Central serous chorioretinopathy following the BNT162b2 mRNA vaccine

Pharmacological associations of central serous chorioretinopathy: Looking beyond corticosteroids

Central serous chorioretinopathy (CSCR) has multiple associations and risk factors. Of these, psychological stress, corticosteroid treatment, and specific personality traits are well recognized. Other drugs, such as sympathomimetic agents, psychotropic drugs and phosphodiesterase inhibitors, are frequently incriminated. Male preponderance and higher incidence among pregnant and menopausal women give credence to a role of gonadal hormones; however, the acceptance or rejection of the proposed role of other drugs remains challenging due to paucity of data resulting from low usage. Despite presence of multiple risk factors in several patients, a large proportion remains idiopathic. We reviewed all such drugs, including sympathomimetic drugs, psychotropic drugs and recreational agents, phosphodiesterase inhibitors, gonadal hormones and analogues, vasopressin, minoxidil, follistatin, fingolimod, topiramate, muscle relaxants, and vaccines. The mechanisms and adverse event profile of these drugs suggest multiple ways such as alteration of hypothalamic-pituitary-adrenal axis, cortisol surge, activation of sympathetic nervous system, nitric-oxide synthetase, proinflammatory cytokines, complement factor F, Cytochrome P450 3A4, voltage gated ion channels, connexins and neurotransmitters that eventually contribute to CSCR. A common denominator, however, is the systemic and choroidal hemodynamic changes. A detailed medication history can unravel the modifiable risk factors in idiopathic CSCR; this history must include drugs that alter the clearance of other drugs and hormones via the cytochrome P450-3A4 system.

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.

Central serous chorioretinopathy: Pathophysiology, systemic associations, and a novel etiological classification

Central serous chorioretinopathy (CSC) has remained an enigmatic disease since its initial description by Von Graefe. Over the years, multiple risk factors have been recognized: these include psychological stress, behavioral traits, and corticosteroids. The basic pathophysiology of CSC involves choroidal thickening, vascular congestion, altered choroidal blood flow (ChBF), and choroidal hyperpermeability, leading to retinal pigment epithelium decompensation and subsequent neurosensory detachment. Multiple organ systems, mainly the nervous, cardiovascular, endocrinal, and renal systems participate in the control of the vascular tone and the ChBF via hypothalamus-pituitary-adrenal axis and renin-angiotensin-aldosterone system, while others such as the hepatic system regulate the enzymatic degradation of corticosteroids. Many vasoactive and psychotropic drugs also modulate the ocular perfusion. In addition, there are anatomical and genetic predispositions that determine its progression to the chronic or recurrent form, through cellular response and angiogenesis. We herein review the basic pathophysiology and immunogenetics in CSC along with the role of multiple organ systems. With this background, we propose an etiological classification that should provide a framework for customized therapeutic interventions.