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      An Unusual Case of Unilateral Maculopathy

      case-report

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          Abstract

          A 44-year-old male presented with unilateral sudden onset reduced visual acuity. The optical coherence tomography (OCT) scan demonstrated submacular fluid with thickening and hyper-reflectivity of the outer retinal layers, together with subfoveal retinal pigment epithelial hyper-reflectivity corresponding to a small area of foveal interdigitation zone/ellipsoid zone (IZ/EZ) loss in the detached retina. An OCT 4 months later showed resolution of the submacular fluid, but the IZ/EZ loss persisted with thinning of the outer nuclear layer, resulting in a poor visual outcome. The clinical findings most likely represent a case of unilateral acute idiopathic maculopathy; however, the OCT features and poor visual outcome are not typical. Differential diagnoses include acute solar maculopathy, central serous chorioretinopathy, poppers maculopathy, whiplash maculopathy, and acute retinal pigment epitheliitis.

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          Most cited references15

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          Central serous chorioretinopathy.

          Central serous chorioretinopathy (CSC) is a disease of the retina characterized by serous detachment of the neurosensory retina secondary to one or more focal lesions of the retinal pigment epithelium (RPE). CSC occurs most frequently in mid-life and more often in men than in women. Major symptoms are blurred vision, usually in one eye only and perceived typically by the patient as a dark spot in the centre of the visual field with associated micropsia and metamorphopsia. Normal vision often recurs spontaneously within a few months. The condition can be precipitated by psychosocial stress and hypercortisolism. Ophthalmoscopic signs of CSC range from mono- or paucifocal RPE lesions with prominent elevation of the neurosensory retina by clear fluid - typical of cases of recent onset - to shallow detachments overlying large patches of irregularly depigmented RPE. The spectrum of lesions includes RPE detachments. Granular or fibrinous material may accumulate in the subretinal cavity. Serous detachment often resolves spontaneously. From first contact, counselling about the potential relation to stress and glucocorticoid medication is warranted. After 3 months without resolution of acute CSC or in chronic CSC, treatment should be considered. Resolution of detachment can usually be achieved in acute CSC by focal photocoagulation of leaking RPE lesions or, in chronic CSC, by photodynamic therapy. The effect of therapy on long-term visual outcome is insufficiently documented. Reattachment within 4 months of onset is considered a relevant therapeutic target because prolonged detachment is associated with photoreceptor atrophy. This suggests that the value of treatment depends upon proper selection of cases that will not resolve without therapy. Chronic CSC may be difficult to differentiate from occult choroidal neovascularization secondary to CSC. Patients with chronic CSC who receive glucocorticoid treatment for systemic disease can often be managed without having to discontinue this medication.
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            High-resolution optical coherence tomography findings in solar maculopathy and the differential diagnosis of outer retinal holes.

            To characterize the morphology of outer retinal holes caused by solar maculopathy, using spectral-domain optical coherence tomography (SD-OCT). This study is an observational case series. The SD-OCT findings of 3 patients (6 eyes) with chronic solar maculopathy are presented. SD-OCT demonstrates a characteristic appearance of partial-thickness hole(s) in the outer retina at the fovea. In 3 of 6 eyes, there is 1 hole directly beneath the umbo. In the remaining 3 eyes, there are multifocal holes spread across the fovea. Holes in more restricted layers, as had been previously reported with time-domain OCT, were not seen. In addition, advanced visualization of SD-OCT data demonstrates a hyperreflective ring around the outer retinal hole. SD-OCT can be used diagnose solar maculopathy. In patients with central scotomas, characteristic outer retinal hole(s) without inner retinal cystic changes may prompt the clinician to uncover an undisclosed history of sungazing. Similar OCT findings can be caused by welder's maculopathy, tamoxifen retinopathy, juxtafoveal macular telangiectasia, foveolar vitreomacular traction, or, rarely, a closed macular hole, achromatopsia, alkyl nitrite abuse, acute retinal pigment epitheliitis, or Stargardt disease. Copyright © 2011 Elsevier Inc. All rights reserved.
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              • Record: found
              • Abstract: not found
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              Acute retinal pigment epitheliitus.

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                Author and article information

                Journal
                COP
                COP
                10.1159/issn.1663-2699
                Case Reports in Ophthalmology
                S. Karger AG
                1663-2699
                2022
                May - August 2022
                09 June 2022
                : 13
                : 2
                : 429-434
                Affiliations
                Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
                Article
                519914 PMC9247484 Case Rep Ophthalmol 2022;13:429–434
                10.1159/000519914
                PMC9247484
                35950029
                90e0ac2e-2a1a-4c9e-b7d8-93204ed44811
                © 2022 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.

                History
                : 08 March 2021
                : 29 August 2021
                Page count
                Figures: 2, Pages: 6
                Funding
                Support provided by the NHS GGC macula research endowment fund.
                Categories
                Case Report

                Vision sciences,Ophthalmology & Optometry,Pathology
                Medical retina,Submacular fluid,Unilateral acute idiopathic maculopathy,Solar retinopathy,Optical coherence tomography

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