Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

26 November 2023: Articles  Greece

A 30-Year-Old Man with a Recent History of COVID-19 Requiring Treatment with Corticosteroids Who Developed Bilateral Central Serous Chorioretinopathy During 7-Month Follow-Up

Unusual clinical course, Unusual or unexpected effect of treatment

Constantine D. Angelidis1ABE, Ilias Georgalas1CE, Ioannis Giachos1BC, Chrysanthos Symeonidis2DE, Aikaterini Mani1BC, Tryfon Rotsos1ABCDE

DOI: 10.12659/AJCR.940241

Am J Case Rep 2023; 24:e940241

0 Comments

Abstract

0:00

BACKGROUND: Central serous chorioretinopathy (CSCR) involves a localized serous macular detachment, secondary to retinal pigment epithelial and choroidal vascular changes, which can be an adverse effect of corticosteroid use. Most CSCR cases resolve spontaneously, and normal vision returns, while some chronic cases can result in blindness. This report is of a 30-year-old man with a recent history of Corona virus disease (COVID)-19 requiring corticosteroid treatment who developed bilateral CSCR with unilateral fibrin and a 7-month follow-up.

CASE REPORT: A 30-year-old male patient presented with malaise and high fever. The patient tested positive for COVID-19, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus and was admitted. During hospitalization, he received intravenous (IV) corticosteroids for 1 week (6 mg dexamethasone IV once daily). Following hospitalization, the patient received per os methylprednisolone 16 mg (16 mg once daily for 3 days, 8 mg once daily for 3 days, 4 mg once daily for 3 days, and 2 mg once daily for 3 days). One month later, the patient presented with bilateral visual acuity (VA) deterioration and acute CSCR. The diagnosis and follow-up were performed by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). The patient was followed-up for a period of 7 months, during which, although the VA improved and remained stable, the OCT findings were changing.

CONCLUSIONS: This report highlights the importance of timely ophthalmological examination in patients with sudden vision loss and identification of the association between corticosteroid use and CSCR, as well as the importance of a longer follow-up period.

Keywords: COVID-19, central serous chorioretinopathy, Male, Humans, Adult, Follow-Up Studies, COVID-19, SARS-CoV-2, Fluorescein Angiography, Adrenal Cortex Hormones, Tomography, Optical Coherence

Background

Central serous chorioretinopathy (CSCR) is a well-studied disease that was first described in 1866 by Von Graefe as “idiopathic detachment of the macula” [1].CSCR is characterized by localized serous detachment of the neurosensory retina due to retinal pigment epithelium (RPE) decompensation secondary to choroidal vascular changes [2].

Men are more commonly affected, with a male-female ratio of 6: 1, as found in a population-based study [3]. Type A personality, hypercortisolism, pregnancy, and Cushing syndrome are also considered as risk factors for developing CSCR [4]. Moreover, Carvalho-Recchia et al [5] reported that the use of corticosteroids, by any systemic route of administration, is associated with the acute onset of CSCR.

Possible symptoms of CSCR are blurred vision, micropsia, meta-morphopsia, relative scotoma, and color vision disturbances. The disease is primarily unilateral, but in up to 40% of cases, it presents as bilateral. CSCR is mainly confirmed by optical coherence tomography (OCT), with the characteristic neuro-sensory retinal detachment. Fundus fluorescein angiography (FFA), with 3 types of leakage – inkblot, smokestack, and diffuse – may also be used [2]. Indocyanine green angiography (ICGA) can also be performed to detect choroidal neovascularization in chronic CSCR. This entity often has a favorable natural course and spontaneous resolution is common in acute cases, so observation is recommended for 3–6 months.

Corona virus disease (COVID)-19, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus, is an infectious disease with a clinical picture ranging from asymptomatic to fatal. In severe cases, it can cause respiratory distress leading to hospitalization in the intensive care unit (ICU). The COVID-19 pandemic is a global medical emergency, with enormous impact on society and global health [6].

In 2020 alone, the SARS-CoV-2 pandemic is estimated to have infected about 70 000 000 people worldwide. About 1 500 000 deaths have been also attributed to coronavirus-19 disease (COVID-19) [6].

During the COVID-19 pandemic, several trials have suggested a suitable treatment for hospitalized patients. Empirical evidence, in some cases, has shown the potential benefit of intravenous corticosteroid treatment [7].

