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Central Serous Choroidopathy

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Br J Ophthalmol: first published as 10.1136/bjo.66.4.240 on 1 April 1982. Downloaded from British Journal ofOphthalmology, 1982, 66, 240-241 Visual disturbances during pregnancy caused by central serous choroidopathy J. R. M. CRUYSBERG AND A. F. DEUTMAN From the Institute of Ophthalmology, University of Nijmegen, Nijmegen, The Netherlands SUMMARY Three patients had during pregnancy visual disturbances caused by central serous choroidopathy. One of them had a central scotoma in her first and second pregnancy. The 2 other patients had a central scotoma in their first pregnancy. Symptoms disappeared spontaneously after delivery. Except for the ocular abnormalities the pregnancies were without complications. The complaints can be misinterpreted as pregnancy-related optic neuritis or compressive optic neuropathy, but careful biomicroscopy of the ocular fundus should avoid superfluous diagnostic and therapeutic measures. Central serous choroidopathy (previously called lamp biomicroscopy of the fundus with a Goldmann central serous retinopathy) is a spontaneous serous contact lens showed a serous detachment of the detachment of the sensory retina due to focal leakage neurosensory retina in the macular region of the from the choriocapillaris, causing serous fluid affected left eye. Fluorescein angiography was not accumulation between the retina and pigment performed because of pregnancy. In her first epithelium. This benign disorder occurs in healthy pregnancy the patient had consulted an ophthal- adults between 20 and 45 years of age, who present mologist on 13 June 1977 for exactly the same with symptoms of diminished visual acuity, relative symptoms, which had disappeared spontaneously http://bjo.bmj.com/ central scotoma, metamorphopsia, and micropsia. after delivery. Except during pregnancy the patient Males are affected more commonly than females by at never had visual complaints. least 10 to one.' Most eyes have a complete visual Delivery was 5 days later. Without treatment the recovery over a variable period of time. The cause of central scotoma and serous detachment disappeared the condition is unknown. within 2 weeks. Both pregnancies had been normal Although this disease usually affects males, we from the obstetrical point of view. have observed central serous choroidopathy in on October 2, 2021 by guest. Protected copyright. pregnant females. The course of symptoms in these CASE 2 patients made a causal relationship with pregnancy A 27-year-old woman (gravida 1) noted a relative probable. central scotoma in her right eye when she was 20 weeks pregnant. Ophthalmological examination on Case reports 18 July 1980 disclosed a serous detachment of the sensory retina in the macular region of the right eye. CASE 1 The macular lesion was evident by the slit-lamp A 34-year-old woman (gravida 2) noted visual microscope and Goldmann contact lens, so blurring and a relative central scotoma in the left eye fluorescein angiography was not performed in when she was 28 weeks pregnant. Ophthalmological pregnancy. The visual acuity was 6/30 in the right eye examination was performed 10 weeks later, on 17 after correction (S+2-0) of hypermetropia and 6/6 in March 1981. Visual acuity was 6/5 in the right eye and the emmetropic left eye. Without treatment the 6/6 in the left eye. Indirect ophthalmoscopy and slit- serous detachment persisted during pregnancy. After delivery the first ocular examination was Correspondence to J. R. M. Cruvsherg. MD. University of performed on 6 March 1981. The visual complaints Nijmegen, Institute of Ophthalmology. Philips van Levdenlaan 15. had disappeared, and visual acuity had returned to Nijmegen, The Netherlands. 6/6 without correction. There was no evidence of 240 Br J Ophthalmol: first published as 10.1136/bjo.66.4.240 on 1 April 1982. Downloaded from Visual disturbances during pregnancy caused by central serous choroidopathy 241 serous detachment of the sensory retina. The macula pregnancy from the obstetrical point of view, without of the right eye showed a slight granularity of the signs of toxaemia. pigment epithelium. The pregnancy had been It is of the utmost importance to distinguish the uneventful from the obstetrical point of view. correct causes of visual disturbances and field defects during pregnancy. In all cases a careful examination CASE 3 of the ocular fundus is