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Resolution of Cystoid Macular Edema by Topical Dorzolamide in a Case of Central Serous Chorioretinopathy: a Case Report

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Resolution of Cystoid Macular Edema by Topical Dorzolamide in a Case of Central Serous Chorioretinopathy: a Case Report Case Report Resolution of cystoid macular edema by topical dorzolamide in a case of central serous chorioretinopathy: a case report Debmalya Das and Eesh Nigam Author for Correspondence: Introduction increased to 20/80 with no change in the left eye Dr. Debmalya Das Central serous chorioretinopathy (CSCR) is a pos- BCVA. OCT showed resolution of SRF in the right Associate Consultant, terior segment disease characterized by localized eye and an increase in CME and schisis in the left Department of Vitreoretinal, Sankara Nethralaya, serous detachments of the neurosensory retina eye (Figure 2). The patient was started on topical Kolkata often associated with focal detachments of an dorzolamide (2%) thrice a day in his left eye. On altered retinal pigment epithelium (RPE) and his next visit, after 1 month, OCT showed com- having multifactorial etiology and complex patho- plete resolution of CME though the visual acuity genesis.1 In chronic CSCR, intraretinal cysts and remained the same (Figure 3). cystoid macular edema (CME) can form. Both topical and systemic carbonic anhydrase inhibitors Discussion (CAIs) have been tried as means of treatment of One of the characteristics of acute CSCR is that both CSCR2 and CME3caused by CSCR. We despite SRF, the morphology of retinal layers gen- present a case of chronic CSCR in which the reso- erally remains unchanged. However, in chronic lution of CME occurred with topical CAI. cases, intraretinal cysts and CME may develop. These may disappear or fluctuate slowly over time, Case report suggesting fluid passage through a compromised A 45-year-old male presented with painless, RPE which contributes to their formation.1 gradual and progressive diminution of vision of However, in our case, CME resolution occurred both eyes for 2 years. On examination, his best within a month, suggesting a possible role of dor- corrected distant visual acuity (BCVA) was 20/120 zolamide in its resolution. in the right eye and 20/200 in the left eye. Investigations of the ability of CAIs to enhance Posterior segment examination revealed extensive SRF absorption based on animal models have areas of RPE atrophy in both eyes with the pres- shown acidification of the subretinal space, a ence of subretinal fluid (SRF) in the right eye. decrease in standing potential, and an increase in Fundus fluorescein angiography corroborated the retinal adhesiveness. This acidification of the sub- clinical findings showing extensive areas of RPE retinal space is responsible for the increased fluid atrophy in both eyes with ink blot leak in the resorption from the retina through the RPE to the right eye. Optical coherence tomography (OCT) of choroid resulting from modulation of carbonic the right eye showed sub- and juxtafoveal RPE anhydrase IV in RPE. RPE loses normal polarity in atrophy with SRF and the left eye revealed juxta- the presence of macular edema, and treatment foveal cystic changes with RPE atrophy (Figure 1). with CAIs re-establishes normal polarization in Focal laser to the area of leak in the right eye was RPE.4–6 Another possible explanation for the done and the patient was asked to review after 2 effect of CAIs on inflammation-related macular months. On his next visit, BCVA of right eye edema is its ability to inhibit γ glutamyl trans Figure 1. OCT through the fovea of the left eye showed Juxtafoveal cystic changes (white arrow) with areas of RPE atrophy (white arrow head). Sci J Med & Vis Res Foun October 2017 | volume XXXV | number 3 | 25 Case Report Figure 2. OCT showed increased cystic and schitic changes (black arrow with white border). Figure 3. OCT showed resolution of cystoid macular edema (white arrow with black border) with foveal thinning and RPE atrophy. peptidase activity in ocular tissues. This facilitates References cellular adhesion, neutrophil chemotaxis and deg- 1. Daruich A, Matet A, Dirani A, et al. Central serous radation through elevation of leukotriene D4 con- chorioretinopathy: recent findings and new physiopathology – centration.7 A similar cellular mechanism may hypothesis. Progress Retinal Eye Res 2015;48:82 118. fl 2. Pikkel J, Beiran I, Ophir A, et al. Acetazolamide for central in uence CSCR-related CME and may contribute serous retinopathy. Ophthalmology 2002;109:1723–5. 2 to its resolution, as was seen in our case. Reports 3. Gonzalez C. Décollements séreux retiniens. J Fr Ophthalmol have also shown that CAI has no effect on the 1992; 15:529–6. final BCVA2 as was also seen in our case. 4. Wolfensberger TJ, Dmitriev AV, Govardovskii VI. Inhibition of One major drawback of our case is that it is a membrane-bound carbonic anhydrase decreases subretinal pH – single case report with no long-term follow-up. and volume. Doc Ophthalmol 1999;97:261 71. 5. Wolfensberger TJ. The role of carbonic anhydrase inhibitors in Also, to date, only one case series, showing the fi the management of macular edema. Doc Ophthalmol 1999;97: ef cacy of systemic CAI in CSCR, has been pub- 387–97. 2 lished. Although small case reports on topical 6. Wolfensberger TJ, Chiang RK, Takeuchi A, et al. Inhibition of CAIs in CSCR have been reported, few have high- membrane-bound carbonic anhydrase enhances subretinal fluid lighted the effect of CAIs on CME3 due to CSCR. absorption and retinal adhesiveness. Graefes Arch Clin Exp Our case report adds to the knowledge that topical Ophthalmol 2000;238:76–80. CAIs are as effective as oral CAIs in the resolution 7. Steinsapir KD, Tripathi RC, Tripathi BJ, et al. Inhibition of ocular gamma glutamyl transpeptidase by acetazolamide [letter]. Exp of CME due to CSCR, but has no effect on the Eye Res 1992;55:179–81. final visual acuity. How to cite this article Das D. and Nigam E. Resolution of cystoid macular edema by topical dorzolamide in a case of central serous chorioretinopathy: a case report, Sci J Med & Vis Res Foun 2017;XXXV:25–26. 26 Sci J Med & Vis Res Foun October 2017 | volume XXXV | number 3 |.
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