Comment on: “Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment”
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Sir, I read with interest the case report on the closure of a macular hole over a serous retinal pigment epithelial detachment (PED) with intravitreal bevacizumab.[1] I want to humbly discuss a few facts. The role of anti-vascular endothelial growth factor (anti-VEGF) agents in serous PED without subretinal or intraretinal fluid or active choroidal neovascular membrane/idiopathic polypoidal choroidal vasculopathy may require further research. In the present case,[1] the shallow subretinal fluid at one margin of the macular hole could have been related to the macular hole itself or the mechanical effect of the high PED. In such a scenario, fundus fluorescein angiogram and indocyanine green angiogram would add significant scientific value and justification for the use of bevacizumab in this case, if they are available. Furthermore, we need to consider the fact that intravitreal anti-VEGF agents can cause retinal pigment epithelial tears[2] in cases of high serous PEDs. The rare but potentially blinding complications of intravitreal anti-VEGF agents such as endophthalmitis[3] and retinal detachment should be kept in mind. The goal of management with intravitreal bevacizumab in the presented case[1] may need elucidation. A history of systemic or local steroid use is also relevant in the presented case, as central serous chorioretinopathy, though unlikely in a 73 year old, needs to be ruled out. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.Keywords:
Fundus (uterus)
In Brief Purpose: To report a case of central serous chorioretinopathy treated with focal laser photocoagulation guided by spectral domain optical coherence tomography (SD-OCT) without fluorescein angiography. Methods: In this interventional case report, a 27-year-old pregnant lady with central serous chorioretinopathy was evaluated with fundus photography and SD-OCT. She was treated with focal laser photocoagulation to the area of micro rip on the summit of pigment epithelial detachment identified by SD-OCT. Results: Successful treatment of serous macular detachment using SD-OCT in a pregnant lady. Conclusion: We report a case of central serous chorioretinopathy evaluated and treated successfully with SD-OCT without the use of fluorescein angiography. The authors report a case of central serous chorioretinopathy evaluated and treated successfully with SD-OCT without the use of fluorescein angiography.
Fundus Photography
Indocyanine green angiography
Fundus fluorescein angiography
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Objective To study the correlation factors about the patients visual acuity of central serous chorioretinopathy.Methods 163 cases(181 eyes)of central serous chorioretinopathy were accepted correlative analysis according to fundus fluorescein angiography.Results Fundus fluorescein angiography could reveal fluorescein leakage clearly.98 eyes of all (54 1%)revealed typical fluorescein leakage.48 1% eyes of the visual acuity were more than 0 7,28 2% were more than 1 0.There was a significant positive correlation between the visual acuity and the situation of the fluorescein leakage.Conclusions Fundus fluorescein angiography could indicate the degree of the rretina pigment epitheliopathy,define the situation and the amount of the fluorescein leakage in order to instruct the treatment for central serous chorioretinopathy.There was a significant positive correlatioln between the visual acuity and the situation of the fluorescein leakage.
Fundus (uterus)
Fundus fluorescein angiography
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Because of limitations in imaging through the retinal pigment epithelium (RPE), fluorescein angiography has not been able to characterize the choroidal abnormalities that are thought to be causative factors in central serous chorioretinopathy (CSC).Digital indocyanine green (ICG) videoangiography and fluorescein angiography were performed in 34 consecutive patients with various forms of CSC to investigate choroidal abnormalities.The ICG videoangiographic studies revealed choroidal staining in association with active, spontaneously resolved, and previously photocoagulated pigment epithelial leaks documented with fluorescein angiography. In the space of a few minutes, the dye progressively spread outward from the region of choroidal staining.Localized hyperpermeability of the choriocapillaris, probably associated with segmental choroidal hyperperfusion, may be a causative factor of characteristic RPE and neurosensory retinal exudative changes in CSC.
Indocyanine Green
Indocyanine green angiography
Choroid
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Central serous chorioretinopathy (CSC, CSCR) may lead to visual impairment, mostly in men between 20–55 years of age. It presents as a typical serous neurosensory retinal detachment and accumulation of subretinal fluid in the centre of the macula. Type A personality, high-stress occupations and corticosteroid therapy have been associated with CSC prevalence. Fluorescein angiography, optical coherence tomography or indocyanine green angiography have been used for diagnosis. Central serous chorioretinopathy is typically a self-limited disease, but about 20% of the cases may be affected by the persistent form of CSC. Central serous chorioretinopathy is successfully treated with laser therapy or anti-VEGF inhibitors. Oral therapies offer a very promising approach, but further prospective randomized trials are required to provide more data.
Indocyanine Green
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Retinal pigmented epithelium detachment is frequently associated to age related macular degeneration or others maculopathies. More rarely no cause can be found, particularly in young patients where it constitutes an entity named "Idiopathic serous detachment of the retinal pigmentary epithelium". We report such a case. We insist on the clinical and angiographical characteristics which allows a differentiation from the idiopathic central serous chorioretinopathy with which it can be confused. Last, it is important to point that for the time being no treatment can shorten the evolution.
Degeneration (medical)
Macula Lutea
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Central serous chorioretinopathy (CSCR) is common in adult male having sudden dimness of vision in one eye and typical pattern of leakage in fundus fluorescein angiography. Treatment of typical central serous chorioretinopathy is conservative and / or focal laser photocoagulation. But atypical central serous chorioretinopathy is uncommon having different patterns of clinical presentation and features in fundous fluorescein angiography. Treatment option of atypical central serous chorioretinopathy is not yet established. Here, we present a case of atypical central serous chorioretinopathy successfully treated with intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF, Bivacizumab).Ibrahim Med. Coll. J. 2015; 9(1): 34-36
Fundus fluorescein angiography
Presentation (obstetrics)
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Purpose Central serous chorioretinopathy leads to a serous detachment of the retina and a deterioration of visual acuity, contrast sensitivity and color vision. This is due to a leakage of serous fluid into the subretinal space through a defect in the retinal pigment epithelium. Methods A female patient aged 34 years experienced a drop in best corrected visual acuity to 20/40 with mild hyperopization and dyschromatopsias for two weeks. The diagnosis of a central serous chorioretinopathy was substantiated by optical coherence tomography (Stratus OCT, Zeiss Meditec, Jena, Germany) and infrared autofluorecence imaging (HRA classic; Heidelberg Engineering, Heidelberg, Germany). The patient additionally underwent retinal imaging by the Retinal Function Imager (RFI, Optical Imaging, Rehovot, Israel). Results The findings suggest that the technique applied by the Retinal Function Imager can be helpful to diagnose central serous chorioretinopathy and to visualize abnormal areas at the level of retinal pigment epithelium in a non-invasive manner. This finding may suggest that the Retinal Function Imager was able to demonstrate a small motion in the subretinal space, originating at the site of detached retinal pigment epithelium. The finding fits with the observation of “smoke stacks” of fluorescein seen in patients with central serous chorioretinopathy when conventional fluorescein angiography is used. Conclusion The technique applied by the Retinal Function Imager can be helpful to diagnose central serous chorioretinopathy and to visualize abnormal areas at the level of retinal pigment epithelium in a non-invasive manner. This finding may suggest that the Retinal Function Imager was able to demonstrate a small motion in the subretina
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Internal limiting membrane
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