This report is of a 30-year-old man with a recent history of COVID-19 requiring treatment with corticosteroids who developed CSCR in both eyes.

Case Report

A 30-year-old male patient presented with symptoms of malaise and high fever (up to 41°C/106°F) for 7 days. The patient had tested positive for SARS-CoV-2, using real-time polymerase chain reaction (RT-PCR, Standard M10 SARS-CoV-2, SD Biosensor, Inc., Korea) for diagnosis confirmation, and was admitted to our hospital.

During his hospitalization, which lasted for 1 week, he received intravenous (IV) corticosteroids (6 mg dexamethasone once daily for 1 week) to reduce the COVID-19-induced systemic inflammatory response. Following his hospitalization, he received per os methylprednisolone 16 mg with gradual tapering (16 mg, once daily for 3 days, 8 mg once daily for 3 days, 4 mg once daily for 3 days, and 2 mg once daily for 3 days).

Upon discharge, he noticed bilateral visual deterioration, but he did not report this to his treating physicians.

One month after his discharge and the onset of his initial symptoms (April 2021), the patient presented for the first time to the Ophthalmology Clinic. Visual acuity (VA) was 20/100 in both eyes and slit lamp examination was normal. OCT demonstrated a small amount of subretinal fluid (SRF) in his right eye (Figure 1A) and SRF in his left eye (Figure 1B).

One month later (May 2021), he presented for his 1st follow-up visit, with a VA of 20/100 in the right eye and 20/20 in the left eye. In the right eye, OCT in the macular area revealed SRF and a small accumulation of subretinal material (Figure 1C). In the left eye, a disruption of the RPE was noted, with no visible SRF (Figure 1D). FFA revealed temporary leakage of the macula in the right eye (smoke stack-like) (Figure 1E, 1F). In the left eye, 2 small staining points in the macular area – 1 at the inferior macula and 1 superotemporal to the optic nerve – were found (Figure 1G, 1H).

One month later, in June 2021 (second follow-up visit), VA was 20/25 in the right eye and 20/20 in the left eye. In the right eye, OCT imaging revealed a small amount of SRF and a significant amount of subretinal fibrin-like material. Temporary folding of the inner retinal layers of the macula was also observed (Figure 2A, 2B). In the left eye, a disruption of the RPE was noted, with no visible SRF (Figure 2D, 2E). FFA demonstrated a single leakage temporally to the posterior pole (smokestack pattern) in the right eye (Figure 2C) the same leakage site observed in his first FFA. The presence or absence of macular neovascularization (MNV) in the right eye was not clear and the presence of MNV was not supported by the FFA images. In the left eye, FFA demonstrated 1 small staining point in the inferior macula (Figure 2F).

In July 2021 (at the third follow-up visit), VA was also 20/25 in the right eye and 20/20 in the left eye. An OCT scan of the right eye revealed a small amount of SRF and a reduction of the fibrin-like material. Folding of the inner retinal layers in the macula was also observed (Figure 3A, 3B), while OCT scans of the left eye revealed no changes (no SRF or disruption of the RPE, Figure 3C, 3D).

In August 2021, OCT scans showed resolution of neurosensory detachment in the macula, a small pigment epithelial detachment (PED), and absorption of most of the fibrin-like material, with residual material remaining temporally in the fovea (Figure 4A, 4B). In the left eye, there were RPE abnormalities, but no neurosensory retinal detachment was present (Figure 4C, 4D).

In September 2021, OCT scans of the right eye demonstrated a shallower PED and a small amount of the residual subretinal material temporally in the macula (Figure 5A, 5B), while an OCT scan of the left eye (Figure 5C, 5D) revealed the appearance of a new locus of SRF superonasally of the macula, surrounding the optic nerve head (ONH) (Figure 5E, 5F).

At the last follow-up visit, in October 2021, OCT images were the same as in September 2021 (Figure 5G–5L).

Visual acuity increased in the left eye after 1 month and in the right eye after 2 months and remained unchanged (20/25 in the right eye and 20/20 in the left eye) from June 2021 until October 2021.

Discussion

As more patients in various age groups are receiving corticosteroids for COVID-19, treating physicians should inform patients about the potential ocular adverse effects and advise them to seek immediate ophthalmic examination in the event of ocular disturbances.

CSCR is a well-studied disease, affecting the retina and the choroid. It can be triggered by various conditions like stress, anxiety, type A personality, and administration of corticosteroids, the latter being one of the most common.

During the COVID-19 pandemic, a significant number of patients of various ages have received corticosteroids, either orally or intravenously [8]. Use of corticosteroids for COVID-19 treatment is possibly related to CSCR development [9].

There have been reports of single cases who developed acute CSCR after hospitalization for COVID-19, treated with oral or IV administration of corticosteroids: 1 unilateral case by Sanjay et al [9], 1 bilateral case by Sharifi et al [10], 1 bilateral case by Mohd et al [11], and 1 unilateral case by Goyal et al [12]. The latter presented 1 mild unilateral CSCR case, who received corticosteroid treatment, in a series of 7 serious cases with ophthalmic complications following COVID-19 disease.

Amulya et al [13] were the first to report a unilateral CSCR case associated with COVID-19-related stress, without any administration of corticosteroids. Abrishami et al [8] also published a case series with 4 bilateral cases in total, with pachychoroid spectrum disorder findings following COVID-19 disease, with no corticosteroids administration. Bilateral localized serous retinal detachment was apparent in 3 out of 4 cases with pachychoroid spectrum disorder. The authors hypothesized that the underlying mechanism could be either the involvement of the choroid in the infection or the increase in cytokines that may ensue. They also concluded that the COVID-19 infection could be proposed as a new etiology for pachychoroid spectrum disorder. Most of the aforementioned cases were either observed or treated with eplerenone or nepafenac. Fibrin-like subretinal material was not observed in any of these cases.

Our patient had bilateral CSCR treated with IV and oral corticosteroids during and after hospitalization for COVID-19, with a follow-up time of 7 months. During the follow-up period, fibrin-like material was also noted subretinally in the right eye of our patient, most of which was absorbed. In the left eye, new loci of manifestation of CSCR were developed during the 7-month follow-up period.

The follow-up period in the aforementioned reports was a few weeks for Goyal et al, 2 months for Amulya et al, 1 month for Sanjay et al, 3 months for Mohd et al, 2 months for Sharifi et al, and 3–5 months for Abrishami et al. In our patient, there was a longer follow-up period (7 months).

Subretinal fibrin-like material in CSCR cases has been reported in the literature [14]. The composition of the subretinal hyper-reflective material (SRHM) is poorly understood. Classically, it has been described to be composed of fibrin in various studies [15,16]. Sahoo et al [17] stated that these deposits could be derived from the shed photoreceptor outer segments rather than fibrin. Eyes with SRHM in CSCR have a good visual prognosis, unless the external limiting membrane (ELM) is involved. The deposits disappear completely in most cases and treatment should be planned according to the severity of collections. Diffuse RPE damage at baseline may lead to persistence of SRHM, eventually predisposing to scar formation [17]. Cong et al [18] noticed that CSCR cases with subretinal hyper-reflective materials are more common in eyes with longer duration of disease. In our case, the fibrin-like material appeared in the right eye of the patient 2 months after the initial symptoms. The amount of the material increased for 2 months and then decreased, leaving a small amount temporally in the macula at the end of follow-up.

Visual acuity increased in the left eye after 1 month and in the right eye after 2 months and remained the same (20/25 in the right eye and 20/20 in the left eye) from June 2021 until October 2021 (the end of the follow-up time). It is unclear why the VA improvement in the right eye was observed for the first time in June 2021, when the amount of fibrin was the most pronounced. The patient’s systemic symptoms of COVID-19 were improved at that time. Concerning the steroid reduction, tapering had been concluded upon initial presentation (April 2021). We cannot attribute the improvement in visual acuity (June 2021) to steroid reduction, since it was observed 2 months after discontinuation of the corticosteroids. We cannot exclude the natural course of CSCR as a cause of improvement in this case. More recent publications used OCT imaging [19], or even histopathological methods [20] and molecular analyses, such as proteomics and metabolomics, to confirm the presence of fibrin or fibrin-like material. Rajesh et al [21] concluded that subretinal fibrin in CSCR seems to be associated with a RPE defect, allowing these large molecules to enter the subretinal space from the hyperpermeable choriocapillaris. In their publication, OCT imaging demonstrated that there may be a hypo-reflective vacuole adjacent to an RPE defect. It is postulated that this vacuole signifies leakage of fluid into the subretinal space, as this corresponded with the RPE leaks on FFA.

Mohan et al [22] pointed out that in cases of pathologies that need to be treated by corticosteroids, the patients must be informed and warned about the adverse effects of the treatment.

Conclusions

We have presented a case of post-COVID-19 development of simultaneous bilateral CSCR and subretinal fibrin-like material after treatment with corticosteroids. Physicians need to inform their patients about the possibility of COVID-19-related ophthalmic manifestations, especially when corticosteroids are administrated.

This report has highlighted the importance of timely ophthalmological examination in patients with sudden vision loss and identification of the association between corticosteroid use and CSCR as well as the importance of a longer follow-up period.

Figures

Baseline examination, 1 month after the onset of the patient’s initial symptoms (April 2021) and 1st follow-up visit (May 2021). The patient received intravenous (IV) corticosteroids (6 mg dexamethasone once daily for 1 week), followed by per os methylprednisolone 16 mg with gradual tapering (16 mg once daily for 3 days, 8 mg once daily for 3 days, 4 mg once daily for 3 days, and 2 mg once daily for 3 days). (A) Optical coherence tomography (OCT) scan of the right eye showing a small amount of subretinal fluid (SRF) in April 2021. (B) OCT scan of the left eye showing SRF in April 2021. (C) OCT scan of the right eye showing a small amount of SRF and the development of a small amount of subretinal fibrin-like material in May 2021. (D) OCT scan of the left eye showing a disruption of the RPE, with no visible SRF (May 2021). (E) Fluorescein fundus angiography (FFA) of the right eye showing a focus of pin point hyperfluorescence temporally to the macula at 00.28.19 (in May 2021). (F) FFA of the right eye showing smokestack-like leakage temporally to the macula at 03.52.29 (in May 2021). (G) FFA of the left eye revealed 2 small staining points (yellow arrows) in the macular area, 1 at the inferior macula and one superotemporal to the optic nerve at 00.59.29 (in May 2021). (H) FFA of the left eye revealed 2 small staining points (yellow arrows) in the macular area, 1 at the inferior macula and 1 superotemporal to the optic nerve at 02.37.00 (in May 2021).Figure 1.. Baseline examination, 1 month after the onset of the patient’s initial symptoms (April 2021) and 1st follow-up visit (May 2021). The patient received intravenous (IV) corticosteroids (6 mg dexamethasone once daily for 1 week), followed by per os methylprednisolone 16 mg with gradual tapering (16 mg once daily for 3 days, 8 mg once daily for 3 days, 4 mg once daily for 3 days, and 2 mg once daily for 3 days). (A) Optical coherence tomography (OCT) scan of the right eye showing a small amount of subretinal fluid (SRF) in April 2021. (B) OCT scan of the left eye showing SRF in April 2021. (C) OCT scan of the right eye showing a small amount of SRF and the development of a small amount of subretinal fibrin-like material in May 2021. (D) OCT scan of the left eye showing a disruption of the RPE, with no visible SRF (May 2021). (E) Fluorescein fundus angiography (FFA) of the right eye showing a focus of pin point hyperfluorescence temporally to the macula at 00.28.19 (in May 2021). (F) FFA of the right eye showing smokestack-like leakage temporally to the macula at 03.52.29 (in May 2021). (G) FFA of the left eye revealed 2 small staining points (yellow arrows) in the macular area, 1 at the inferior macula and one superotemporal to the optic nerve at 00.59.29 (in May 2021). (H) FFA of the left eye revealed 2 small staining points (yellow arrows) in the macular area, 1 at the inferior macula and 1 superotemporal to the optic nerve at 02.37.00 (in May 2021). Follow-up visit in June 2021. (A) Infrared photo of the right eye (June 2021). (B) Corresponding optical coherence tomography (OCT) scan of the right eye. Temporally, a small amount of subretinal fluid (SRF) with a significant amount of subretinal fibrin-like material as well as folding of the inner retinal layers of the macula was observed (June 2021). (C) Fluorescein fundus angiography (FFA) of the right eye revealing a smokestack leakage temporally to the macula (yellow arrow) at 03.30.46. (June 2021). (D) Infrared photo of the left eye (June 2021). (E) Corresponding OCT scan of the left eye. A disruption of the RPE was noted, with no visible SRF (June 2021). (F) FFA of the left eye demonstrated 1 small staining point at the inferior macula (yellow arrow) at 05.27.30 (June 2021).Figure 2.. Follow-up visit in June 2021. (A) Infrared photo of the right eye (June 2021). (B) Corresponding optical coherence tomography (OCT) scan of the right eye. Temporally, a small amount of subretinal fluid (SRF) with a significant amount of subretinal fibrin-like material as well as folding of the inner retinal layers of the macula was observed (June 2021). (C) Fluorescein fundus angiography (FFA) of the right eye revealing a smokestack leakage temporally to the macula (yellow arrow) at 03.30.46. (June 2021). (D) Infrared photo of the left eye (June 2021). (E) Corresponding OCT scan of the left eye. A disruption of the RPE was noted, with no visible SRF (June 2021). (F) FFA of the left eye demonstrated 1 small staining point at the inferior macula (yellow arrow) at 05.27.30 (June 2021). Follow-up of the patient in July 2021.(A) Infrared photo of the right eye in July 2021. (B) Corresponding optical coherence tomography (OCT) scan of the right eye revealed a small amount of SRF and a reduction of the fibrin-like material. Folding of the inner retinal layers at the macula was also observed (July 2021). (C) Infrared photo of the left eye in July 2021. (D) Corresponding OCT scan of the left eye remained stable, without subretinal fluid (SRF), with disruption of the RPE (July 2021).Figure 3.. Follow-up of the patient in July 2021.(A) Infrared photo of the right eye in July 2021. (B) Corresponding optical coherence tomography (OCT) scan of the right eye revealed a small amount of SRF and a reduction of the fibrin-like material. Folding of the inner retinal layers at the macula was also observed (July 2021). (C) Infrared photo of the left eye in July 2021. (D) Corresponding OCT scan of the left eye remained stable, without subretinal fluid (SRF), with disruption of the RPE (July 2021). Follow-up visit in August 2021. (A) Infrared photo of the right eye in August 2021. (B) Corresponding optical coherence tomography (OCT) scan showed resolution of neurosensory detachment of the macula, a small pigment epithelial detachment (PED), and absorption of most of the fibrin-like material with residual material of the fovea remaining temporally (August 2021). (C) Infrared photo of the left eye in August 2021. (D) Corresponding OCT scan of the left eye. Note retinal pigment epithelium (RPE) abnormalities, without neurosensory retinal detachment (August 2021).Figure 4.. Follow-up visit in August 2021. (A) Infrared photo of the right eye in August 2021. (B) Corresponding optical coherence tomography (OCT) scan showed resolution of neurosensory detachment of the macula, a small pigment epithelial detachment (PED), and absorption of most of the fibrin-like material with residual material of the fovea remaining temporally (August 2021). (C) Infrared photo of the left eye in August 2021. (D) Corresponding OCT scan of the left eye. Note retinal pigment epithelium (RPE) abnormalities, without neurosensory retinal detachment (August 2021). September 2021 and October 2021 follow-up visits. (A) Infrared photo of the right eye in September 2021. (B) Corresponding optical coherence tomography (OCT) scan showed resolution of neurosensory detachment of the macula, a shallower pigment epithelial detachment (PED), and absorption of most of the fibrin-like material, with residual material of the fovea remaining temporally (September 2021). (C) Infrared photo of the left eye in September 2021. Green arrow showing the scanning area at the macula. (D) Corresponding OCT scan of the left eye. Note retinal pigment epithelium (RPE) abnormalities, without neurosensory retinal detachment at the macula (September 2021). (E) Infrared photo of the left eye in September 2021. Green arrow showing the scanning area at a dark area superotemporal to the optic nerve. (F) Corresponding OCT scan of the left eye. Notice the subretinal fluid (SRF) at the place of the one of the 2 small staining points that was superotemporal to the optic nerve in May 2021 and disappeared in June 2021 (September 2021). (G) Infrared photo of the right eye in October 2021. (H) Corresponding optical coherence tomography (OCT) scan showed resolution of neurosensory detachment of the macula absorption of most of the fibrin-like material, with residual material of the fovea remaining temporally (October 2021). (I) Infrared photo of the left eye in October 2021. Green arrow showing the scanning area at the macula. (J) Corresponding OCT scan of the left eye. Note RPE abnormalities without neurosensory retinal detachment at the macula (October 2021). (K) Infrared photo of the left eye in October 2021. Green arrow showing the scanning area at a dark area superotemporal to the optic nerve. (L) Corresponding OCT scan of the left eye. The SRF located superotemporal to the optic nerve, at the area were one of the staining points of May 2021 was located, is shallower (October 2021).Figure 5.. September 2021 and October 2021 follow-up visits. (A) Infrared photo of the right eye in September 2021. (B) Corresponding optical coherence tomography (OCT) scan showed resolution of neurosensory detachment of the macula, a shallower pigment epithelial detachment (PED), and absorption of most of the fibrin-like material, with residual material of the fovea remaining temporally (September 2021). (C) Infrared photo of the left eye in September 2021. Green arrow showing the scanning area at the macula. (D) Corresponding OCT scan of the left eye. Note retinal pigment epithelium (RPE) abnormalities, without neurosensory retinal detachment at the macula (September 2021). (E) Infrared photo of the left eye in September 2021. Green arrow showing the scanning area at a dark area superotemporal to the optic nerve. (F) Corresponding OCT scan of the left eye. Notice the subretinal fluid (SRF) at the place of the one of the 2 small staining points that was superotemporal to the optic nerve in May 2021 and disappeared in June 2021 (September 2021). (G) Infrared photo of the right eye in October 2021. (H) Corresponding optical coherence tomography (OCT) scan showed resolution of neurosensory detachment of the macula absorption of most of the fibrin-like material, with residual material of the fovea remaining temporally (October 2021). (I) Infrared photo of the left eye in October 2021. Green arrow showing the scanning area at the macula. (J) Corresponding OCT scan of the left eye. Note RPE abnormalities without neurosensory retinal detachment at the macula (October 2021). (K) Infrared photo of the left eye in October 2021. Green arrow showing the scanning area at a dark area superotemporal to the optic nerve. (L) Corresponding OCT scan of the left eye. The SRF located superotemporal to the optic nerve, at the area were one of the staining points of May 2021 was located, is shallower (October 2021).

References:

1.. Von Graefe A, Kurzere Abhandlungen. Notizen und casaistische Mitheilungen vermischten Inhalts: VI (Ueber zentrale recidivirende Retinitis): Albrecht Von Graefes Arch Klin Exp Ophthalmol, 1866; 12; 211-15 [in German]

2.. Gupta A, Tripathy K, Central serous chorioretinopathy: StatPearls Feb 22, 2023, StatPearls Publishing 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK558973/

3.. Kitzmann AS, Pulido JS, Diehl NN, The incidence of central serous chorioretinopathy in Olmsted County, Minnesota, 1980–2002: Ophthalmology, 2008; 115; 169-73

4.. Yannuzzi LA, Type A behavior and central serous chorioretinopathy: Retina, 2012; 32(Suppl. 1); 709

5.. Carvalho-Recchia CA, Yannuzzi LA, Negrão S, Corticosteroids and central serous chorioretinopathy: Ophthalmology, 2002; 109; 1834-37

6.. : WHO coronavirus disease (COVID-19) dashboard, 2020, Geneva, World Health Organization Available online: https://covid19.who.int/

7.. Pfortmueller CA, Spinetti T, Urman RD, COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment – a narrative review: Best Pract Res Clin Anaesthesiol, 2021; 35; 351-68

8.. Abrishami M, Daneshvar R, Shoeibi N, Pachychoroid spectrum disorder findings in patients with coronavirus disease 2019: Case Rep Ophthalmol Med, 2021; 13; 4688764

9.. Sanjay S, Gowda PB, Rao B, “Old wine in a new bottle” – post COVID-19 infection, central serous chorioretinopathy and the steroids: J Ophthalmic Inflamm Infect, 2021; 11; 14

10.. Sharifi A, Daneshtalab A, Zand A, Bilateral central serous chorioretinopathy after treatment of COVID-19 infection: Cureus, 2022; 14; e23446

11.. Mohd-Alif WM, Nur-Athirah A, Hanapi MS, Bilateral and multiple central serous chorioretinopathy following COVID-19 Infection: A case report and literature review: Cureus, 2022; 14; e23246

12.. Goyal M, Murthy SI, Annum S, Retinal manifestations in patients following COVID-19 infection: A consecutive case series: Indian J Ophthalmol, 2021; 69; 1275-82

13.. Amulya G, Thanuja GP, Central serous retinopathy in a post COVID-19 asymptomatic healthcare worker at a tertiary care hospital: A unique case report: Ophthalmology Research: An International Journal, 2021; 14; 23-27

