Central serous chorioretinopathy and uveitis Central serous chorioretinopathy and uveitis Rim Kahloun, MD Sonia Zaouali, MD Moncef Khairallah, MD Moncef Khairallah, MD Department of ophthalmology Fattouma Bourguiba University Hospital Faculty of Medicine,University of Monastir Monastir, Tunisia

History A 22-year-old man A 22-year-old man Behçet disease with pulomonary embolism and thrombophlebitis of the right lower limb Behçet disease with pulomonary embolism and thrombophlebitis of the right lower limb

First Presentation Visual acuity: 20/20 OD, 20/400 OS Visual acuity: 20/20 OD, 20/400 OS Mild anterior chamber inflammatory reaction OU Mild anterior chamber inflammatory reaction OU Vitreous cells: 1+ OD, 3+ OS Vitreous cells: 1+ OD, 3+ OS Intraocular pressure: 12 mmHg OD, 10 mmHg OS Intraocular pressure: 12 mmHg OD, 10 mmHg OS

Fundus examination shows diffuse retinal vein sheathing with branch retinal vein occlusion OU. OCT shows a serous retinal detachment (SRD) sparing the fovea OD, and a SRD associated with macular edema involving the fovea OS.

Fluorescein angiography Fluorescein angiography (FA) shows retinal vascular leakage in the posterior pole and inferiorly OU.

Initial Diagnosis  Behçet’s uveitis associated with retinal vasculitis and inflammatory SRD OU  The patient was treated with oral prednisone (1mg/kg/day) + azathioprine (2.5mg/kg/day)

Two weeks later Two weeks later Decrease in visual acuity OD and improvement in VA OS Decrease in visual acuity OD and improvement in VA OS Visual acuity: 20/32 OD, 20/63 OS Visual acuity: 20/32 OD, 20/63 OS Follow-up

Follow-up The SRD in the RE has enlarged, extending to the fovea with a focal leakage on FA. The SRD in the LE has resolved with macular star formation. Note the decrease of retinal vascular leakage on FA.

Final Diagnosis Central serous chorioretinopathy (CSCR) exacerbated by corticosteroid therapy in Behçet’s uveitis

Follow-up One month after direct laser photocoagulation to the focal leakage, along with gradual tapering of corticosteroids to 7.5 mg/day, SRD has completely resolved OD.

Conclusion The development of corticosteroid-induced CSCR in patients with uveitis should be borne in mind. The development of corticosteroid-induced CSCR in patients with uveitis should be borne in mind. This could be a challenging diagnosis, as features of CSCR might be initially misinterpreted as a worsening of the primary inflammatory condition. This could be a challenging diagnosis, as features of CSCR might be initially misinterpreted as a worsening of the primary inflammatory condition.

Conclusion Clinical examination and results of ancillary tests including the Clinical examination and results of ancillary tests including the dome-shaped pattern of SRD, the absence of associated macular edema, and the point of leakage on FA, as well as the worsening under corticosteroid therapy provide us clues for the definitive diagnosis. Early recognition of CSCR related to the use of corticosteroids and proper management by discontinuation of corticosteroid therapy, whenever possible, are mandatory to prevent further exacerbation of the disease, chronicity, and subsequent permanent visual loss. Early recognition of CSCR related to the use of corticosteroids and proper management by discontinuation of corticosteroid therapy, whenever possible, are mandatory to prevent further exacerbation of the disease, chronicity, and subsequent permanent visual loss.