Ciliochoroidal effusion syndrome with central serous-like chorioretinopathy and secondary angle closure following exogenous testosterone use

Abstract

Purpose To report a unique presentation of ciliochoroidal effusion syndrome with central serous-like chorioretinopathy and secondary angle closure following exogenous testosterone use. Observations A 37 year-old man presented with a two week history of blurred vision, elevated intraocular pressure, and myopic shift in his right eye. Gonioscopy showed angle closure. After YAG iridotomy, ultrasound biomicroscopy (UBM) showed ciliochoroidal effusion and anterior rotation of the ciliary processes. Subsequent color fundus photography, enhanced depth imaging optical coherence tomography (EDI-OCT) and near-infrared reduced-illuminance autofluorescence imaging (NIR-RAFI) showed macular striae, choroidal folds, and increased choroidal thickness without presence of subretinal fluid (SRF) or pigment epithelial detachment (PED). Further questioning revealed the patient was using dermal testosterone gel for six months for treatment of hypogonadism. The patient stopped using the testosterone gel, and his visual acuity and intraocular pressure significantly improved six weeks later. Follow-up UBM showed significant improvement of the ciliochoroidal effusion, and repeat multimodal images demonstrated resolution of the macular striae and choroidal folds, and slightly improved choroidal thickness. Conclusions and importance Our patient demonstrates a rare case of ciliochoroidal effusion, central serous-like chorioretinopathy, and secondary angle closure that dramatically improved with cessation of testosterone. We believe that this unique clinical constellation is the first to be reported associated with exogenous testosterone use.

The associations between central serous chorioretinopathy and muscle relaxants

“…Many drugs associated with CSC have a propensity to modulate the vascular tone or choroidal blood flow (ChBF) through diverse mechanisms that include actions on the autonomic nervous system, as well as on vascular smooth muscles. [ 4 5 6 9 10 11 12 13 14 15 16 ] In our settings, 21% of CSC patients were idiopathic. This prompted us to explore the potential role of other drugs or comorbid conditions in CSC.…”

Cross Sectional Study among Intraocular Pressure, Mean Arterial Blood Pressure, and Serum Testosterone according to the Anthropometric Obesity Indices in Korean Men

“…The overdose of testosterone therapy can cause an increase in IOP due to the positive correlation of IOP-testosterone in normal-weight healthy men as shown by this study. In a previous study, increased IOP and ciliochoroidal effusion syndrome with chorioretinopathy due to using topical testosterone gel for 6 months was reported [ 29 ]. Prospective study of the correlation between the testosterone level and IOP is required to eliminate the bias variation which is affect serum testosterone level in men.…”