Idiopathic Central Serous Chorioretinopathy

A 47-year-old male with previous diagnosis of exudative AMD s/p multiple Avastin injections presents with complaint of decreased vision OU. Exam was significant for VA 20/200 OD, 20/25 OS. DFE significant for macular mottling OU. OCT shows serous retinal detachment with pigment epithelial detachment OD and nasal serous retinal detachment OS. Swept-source OCT imaging provided 12x12 scans showing thickening of choroid OU with topographical maps defining areas of elevation. A diagnosis of Idiopathic central serous retinopathy was confirmed following the imaging. The patient was initially observed however on follow-up 2 months later the SS-OCT showed persistent disease OU. Given the persistent disease the patient was started on eplerenone 50 mg daily for management given diffuse, bilateral disease. The patient was instructed to get regular potassium checks and to return 6 weeks later to assess treatment response. Due to the COVID-19 pandemic the patient was unable to make his return visit. Eventually the patient returned 6 months later with repeat SS-OCT imaging at this visit showing improvement OU.

An 82-year-old monocular male presented to the VA Eye Clinic with a red, swollen right eye for three weeks. Examination revealed 20/50 vision, proptosis, and an increased IOP. CT scan revealed a large mass in the nasopharynx and orbit. Middle turbinate biopsy was significant for large B-cell lymphoma with a high proliferative fraction. One week later, the patient was NLP in the right eye secondary to optic nerve compression. He was admitted for IV steroids, and he developed a GI bleed requiring a cessation of steroids. He recovered no vision. The patient refused palliative surgery, chemotherapy, and radiotherapy, and he was transferred to hospice care. His untreated course is documented photographically in this presentation.  

Presentation Date: 09/03/2020

Issue Date: 02/05/2021