Severe visual loss secondary to central serous chorioretinopathy following prolonged immune suppression with oral prednisolone

Comparison of the Clinical Manifestations between Acute Vogt-Koyanagi-Harada Disease and Acute Bilateral Central Serous Chorioretinopathy

Purpose

To compare clinical, angiographic, and optical coherence tomographic characteristics between eyes with acute Vogt-Koyanagi-Harada (VKH) disease and eyes with acute bilateral central serous chorioretinopathy (CSC), and to demonstrate distinguishing features between the two diseases in confusing cases.

Methods

The medical records of 35 patients with VKH disease and 25 patients with bilateral CSC were retrospectively reviewed. Characteristics according to slit-lamp biomicroscopy, ophthalmoscopy, fundus photography, fluorescein angiography, indocyanine green angiography, and spectral-domain optical coherence tomography were compared between the two diseases.

Results

Five of 35 patients (10 of 70 eyes, 14.3%) with VKH disease were initially misdiagnosed as CSC patients, and six of 25 patients (12 of 50 eyes, 24%) with bilateral CSC were initially misdiagnosed as patients with VKH disease. Pigment epithelial detachment in CSC and optic disc hyperemia in VKH disease show the highest positive predictive values of 100% for each disease.

Conclusions

Optic disc hyperemia in VKH disease and pigment epithelial detachment in bilateral CSC are the most specific clinical manifestations of each disease at initial patient presentation.

Central Serous Chorioretinopathy: Signal to Reduce Corticoid in Renal Transplant Recipients?

OBJECTIVE

The aim of this work was to report the treatment effectiveness of central serous chorioretinopathy (CSCR) in a renal transplant recipient who received conventional therapy with little effect, and then reducing corticoid successively and with a better outcome later.

METHODS

We performed a retrospective comparison of best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) of a 57-year-old renal transplant recipient who received conventional therapy and reducing corticoid successively after he was diagnosed as CSCR in the left eye.

RESULTS

The BCVA of the left eye stayed at 20/200 after 3 months' conventional therapy, but rapidly improved to 20/25 after reducing corticoid by one-half. At the same time, SD-OCT showed much more obvious absorption of retinal liquid in the left eye from reducing corticoid than from conventional therapy. Despite the reducing of corticoid by one-half, the patient did not show any signs of rejection of the renal transplant.

CONCLUSIONS

CSCR may be a sign in renal transplant recipients for reducing corticoid, and reducing corticoid might be a more reliable and safer treatment for such patients.