A 48-year-old female presents with a history of chronically decreased vision in her right eye. Multimodal imaging reveals serous macular detachment, thickened choroid, and focal areas of late leakage on fluorescein angiography. The left eye has pigmentary changes in the peripheral macula without subretinal fluid. Imaging and examination findings are consistent with a diagnosis of central serous retinopathy. Observation for up to 3 months is a well-accepted initial management choice in these cases, as in many cases the serous detachment will resolve spontaneously. However, fluid may persist as chronic disease, eventually leading to permanent visual loss. Treatment options include micropulse laser, focal laser, photodynamic therapy, or oral mineralocorticoid receptor antagonists. The patient was treated with micropulse laser and eplerenone without improvement in vision or subretinal fluid. Eventually, the macular detachment resolved after photodynamic therapy, although her visual acuity did not improve.
Presentation Date: 08/02/2018
Issue Date: 08/01/2020