14.. Gass JDM, Central serous chorioretinopathy with white subretinal exudation in pregnancy: Arch Ophthalmol, 1991; 109; 677-81

15.. Ie D, Yannuzzi LA, Spaide RF, Subretinal exudative deposits in central serous chorioretinopathy: Br J Ophthalmol, 1993; 77; 349-53

16.. Schatz H, McDonald HR, Johnson RN, Subretinal fibrosis in central serous chorioretinopathy: Ophthalmology, 1995; 102; 1077-88

17.. Sahoo NK, Govindhari V, Bedi R, Subretinal hyperreflective material in central serous chorioretinopathy: Indian J Ophthalmol, 2020; 68; 126-29

18.. Cong Q, Zhou L, Huang C, Changes of microstructure of central serous chorioretinopathy on OCT and its relationship with prognosis: Photodiagnosis Photodyn Ther, 2023; 42; 103499

19.. Symeonidis C, Kaprinis K, Manthos K, Central serous chorioretinopathy with subretinal deposition of fibrin-like material and its prompt response to ranibizumab injections: Case Rep Ophthalmol, 2011; 2; 59-64

20.. Komoto S, Maruyama K, Hashida N, Bilateral serous retinal detachment associated with subretinal fibrin-like material in a case of pregnancy-induced hypertension: Am J Ophthalmol Case Rep, 2019; 16; 100572

21.. Rajesh B, Kaur A, Giridhar A, Gopalakrishnan M, “Vacuole” sign adjacent to retinal pigment epithelial defects on spectral domain optical coherence tomography in central serous chorioretinopathy associated with subretinal fibrin: Retina, 2017; 37; 316-24

22.. Mohan R, Arthi M, Basker A, Sivakumar P, Central serous chorioretinopathy following intravenous steroid therapy for retrobulbar optic neuritis – “Treatment dilemma” – case report and review of literature: TNOA Journal of Ophthalmic Science and Research, 2021; 59; 376

