Atypical Central Serous Chorioretinopathy

Abstract

Bullous central serous chorioretinopathy (CSCR) is a rare variant of CSCR characterized by severe serous retinal detachment which especially involves the inferior quadrants. Corticosteroid therapy administered for systemic or ocular misdiagnoses may induce and exacerbate CSCR. The purpose of this study was to report diagnosis and treatment results of an unusual case of bullous CSCR induced by systemic and periocular corticosteroid therapy received at another medical center due to a misdiagnosis of Vogt-Koyanagi-Harada disease.

Keywords: Corticosteroid; Vogt-Koyanagi-Harada disease; central serous chorioretinopathy.

Figure 1. Fundus photography and ultrasonography (USG) images from the patient’s right and left eyes. A) Bullous retinal detachment extending to the superotemporal vascular arcade in the right eye; B) Serous retinal detachment in the inferior periphery and subretinal fibrin visible at the inferior and superior temporal arcades and in the nasal quadrant in the left eye; C) Retinal detachment in the inferior and superior quadrants on the USG in the right eye; D) Retinal detachment in the inferior quadrant on USG in the left eye

Figure 2. A) Fluorescein angiography (FA) in the right eye revealed an area of early hypofluorescence in the inferior quadrants and hyperfluorescence at the superotemporal vascular arcade; B) Indocyanine green angiography (ICGA) in the right eye revealed early hypofluorescence in the inferior quadrants and dilated choroidal vessels at the superotemporal arcade; C) FA in the left eye revealed early hypofluorescence at the superior and inferior temporal arcades and in the nasal quadrant; D) ICGA in the left eye revealed dilated choroidal vessels at the level of the temporal vascular arcade; E) FA in the right eye showed hyperfluorescence at the superotemporal vascular arcade due to leakage and hypofluorescence in the inferior quadrants at late phases; F) ICGA in the right eye showed late hyperfluorescence at the superotemporal arcade and hypofluorescence in the inferior quadrants; G) left eye revealed increased hyperfluorescence in late phases in the macula, superotemporal and inferotemporal arcades, and nasal quadrant; H) ICGA in the left eye showed hyperfluorescence in the macula, superotemporal and inferotemporal vascular arcades, and nasal quadrant in late phases; I) In the right eye, subretinal fluid and a subretinal hyperreflective band are visible on enhanced depth imaging-optic coherence tomography (EDI-OCT) from the section passing through the superotemporal vascular arcade; J) In the left eye, the macular EDI-OCT section reveals subretinal fluid, retinal pigment epithelium irregularities, internal limiting membrane folds, and a subfoveal choroid thickness of 591 µm; K) In the left eye, the OCT cross-section taken at the level of the superotemporal arcade reveals subretinal accumulation of hyperreflective material and a hyporeflective space

Figure 3. Fundus images from the left and right eyes taken 4 months after treatment. A) In the right eye, serous retinal detachment regressed to the level of the inferotemporal arcade, while a subretinal band is apparent at the level of the superotemporal arcade; B) In the left eye, subretinal fibrosis is apparent at the superior and inferior temporal arcades; C) Enhanced depth imaging-optic coherence tomography (EDI-OCT) in the right eye shows subretinal fluid and subfoveal choroid thickness of 537 µm in the section taken at the macula; D) EDI-OCT in the left eye revealed subretinal fluid in the macula, hyperreflective material in subretinal area, and subfoveal choroid thickness of 335 µm