Spark ImageWise 12 – Retina

Acute Central Serous Chorioretinopathy

Dr. Sarang Lambat, Dr. Vinay Nangia 
Suraj Eye Institute, 559 New Colony, Nagpur 

Case Description
A female, 39 years of age, came with sudden blurring of vision in right eye since 10 days. She didn’t have any systemic illness. Her best corrected visual acuity was 6/36 in right eye and 6/6 in the left eye. Anterior segment examination was normal in both eyes. Intraocular pressure recorded by Goldmann applanation tonometer was 18 mmHg in both eyes. Fundus examination revealed a blister like elevation at the posterior pole in the right eye and left eye was normal. Patient underwent fluorescein angiography and SDOCT

Figure 1: Fundus photograph of the right eye showing a blister like elevation at the macula (yellow arrows) with a yellowish area (red arrow – suggestive of subretinal fibrin) suggestive of central serous chorioretinopathy (Figure 1a). Fluorescein angiography images showing a leak in the early arteriovenous phase (yellow arrow) which develops into an ink blot leak in subsequent phases of the angiogram (Figure 1b, 1c, 1d).
Figure 2: Fundus photograph of the left eye shows a normal appearance of the retina and optic disc (Figure 2a). Fluorescein angiogram of the left eye shows a normal dye transit (Figure 2b)

Figure 3: SDOCT horizontal line scan of the right eye shows presence of hypo reflective space (yellow arrow) between the neurosensory retina and the RPE suggestive of fluid collection in the subretinal space. The inner surface of the photoreceptors show hyper-reflective extensions suggestive of elongation(red arrow)
Figure 4: SDOCT line scan shows presence of hyper-reflective area within the neurosensory detachment (Yellow arrow) suggestive of subretinal fibrin

On the basis of these findings she was diagnosed as acute central serous chorioretinopathy (CSC). She was advised to undergo focal laser to the site of leakage which was done on the same day. We document the resolution of the CSC with serial SDOCT scans. Her BCVA improved to 6/6 at the last follow up. 

Figure 4: Serial SDOCT scans of Right eye showing gradual resolution of the CSC. Last follow up scan shows thinning of the fovea along with the outer nuclear layer and distortion of the ellipsoid zone. 

Discussion

This patient had a typical acute idiopathic CSC and a significant amount of fluid at the macula. CSC is the fourth most common disease  of retina associated with fluid leakage (after neovascular age-related macular degeneration (AMD), diabetic macular oedema, and retinal vein occlusion). Cases of CSC generally undergo spontaneous resolution over a period of many months. 
This patient had a significant drop in vision and had high visual requirements as per her profession. Hence we went ahead with focal laser photocoagulation of the leak. The patient responded  well to the intervention, and there was complete resolution of the fluid in less than two months. Intervention can be justified in such cases with high visual requirements and has been documented to enhance the resolution of fluid within a shorter duration. Laser energy should be titrated to the minimum so as to avoid the potential side effects. 

ReadWise

  1. Van Rijssen TJ, van Dijk EHC, Yzer S, Ohno-Matsui K, Keunen JEE, Schlingemann RO, Sivaprasad S, Querques G, Downes SM, Fauser S, Hoyng CB, Piccolino FC, Chhablani JK, Lai TYY, Lotery AJ, Larsen M, Holz FG, Freund KB, Yannuzzi LA, Boon CJF. Central serous chorioretinopathy: Towards an evidence-based treatment guideline. Prog Retin Eye Res. 2019 Nov;73:100770. doi: 10.1016/j.preteyeres.2019.07.003. Epub 2019 Jul 15. PMID: 31319157.
  2. Sahoo NK, Singh SR, Rajendran A, Shukla D, Chhablani J. Masqueraders of central serous chorioretinopathy. Surv Ophthalmol. 2019 Jan-Feb;64(1):30-44. doi: 10.1016/j.survophthal.2018.09.001. Epub 2018 Sep 20. PMID: 30243734.

Dr. Sarang Lambat
MS, FRF
Consultant
Vitreoretinal services
Suraj Eye Institute
Nagpur
Email – education@surajeye.org

× Hello!
%d bloggers like this: