Korean J Ophthalmol.  2006 Jun;20(2):131-138. 10.3341/kjo.2006.20.2.131.

Surgical Management of Bilateral Exudative Retinal Detachment associated with Central Serous Chorioretinopathy

• Kang JE
• Kim HJ
• Boo HD
• Kim HK
• Lee JH

• KMID: 1099050
• DOI: http://doi.org/10.3341/kjo.2006.20.2.131

Abstract

PURPOSE: To report a case of bilateral bullous exudative retinal detachment in central serous chorioretinopathy (CSC) which was attached by vitrectomy and internal drainage of the subretinal fluid. METHODS: A 47-year-old man affected by bilateral atypical CSC with a bullous retinal detachment with subretinal exudate. A fluorescein angiogram (FAG) showed multiple points of leakage and staining of subretinal fibrosis. A tentative diagnosis of Vogt-Koyanagi-Harada (VKH) syndrome was made and the patient was treated with systemic corticosteroids and immunosuppressive agents. However, the subretinal fluid was not absorbed. He was then treated with vitrectomy and internal drainage of subretinal fluid. RESULTS: The retina was attached successfully in both eyes. Visual acuity improved to 20/50 in his left eye but did not improve in the right eye due to subretinal fibrotic scarring and atropic changes on the macula. CONCLUSIONS: Our case suggests that the surgical management of bullous exudative retinal detachment is safe and necessary.

Keyword

Bullous retinal detachment; Central serous chorioretinopathy; Subretinal fluid drainage; Vitrectomy

MeSH Terms

*Vitrectomy
Retinal Detachment/etiology/pathology/*surgery
Middle Aged
Male
Humans
Fundus Oculi
Follow-Up Studies
Fluorescein Angiography
Exudates and Transudates
Drainage/*methods
Diagnosis, Differential
Choroid Diseases/*complications/diagnosis

Figure

• 

  Fig. 1 Color fundus photographs (A, B), fluorescein angiograms (C, D), and indocyanine green angiogram (E, F) before systemic steroid therapy. (A) Right eye. Subretinal fibrosis, retinal fold and pigmented lesion on the posterior pole. (B) Left eye. RPE changes in the macular region and around the vascular arcade. (C) Right eye. Multiple points of dye leakage and pooling into the subretinal space, and variable blockage and staining of areas of subretinal fibrosis. (D) Left eye. Multiple pinpoint leakages. (E) Right eye and (F) left eye, showing multiple choroidal vascular hyperpermeability and focal staining of pigment epithelium.

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  Fig. 2 Color fundus photographs (A, B), fluorescein angiograms (C, D), and indocyanine green angiogram (E, F) two weeks after systemic steroid therapy. (A) Right eye. Progressed exudative retinal detachment, subretinal fibrosis, retinal fold and pigmented lesion on the posterior pole. (B) Left eye. Multiple localized PEDs. (C) Right eye. Multiple points of dye leakage and pooling into the subretinal space, and variable blockage and staining of areas of subretinal fibrosis. (D) Left eye. Multiple pinpoint leakages. (E) Right eye. (F) Left eye, multiple choroidal vascular hyperpermeability and focal staining of the pigment epithelium.

• 

  Fig. 3 Color fundus photographs (A, B), fluorescein angiograms (C, D), and indocyanine green angiogram (E, F) at the time that oral steroid and immunosuppresive treatment were stopped. (A) Right eye. Inferior bullous exudative RD, subretinal fibrotic band, fixed retinal fold, and subtle intraretinal hemorrhages. (B) Left eye. Multiple PEDs and exudative flecks. (C) Right eye. Large blockage of an area of exudative RD, variable blockage and staining of areas of subretinal fibrosis, and leakage and pooling into the subretinal space. (D) Left eye. Multiple pinpoint leakages and poolings. (E) Right eye. (F) left eye. Multiple choroidal vascular hyperpermeability and focal staining of the pigment epithelium.

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  Fig. 4 B-scan (A, B). showing shifting of subretinal fluid. (A) sitting position. (B) supine position.

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  Fig. 5 Color fundus photographs (A, B) and fluorescein angiograms (C, D) six weeks after external drainage of subretinal fluid in the right eye. (A) Right eye. Attached retina with subretinal proliferation. (B) Left eye. Multiple PEDs and exudative flecks. (C) Right eye, Eye absorbed subretinal fluid. (D) Left eye. Multiple points of dye leakage and pooling into the subretinal space.

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  Fig. 6 Color fundus photographs (A, B) after vitrectomy and internal drainage of subretinal fluid of both eyes. (A) Right eye and (B) left eye. Demonstrating an attached retina with atrophic change and subretinal proliferation.

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