Unilateral recurrent central serous chorioretinopathy (CSCR) following COVID-19 vaccination- A multimodal imaging study

Clinical characteristics and risk factors of bacillary layer detachment in central serous chorioretinopathy: a comparative multicenter study

BACKGROUND

Central serous chorioretinopathy (CSC) is marked by serous retinal detachments caused by fluid leakage from the retinal pigment epithelium, often associated with stress, psychiatric disorders and the use of corticosteroids. This study aims to investigate the clinical and systemic characteristics associated with BALAD in patients with CSC, comparing those with and without BALAD to clarify its function as a biomarker of CSC severity and improve diagnostic and treatment approaches.

PURPOSE

Compare the clinical characteristics, risk factors, and optical coherence tomography (OCT) findings in patients with Central Serous Chorioretinopathy (CSC) with and without Bacillary Layer Detachment (BALAD), and to identify the distinguishing features and associated conditions of CSC with BALAD.

METHODS

This observational, retrospective, multicenter case-control study collected data from 12 retina centers worldwide on patients with central serous chorioretinopathy (CSC) from December 1, 2022, to April 1, 2023. CSC was defined by serous retinal detachment and fluid leakage through the retinal pigment epithelium. Patients underwent detailed evaluations, including OCT, and were classified as having acute or chronic CSC. Inclusion criteria included a CSC diagnosis with RPE leakage, BALAD confirmed by three authors, age over 18, and a detailed medical history from the 30 days before symptom onset. The study assessed visual acuity, choroidal thickness, psychiatric disorders, corticosteroid use, prior CSC treatments, and hyperreflective material on OCT.

RESULTS

Thirty-seven patients (40 eyes; mean age, 48.0 ± 11.9 years) had CSC and BALAD and were followed for a mean of 4.92 ± 6.65 months. The control group was comprised of 40 patients with CSC without BALAD (40 eyes; mean age, 48.2 ± 11.9 years). On clinical examination, BALAD was as a circular, yellowish macular lesion. On OCT, BALAD was a detachment of the ellipsoid zone with splitting of the photoreceptor inner segment. BALAD was associated with psychiatric disorders (p = 0.014), use of corticosteroids (p = 0.004), previous treatment for CSC (p = 0.041) and thickened choroid (p = 0.036).

CONCLUSIONS

BALAD in CSC differs from a typical CSC due to the presence of a circular, yellowish macular lesion, detachment of the ellipsoid zone, segmentation of the inner segment of the photoreceptor, a thicker choroid, the use of corticosteroids, and generally more aggressive previous treatments. These results suggest that BALAD may serve as a valuable biomarker for the severity of CSC and highlight the influence of inflammation and previous treatments.

Bilateral Serous Detachments with Roth Spots after COVID-19 Vaccination: A Case Report

With the rise of novel types of vaccines during the pandemic, new side effects are encountered. The aim of this paper is to describe an atypical case of bilateral serous detachments with Roth spots after COVID-19 vaccination using an mRNA vaccine. A healthy, 38-year-old male presented with a central scotoma and metamorphopsia in his left eye, 4 days after his second COVID-19 booster shot. Bilateral serous detachments were seen, with one area showing Roth spots. Patient's symptoms resolved spontaneously without any treatment. Although serous detachment after COVID-19 vaccination has been described in the context of other diseases, such as Vogt-Koyanagi-Harada disease, central serous chorioretinopathy, and posterior scleritis, this is the first report of serous detachments with Roth spots as an isolated entity.

COVID-19 vaccination and recurrent anterior uveitis

A 35-year-old Asian Indian female previously diagnosed with bilateral anterior uveitis and on oral methotrexate developed bilateral anterior uveitis following first/second dose of coronavirus disease 2019 (COVID-19) vaccination. She had skipped her weekly dose of oral methotrexate following first dose of vaccination. Following the second dose, she reduced her oral methotrexate from 25 to 15 mg on her own, but did not stop like the previous occasion. She had extensive workup for her uveitis in the past with only positive severe acute respiratory syndrome coronavirus (SARS-CoV-2) antibodies. She developed unilateral anterior uveitis after she had COVID-19 in July 2022, which resolved with topical steroids and continuation of immunosuppression. This report illustrates that COVID-19 or its vaccination may presumably play a role in triggering the immune system and can cause recurrent ocular inflammation even in the absence of an extraocular inflammation.