Jeyanathan Bava, Micieli Jonathan
Kensington Vision and Research Centre, Kensington Research Institute, Toronto, ON, USA.
Department of Ophthalmology and Vision Sciences, Department of Medicine, University of Toronto, Toronto, ON, USA.
Case Rep Ophthalmol. 2025 Apr 23;16(1):372-376. doi: 10.1159/000546053. eCollection 2025 Jan-Dec.
Central serous chorioretinopathy (CSCR) is a known complication of corticosteroid use, characterized by the accumulation of subretinal fluid (SRF), which can lead to changes in vision. Giant cell arteritis (GCA) is a systemic vasculitis that often necessitates high-dose corticosteroid treatment to prevent serious complications including permanent vision loss. Although the association between CSCR and corticosteroids is well established, its occurrence in patients diagnosed with GCA remains rarely reported in literature.
We present a case of a 71-year-old man who developed CSCR following 6 months of corticosteroid treatment for GCA. The patient presented with decreased vision in the left eye for 10 days, prompting ophthalmologic evaluation. Initial visual acuity (VA) was measured at 20/60, and OCT identified the presence of SRF, confirming CSCR as the underlying etiology. Following gradual tapering of his prednisone dosage, subsequent OCT confirmed significant reduction in SRF, with VA improving to 20/30 within 3 months.
This case highlights the importance of considering CSCR in the differential diagnosis of new or worsening visual symptoms in GCA patients receiving corticosteroids. The risk for corticosteroid-induced CSCR in these patients creates a diagnostic challenge, as worsening vision may be incorrectly attributed to disease progression rather than being recognized as a treatment-related adverse effect. This case emphasizes the importance of early recognition of CSCR and highlights the need for interdisciplinary collaboration between rheumatologists and ophthalmologists to ensure appropriate management for patients with GCA.
中心性浆液性脉络膜视网膜病变（CSCR）是已知的使用皮质类固醇的并发症，其特征是视网膜下液（SRF）积聚，可导致视力变化。巨细胞动脉炎（GCA）是一种全身性血管炎，通常需要高剂量皮质类固醇治疗以预防包括永久性视力丧失在内的严重并发症。尽管CSCR与皮质类固醇之间的关联已得到充分证实，但在诊断为GCA的患者中其发生情况在文献中仍鲜有报道。
我们报告一例71岁男性，在接受GCA皮质类固醇治疗6个月后发生CSCR。患者因左眼视力下降10天就诊，促使进行眼科评估。初始视力（VA）测量为20/60，光学相干断层扫描（OCT）确定存在SRF，证实CSCR为潜在病因。随着泼尼松剂量逐渐减少，随后的OCT证实SRF显著减少，3个月内视力提高到20/30。
本病例强调了在接受皮质类固醇治疗的GCA患者出现新的或恶化的视觉症状的鉴别诊断中考虑CSCR的重要性。这些患者中皮质类固醇诱导的CSCR风险带来了诊断挑战，因为视力恶化可能被错误地归因于疾病进展，而不是被识别为与治疗相关的不良反应。本病例强调了早期识别CSCR的重要性，并突出了风湿病学家和眼科医生之间跨学科合作以确保对GCA患者进行适当管理的必要性。
