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Bilateral central serous chorioretinopathy with retinal pigment epithelium
tears following epidural steroid injection
Sung-Bok Lee, Jung-Yeul Kim, Woo-Jin Kim, Chul-Bum Cho1, Takeshi Iwase2, Young-Joon Jo
The cause of central serous chorioretinopathy (CSC) is mostly idiopathic. Other cause such as stressful
event or use of corticosteroid has been associated with severe form of CSC. Atypical presentation of CSC
has widespread degeneration of retinal pigment epithelium (RPE) or bullous retinal detachment. In this
report, we describe a case of bilateral CSC with RPE tear after epidural steroid injection.
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Key words: Central serous chorioretinopathy, epidural steroid, retinal pigment epithelium detachment,
retinal pigment epithelium tear
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DOI:
10.4103/0301-4738.119441
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A 79‑year‑old man visited our clinic with a complain of
deterioration in the visual acuity of right eye. Best corrected OD
visual acuity was 20/32, and OS was 20/25. Recently, he had had
four epidural injections of triamcinolone and dexamethasone
for chronic back pain.
In fundus examination, dark‑gray colored lesions were
detected in both eyes that were associated with dome‑shape
large elevated lesion of retinal pigment epithelium (RPE).
Inferior serous retinal detachment was observed in both
eyes. On fluorescein angiography (FA), the pigment epithelial
detachment (PED) lesion showed round, well‑demarcated
uniform hypofluorescence in the early phase and pooling
in the late phase [Figs. 1 and 2]. In contrast, the late phase
of ICGA demonstrated persistent hypofluorescence.
RPE tear, which was dark‑gray colored lesion, showed
hyperfluorescence from the early phase of FA and was still
hyperfluorescent with staining into the surrounding tissue
in the late phase. On spectral domain‑optical coherence
tomography (SD‑OCT), tear‑ and rolled‑edge of RPE was
observed [Fig. 3]. Corticosteroid treatment was discontinued
without any treatment. One month later, although the area
of serous retinal detachment was decreased, the RPE tear
Department of Ophthalmology, Chungnam National University,
College of Medicine, Daejeon, 1Department of Neurosurgery, College
of Medicine, The Catholic University of Korea, Bucheon St. Mary'
Hospital, Bucheon, Republic of Korea, 2Nagoya University Graduate
School of Medicine, Nagoya, Japan
Correspondence to: Dr. Young-Joon Jo, 640 Daesa-dong, Jung-Gu,
Department of Ophthalmology, Chungnam National University College
of Medicine, Daejeon, Republic of Korea. E-mail: youngjoon@cnu.ac.kr
Manuscript received: 16.12.12; Revision accepted: 21.03.13
a
b
c
Figure 1: Fundus photograph of both eyes showing neurosensory
retinal detachment in the macular region. The gray‑colored lesions
reveal retinal pigment epithelium tear. (a) Right eye, (b) Left eye,
and (c) At 1 month after first visit. The lesion is progressing into
larger regions
was enlarged inferiorly and the visual acuity in the right eye
decreased to 20/100.
Discussion
Recent studies have considered steroids as a risk factor for acute
central serous chorioretinopathy (CSC).[1] Steroids increase the
development of CSC by impeding the healing of RPE injury
and increasing the permeability of the choriocapillaris.[2‑4] In
most CSC patients, local serous retinal detachment occurs
in the neurosensory retina or RPE and, if steroids are used,
it is associated with atypical patterns, such as overall diffuse
retinal pigment epitheliopathy.[5] We experienced the CSC with
large PED and RPE tears after epidural steroid injection and
could confirm the diagnosis by sp ecific findings of FA, ICGA,
and OCT. These findings may help understand fundus and
angiographic findings of the PED and RPE tears in various
conditions.
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515
Lee, et al.: Bilateral CSC and RPE tear associated with steroid
September 2013
a
b
e
f
c
d
g
h
Figure 2: (a, e) Early‑phase fluorescein angiography (FA) showing well‑demarcated area of hypofluorescence corresponding to the pigment
epithelial detachment (PED) and hyperfluorescence due to window defect of retinal pigment epithelium (RPE) tear. (b, f) Late‑phase FA revealing
hyperfluorescence of PED and strong hyperfluorescence area of RPE tear. (c, d, g, h) Early‑phase indocyanine green angiography showing area
of hypofluorescence of PED that persisted in the late‑phase and hyperfluorescence of the RPE tear lesion, followed by decrease of fluorescence
on the late‑phase
References
1. Mondal LK, Sarkar K, Datta H, Chatterjee PR. Acute bilateral
central serous chorioretinopathy following intra‑articular injection
of corticosteroid. Indian J Ophthalmol 2005;53:132‑4.
2. Garg SP, Dada T, Talwar D, Biswas NR. Endogenous cortisol profile
in patients with central serous chorioretinopathy. Br J Ophthalmol
1997;81:962‑4.
3. Iida T, Spaide RF, Negrao SG, Carvalho CA, Yannuzzi LA. Central
serous chorioretinopathy after epidural corticosteroid injection.
Am J Ophthalmol 2001;132:423‑5.
4. Kao LY. Bilateral serous retinal detachment resembling central
serous chorioretinopathy following epidural steroid injection.
Retina 1998;18:479‑81.
Figure 3: Spectral domain optical coherence tomography shows serous
pigment epithelial detachment with pigment epithelial tears and rolled
edge (red arrows)
5. Bouzas EA, Karadimas P, Pournaras CJ. Central serous
chorioretinopathy and glucocorticoids. Surv Ophthalmol
2002;47:431‑48.
Acknowledgment
Cite this article as: Lee S, Kim J, Kim W, Cho C, Iwase T, Jo Y. Bilateral
central serous chorioretinopathy with retinal pigment epithelium tears following
epidural steroid injection. Indian J Ophthalmol 2013;61:514-5.
This study was financially supported by the research fund of
Chungnam National University in 2010.
Source of Support: Chungnam National University in 2010.
Conflict of Interest: None declared.