SCIENTIFIC POSTER 2016_Atypical Case of Persistant Subretinal Fluid, Mimicking Acute Exudative Polymorphous Vitelliform Maculopathy or CSC Philippe Koch

Introduction:

To describe the case of an atypical persistent subretinal fluid presentation following a macula on retinal detachment (R.D).

Results:

A 64 y.o woman developed a macula on RD extending from 5 to 11 o’clock, a retinal break at 10 o’clock with the RD threatening the macular area. For such reason, a pars plana vitrectomy was undertaken to drain the subretinal fluid before it detaches the macula, combined with cryocoagulation of the break and SF6 gas tamponade. No PFCL was injected and subretinal fluid was aspirated through the break. Surgery went normally, without any complication and early follow-up was uneventful. Even that a trained medical retina specialist as well as a trained surgical retina specialist have first examined the patient, no particular retinal pathologic images have been noticed in the fundus before surgery. However, when the SF6 gas bubble totally disappeared three weeks after surgery, a huge amount of yellowish retinal lesions were noted, located between the RPE and Photoreceptor layers over the whole retina as highlightened by OCT, and associated with the accumulation of inferior subretinal fluid. Such lesions may have been mis-diagnosed as a polymorphous vitelliform maculopathy or a central serous choroidopathy (CSC), but this was unilateral with pristine macula in the contralateral eye. A complete examination comprising routine blood examination, psychological investigations, repeated visual acuity measurement, extensive fundus examination by five retina specialists (including uveitis specialists), repeat macular OCT, fluoroangiography, ICG, visual field, brain CT-Scan & MRI were non revealining except for the yellowish 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 forms of persistent subretinal fluid can take an uncommon presentation, mimicking acute exudative polymorphous vitelliform maculopathy or a CSC. Due to its unilaterality, temporal relationship to RD and RD surgery and the absence of any other cause to explain the maculopathy, this case was diagnosed as an atypical persistent subretinal fluid after retinal detachment surgery.

Contact Details:

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

Philippe Koch