Bilateral simultaneous central serous chorioretinopathy in a teenage girl with systemic arterial hypertension

Abstract

We present a case of bilateral simultaneous central serous chorioretinopathy (CSCR) in a teenage girl with a history of systemic arterial hypertension. A 19-year-old Caucasian female, with a history of systemic arterial hypertension, presented with gradual decrease in her central vision for 1 month. She was diagnosed with bilateral simultaneous CSCR, based on the findings of spectral domain optical coherence tomography (SD-OCT), indocyanine green angiography (ICG), fundus auto-fluorescence, fluorescein angiography and color fundus photographs, which are described. Blood pressure was 134/95 mmHg at presentation. Systemic evaluation failed to reveal a cause for the high blood pressure, and included a panel of blood tests, which were all normal. Her best-corrected visual acuity was 20/30 OD and 20/25 OS. Dilated fundus examination showed normal optic discs and retinal vasculature, with no evidence of hypertensive retinopathy. However, shallow retinal fluid associated with pigmentary changes was noted in the center of both maculae. OCT and ICG findings were consistent with the diagnosis of bilateral CSCR. CSCR can manifest in patients with demographics outside the range of those previously reported. This is the first report of CSCR occurring in a teenage girl, with a history of systemic arterial hypertension. It is important to consider this disease in any patient who has a clinically compatible presentation.

Fig 1. Color Fundus Photographs

Color fundus photographs from both eyes showing shallow retinal fluid and pigmentary changes in both maculae (black arrows). The retinal periphery looks normal. Notice the absence of changes associated with hypertensive retinopathy.

Fig 2. Fluorescein Angiography Images

Late fluorescein angiography images from both eyes revealing pinpoint areas of hyper-fluorescence in both maculae (black arrows). Notice the absence of typical signs of fluorescein leakage, normally seen in central serous chorioretinopathy.

Fig 3. Indocyanine Green Angiography Images

Late indocyanine green (ICG) angiography images from both eyes, revealing multiple areas of hyper-fluorescence (black arrows), suggestive of hyper-permeability.

Fig 4. Optical Coherence Tomography Images

Macular optical coherence tomography (OCT) scans from both eyes showing an elevation of the neurosensory retina in both eyes (asterisk). Notice the accumulation of the shed outer segments of the photoreceptors, visible as hyper-reflective deposits in the rim of the elevated retina (white arrows).

Fig 5. Fundus Auto-fluorescence Images

Fundus auto-fluorescence images from both eyes showing hyper auto-fluorescent flecks in both eyes reflecting shed photoreceptors outer segments (black arrows). Notice the absence of the normal hypo auto-fluorescence in macular region due the subretinal fluid accumulation.