scholarly journals Central serous chorioretinopathy in active endogenous Cushing’s syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Joost Brinks ◽  
Femke M. van Haalen ◽  
Thomas J. van Rijssen ◽  
Nienke R. Biermasz ◽  
Onno C. Meijer ◽  
...  
Keyword(s):  
Fluorescein Angiography ◽  
Cushing’S Syndrome ◽  
Central Serous Chorioretinopathy ◽  
Vision Loss ◽  
De Novo ◽  
Case Series ◽  
Subretinal Fluid ◽  
Cushing's Syndrome ◽  
Enhanced Depth Imaging ◽  
Ophthalmological Examination

AbstractMultiple case series have provided evidence for a relatively high incidence of central serous chorioretinopathy (CSC) in patients with active Cushing’s syndrome (CS). We describe the ophthalmological status in detail of consecutive patients with active endogenous CS (either de novo or recurrent active endogenous CS) in this prospective cohort study. All patients underwent complete ophthalmological examination, including multimodal imaging, which was performed shortly after establishing the diagnosis of active CS in hypercortisolemic state. Eleven CS patients (4 men, 7 women) with active hypercortisolism were included. Abnormalities reminiscent of (subclinical) CSC were found in 3 patients. Optical coherence tomography (OCT) revealed macular subretinal fluid in 1 patient, who was diagnosed as having active CSC and was successfully treated with half-dose photodynamic therapy. Two other patients showed CSC-like abnormalities: an unilateral pseudovitelliform lesion on OCT and hyperfluorescent changes on fluorescein angiography in one patient, and unilateral leakage on fluorescein angiography in the other patient. Mean subfoveal choroidal thickness on enhanced depth imaging OCT was 270 ± 40 μm (range, 178 – 357 μm). Retinal abnormalities resembling (subclinical) CSC may be more common than previously thought in patients with active CS, and may exist even in patients without visual complaints. Clinicians should have a low threshold for ophthalmological evaluation in case of a CS patient with visual symptoms since there may be therapeutic opportunities to prevent vision loss.

Non-central serous chorioretinopathy in a patient with systemic lupus erythematosus and hydroxychloroquine retinopathy

2021 ◽  
Vol 14 (1) ◽  
pp. e237243
Author(s):  
Diogo Hipolito-Fernandes ◽  
Maria Elisa Luís ◽  
Rita Flores ◽  
Rita Anjos
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Central Serous Chorioretinopathy ◽  
Vision Loss ◽  
Subretinal Fluid ◽  
Ophthalmological Examination ◽  
Systemic Lupus ◽  
Diagnostic Challenge ◽  
Hydroxychloroquine Retinopathy ◽  
The Right

Subretinal fluid accumulation in a patient with systemic lupus erythematosus (SLE) may represent a diagnostic challenge. We present a case of a 43-year-old man with baseline diagnosis of SLE and hydroxychloroquine-associated maculopathy who reported progressive vision loss on the right eye, associated with corticosteroids use for an arthritic crisis. Ophthalmological examination did not reveal any acute finding. On optical coherence tomography, subretinal fluid in the perifoveal area was visible on the right eye, with corresponding enlargement of the visual field defect. An increased choroidal thickness was also visible. Fluorescein angiography revealed, on the right eye, two pinpoint areas of leakage and indocyanine green angiography signs of choroidal vascular hyperpermeability. Considering a diagnosis of a non-central central serous chorioretinopathy, corticosteroids use was interrupted, with resolution of the subretinal fluid. This case illustrates the relevance of a multimodal imaging approach to guide the diagnosis of patient with an SLE with subretinal fluid.

Eye-selfie to resolve the enigmatic diagnosis of transient “eye spot”

2020 ◽  
pp. 112067212095092
Author(s):  
Pierluigi Iacono ◽  
Sandro Saviano ◽  
Mariacristina Parravano ◽  
Monica Varano ◽  
Maurizio Battaglia Parodi
Keyword(s):  
Fluorescein Angiography ◽  
Healthy Subjects ◽  
Vision Loss ◽  
Case Series ◽  
Complete Recovery ◽  
Ophthalmological Examination ◽  
Apparently Healthy

Purpose: To describe two cases of Cobb’s tufts in apparently healthy subjects. Methods: Observational case series. Results: Two patients reporting sudden vision loss, with subsequent complete recovery, underwent a complete ophthalmological examination, including iris fluorescein angiography. Both patients took an “eye-selfie” using their smartphone to provide evidence of the iris bleeding. Iris fluorescein angiography confirmed the presence of iris neovascular tufts at the pupillary margin. Conclusion: Diagnosis of Cobb’s tufts can frequently be challenging. The two patients’ astute action in taking photographs of the eye enabled the condition to be promptly identified.