necessary to exclude a retinal A 32-year-old woman (gravida 1) noted blurred cause. The central scotoma can be misinterpreted as a vision and central scotoma in her right eye when result of optic neuritis. The association of optic she was 32 weeks pregnant. Ophthalmological neuritis and pregnancv has previously been examination on 14 August 1980, one week after the suggested.47 Visual disturbances during pregnancy initial symptoms. disclosed a serous detachment of have been reported as a result of the expansion of the sensory retina in the macular region of her right intracranial tumours (meningiomas, pituitary eve. Visual acuity was 6/30 in the right eye and 6/6 in adenomas, and craniopharyngiomas) owing to the left eve. hormonal changes.5 8-11 As in our patients with After deliverv on 29 September visual complaints central serous choroidopathy the spontaneous disappeared spontaneously. On 27 November 1980 recovery of visual functions after delivery has been ophthalmological examination disclosed visual acuitv described in patients with intracranial tumrours.9'2 6/6 in the right eye. There was still some If central serous choroidopathv is the cause of metamorphopsia (Amsler grid). but the serous visual disturbances during pregnancv. its correct detachment had disappeared. The pregnancy had diagnosis mav avert superfluous diagnostic and been normal from the obstetrical point of view. therapeutic measures. Discussion References The occurrence of central serous choroidopathy in 4 I Gass JDM. Stereoscopic Atlas of Macular Diseases: A pregnancies of these 3 patients, and the spontaneous finduscopic and Angiographic Presentation. St Louis: Mosby. recovery after delivery, suggested a causal relation- 1977:28. 2 RN. serous retinopathv and pregnancy. and Chumblev LC. Frank Central ship of the disorder and Chumbley pregnancv. Am J Ophthalrnol 1974: 77: 158-60. Frank2 reported central serous retinopathy in a 34- 3 Fastenberg DM. Fetkenhour CL. Choromokos E. Shoch DE. vear-old woman during 4 consecutive pregnancies, Choroidal vascular changes in toxemia of pregnancv. Am J with remission after delivery or spontaneous Ophthalmol 1980:89: 362-8. 4 Kogan JA. Retrobulbar neuritis during pregnancv. Sov'et Vestn abortion. The authors suggest that a hormonal agent, Oftalmol 1934; 5: 503-5. http://bjo.bmj.com/ which increases in concentration during pregnancy, is 5 Hagedoorn A. The chiasmal svndrome and retrobulhar neuritis one possible causative factor in this disease. in pregnancv. Am J Ophthalmol 1937; 20: 690-9. However, since the disorder is more common in men, 6 Caderas de Kerleau J. Cazahan R. Etude clinique des atteintes du nerf optique au cours de la grossesse. Presse Mid 1952; 60:943-4. and usually unilateral, other svstemic and ocular 7 Caderas de Kerleau J. Durand G. Cazahan R. Nevrite retro- factors must play a role. hulbaire gravidique aggrav6e apres l'accouchement. Apparition One of the changes in a normal pregnancv is an de lesions chorior6tiniennes deux mois apres. Blull Soc Ophtalmol France 1952: 52: 319-21. increase of plasma volume and total blood volume. on October 2, 2021 by guest. Protected copyright. 8 Enoksson P. Lundberg N, Sjdstedt S, Skanse B. Influence of Probably circulatory changes in the choriocapillaris pregnancv on visual fields in suprasellar tumours. Acta Psvchiatr can provoke central serous choroidopathv in pre- Nelurol Scand 1961; 36: 524-38. disposed eyes. The importance of the ocular factor is 9 Swver GIM, Little V. Harries BJ. Visual disturhance in suggested by the fact that in consecutive pregnancies pregnancv after induction of ovulation. Br Med J 1971: iv: 9(- 1. I0 Corbev RS, Cruvsberg JRM, Rolland R. Visual ahnormalities in the relapse of central serous choroidopathv occurred a pregnancv following hromocriptin medication. Obstet Givnecol in the same eye. 1977: 50: 69s-71 s. Fastenberg et al.3 found predominantly abnormal 11 Lamberts SWJ. Seldenrath HJ. Kwa HG. Birkenh5ger JC. choroidal vascular patterns in toxaemia of pregnancy, Transient bitemporal hemianopsia during pregnancv after treatment of galactorrhea-amenorrhea svndrome with implicating choroidal vascular insufficiencv as the bromocriptine. J Clin Endocrinol Metah 1977;:44: 190-4. basis for secondary retinal detachments seen in this 12 Husami N. Jewelewicz R. Vande Wiele RL. Pregnancv in complication. However, our patients had a normal patients with pituitarv tumors. Fertil Steril 1977; 28: 920-5..
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