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Surgical management of bilateral exudative retinal detachment associated with central serous chorioretinopathy.

Kang JE, Kim HJ, Boo HD, Kim HK, Lee JH - Korean J Ophthalmol (2006)

Bottom Line: However, the subretinal fluid was not absorbed.The 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To 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.

Methods: A 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.

Results: The 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.

Conclusions: Our case suggests that the surgical management of bullous exudative retinal detachment is safe and necessary.

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Related in: MedlinePlus

Color fundus photographs (A, B), fluorescein angiograms (C, D), and indocyanine green angiogram (E, F) at the time that oral steroid and immunosuppresive treatment were stopped. (A) Right eye. Inferior bullous exudative RD, subretinal fibrotic band, fixed retinal fold, and subtle intraretinal hemorrhages. (B) Left eye. Multiple PEDs and exudative flecks. (C) Right eye. Large blockage of an area of exudative RD, variable blockage and staining of areas of subretinal fibrosis, and leakage and pooling into the subretinal space. (D) Left eye. Multiple pinpoint leakages and poolings. (E) Right eye. (F) left eye. Multiple choroidal vascular hyperpermeability and focal staining of the pigment epithelium.
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Figure 3: Color fundus photographs (A, B), fluorescein angiograms (C, D), and indocyanine green angiogram (E, F) at the time that oral steroid and immunosuppresive treatment were stopped. (A) Right eye. Inferior bullous exudative RD, subretinal fibrotic band, fixed retinal fold, and subtle intraretinal hemorrhages. (B) Left eye. Multiple PEDs and exudative flecks. (C) Right eye. Large blockage of an area of exudative RD, variable blockage and staining of areas of subretinal fibrosis, and leakage and pooling into the subretinal space. (D) Left eye. Multiple pinpoint leakages and poolings. (E) Right eye. (F) left eye. Multiple choroidal vascular hyperpermeability and focal staining of the pigment epithelium.

Mentions: During next 2 weeks, the visual acuity in the right eye deteriorated to hand motions, but that of the left eye was unchanged. In the right eye, the exudative RD extended to the fovea and a subretinal fibrotic band grew across the macula (Fig. 3A, C, E). In the left eye, multiple exudative flecks appeared on the posterior pole (Fig. 3B, D, F). B-scan ultrasonography of the right eye revealed an inferior bullous RD with a shifting of subretinal fluid (Fig. 4). We stopped oral corticosteroid and cyclosporine treatment and considered surgical management for the right eye. Two months after his first visit to our clinic, transscleral drainage of subretinal fluid, gas injection through the pars plana, radial scleral buckling, and focal laser photocoagulation were performed on the right eye. One month after the operation, fundus examination showed diminution of the exudative RD in the right eye and the new development of an exudative RD inferiorly in the left eye. His visual acuity was hand motions in the right eye and 20/40 in the left.


Surgical management of bilateral exudative retinal detachment associated with central serous chorioretinopathy.

Kang JE, Kim HJ, Boo HD, Kim HK, Lee JH - Korean J Ophthalmol (2006)

Color fundus photographs (A, B), fluorescein angiograms (C, D), and indocyanine green angiogram (E, F) at the time that oral steroid and immunosuppresive treatment were stopped. (A) Right eye. Inferior bullous exudative RD, subretinal fibrotic band, fixed retinal fold, and subtle intraretinal hemorrhages. (B) Left eye. Multiple PEDs and exudative flecks. (C) Right eye. Large blockage of an area of exudative RD, variable blockage and staining of areas of subretinal fibrosis, and leakage and pooling into the subretinal space. (D) Left eye. Multiple pinpoint leakages and poolings. (E) Right eye. (F) left eye. Multiple choroidal vascular hyperpermeability and focal staining of the pigment epithelium.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908829&req=5

Figure 3: Color fundus photographs (A, B), fluorescein angiograms (C, D), and indocyanine green angiogram (E, F) at the time that oral steroid and immunosuppresive treatment were stopped. (A) Right eye. Inferior bullous exudative RD, subretinal fibrotic band, fixed retinal fold, and subtle intraretinal hemorrhages. (B) Left eye. Multiple PEDs and exudative flecks. (C) Right eye. Large blockage of an area of exudative RD, variable blockage and staining of areas of subretinal fibrosis, and leakage and pooling into the subretinal space. (D) Left eye. Multiple pinpoint leakages and poolings. (E) Right eye. (F) left eye. Multiple choroidal vascular hyperpermeability and focal staining of the pigment epithelium.
Mentions: During next 2 weeks, the visual acuity in the right eye deteriorated to hand motions, but that of the left eye was unchanged. In the right eye, the exudative RD extended to the fovea and a subretinal fibrotic band grew across the macula (Fig. 3A, C, E). In the left eye, multiple exudative flecks appeared on the posterior pole (Fig. 3B, D, F). B-scan ultrasonography of the right eye revealed an inferior bullous RD with a shifting of subretinal fluid (Fig. 4). We stopped oral corticosteroid and cyclosporine treatment and considered surgical management for the right eye. Two months after his first visit to our clinic, transscleral drainage of subretinal fluid, gas injection through the pars plana, radial scleral buckling, and focal laser photocoagulation were performed on the right eye. One month after the operation, fundus examination showed diminution of the exudative RD in the right eye and the new development of an exudative RD inferiorly in the left eye. His visual acuity was hand motions in the right eye and 20/40 in the left.

Bottom Line: However, the subretinal fluid was not absorbed.The 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To 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.

Methods: A 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.

Results: The 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.

Conclusions: Our case suggests that the surgical management of bullous exudative retinal detachment is safe and necessary.

Show MeSH
Related in: MedlinePlus