Duran Munevver, Shieh David, Choi Preston, He Yu-Guang, Ufret-Vincenty Rafael L
Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, USA.
Case Rep Ophthalmol. 2024 May 24;15(1):448-457. doi: 10.1159/000538736. eCollection 2024 Jan-Dec.
We aimed to describe a clinical presentation of central serous retinopathy that poses a diagnostic and management dilemma.
A 30-year-old male patient presented with bilateral vision loss and multifocal serous retinal detachments involving the posterior pole of both eyes. Optical coherence tomography revealed prominent bilateral bacillary layer detachments. The patient complained of recent headaches and tinnitus. However, the clinical exam did not reveal overt inflammation and the patient admitted to being under significant stress. The clinical presentation raised concerns for both central serous retinopathy (CSR) and Vogt-Koyanagi-Harada (VKH). Additional findings, including white fundus spots and focal areas of retinal vascular leakage, were seen in our patient. We highlight these because, while they have been described in CSR, they are not commonly discussed and could add to the diagnostic dilemma. After a conservative approach that avoided steroids, our patient showed marked improvement over the following month, supporting a diagnosis of CSR.
CSR can mimic VKH disease. A high level of suspicion is needed to avoid instituting steroid therapy that could induce a severe iatrogenic exacerbation of the disease.
我们旨在描述一种中央性浆液性视网膜病变的临床表现，该病变带来了诊断和治疗上的难题。
一名30岁男性患者出现双侧视力丧失，双眼后极部有多灶性浆液性视网膜脱离。光学相干断层扫描显示双侧显著的视网膜色素上皮层脱离。患者主诉近期头痛和耳鸣。然而，临床检查未发现明显炎症，且患者承认承受着巨大压力。这种临床表现引发了对中央性浆液性视网膜病变（CSR）和伏格特-小柳-原田病（VKH）的担忧。在我们的患者中还发现了其他表现，包括眼底白色斑点和视网膜血管渗漏的局部区域。我们强调这些表现，因为虽然它们在CSR中已有描述，但并不常被讨论，且可能增加诊断难题。在采取避免使用类固醇的保守治疗方法后，我们的患者在接下来的一个月内有明显改善，支持CSR的诊断。
CSR可模仿VKH病。需要高度怀疑以避免采用可能导致疾病严重医源性加重的类固醇治疗。
