Bilateral chorioretinal folds in patients with central serous chorioretinopathy

Abstract

Introduction: Chorioretinal folds accompanied by central serous chorioretinopathy (CSC) are relatively uncommon. Here, we report CARE-compliant 2 patients with bilateral CSC chorioretinal folds and CSC that was followed-up for 2 years. Patient concerns: Case 1 was a 68-year-old female who complained of central visual field disturbance in her left eye. At the initial visit, her visual acuity (VA) was 20/20 in her right eye and 20/40 in her left. She had a history of systemic hypertension and an optic neuropathy in her left eye 20 years previously. Case 2 was a 63-year-old female with CSC in her right eye. Her VA at her first visit was 20/200 in her right eye and 20/20 in her left. Diagnosis: In case 1, an examination revealed serous retinal detachment (SRD) in the macula and optic disc atrophy in her left eye and both fundi showed chorioretinal folds. Fluorescein angiography showed a fluorescein leakage area in her left eye. In case 2, examination of fundus showed marked SRD in her right macula and both fundi had chorioretinal folds. fluorescein angiography showed a fluorescein leakage area and indocyanine green angiography showed vascular hyperpermeability, but no choroidal neovascularization. Interventions and outcomes: In case 1, the patient rejected the photocoagulation treatment. Her SRD resolved spontaneously and the VA improved to 20/20 in her left eye nine months after the first visit. But the chorioretinal folds in both eyes remain till date. In case 2, photodynamic therapy was planned; however, her SRD disappeared spontaneously. Photocoagulation therapy was performed at the leak point and her VA improved to 20/20, but the bilateral chorioretinal folds remain till date. There has been no recurrence of CSC in both the patients in the 2 year follow-up. Conclusions: The exact mechanism of CSC remains uncertain. Choroidal vascular abnormalities, such as choroidal hyperpermeability and dilated choroidal vessels associated with congested vortex veins, have been previously reported even in the unaffected eye of CSC patients. We theorize that the bilateral chorioretinal folds in CSC patients were possibly induced by the outflow congestion of the vortex vein due to the marked CSC and choroidal dysregulation. As the choroid expanded due to CSC, the overlying Bruch membrane was forced into folds. Further investigation of the pathophysiology of CSC is needed.