Atypical Case of Persistant Subretinal Fluid, Mimicking an Acute Exudative Polymorphous Vitelliform Maculopathy or a CSC Philippe Koch

 

 

 

 

 

 

 

 

 

Introduction:

To describe the case of an atypical Persistent Subretinal Fluid presentation following a macula ON R.D.

Results:

A 64 y.o woman developed a Macula ON retinal detachment extending from 5 to 11 o’clock, with a unique retinal break at 10 o’clock but threatening the Macular area. For such reason, a vitrectomy was realised to drain the subretinal fluid before it detaches the macular area, associated to a cryocoagulation of the break and SF6 gaz tamponnade. No PFCL was injected and subretinal fluid was aspirated through the break. Surgery went normally, without any complication and early follow-up were common. Even if a trained medical retina specialist as well as a trained surgical retina specialist has first examined the patient, no particular retinal pathologic images have been noticed in the fundus before surgery. However, when SF6 gas bubble totally disappeared three weeks after surgery, a huge amount of yellowish retinal lesions were observable, located between the RPE and Photoreceptor layers over the whole retina as exemplified by OCT, and associated to the accumulation of inferior subretinal fluid. Such lesions should have been mis-diagnosed as a polymorphous vitelliform maculopathy or a Central Serous Choroidopathy, but being unilateral since the second, contralateral, eye is perfectly normal. A complete examination combining common blood examination, psychological investigations, repeated visual acuity measurement, extensive fundus examination by five retina specialists (including Uveitis Specialists), Macular OCT, Fluoroangiography, ICG, Visual Field, Brain CT-Scan & MRI were realized without any positive results else than a yellowish sur-elevation of the RPE-Photoreceptor barrier and an inferior subretinal fluid accumulation. Visual acuity (0.6) and retinal lesions remained the same during one year, without any aggravating or resolving features.

Conclusion:

Some form of persistent subretinal fluid can take an uncommon presentation, mimicking Acute exsudative Polymorphous vitelliform maculopathy or a CSC. Due to its unilaterality and since no other factor have been evidenced, an atypical persistent subretinal fluid presentation was diagnosed.

Contact Details:

Email: drkoch@docteurkoch.be
Cell Phone: +32496104081

Philippe Koch