Thirty-six years old female phakic optometrist presented to me with reduced vision. Her BCVA is 20/60 in her left eye, while in her right eye, the BCVA is 20/20; fundus examination showed no remarkable findings.
On clinical exam, there is subretinal fluid above and adjacent to a yellowish rounded elevation of RPE.
OCT shows central subretinal fluid with PED and visible Bruch's membrane featuring double-layered sign, along with elongation of photoreceptor cells and increased the thickness of choroid and dilated of Haller's.
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| OCT cross-section showing CSCR pre and post-treatment with subthreshold microsecond laser |
Diagnosis: Acute central serous retinopathy
Management
The patient was managed with a subthreshold microsecond laser.
Discussion
Acute CSR can present as central serous retinal detachment, which features a fluid leak due to RPE pump defect, causing reduced RPE pumping function to keep the retina dry along with increased leakage due to choroidal vasculopathy.
Treating central serous retinopathy is a clinical challenge, but usually, it has a good prognosis; however, cases of acute CSCR are observed for spontaneous resolution within three months. If spontaneous resolution didn't occur, then half-dose PDT or subthreshold microsecond laser can be considered.
In chronic cases, then treatment with non-selective mineralocorticoids such as spironolactone should be considered.
However, potassium levels and liver enzyme levels should monitor under the supervision of an internist.
The patient was promptly managed with a subthreshold microsecond laser due to her high visual demands and showed significant resolution of subretinal fluids after 28 days and improved vision to 20/25.
Please tell me how you would manage this case in your clinical practice??!!!
Please check Clinical guidelines for central serous chorioretinopathy
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