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Francisco J. Ascaso, Esther Nuñez, Laura Lavilla, María A. Del Buey, José A. Cristóbal (Zaragoza, Spain)

Advantages:

Macular neurosensory retinal detachments (RD) that present in an atypical fashion constitute a diagnostic challenge to retinal specialists. We recommend observation when they are associated with a congenital retinal macrovessel (CRM). Fluorescein angiography (FA) proves to be valuable in establishing a definitive diagnosis.

Methods:

An otherwise healthy 46-year-old male complained with sudden visual loss and a black spot in his left eye. Fundus examination of the left eye revealed a serous elevation of the retina in the macular area. There was also a peculiar large aberrant superotemporal venule branching inferiorly and crossing the horizontal raphe. FA demonstrated a few microaneurysms in the capillary network of the perifoveal area, and an early leakage point of fluorescein that spread over time diffusely under the macula. OCT revealed a serous macular detachment without vitreous traction. The patient showed elevated 24-hour urine cortisol. A diagnosis of central serous chorioretinopathy (CSCR) with CRM was made. One month later visual acuity improved to 20/20, no dye leakage was detectable on FA and the serous RD resolved spontaneously.

Effectiveness / Safety:

In the present case, the decreased visual acuity was secondary to the serous RD that occurred suddenly at 46 years of age, even though the arteriovenous abnormality seemed to be congenital. Although combined presentation of serous RD with CRM has been previously described once, the macular detachment was attributed to vitreous traction which resolved spontaneously following posterior hyaloid detachment. Present case is the first report of a spontaneously resolved CSCR associated with CRM. There was no vitreous traction or arteriovenous communication that could account for the occurrence of CSCR. Microalterations of the blood-retinal barrier might take place around the abnormal macrovessel over the years and be associated with the anomalies of the perifoveal capillary bed.

Take home message:

Expectant attitude is effective and safety in these cases.