Indian Journal of Ophthalmology

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


Aditya Aseem, Kushagra Jain, Naresh Kumar Yadav, Ramesh Venkatesh 
 Department of Retina-Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st‘R’ Block, Rajaji Nagar, Benguluru, Karnataka, India

Correspondence Address:
Dr. Ramesh Venkatesh
Narayana Nethralaya, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Benguluru - 560 010, Karnataka
India




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;67:1254-1255


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 2020 Apr 2 ];67:1254-1255
Available from: http://www.ijo.in/text.asp?2019/67/7/1254/261040


Full Text



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

1Majumder 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.
2Nicholson BP, Atchison E, Idris AA, Bakri SJ. Central serous chorioretinopathy and glucocorticoids: an update on evidence for association. Surv Ophthalmol 2018;63:1-8.
3Chan LY, Adam RS, Adam DN. Localized topical steroid use and central serous retinopathy. J Dermatolog Treat 2016;27:425-6.
4Papadia 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.