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LETTER TO THE EDITOR
Year : 2019  |  Volume : 67  |  Issue : 7  |  Page : 1254-1255

Comment: Clinical profile of uveitis patients developing central serous chorioretinopathy - An experience at a tertiary eye care center in India


Department of Retina-Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st‘R’ Block, Rajaji Nagar, Benguluru, Karnataka, India

Date of Web Publication25-Jun-2019

Correspondence Address:
Dr. Ramesh Venkatesh
Narayana Nethralaya, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Benguluru - 560 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_331_19

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How to cite this article:
Aseem A, Jain K, Yadav NK, Venkatesh R. Comment: Clinical profile of uveitis patients developing central serous chorioretinopathy - An experience at a tertiary eye care center in India. Indian J Ophthalmol 2019;67:1254-5

How to cite this URL:
Aseem A, Jain K, Yadav NK, Venkatesh R. Comment: Clinical profile of uveitis patients developing central serous chorioretinopathy - An experience at a tertiary eye care center in India. Indian J Ophthalmol [serial online] 2019 [cited 2019 Jul 20];67:1254-5. Available from: http://www.ijo.in/text.asp?2019/67/7/1254/261040



Dear Sir,

We read with great interest the article by Majumder et al.,[1] titled “Clinical profile of uveitis patients developing central serous chorioretinopathy: An experience at a tertiary eye care center in India.” In this paper, the authors have described the demographic and clinical features of central serous chorioretinopathy (CSCR) in eyes with previously diagnosed cases of uveitis. However, we have a few comments to make.

The two main factors responsible for the development of CSCR in uveitic patients are use of long-term corticosteroids (all routes)[2],[3] and inflammation itself leading to the breakdown of the blood–retinal barrier and increased choroidal hyperpermeability. Also, in cases of long-standing uveitis, the retinal pigment epithelium becomes dysfunctional leading to the poor absorption of the overlying subretinal fluid. With these mechanisms in mind, the authors have not addressed certain important aspects regarding the disease in their methodology or discussion. There is no mention in the paper regarding the mean duration of corticosteroid usage for developing CSCR, presence of unilateral/bilateral uveitis, whether the CSCR affected the same eye as the uveitis or fellow eye, was the uveitis active/inactive at the time of development of CSCR, and was the patient a known case of CSCR before the development of uveitis. All these factors are important and would play an important role in deciding the management of both uveitis and CSCR. Also, the presence of multiple leaks on fluorescein angiography could confuse other conditions like Vogt–Koyanagi–Harada syndrome, sympathetic ophthalmia, and posterior scleritis with CSCR.[4] Identification of pigment epithelial detachment on optical coherence tomography would tilt the diagnosis more in favor of CSCR in cases of dilemma.

Hence, to conclude, the presence of CSCR in uveitic eyes is always challenging in terms of diagnosis and formulating treatment strategy for both uveitis and CSCR.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Majumder PD, Menia N, Sudharshan S, Rao C, Ganesh SK, Biswas J. Clinical profile of uveitis patients developing central serous chorioretinopathy: An experience at a tertiary eye care center in India. Indian J Ophthalmol 2019;67:247-51.  Back to cited text no. 1
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2.
Nicholson BP, Atchison E, Idris AA, Bakri SJ. Central serous chorioretinopathy and glucocorticoids: an update on evidence for association. Surv Ophthalmol 2018;63:1-8.  Back to cited text no. 2
    
3.
Chan LY, Adam RS, Adam DN. Localized topical steroid use and central serous retinopathy. J Dermatolog Treat 2016;27:425-6.  Back to cited text no. 3
    
4.
Papadia M, Jeannin B, Herbort CP. Central serous chorioretinopathy misdiagnosed as posterior uveitis and the vicious circle of corticosteroid therapy. J Ophthalmic Vis Res 2015;10:303-8.  Back to cited text no. 4
[PUBMED]  [Full text]  




 

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