Figures

Figure 1.. Baseline examination, 1 month after the onset of the patient’s initial symptoms (April 2021) and 1st follow-up visit (May 2021). The patient received intravenous (IV) corticosteroids (6 mg dexamethasone once daily for 1 week), followed by per os methylprednisolone 16 mg with gradual tapering (16 mg once daily for 3 days, 8 mg once daily for 3 days, 4 mg once daily for 3 days, and 2 mg once daily for 3 days). (A) Optical coherence tomography (OCT) scan of the right eye showing a small amount of subretinal fluid (SRF) in April 2021. (B) OCT scan of the left eye showing SRF in April 2021. (C) OCT scan of the right eye showing a small amount of SRF and the development of a small amount of subretinal fibrin-like material in May 2021. (D) OCT scan of the left eye showing a disruption of the RPE, with no visible SRF (May 2021). (E) Fluorescein fundus angiography (FFA) of the right eye showing a focus of pin point hyperfluorescence temporally to the macula at 00.28.19 (in May 2021). (F) FFA of the right eye showing smokestack-like leakage temporally to the macula at 03.52.29 (in May 2021). (G) FFA of the left eye revealed 2 small staining points (yellow arrows) in the macular area, 1 at the inferior macula and one superotemporal to the optic nerve at 00.59.29 (in May 2021). (H) FFA of the left eye revealed 2 small staining points (yellow arrows) in the macular area, 1 at the inferior macula and 1 superotemporal to the optic nerve at 02.37.00 (in May 2021).Figure 2.. Follow-up visit in June 2021. (A) Infrared photo of the right eye (June 2021). (B) Corresponding optical coherence tomography (OCT) scan of the right eye. Temporally, a small amount of subretinal fluid (SRF) with a significant amount of subretinal fibrin-like material as well as folding of the inner retinal layers of the macula was observed (June 2021). (C) Fluorescein fundus angiography (FFA) of the right eye revealing a smokestack leakage temporally to the macula (yellow arrow) at 03.30.46. (June 2021). (D) Infrared photo of the left eye (June 2021). (E) Corresponding OCT scan of the left eye. A disruption of the RPE was noted, with no visible SRF (June 2021). (F) FFA of the left eye demonstrated 1 small staining point at the inferior macula (yellow arrow) at 05.27.30 (June 2021).Figure 3.. Follow-up of the patient in July 2021.(A) Infrared photo of the right eye in July 2021. (B) Corresponding optical coherence tomography (OCT) scan of the right eye revealed a small amount of SRF and a reduction of the fibrin-like material. Folding of the inner retinal layers at the macula was also observed (July 2021). (C) Infrared photo of the left eye in July 2021. (D) Corresponding OCT scan of the left eye remained stable, without subretinal fluid (SRF), with disruption of the RPE (July 2021).Figure 4.. Follow-up visit in August 2021. (A) Infrared photo of the right eye in August 2021. (B) Corresponding optical coherence tomography (OCT) scan showed resolution of neurosensory detachment of the macula, a small pigment epithelial detachment (PED), and absorption of most of the fibrin-like material with residual material of the fovea remaining temporally (August 2021). (C) Infrared photo of the left eye in August 2021. (D) Corresponding OCT scan of the left eye. Note retinal pigment epithelium (RPE) abnormalities, without neurosensory retinal detachment (August 2021).Figure 5.. September 2021 and October 2021 follow-up visits. (A) Infrared photo of the right eye in September 2021. (B) Corresponding optical coherence tomography (OCT) scan showed resolution of neurosensory detachment of the macula, a shallower pigment epithelial detachment (PED), and absorption of most of the fibrin-like material, with residual material of the fovea remaining temporally (September 2021). (C) Infrared photo of the left eye in September 2021. Green arrow showing the scanning area at the macula. (D) Corresponding OCT scan of the left eye. Note retinal pigment epithelium (RPE) abnormalities, without neurosensory retinal detachment at the macula (September 2021). (E) Infrared photo of the left eye in September 2021. Green arrow showing the scanning area at a dark area superotemporal to the optic nerve. (F) Corresponding OCT scan of the left eye. Notice the subretinal fluid (SRF) at the place of the one of the 2 small staining points that was superotemporal to the optic nerve in May 2021 and disappeared in June 2021 (September 2021). (G) Infrared photo of the right eye in October 2021. (H) Corresponding optical coherence tomography (OCT) scan showed resolution of neurosensory detachment of the macula absorption of most of the fibrin-like material, with residual material of the fovea remaining temporally (October 2021). (I) Infrared photo of the left eye in October 2021. Green arrow showing the scanning area at the macula. (J) Corresponding OCT scan of the left eye. Note RPE abnormalities without neurosensory retinal detachment at the macula (October 2021). (K) Infrared photo of the left eye in October 2021. Green arrow showing the scanning area at a dark area superotemporal to the optic nerve. (L) Corresponding OCT scan of the left eye. The SRF located superotemporal to the optic nerve, at the area were one of the staining points of May 2021 was located, is shallower (October 2021).

In Press

Case report  Brazil

Successful Case of Double Valve Replacement Surgery Using Autologous Blood Transfusion: A Patient's Autonom...

Am J Case Rep In Press; DOI: 10.12659/AJCR.943675  

0:00

Case report  Saudi Arabia

Pancreatitis with Intraabdominal Venous Thrombosis as an Initial Presentation of Parathyroid Adenoma: A Rar...

Am J Case Rep In Press; DOI: 10.12659/AJCR.943838  

0:00

Case report  Singapore

Delayed-Onset Hypnopompic Visual Hallucinations 20 Years After Initiation of Propranolol Therapy for System...

Am J Case Rep In Press; DOI: 10.12659/AJCR.944342  

Case report  China (mainland)

Odontogenic Keratocyst in Maxillary Sinus with Ectopic Third Molar: A Case Report

Am J Case Rep In Press; DOI: 10.12659/AJCR.944543  

Most Viewed Current Articles

07 Mar 2024 : Case report  USA 39,654

Neurocysticercosis Presenting as Migraine in the United States

DOI :10.12659/AJCR.943133

Am J Case Rep 2024; 25:e943133

0:00

10 Jan 2022 : Case report  Germany 31,349

A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...

DOI :10.12659/AJCR.935263

Am J Case Rep 2022; 23:e935263

23 Feb 2022 : Case report  USA 18,313

Penile Necrosis Associated with Local Intravenous Injection of Cocaine

DOI :10.12659/AJCR.935250

Am J Case Rep 2022; 23:e935250

19 Jul 2022 : Case report  Saudi Arabia 18,005

Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19

DOI :10.12659/AJCR.936128

Am J Case Rep 2022; 23:e936128

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923