A Novel GNAS Mutation Causing Isolated Infantile Cushing’s Syndrome

2019 ◽  
Vol 92 (3) ◽  
pp. 196-202
Author(s):  
Prapai Dejkhamron ◽  
Chupong Ittiwut ◽  
Hataitip TangNgam ◽  
Kanokkarn Sunkonkit ◽  
Rungrote Natesirinilkul ◽  
...  
Keyword(s):  
Fibrous Dysplasia ◽  
Precocious Puberty ◽  
Cushing’S Syndrome ◽  
De Novo ◽  
Cushing Syndrome ◽  
Skin Pigmentation ◽  
Cushing's Syndrome ◽  
Polyostotic Fibrous Dysplasia ◽  
Pneumocystis Jiroveci ◽  
Gnas Gene

Infantile Cushing’s syndrome is potentially found as part of McCune-Albright syndrome (MAS) which is caused by postzygotic somatic mutations of the GNAS gene. MAS is typically characterized by a triad of polyostotic fibrous dysplasia, café-au-lait skin pigmentation, and precocious puberty or other endocrine hyperfunction. Here, we describe a 2-month-old female infant with features of Cushing’s syndrome without café au lait spots, polyostotic fibrous dysplasia, and clinical evidence of other endocrine hyperfunction. Investigations demonstrated adrenocorticotropic hormone-independent Cushing’s syndrome with bilateral adrenal gland enlargement. Whole-exome sequencing of leukocytes identified a de novo heterozygous novel missense mutation (c.521G>A, p.Cys174Tyr) in the GNAS gene. The patient experienced clinical improvement of Cushing’s syndrome during ketoconazole treatment. Her clinical course was complicated by Pneumocystis jiroveci pneumonia. She also had shortened activated partial thromboplastin time indicating a hypercoagulable state and resulting in pulmonary embolism. She eventually manifested gonadotropin-independent precocious puberty at the age of 13 months after ketoco­nazole was discontinued. This patient demonstrated that Cushing syndrome can be the presenting sign of MAS in infancy. A high index of suspicion followed by genetic analysis is essential in order to establish a diagnosis.

Retinal Manifestations of Incontinentia Pigmenti: A Case Series of 14 Patients Highlighting the Importance of Intravenous Fluorescein Angiography and the Benefits of Early Laser Photocoagulation

2020 ◽  
pp. 247412642096264
Author(s):  
Jaimie Bryan ◽  
Reda Issa ◽  
Benjamin Bakall ◽  
Matthew Welch ◽  
J. Shepard Bryan
Keyword(s):  
Fluorescein Angiography ◽  
Laser Photocoagulation ◽  
Vision Loss ◽  
Case Series ◽  
Vitreoretinal Surgery ◽  
Vitreous Hemorrhage ◽  
Fundus Photography ◽  
Incontinentia Pigmenti ◽  
Peripheral Ischemia ◽  
Fundus Photographs

Purpose: This case series describes the nature and frequency of retinal manifestations in patients with incontinentia pigmenti (IP). Methods: This is a retrospective single-center case series of all known patients with IP who presented to Associated Retina Consultants (Phoenix, AZ) between May 2016 and April 2019. Twenty-eight eyes of 14 patients with a dermatologic diagnosis of IP were included (n = 28). Most patients underwent examination under anesthesia with fundus photographs and intravenous fluorescein angiography (IVFA). Results: Of the 28 eyes, 8 (28.6%) had abnormal retinal findings on fundus examination. Of the 26 eyes that had IVFA, 10 (38.5%) had abnormal findings: Seven eyes (26.9%) had peripheral ischemia, 2 (7.7%) had previous peripheral laser scarring, and 2 (7.7%) had active peripheral neovascularization. Three eyes with normal examination results were found to have mild ischemia by IVFA. Patients with ischemia confirmed by IVFA were treated with laser photocoagulation. During follow-up, 4 previously treated eyes received additional laser photocoagulation. No patients showed vision loss, vitreous hemorrhage, retinal detachment, or adverse effects of treatment. No patients required vitreoretinal surgery. Conclusions: IP is a potentially blinding disease. Our case series demonstrates the efficacy of early treatment and the importance of ancillary testing with IVFA and fundus photography.

