Case Report

Central Serous Chorioretinopathy Leading to sub Retinal Bleed to Postvitrectomy : Diagnostic Dilemma

Balbir Khan1, Vartika Anand1*, Sachin Anand2 and Meenu Kashyap1

1Adesh Medical College and Hospital Mohri NH 1 Ambala, India 2Shri Har Rai Shaib Diagnostic Centre, Sector 22 D, Chandigarh, India

Keywords: Endophthalmitis, Subretinal Haemorrhage, Central Serous

ABSTRACT

Central serous retinopathy (CSR) is a common cause of visual disturbance in the younger age group. Spontaneous visual recovery occurs in the majority of patients. A minority of patients, however, suffer permanent visual loss commonly caused by chronic retinal pigment epithelial changes. We report a devastating complication of CSR, with sub .

*Corresponding author: Dr. Vartika Anand, House NO.169 Sector 19-A Chandigarh 160019, India. Phone: +91 9988880755 E-mail: [email protected]

This work is licensed under the Creative commons Attribution 4.0 License. Published by Pacific Group of e-Journals (PaGe) Case Report C-76

Introduction was confirmed. This time 0.05ml of IVA(avastin) was Central serous chorioretinopathy (CSCR) is a disease in given and he responded well.On further follow up his which a serous detachment of the neurosensory visual acquity recovered to 6/9. After one year he came occurs over an area of leakage from the choriocapillaris back with complaints of decreased vision and some through the retinal pigment epithelium (RPE). Other coming in front of eye, visual acquity was counting finger. causes for RPE leaks, such as choroidal neovascularization, Fundus examination revealed a massive macular sub retinal , or tumors, should be ruled out to make the haemorrhage in the right eye.FFA shows extensive masking diagnosis. (fig. 1). OCT also shows detachment of neurosensory retina with underlying blood (fig.2). Physical examination and Case Report investigations revealed no evidence of underlying systemic A 34 year old young male presented with a 2 week history disease. Full blood count and screen were of blurred central vision and metamorphopsia affecting his normal. We kept the patient for observation for at least 1 right eye. Ocular examination revealed best corrected visual month but haemorrhage didn’t resolved so he underwent acuity of 6/12 in right eye and 6/6 in left eye. Funduscopy 23G PPV. To our surprise very next day pt developed revealed a neurosensory overlying the endophthalmitis, intravitreal with ceftazidine right fovea, with retinal pigment epithelial changes. Fundus and given endophthalmitis didn’t resolved, (FFA) confirmed the diagnosis of planned for revitrectomy with silicon oil insertion with CSR. He was taking steroids for his nasal problem. Advised intravitreal vanco with ceftazidine. During revitrectomy him to stop the steroids and put the patient on NSAIDS. there was touch to the posterior capsule of which leads He recovered well. Then again after six months he came to development of for which patient underwent back with decreased vision in right eye to 6/60.Anterior phaco with IOL implantation in sulcus and silicon oil segment was normal fundus revealed neurosensory removal. After 6 weeks patient recovered 6/12 vision and it detachment overlying the right fovea, diagnosis of CSR remained stable till date.

Fig. 1: Fundus examination revealed a massive macular sub retinal haemorrhage in the right eye. FFA shows extensive masking.

http://www.pacificejournals.com/aabs C-77 AABS; 3(4): 2016

Fig. 2: OCT also shows detachment of neurosensory retina with underlying blood. Discussion Conclusion Massive sub retinal macular haemorrhage can occur Still it’s a diagnostic dilemma what was the cause for secondary to a number of causes such as choroidal developing subretinal bleed after CSR, may be there was neovascularisation (CNV), retinal artery macro aneurysm, polyps which we missed as ICG was not done. idiopathic polypoidal choroidal vasculopathy, blood dyscrasia, or trauma. Histopathological analysis of patients Acknowledgements with age related CNV, complicated by massive sub retinal None haemorrhage may be associated with rupture of a large Funding choroidal blood vessel.1 None CNV is known to occur infrequently in patients with CSR treated with laser photocoagulation.2 In only two previous Competing Interests cases have CNV developed spontaneously in patients with None CSR.3 Massive sub retinal haemorrhage, however, was not Reference the feature in these two reported cases. 1. El Baba F, Jarrett WH, Harbin TS, et al. Massive The pathogenesis of CSR has been disputed. Recent studies hemorrhage complicating age-related macular with ICG suggest focal choroidal hyper permeability as the degeneration: clinic pathologic correlation and role of possible initial event, leading to the formation of serous anticoagulants. 198693:1581–1592. retinal pigment epithelial detachment. Excessive fluid 2. Schatz H, Yanuzzi L, Gitter KA. Sub retinal accumulation then leads to pressure on the retinal pigment neovascularisation following argon laser epithelium, resulting in either mechanical disruption or photocoagulation treatment for central retinal pigment epithelial decompensation.4 The chronic serous chorioretinopathy: complication or secondary retinal pigment epithelial changes, if extensive, misdiagnosis? Trans Am Acad Ophthalmology could predispose to the development of CNV. In our Otolaryngology 1977;83:893–906. patient, the sudden onset of haemorrhage in right eyes may in part be explained by the presence of disorganised and 3. Gromolin J. Choroidal neovascularisation and central dysfunctional choroidal blood vessels. The latter leads to an serous retinopathy. Can J Ophthalmol 1989;24:20–23. initial increase in choroidal hyper permeability (hence the 4. Guyer DR, Yannuzzi LA, Slakter JS, et al. Digital CSR) and later, the tendency to rupture suddenly resulting indocyanine green video angiography of central serous in massive haemorrhage (as illustrated by our case). chorioretinopathy. Arch Ophthalmol 1994;112:1057–1062.

Annals of Applied Bio-Sciences, Vol. 3; Issue 4: 2016 e-ISSN: 2349-6991; p-ISSN: 2455-0396