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Scleral resection in chronic central serous chorioretinopathy complicated by exudative retinal detachment

View Article: PubMed Central - PubMed

ABSTRACT

Background: Effective therapeutic options are limited for the management of chronic central serous chorioretinopathy (CSCR) complicated by exudative retinal detachments (RD). The authors describe the resolution of one such case following partial thickness scleral resection with mitomycin C.

Case presentation: This 39-year-old male presented with a unilateral inferior exudative RD in the right eye. There was no history of steroid use either locally or systemically. The fundus fluorescein angiogram showed window defects and leaks typical of chronic CSCR. The axial length was 21.06 mm in the right eye and 21 mm in the left eye. Thickening of the ocular coats was evident on ocular ultrasound. Considering an axial length in the borderline-low range inferotemporal and inferonasal partial thickness scleral resection with mitomycin C was performed. The exudative RD resolved at 4 months.

Conclusion: Partial thickness scleral resection may be considered as an option for treating chronic CSCR patients with borderline-low axial length complicated by exudative RD.

No MeSH data available.


Related in: MedlinePlus

Preoperative fundus findings of the patient. a Fundus photograph of the right eye shows inferior exudative retinal detachment with subretinal exudation (fibrin) inferior to the macula. b Fundus photograph of the left eye shows pigmentary changes at the posterior pole consistent with diffuse retinal pigment epitheliopathy. c Fluorescein angiography (late phase) of the right eye reveals an annular zone of small hyper and hypofluorescent areas corresponding to the mottled appearance of the RPE with pooling of dye in the subretinal space. Most of the hyperfluorescent areas being window defects with few increasing in size and intensity with time suggest active leaks. A small focal leaking area of hyperfluorescence is also seen inferonasal to the disc. d Optical coherence tomography (OCT) of the right eye shows the neurosensory detachment at the fovea with some underlying hyperreflective material suggestive of fibrin and a pigment epithelial detachment (PED)
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Fig1: Preoperative fundus findings of the patient. a Fundus photograph of the right eye shows inferior exudative retinal detachment with subretinal exudation (fibrin) inferior to the macula. b Fundus photograph of the left eye shows pigmentary changes at the posterior pole consistent with diffuse retinal pigment epitheliopathy. c Fluorescein angiography (late phase) of the right eye reveals an annular zone of small hyper and hypofluorescent areas corresponding to the mottled appearance of the RPE with pooling of dye in the subretinal space. Most of the hyperfluorescent areas being window defects with few increasing in size and intensity with time suggest active leaks. A small focal leaking area of hyperfluorescence is also seen inferonasal to the disc. d Optical coherence tomography (OCT) of the right eye shows the neurosensory detachment at the fovea with some underlying hyperreflective material suggestive of fibrin and a pigment epithelial detachment (PED)

Mentions: A 39-year-old male presented with painless progressive diminution of vision in the right eye (RE) of 5 years and in the left eye (LE) of 6 months duration. There was no history of chronic drug use, specifically, use of steroid in any form. The visual acuity was 1/60 (RE) and 6/18 (LE). There was no anterior chamber or retrolental cells in both eyes and intraocular pressures were normal. The RE had a bullous inferior RD involving the macula with a smooth surface and shifting fluid. There was whitish subretinal exudation inferior to the macula (fibrin, Fig. 1a). The LE showed pigmentary changes at the posterior pole and multiple pigment epithelial detachments (PEDs) (Fig. 1b). No mass lesion or peripheral break was detected in either eye. Fluorescein angiography (FA) of the RE showed window defects at the posterior pole with leaks at the nasal part of the window defect and inferonasal to the optic disc (Fig. 1c). There was no disc leak or vasculitis. The LE revealed window defects with multiple PEDs. Optical coherence tomography (OCT) of the RE revealed subfoveal fluid with some underlying hyperreflective material suggestive of fibrin and a serous PED (Fig. 1d). OCT of the LE revealed multiple serous PEDs. The sclero-chorioretinal thickness was 2 mm (RE) and 2.01 mm (LE). Axial lengths were 21.06 mm (RE) and 21 mm (LE). Serum cortisol level, blood pressure, and kidney functions tests were normal. A diagnosis of bilateral chronic CSCR with an exudative RD in the RE was made. Some cases of CSR can undergo spontaneous resolution. Thus at the first presentation, the patient was advised to follow-up.Fig. 1


