High dose steroid and acute visual loss: case report and discussion on acute central serous chorioretinopathy in elderly
Keywords:Central serous chorioretinopathy, Steroids, Retinal detachment
Central serous chorioretinopathy (CSCR) is one of sight-threatening side effects of systemic steroids. Although it is uncommon, CSCR seriously threatens the patient’s vision and it has the potential for permanent visual morbidity. This article reports about a 54-year-old Malay gentleman who developed central vision loss after received a course of oral prednisolone 50 mg/day for a month period for the treatment of multifocal motor neuropathy. His vision recovered 1 year after cessation of steroid as the CSCR resolved. However, subjectively the visual quality is poor. Steroids in any route of administration can induce CSCR and it must be used with precaution especially in the elderly. Although resolutions are usually spontaneous after cessation of steroid, chronic and recurrent CSCR can lead to irreversible visual impairment. Judicious use of systemic steroids, early detection and prompt co-management with the treating physician can help prevent permanent visual disturbance.
Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9(1):30.
Nicholson B, Noble J, Forooghian F, Meyerle C. Central serous chorioretinopathy: update on pathophysiology and treatment. Surv Ophthalmol. 2013;58(2):103-26.
Bouzas EA, Scott MH, Mastorakos G, Chrousos GP, Kaiser-Kupfer MI. Central serous chorioretinopathy in endogenous hypercortisolism. Arch Ophthalmol. 1993;111(9):1229-33.
Allibhai ZA, Gale JS, Sheidow TS. Central serous chorioretinopathy in a patient taking sildenafil citrate. Ophthalmic Surg Lasers Imaging. 2004;35(2):165-7.
Hardwig PW, Silva AO, Pulido JS. Forgotten exogenous corticosteroid as a cause of central serous chorioretinopathy. Clin Ophthalmol. 2008;2(1):199-201.
Bouzas EA, Karadimas P, Pournaras CJ. Central serous chorioretinopathy and glucocorticoids. Surv Ophthalmol. 2002;47(5):431-48.
Wang M, Munch IC, Hasler PW, Prünte C, Larsen M. Central serous chorioretinopathy. Acta Ophthalmol. 2008;86(2):126 45.
Teke MY, Elgin U, Nalcacioglu-Yuksekkaya P, Sen E, Ozdal P, Ozturk F. Comparison of autofluorescence and optical coherence tomography findings in acute and chronic central serous chorioretinopathy. Int J Ophthalmol. 2014;7(2):350-4.
Tewari HK, Gadia R, Kumar D, Venkatesh P, Garg SP. Sympathetic-parasympathetic activity and reactivity in central serous chorioretinopathy: a case-control study. Invest Ophthalmol Vis Sci. 2006;47(8):3474-8.
Spitznas M. Pathogenesis of central serous retinopathy: a new working hypothesis. Graefes Arch Clin Exp Ophthalmol. 1986;224(4):321-4.
Marmor MF. New hypotheses on the pathogenesis and treatment of serous retinal detachment. Graefes Arch Clin Exp Ophthalmol. 1988;226(6):548-52.
Wakakura M, Song E, Ishikawa S. Corticosteroid-induced central serous chorioretinopathy. Jpn J Ophthalmol. 1997;41(3):180-5.
Koyama M, Mizota A, Igarashi Y, Adachi-Usami E. Seventeen cases of central serous chorioretinopathy associated with systemic corticosteroid therapy. Ophthalmologica. 2004;218(2):107-10.
Kitzmann AS, Pulido JS, Diehl NN, Hodge DO, Burke JP. The incidence of central serous chorioretinopathy in Olmsted County, Minnesota, 1980-2002. Ophthalmology. 2008;115(1):169-73.