Surgical Management of Bilateral Exudative Retinal Detachment Associated with Central Serous Chorioretinopathy

Abstract

PurposeTo report a case of bilateral bullous exudative retinal detachment in central serous chorioretinopathy (CSC) which was attached by vitrectomy and internal drainage of the subretinal fluid.MethodsA 47-year-old man affected by bilateral atypical CSC with a bullous retinal detachment with subretinal exudate. A fluorescein angiogram (FAG) showed multiple points of leakage and staining of subretinal fibrosis. A tentative diagnosis of Vogt-Koyanagi-Harada (VKH) syndrome was made and the patient was treated with systemic corticosteroids and immunosuppressive agents. However, the subretinal fluid was not absorbed. He was then treated with vitrectomy and internal drainage of subretinal fluid.ResultsThe retina was attached successfully in both eyes. Visual acuity improved to 20/50 in his left eye but did not improve in the right eye due to subretinal fibrotic scarring and atropic changes on the macula.ConclusionsOur case suggests that the surgical management of bullous exudative retinal detachment is safe and necessary.

Results of One-Year Follow-Up Examinations after Intravitreal Bevacizumab Administration for Chronic Central Serous Chorioretinopathy

“…Various treatments for CSC, including the use of medication [12,13,14,15], transpupillary thermotherapy [16,17] and surgery [18], have been studied. However, no optimal treatment for CSC has been determined.…”

Unusual peripapillary new vessels in eye with central serous chorioretinopathy

“…We did not note any capillary non‐perfusion on fluorescein angiography in the posterior pole of the left eye, which again supports the diagnosis of central serous chorioretinopathy and rules out the possibility of other retinal vasculopathies, like old retinal vascular occlusions or retinal vasculitis. Such abnormal arborising peripapillary vessels have not been reported before in central serous chorioretinopathy probably because inferior retinal detachment in central serous chorioretinopathy is a rare manifestation of this disease …”

Atypical Central Serous Chorioretinopathy

“…The findings of bullous CSCR may be confused with uveal effusion, metastatic carcinoma or lymphoma, rhegmatogenous retinal detachment, and diseases that cause inflammation such as VKH disease, multifocal choroiditis, and sympathetic ophthalmia, and misdiagnosis results in unnecessary tests and treatments. 5 , 9 Kang et al 10 observed progression of bullous detachment in a 47-year-old male patient who was treated with systemic corticosteroids for a prediagnosis of VKH; they subsequently discontinued the medication and successfully treated the patient with vitrectomy and internal subretinal fluid drainage. Gao and Li 11 reported a patient with a previous history of CSCR whose disease converted to the bullous form after being treated with systemic methylprednisolone due to misdiagnosis of VKH.…”