Standardized scleral buckling approach in the management of noncomplex primary rhegmatogenous retinal detachment

2020 ◽  
pp. 112067212094020
Author(s):  
Paolo Radice ◽  
Elisa Carini ◽  
Patrizio Seidenari ◽  
Andrea Govetto
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Vision Loss ◽  
Case Series ◽  
Subretinal Fluid ◽  
Scleral Buckling ◽  
Full Thickness Macular Hole ◽  
Air Tamponade ◽  
Subretinal Fluid Drainage ◽  
Anatomical Success

Purpose: To analyze the anatomical and functional outcomes of a standardized scleral buckling approach in patients with noncomplex primary rhegmatogenous retinal detachment (RRD). Methods: Retrospective institutional case series of 135 eyes of 131 patients diagnosed with noncomplex primary RRD. All patients underwent scleral buckling surgery with the placement of an encircling 5 mm oval sponge at 15 ± 2 mm posteriorly from the limbus, cryopexy, subretinal fluid drainage, and air tamponade. Results: Final anatomical success at 12 months was achieved in all 135 eyes (100%). Primary anatomical surgical success was obtained in 127 out of 135 eyes (94%), while re-detachment occurred in eight out of 135 cases (6%). Primary anatomical success was significantly lower in pseudophakic eyes ( p < 0.001). At the end of the follow-up period, no vision loss was observed in any patient and both sphere and cylinder refraction shift was mild. There was a low rate of postoperative complications. Nine out of 135 eyes (6.6%) developed full thickness macular hole, whether in 24 out of 135 eyes (17.8%) epiretinal membrane development was noticed. Conclusion: A standardized scleral buckling approach for primary noncomplex RRD may be effective. The technique is reproducible, easier, and quicker to perform if compared to classic scleral buckling procedures, suggesting that it may represent a valuable surgical option. Special care is needed in the management of pseudophakic RRD due to higher risk of RRD recurrence.

scholarly journals Short-term eplerenone for treatment of chronic central serous chorioretinopathy; a prospective study

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Hamid-Reza Moein ◽  
Lauren W. Bierman ◽  
Eduardo A. Novais ◽  
Carlos Moreira-Neto ◽  
Caroline R. Baumal ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Prospective Study ◽  
Central Serous Chorioretinopathy ◽  
Subretinal Fluid ◽  
Enhanced Depth Imaging ◽  
Short Term ◽  
Chronic Central Serous Chorioretinopathy ◽  
Therapeutic Trials ◽  
Imaging Optical Coherence Tomography ◽  
A Prospective Study

Abstract Background Increased mineralocorticoid activity is one of the plausible causes of chronic central serous chorioretinopathy (CSCR) and mineralocorticoid inhibitors such as eplerenone have been investigated as its potential therapy. This study investigates the short-term safety and efficacy of oral eplerenone in patients with chronic CSCR. Patients and methods Prospective study of 13 eyes of 13 patients with the diagnosis of chronic CSCR. All patients received eplerenone 50 mg/day for 4 weeks. Enhanced depth imaging optical coherence tomography (OCT) was obtained. Best corrected visual acuity (BCVA), and OCT parameters including sub retinal fluid (SRF), choroidal thickness (CT) and central macular thickness (CMT), were measured manually. Results The mean SRF height decreased slightly at 1-month follow-up as compared to baseline, but the change was not statistically significant (94.18 ± 17.53 vs. 113.15 ± 18.69; p = 0.08). Subfoveal CT and CMT was significantly reduced as compared to baseline (6.6% [p = 0.002] and 7.05% [p = 0.04], respectively). The BCVA did not change significantly (20/28 vs. 20/30 [p = 0.16]). Conclusion This study suggests that oral eplerenone may be used as a safe and potentially effective treatment in chronic CSCR, however there are minimal short-term effects on subretinal fluid or visual acuity therefore therapeutic trials longer than one month are necessary to test its benefits. Trial registration Clinicaltrials.gov identification number: NCT01822561. Registered 3/25/13, https://clinicaltrials.gov/ct2/show/study/NCT01822561

