Central Serous Chorioretinopathy with Subretinal Deposition of Fibrin-Like Material and Its Prompt Response to Ranibizumab Injections

Abstract

Purpose: Central serous chorioretinopathy (CSCR) manifests as neurosensory detachment of the macula and can be attributed to focal or multifocal leakage in the retinal pigment epithelium (RPE). Fibrin accumulation in the subretinal space is an unusual and heretofore unreported visually damaging manifestation of severe CSCR. Methods: The patient was followed up with the use of biomicroscopy, fluorescein angiography, and optical coherence tomography (OCT). Results: A 32-year-old woman was referred to our department complaining of metamorphopsia and decreased visual acuity in the right eye. Best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/20 in the left eye. Biomicroscopy revealed an irregularly shaped foveal elevation and wrinkling in the right eye. OCT showed a steep neurosensory retina elevation with a highly reflective material accumulation in the subretinal space, presumably fibrin. Our diagnosis was CSCR complicated by subretinal fibrin accumulation. Since most of these cases resolve spontaneously, the patient was kept under observation; 1 month later, the fibrin accumulation had expanded subfoveally (BCVA 20/200). The patient was offered 3 intravitreal ranibizumab injections. After the initial injection, BCVA improved to 20/50 and, after the 3 injections, to 20/30. Two months later (BCVA 20/30), fresh leakage was observed at the margin of the original lesion, and an additional intravitreal ranibizumab injection was performed. After another 2 months, BCVA stabilized at 20/25 and remained stable throughout the 12 months after the initial injection. Conclusions: Prompt recognition of CSCR complicated by subretinal fibrin and immediate intervention may result in recovery from this potentially devastating complication. Ranibizumab may be an alternative treatment option in the management of refractory CSCR complicated by subretinal fibrin accumulation.

Multifocal Central Serous Chorioretinopathy Associated with Steroids in a Patient with Myasthenia Gravis

“…Contrary to previous reports, however, the result was disappointing as the patient's BCVA continued to decline [10, 14]. Another possible therapeutic option in our patient was the use of focal argon laser coagulation at sites of leakage [1].…”

Multimodal imaging of posterior ocular involvement in McArdle's disease

“…Another possible mechanism involved is a choriocapillary endothelial hyperpermeability which could justify the prompt response to the anti‐VEGF treatment. Of note, Symeonidis et al reported an interesting case of central serous chorioretinopathy with fibrin‐like material and absence of choroidal neovascularisation which promptly responded to one ranibizumab injection. However, we cannot exclude with certainty that the hyper‐reflective material was secondary to the presence of a small area of choroidal neovascularisation which was not detectable on the currently available imaging modalities.…”

Peripapillary Subretinal Space of the Blunt Traumatic Optic Neuropathy: RPE/Bruch’s Membrane Complex Micro-Rips - The Novel SD-OCT Findings

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