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Multimodal imaging for the diagnosis of an atypical case of central serous chorioretinopathy.

Kahloun R, Chebbi A, Amor SB, Ksiaa I, Nacef L, Khairallah M - Middle East Afr J Ophthalmol (2014 Oct-Dec)

Bottom Line: However, visual acuity remained severely impaired in one eye.Failure to differentiate atypical CSCR from inflammatory chorioretinal diseases may lead to severe and irreversible visual impairment.Multimodal imaging helps recognition of the atypical presentations of CSCR, avoiding misdiagnosis and inappropriate management.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia.

ABSTRACT
We report a case of a 52-year-old woman presented with atypical central serous chorioretinopathy (CSCR) that had been misdiagnosed as posterior uveitis and treated with systemic corticosteroids and immunosuppressive therapy, with subsequent severe chorioretinal damage. Diagnosis was straightened through multimodal imaging. Anatomical improvement was achieved after discontinuation of corticosteroids and intravitreal injection of bevacizumab. However, visual acuity remained severely impaired in one eye. Failure to differentiate atypical CSCR from inflammatory chorioretinal diseases may lead to severe and irreversible visual impairment. Multimodal imaging helps recognition of the atypical presentations of CSCR, avoiding misdiagnosis and inappropriate management.

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Related in: MedlinePlus

Late-phase fluorescein angiogram of the LE shows multiple pinpoints
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F1d: Late-phase fluorescein angiogram of the LE shows multiple pinpoints

Mentions: A 52-year-old woman, with a history of well-controlled systemic hypertension, complained of decreased vision in both eyes of 3-year-duration. A diagnosis of idiopathic bilateral posterior uveitis had been made by her ophthalmologist based on a negative extensive comprehensive work-up for infectious and non-infectious diseases. The patient had been treated with several courses of oral prednisone, intravenous methylprednisolone, azathioprine, and intravenous cyclophosphamide with no improvement. The patient was referred to us to rule out a masquerade syndrome. On examination, her best-corrected visual acuity (BCVA) was 20/400 in the right eye (RE) and 20/50 in the left eye (LE). Results of anterior segment examination were unremarkable with no features of active or inactive anterior uveitis. Intraocular pressure was normal in both eyes. There was mild vitreous hemorrhage in the RE and normal vitreous in the LE. Dilated fundus examination of the RE showed normal optic disc, preretinal hemorrhage, subretinal fibrotic lesion in the macular area, epiretinal membrane (ERM), RPE changes, and a retinal detachment involving the periphery inferiorly without associated retinal breaks [Figure 1a]. Fundus examination of the LE showed area of macular RPE atrophy and area of RPE changes with no retinal detachment or other peripheral lesions [Figure 1b]. Fluorescein angiography (FA) revealed multifocal pinpoints, retinal neovascularization, and extensive RPE changes in the RE [Figure 1c], and multifocal pinpoints in the LE [Figure 1d]. Indocyanine green angiography (ICGA) showed dilation of choroidal veins and multiple areas of choroidal vascular hyperpermeability in both eyes [Figures 1e–h]. Optical coherence tomography (OCT) showed serous retinal detachment (SRD), ERM, and a subretinal hyperreflective lesion in the RE corresponding the fibrotic lesion seen clinically [Figure 1i]. B-scan ultrasonography of the RE confirmed the presence of retinal detachment without associated vitreous traction, choroidal tumor, or infiltration. Ultrasonography results of the LE were unremarkable.


Multimodal imaging for the diagnosis of an atypical case of central serous chorioretinopathy.

Kahloun R, Chebbi A, Amor SB, Ksiaa I, Nacef L, Khairallah M - Middle East Afr J Ophthalmol (2014 Oct-Dec)

Late-phase fluorescein angiogram of the LE shows multiple pinpoints
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219231&req=5

F1d: Late-phase fluorescein angiogram of the LE shows multiple pinpoints
Mentions: A 52-year-old woman, with a history of well-controlled systemic hypertension, complained of decreased vision in both eyes of 3-year-duration. A diagnosis of idiopathic bilateral posterior uveitis had been made by her ophthalmologist based on a negative extensive comprehensive work-up for infectious and non-infectious diseases. The patient had been treated with several courses of oral prednisone, intravenous methylprednisolone, azathioprine, and intravenous cyclophosphamide with no improvement. The patient was referred to us to rule out a masquerade syndrome. On examination, her best-corrected visual acuity (BCVA) was 20/400 in the right eye (RE) and 20/50 in the left eye (LE). Results of anterior segment examination were unremarkable with no features of active or inactive anterior uveitis. Intraocular pressure was normal in both eyes. There was mild vitreous hemorrhage in the RE and normal vitreous in the LE. Dilated fundus examination of the RE showed normal optic disc, preretinal hemorrhage, subretinal fibrotic lesion in the macular area, epiretinal membrane (ERM), RPE changes, and a retinal detachment involving the periphery inferiorly without associated retinal breaks [Figure 1a]. Fundus examination of the LE showed area of macular RPE atrophy and area of RPE changes with no retinal detachment or other peripheral lesions [Figure 1b]. Fluorescein angiography (FA) revealed multifocal pinpoints, retinal neovascularization, and extensive RPE changes in the RE [Figure 1c], and multifocal pinpoints in the LE [Figure 1d]. Indocyanine green angiography (ICGA) showed dilation of choroidal veins and multiple areas of choroidal vascular hyperpermeability in both eyes [Figures 1e–h]. Optical coherence tomography (OCT) showed serous retinal detachment (SRD), ERM, and a subretinal hyperreflective lesion in the RE corresponding the fibrotic lesion seen clinically [Figure 1i]. B-scan ultrasonography of the RE confirmed the presence of retinal detachment without associated vitreous traction, choroidal tumor, or infiltration. Ultrasonography results of the LE were unremarkable.

Bottom Line: However, visual acuity remained severely impaired in one eye.Failure to differentiate atypical CSCR from inflammatory chorioretinal diseases may lead to severe and irreversible visual impairment.Multimodal imaging helps recognition of the atypical presentations of CSCR, avoiding misdiagnosis and inappropriate management.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia.

ABSTRACT
We report a case of a 52-year-old woman presented with atypical central serous chorioretinopathy (CSCR) that had been misdiagnosed as posterior uveitis and treated with systemic corticosteroids and immunosuppressive therapy, with subsequent severe chorioretinal damage. Diagnosis was straightened through multimodal imaging. Anatomical improvement was achieved after discontinuation of corticosteroids and intravitreal injection of bevacizumab. However, visual acuity remained severely impaired in one eye. Failure to differentiate atypical CSCR from inflammatory chorioretinal diseases may lead to severe and irreversible visual impairment. Multimodal imaging helps recognition of the atypical presentations of CSCR, avoiding misdiagnosis and inappropriate management.

Show MeSH
Related in: MedlinePlus