continued use of corticosteroids.Conclusion:CSCR is a rare but not negligible misdiagnosis in posterior uveitis representing approximately 1% of subjects from a collective series of uveitis cases at a referral center. Investigative measures such as FA, ICGA and OCT are crucial for reaching a correct diagnosis and avoiding disease aggravation due to corticosteroid therapy.

Clinical profile of uveitis patients developing central serous chorioretinopathy: An experience at a tertiary eye care center in India

“…The association of CSC with corticosteroid therapy is well known and has been described by various authors. [4678] Although the exact cause of corticosteroid-induced CSC remains unclear, the corticosteroid-induced increased level of catecholamine and choroidal vascular hyperpermeability are believed to play a major role. [9] CSC following exogenous administration of corticosteroid through topical, inhalational, systemic, local injections has been described in the literature.…”

“…Treatment with corticosteroid in these patients can further aggravate the condition and can lead to severe loss of vision. In a case series by Papadia et al ,[4] 15 patients of CSC were misdiagnosed as posterior uveitis and three of them were treated with oral steroids.…”

“…Many case reports and few case series have described the association of CSC with patients receiving corticosteroid during the treatment of uveitis. The largest series on CSC in uveitis patients published to-date is by Papadia et al [4] and included 20 eyes of 14 patients. As the majority of the cases of uveitis with CSC are related to corticosteroid use, it is important to assess the role of other associated confounding factors in these patients.…”

“…As the management of these conditions is paradoxical, initiation of corticosteroids in CSC can further aggravate and deteriorate the disease process. [4] Development of concurrent CSC in patients of uveitis who are in need of acute immunomodulation can pose serious therapeutic challenge. Barring some of the case series, there is a scarcity of literature on CSC in patients with uveitis and we seek to investigate the demographic profile, treatment, and visual outcomes in patients of uveitis developing CSC in a tertiary eye care center in India.…”

Multimodal Imaging in Fibrinous Central Serous Chorioretinopathy Compared with Exudative Maculopathy

“…Fibrinous CSC can show diverse clinical signs. Because of overlapping features with other diseases or an atypical presentation of the disease itself, fibrinous CSC is a great mimicker that can be misdiagnosed as exudative maculopathy ranging from idiopathic choroidal neovascularization (idiopathic CNV), Vogt-Koyanagi-Harada disease (VKH), unilateral acute idiopathic maculopathy (UAIM), and acute syphilitic posterior placoid chorioretinitis (ASPPC) to tubercular posterior uveitis [15, 16]. Moreover, when CSC is erroneously diagnosed as an inflammatory chorioretinal disorder, it could be exacerbated by systemic steroid treatment [17].…”