Surgical Management of Bilateral Exudative Retinal Detachment Associated with Central Serous Chorioretinopathy

Department of Ophthalmology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
Korean Journal of Ophthalmology 07/2006; 20(2):131-8. DOI: 10.3341/kjo.2006.20.2.131
Source: PubMed

ABSTRACT To report a case of bilateral bullous exudative retinal detachment in central serous chorioretinopathy (CSC) which was attached by vitrectomy and internal drainage of the subretinal fluid.
A 47-year-old man affected by bilateral atypical CSC with a bullous retinal detachment with subretinal exudate. A fluorescein angiogram (FAG) showed multiple points of leakage and staining of subretinal fibrosis. A tentative diagnosis of Vogt-Koyanagi-Harada (VKH) syndrome was made and the patient was treated with systemic corticosteroids and immunosuppressive agents. However, the subretinal fluid was not absorbed. He was then treated with vitrectomy and internal drainage of subretinal fluid.
The retina was attached successfully in both eyes. Visual acuity improved to 20/50 in his left eye but did not improve in the right eye due to subretinal fibrotic scarring and atropic changes on the macula.
Our case suggests that the surgical management of bullous exudative retinal detachment is safe and necessary.

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    ABSTRACT: Background Acute Vogt-Koyanagi-Harada (VKH) disease and acute central serous chorioretinopathy (CSCR) are two common disorders with serous retinal detachment caused by dysfunction of choroid. The purpose of this study is to compare the morphological changes of these two diseases with spectral domain optical coherence tomography (SD-OCT). Methods In this retrospective comparative study, the SD-OCT images of 65 eyes with acute VKH and 52 eyes with acute CSCR were reviewed for the presence of subretinal fluid, folds of retinal pigment epithelial (RPE), fluctuation of internal limiting membrane (ILM), subretinal septa, retinal pigment epithelium detachment (PED) and bulge of RPE. The foveal thickness was measured using the manual caliper of OCT software. The characteristics of SD-OCT were compared between two diseases. Results Subretinal fluid was present in both diseases. Folds of RPE, fluctuation of ILM, subretinal septa were seen only in VKH. Bulge of RPE presented only in CSCR. PED was more common in CSCR than in VKH (44.2% vs 3.1%, p < 0.001). The thickness of fovea and RPE undulation index were significantly greater in VKH compared to that in CSCR (746.7 ± 423.8 vs 444.9 ± 158.8 μm, p < 0.001 and 1.0667 ± 0.0509 vs. 1.0177 ± 0.0023, p = 0.003). Conclusion Our study showed that although VKH and CSCR share similar features on SDOCT, there are characteristic differences between both disease entities.
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