Bilateral bullous exudative retinal detachment complicating idiopathic central serous chorioretinopathy during systemic corticosteroid therapy.
OBJECTIVE
To present evidence that systemic corticosteroid therapy may cause bilateral bullous serofibrinous exudative retinal detachment in some patients with idiopathic central serous chorioretinopathy.


BACKGROUND
Idiopathic central serous chorioretinopathy usually causes mild, transient loss of central vision, usually in otherwise healthy men with a type A personality. A few patients have permanent visual loss because of chronic and recurrent retinal detachment. The clinical findings in these patients may lead to incorrect diagnoses and use of corticosteroid therapy.


METHODS
The clinical and photographic records of three patients in whom bilateral bullous serofibrinous exudative retinal detachment associated with idiopathic central serous chorioretinopathy developed after treatment with systemic corticosteroids were reviewed.


RESULTS
Systemic corticosteroid treatment was instituted (1) as a prophylaxis to prevent exacerbation of the disease while undergoing surgery in the fellow eye, and (2) as the result of misdiagnoses of multifocal choroiditis and retinal vasculitis (Eales disease). Two of the patients had a history of chronic recurrent retinal detachments before institution of corticosteroid treatment. In one of these patients, bilateral chronic inferior retinal detachment developed, causing peripheral retinal vascular nonperfusion, retinal neovascularization, and vitreous hemorrhage. All three patients had severe permanent visual loss in one or both eyes.


CONCLUSIONS
The findings in these patients provide further evidence that systemic corticosteroid treatment may cause severe exacerbation of retinal detachment and lasting visual loss in some patients with idiopathic central serous retinopathy. Recognition of the atypical presentations of this disorder is important to avoid incorrect diagnoses and treatment.
Gass
J D
JD
Bascom Palmer Eye Institute, University of Miami School of Medicine, Department of Ophthalmology, FL 33101, USA.
Little
H
H
D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D002829:Choroid / Q000473:pathology; D015862:Choroid Diseases / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D005122:Exudates and Transudates; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000473:pathology; D012163:Retinal Detachment / Q000139:chemically induced* / Q000473:pathology; D012164:Retinal Diseases / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D013315:Stress, Psychological / Q000150:complications; D014434:Type A Personality; D014786:Vision Disorders / Q000209:etiology; D014792:Visual Acuity
D000305:Adrenal Cortex Hormones