Scleral resection in chronic central serous chorioretinopathy complicated by exudative retinal detachment
Preoperative fundus findings of the patient. a Fundus photograph of the right eye shows inferior exudative retinal detachment with subretinal exudation (fibrin) inferior to the macula. b Fundus photograph of the left eye shows pigmentary changes at the posterior pole consistent with diffuse retinal pigment epitheliopathy. c Fluorescein angiography (late phase) of the right eye reveals an annular zone of small hyper and hypofluorescent areas corresponding to the mottled appearance of the RPE with pooling of dye in the subretinal space. Most of the hyperfluorescent areas being window defects with few increasing in size and intensity with time suggest active leaks. A small focal leaking area of hyperfluorescence is also seen inferonasal to the disc. d Optical coherence tomography (OCT) of the right eye shows the neurosensory detachment at the fovea with some underlying hyperreflective material suggestive of fibrin and a pigment epithelial detachment (PED)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5016948&req=5

Fig1: Preoperative fundus findings of the patient. a Fundus photograph of the right eye shows inferior exudative retinal detachment with subretinal exudation (fibrin) inferior to the macula. b Fundus photograph of the left eye shows pigmentary changes at the posterior pole consistent with diffuse retinal pigment epitheliopathy. c Fluorescein angiography (late phase) of the right eye reveals an annular zone of small hyper and hypofluorescent areas corresponding to the mottled appearance of the RPE with pooling of dye in the subretinal space. Most of the hyperfluorescent areas being window defects with few increasing in size and intensity with time suggest active leaks. A small focal leaking area of hyperfluorescence is also seen inferonasal to the disc. d Optical coherence tomography (OCT) of the right eye shows the neurosensory detachment at the fovea with some underlying hyperreflective material suggestive of fibrin and a pigment epithelial detachment (PED)
Mentions: A 39-year-old male presented with painless progressive diminution of vision in the right eye (RE) of 5 years and in the left eye (LE) of 6 months duration. There was no history of chronic drug use, specifically, use of steroid in any form. The visual acuity was 1/60 (RE) and 6/18 (LE). There was no anterior chamber or retrolental cells in both eyes and intraocular pressures were normal. The RE had a bullous inferior RD involving the macula with a smooth surface and shifting fluid. There was whitish subretinal exudation inferior to the macula (fibrin, Fig. 1a). The LE showed pigmentary changes at the posterior pole and multiple pigment epithelial detachments (PEDs) (Fig. 1b). No mass lesion or peripheral break was detected in either eye. Fluorescein angiography (FA) of the RE showed window defects at the posterior pole with leaks at the nasal part of the window defect and inferonasal to the optic disc (Fig. 1c). There was no disc leak or vasculitis. The LE revealed window defects with multiple PEDs. Optical coherence tomography (OCT) of the RE revealed subfoveal fluid with some underlying hyperreflective material suggestive of fibrin and a serous PED (Fig. 1d). OCT of the LE revealed multiple serous PEDs. The sclero-chorioretinal thickness was 2 mm (RE) and 2.01 mm (LE). Axial lengths were 21.06 mm (RE) and 21 mm (LE). Serum cortisol level, blood pressure, and kidney functions tests were normal. A diagnosis of bilateral chronic CSCR with an exudative RD in the RE was made. Some cases of CSR can undergo spontaneous resolution. Thus at the first presentation, the patient was advised to follow-up.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Effective therapeutic options are limited for the management of chronic central serous chorioretinopathy (CSCR) complicated by exudative retinal detachments (RD). The authors describe the resolution of one such case following partial thickness scleral resection with mitomycin C.

Case presentation: This 39-year-old male presented with a unilateral inferior exudative RD in the right eye. There was no history of steroid use either locally or systemically. The fundus fluorescein angiogram showed window defects and leaks typical of chronic CSCR. The axial length was 21.06 mm in the right eye and 21 mm in the left eye. Thickening of the ocular coats was evident on ocular ultrasound. Considering an axial length in the borderline-low range inferotemporal and inferonasal partial thickness scleral resection with mitomycin C was performed. The exudative RD resolved at 4 months.

Conclusion: Partial thickness scleral resection may be considered as an option for treating chronic CSCR patients with borderline-low axial length complicated by exudative RD.

No MeSH data available.


Related in: MedlinePlus