presentation

2. ZAMEER SADHAYO

3.  What is?
 Risk factor.
 Symptoms.
 Signs.
 Investigations.
 Treatment.

4.  Idiopathic disorder (unknown cause)
 Localized serous detachment of the neurosensory
retina in the region of macula.

5.  Usually occur in male age 25-50 years
 In female typically occur at a slightly older age and has
association with pregnancy.
 Excessive use of steroids……..
 Psych0logical or physiological stress in rare case.
 People engaged in visually demanding work.

6.  Central scotoma

7.  Blurred vision
 Micropsia
 Metamorphopsia
 headache

8.  A round or oval detachment of the sensory retina is
present at the macula
 The subretinal fluid may be clear (particularly in early
lesions)
 One or more abnormal depigmented RPE foci
(sometimes small PED) of variable size may be visible
within the neurosensory detachment.
 The optic disc should be examined to exclude a
congenital pit.

9.  Amsler gird Amsler grid test to document the area of
field involved. See Appendix 4, Amsler Grid.
 Slit-lamp examination of the macula with a fundus
contact, Hruby, or 60- or 90-diopter lens to rule out a
concomitant CNV. In addition, search for an optic pit
of the disc.
 Indirect ophthalmoscope dilated fundus examination
with

10.  Optical coherence tomography (OCT)
 OCT shows an optically empty neurosensory
elevation. A RPE detachment or a deficit in the RPE
may also be seen.

11.  Fundus fluorescein angiography
may show the following patterns:
 Smoke stack
Manifests as early hyperfluorescein spot. that
progresses to form a vertical column by the late venous
phase.

12.  ‘Ink blot’ (most common) shows an early
hyperfluorescein spot. that gradually enlarges .

13.  Chronic CSCR
Course lasting more than 12 months constitutes a
minority and typically affects older patients.
• Multiple recurrent attacks may also give a similar
clinical picture.
• FA shows granular hyperfluoresceince with one or
more leaks.

14.  Observation:
Prognosis for spontaneous recovery of visual
acuity to at least 20/30 is excellent. Worse prognosis for
patients with recurrent disease, multiple areas of
detachment, or prolonged course.
 Laser therapy:
Accelerates visual recovery. Does not improve
final visual outcome. May increase risk of CNV
formation. Given the CNV risk, use low laser intensity.
Consider laser

15.  Laser therapy:
 Persistence of a serous detachment for several months.
 Recurrence of the condition in an eye that sustained a
permanent visual deficit from a previous episode.
 Occurrence in the contralateral eye after a permanent
visual deficit resulted from a previous episode.
 Patient requires prompt restoration of vision (e.g.,
occupational necessity).

16.  Stop steroids:
If possible, including topical skin preparations
and nasal sprays.
 anti-VEGF therapy:
If CNV develops.
 photodynamic therapy: (PDT)
In case of chronic cscr.

17.  Examine patients every 6 to 8 weeks until resolution.
THE END

18.  Kanski 7th edition clinical ophthalmology
 The Wills Eye Manual 6th edition
 Baki inter net se…………….