Evaluating Central Serous Chorioretinopathy with Multifocal Electroretinogram

2009 ◽  
Vol 03 (01) ◽  
pp. 71
Author(s):  
Marilita M Moschos ◽  
Michael Moschos ◽  
◽  
Keyword(s):  
Visual Acuity ◽  
Fluorescein Angiography ◽  
Central Serous Chorioretinopathy ◽  
Multifocal Electroretinogram ◽  
Ophthalmological Examination ◽  
Corrected Visual Acuity ◽  
The Mean ◽  
Retinal Response ◽  
Normal Controls ◽  
Best Corrected Visual Acuity

Purpose: To evaluate central serous chorioretinopathy (CSCR) by multifocal electroretinogram (mf-ERG). Patients and methods: Twenty-one patients (21 eyes) with unilateral CSCR were examined. Both eyes of each patient underwent complete ophthalmological examination, including measurement of best corrected visual acuity, fluorescein angiography and mf-ERG recording. Our results were compared with the corresponding findings of 33 age-matched normal volunteers. Results: At presentation, the mean retinal response density (RRD) of the affected eyes in area 1 was 50.8% lower compared with normal controls (p<0.001). After CSCR regression, the mean RRD of the affected eyes was 30.1% lower compared with normal controls (p<0.001). Six fellow unaffected eyes showed a mean RRD in area 1 equal to 12nV/deg2. Conclusion: During the acute phase of CSCR, the mean RRD of the fovea was significantly abnormal. After its regression, mf-ERG values ameliorate, but they remain significantly abnormal. Abnormal values in area 1 were also found in the unaffected eyes.

scholarly journals Evaluation of acute central serous chorioretinopathy using enhanced depth imaging OCT and multifocal electroretinography

2020 ◽  
Author(s):  
In Hwan Hong ◽  
In Boem Chang ◽  
Jae Ryong Han
Keyword(s):  
Central Serous Chorioretinopathy ◽  
Choroidal Thickness ◽  
Serous Retinal Detachment ◽  
Subretinal Fluid ◽  
Multifocal Electroretinography ◽  
Enhanced Depth Imaging ◽  
Implicit Time ◽  
Depth Imaging ◽  
Acute Central Serous Chorioretinopathy ◽  
Normal Controls

Abstract Background To evaluate the functional and structural abnormalities in patients with acute central serous chorioretinopathy (CSC) by multifocal electroretinography (mfERG) and enhanced depth imaging optical coherence tomography (EDI-OCT) Methods This prospective observational study included 57 patients with unilateral CSC. Both eyes underwent mfERG and EDI-OCT. Peak amplitudes and implicit times of the first kernel responses were analyzed and compared with those in 25 age-matched normal controls. Correlational analyses were performed between the mfERG results and EDI-OCT parameters. The thicknesses of the central retina, subretinal fluid, and choroid was measured at baseline and 3 months later. Results Compared with the normal controls, the amplitude and implicit time on mfERG were significantly impaired in the area with serous retinal detachment (SRD). The P1 amplitude and implicit time of the areas beyond the SRD were also found to be significantly impaired in the affected eyes. Eyes with a greater reduction in SRD had a less impaired mfERG response in fellow eyes than those whose retinal detachments were not spontaneously decreased by more than 90% after 3 months. Correlational analysis did not reveal any significant correlations between mfERG values and OCT parameters except for central choroidal thickness. The subfoveal choroidal thickness was negatively correlated with the mfERG parameters. Conclusion The findings of this study indicate diffuse functional impairment in acute CSC which involves both eyes and areas beyond the SRD. The retinal response of the unaffected eye was associated with regression of SRD and functional retinal abnormality is correlated with pathological changes in the choroid.

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