Faculty Bibliography

PURPOSE: The purpose of this study is to investigate the relationship between corticosteroid use and central serous chorioretinopathy (CSC). DESIGN: A prospective, case-controlled study. PARTICIPANTS AND CONTROLS: A consecutive series of patients with acute manifestations of CSC and a control group matched for age, race, and gender were recruited between January 2000 and July 2000. METHODS: A detailed clinical history was taken, and fundus examination with slit-lamp biomicroscopy was performed on all patients. Fluorescein angiography was obtained on the study patients. RESULTS: A total of 50 patients was recruited. Twenty-six patients (52%) had a history of exogenous steroid use, including oral, intravenous, intranasal, and intraarticular administration. Two additional patients had a history of endogenous hypercortisolism (Cushing's syndrome). In a matched control group, eight patients (18%) had a history of steroid use. The difference in corticosteroid exposure between study patients and controls was statistically significant (P < 0.0001). MAIN OUTCOME MEASURES: History of corticosteroid use or Cushing's syndrome. CONCLUSIONS: This study is consistent with previous reports associating steroid use with CSC. It identifies corticosteroids as a significant risk factor for the development of acute, exudative macular manifestation and implicates hypercortisolism as a factor in the pathogenesis of this disorder. Several forms of corticosteroid administration were observed to be a risk factor for CSC. Accordingly, susceptible patients in need of corticosteroids should be advised of the risk of developing acute manifestations of CSC

BACKGROUND: Variability is introduced in three-dimensional (3-D) ultrasound assessments of intraocular tumours when multiple observers examine the same tumour or when multiple scans and measurements of the same tumour are carried out. We evaluated the magnitude and sources of variation associated with 3-D ultrasound measurements of choroidal tumour volume. METHODS: Three examiners performed 3-D ultrasonography of five choroidal tumours. Each examiner performed three scans of each tumour and then measured each scan three times to determine the volume. We determined the variation attributable to differences between examiners, scans and measurements by evaluating the contribution of each to the overall variation in tumour volume. A similar process was performed for tumour height for comparison purposes. RESULTS: The reliability of tumour volume measurements was found to be very high. The amount of overall variation, as defined by the coefficient of variation, was similar for tumour volume and tumour height and ranged from 4% to 17%. A total of 97% of the variation in tumour volume measurements and 84% of the variation in tumour height measurements was due to differences between tumours. Differences between examiners accounted for the most of the remaining variation (2% for volume and 7% for height). INTERPRETATION: Three-dimensional ultrasonography of intraocular tumours was highly reliable. Differences between examiners were the main source of variation

PURPOSE: To describe the clinical and angiographic features of patients with polypoidal choroidal vasculopathy, exudative detachment of the macula, and an associated retinal microangiopathy. METHODS: Case series. RESULTS: Four patients with chronic exudative detachment of the macula with a variable degree of lipid deposition are described. The retina in the detached area, but not beyond, was noted to have a microangiopathy. There was capillary telangiectasia, microaneurysm formation, patchy nonperfusion, and intraretinal leakage. In each patient, there were no other retinal vascular changes in the fundus of either eye. The fluorescein angiogram showed subretinal leakage suspicious for occult choroidal neovascularization. The indocyanine green angiogram showed the presence of underlying polypoidal choroidal neovascularization, accounting for the exudative detachment. After photocoagulation, the retinal angiopathy improved, but not completely. CONCLUSION: Retinal microangiopathy may occur in a chronic macular detachment secondary to polypoidal choroidal neovascularization. The development of these secondary retinal changes is not clearly understood; however, hypoxia from the chronic detachment, a neurotoxic effect from the lipid deposition, or a biochemically induced microvascular abnormality from secretion of vasogenic mediators are possible mechanisms. Indocyanine green angiography is helpful in making a definitive diagnosis. Clinicians should be aware that a retinal microangiopathy may occur in such eyes so that the proper diagnosis can be made and appropriate treatment administered

BACKGROUND: Controversy exists as to whether a common causal entity is responsible for multifocal choroiditis (MFC) and multiple evanescent white dot syndrome (MEWDS). It is commonly known that patients with MEWDS can later develop manifestations of MFC, but the reverse is rarely seen. PURPOSE: To report cases of MEWDS in patients previously diagnosed with MFC. DESIGN: Retrospective case series. PARTICIPANTS: Four female patients 29 to 34 years old. METHODS: The charts of four patients with acute unilateral onset of MEWDS and evidence of previous MFC were examined retrospectively. MAIN OUTCOME MEASURES: Photographic and angiographic interpretation of fundus appearance. RESULTS: At the time of diagnosis with typical MEWDS, one patient had a documented previous episode of acute MFC; one patient had previous bilateral choroidal neovascularization associated with discrete, posterior atrophic scars; and two patients had peripheral discrete chorioretinal pigmented lesions and peripapillary atrophy. CONCLUSIONS: MEWDS may occur after MFC. Now that both directions of disease progression, MFC to MEWDS and MEWDS to MFC, have been well documented, it is likely that there is a common host susceptibility between these two distinct clinical diseases, if not a common pathogenesis

OBJECTIVE: To describe clinical and angiographic features of patients with central serous chorioretinopathy (CSC) who had yellowish subretinal deposits forming a reticulated leopard-spot pattern during fluorescein angiography. METHODS: We conducted case studies using the clinical and photographic records of 5 patients. RESULTS: All 5 patients were older men between the ages of 68 and 81 years who had been treated with corticosteroids and had bilateral CSC. Nine eyes of the 5 patients developed yellowish deposits in a reticulated pattern in the macular region under the chronic detached neurosensory retina. The pattern of leopard-spot deposits was well demonstrated on the fluorescein angiogram, with hypofluorescence in most of the deposits and hyperfluorescence from atrophy of the retinal pigment epithelium. Later phases of the fluorescein angiographic study showed leaks from the retinal pigment epithelium. During the indocyanine green angiography evaluation of 4 patients, all had bilateral multifocal patches of hyperfluorescence in the midphase, findings typical of CSC. CONCLUSIONS: Yellowish deposits forming a reticulated leopard-spot pattern may occur under the neurosensory retina and are associated with chronic neurosensory detachment caused by CSC. All patients were older men being treated with corticosteroids. This report described a newly recognized finding: the subretinal deposition of a yellowish material in a leopard-spot pattern in eyes with CSC