Clinical factors related to visual outcome in central serous chorioretinopathy.

PURPOSE: The purpose of this study was to describe clinical, angiographic, and tomo-graphic prognostic factors in central serous chorioretinopathy. METHODS: This is a prospective uncontrolled case series. Forty-six eyes (43 patients) with clinical and angiographic findings consistent with central serous chorioretinopathy were included. Clinical data regarding age, sex, duration of symptoms, associated conditions, and best-corrected visual acuity (BCVA) were collected at baseline. Optical coherence tomography was performed at baseline, monthly until fluid resolution occurred, and at the end of the follow-up. RESULTS: Mean follow-up was 22.8 months. Mean baseline and final logarithm of the minimum angle of resolution BCVA were 0.3 and 0.12 (P < 0.0001), respectively. Statistically significant correlations were observed between the baseline BCVA as well as duration of symptoms and final BCVA. Angiographic patterns were not significantly correlated with the visual outcome. Shorter periods of subfoveal fluid during the follow-up were correlated with better visual acuity. Mean foveal thickness after fluid resolution was 178 +/- 22 microm. Both baseline and final BCVA were strongly correlated with the foveal thickness after fluid resolution. CONCLUSION: Initial BCVA may be a reliable predictor of the visual outcome in central serous chorioretinopathy. Eyes with worse BCVA may have an increased risk of foveal atrophy. Fluid persistence on optical coherence tomography may be associated with worse visual prognosis.

Peripapillary haemorrhagic retinal pigment epithelium detachment following radial optic neurotomy.

Central retinal vein occlusion is a common vascular cause of blidness. In this paper, we first report focal haemorrhagic pigment epithelium detachment and chorioretinal anastomosis in the peripapillary area as an intraoperative complication of radial optic neurotomy (RON). A 65-year-old white man presented with ischaemic central vein occlusion OS. He underwent vitrectomy with RON, panretinal photocoagulation and intravitreal injection of triamcinolone acetonide. A circumscribed subretinal haemorrhage was noted intraoperatively at the nasal site of the RON. The haemorrhage size decreased at the seventh postoperative day when an optical coherence tomography scan disclosed a haemorrhagic pigment epithelium detachment. Fluorescein angiography and fundus photograph revealed a chorioretinal anastomosis formation nasal to the optic nerve confirmed by indocyanine green angiography. Best-correlated visual acuity improved from hand movements to 6/18 at the fourth week and it was stable until last examination. This case illustrates the role of chorioretinal anastomosis formation in the vision improvement following RON.

Severe retinal thermal injury after indocyanine green-mediated photothrombosis for central serous chorioretinopathy.

PURPOSE: To report severe retinal thermal damage after indocyanine green-mediated photothrombosis (IMP) for chronic central serous chorioretinopathy (CSC). DESIGN: Interventional case report. METHODS: A 31-year-old white male underwent IMP for chronic CSC. RESULTS: During the procedure, retinal whitening was observed in the area of the treatment spot. Fluorescein angiography revealed staining of the retinal arteries in the treated area. One year later, macular retinal pigment epithelial (RPE) changes were seen, accompanied by severe loss of vision. CONCLUSIONS: IMP has been described as a relatively safe treatment option for persistent CSC. However, we herein report a case in which severe retinal damage occurred as a consequence of the treatment. We thus alert clinicians of this potential adverse event.

STRATUSOCT and multifocal ERG in unilateral acute idiopathic maculopathy.

BACKGROUND: Unilateral acute idiopathic maculopathy (UAIM) is a rare entity, in which an inflammatory process involves the macular retinal pigment epithelium (RPE) and outer retina. It represents a wide spectrum of ocular findings not consistently present in all patients, which may lead to difficulties in the recognition of the condition. METHODS: This observational case report presents the third-generation optical coherence tomography (StratusOCT) and multifocal electroretinogram (mfERG) findings in a 31-year-old woman with UAIM in the acute phase as well as two months later, and discusses the role of StratusOCT in the diagnosis. RESULTS: In the acute phase, StratusOCT demonstrated abnormal heterogeneous hyperreflectivity and thickening at the level of the outer retina and RPE in the foveal region. Two months after the initial presentation, StratusOCT examination showed a subfoveal area of homogeneous hyperreflectivity that extended from the RPE to the outer retinal layers with posterior shadowing, and sparse points of hyperreflectivity at several different levels of the neurosensory retina, including its superficial layers. The foveal retinal thickness during the acute phase was thicken compared with that after resolution. Seven days after the initial evaluation, mfERG showed severely reduced N1-P1 amplitudes with normal latencies in the region corresponding to the affected area of the papillomacular bundle and fovea. Two months later, mfERG results were normal. CONCLUSIONS: StratusOCT provided valuable information, allowing for the exclusion of other disorders that might mimic UAIM. mfERG findings were consistent with transient outer retinal dysfunction as the cause of visual loss. We are unaware of previous reports of UAIM studied by these methods and could find no reference to them in a computerized search using MEDLINE.

Bilateral central retinal vein occlusion associated with multiple myeloma.

PURPOSE: To report a case of simultaneous bilateral central retinal vein occlusion (CRVO) associated with multiple myeloma. METHODS: A 65-year-old woman had sudden, painless loss of vision in both eyes for 20 days. Ophthalmologic examination revealed bilateral CRVO. Appropriate medical workup was conducted, and multiple myeloma was diagnosed as the underlying cause. RESULTS: Clinical support and chemotherapy effectively controlled paraprotein production, leading to improvement of both systemic and ocular alterations. CONCLUSIONS: Many conditions have been noted to be associated with CRVO. Based on a Medline search, this is the first report of simultaneous bilateral CRVO as the first manifestation of multiple myeloma, illustrating the need for a primary care ophthalmologist to be involved in the basic assessment for associated underlying diseases in retinal disorders.