Central serous chorioretinopathy secondary to tuberculosis: cause or coincidence

Concomitant cavernous sinus thrombosis and central serous chorioretinopathy in a patient with total ophthalmoplegia and monocular blindness: a case report

Cavernous sinus thrombosis (CST) is an unusual condition that can result in high mortality and morbidity rate if not treated immediately.

Case presentation

An Indonesian male, 47 years old, presented with total right ocular ophthalmoplegia followed by blindness, headache, ptosis, periorbital swelling, and hypoesthesia over the left V1 region. MRI of the brain showed suitable cavernous thickening until the right orbital apex, which in contrast showed enhancement suggestive of right Tolosa-Hunt syndrome. The patient was treated with a high dose of steroids, but the patient's complaints did not improve. The patient underwent digital subtraction angiography and found CST. The optical coherence tomography was found to be central serous chorioretinopathy. He was treated with an antibiotic, anticoagulant, and extraction of the right maxillary molar was performed to remove the source of the infection. After 3 weeks, visual acuity and optical coherence tomography examination were improved.

Discussion

A comprehensive examination, such as digital subtraction angiography, is essential to confirm CST diagnosis for the patient to obtain the right therapy. This report highlighted the value of the prompt diagnosis of CST through neuroimaging and the importance of proper therapy in patient management.

Conclusions

Early diagnosis, comprehensive examination, and proper treatment of CST will increase good prognosis.

Efficacy of oral rifampicin in chronic central serous chorioretinopathy

Objective:

To evaluate the role of oral rifampicin in the management of chronic central serous chorioretinopathy.

Methods:

Retrospective analysis of patients diagnosed with chronic central serous chorioretinopathy (duration >3 months) and treated with oral rifampicin 600 mg daily for a maximum period of 3 months was carried out. Baseline visual acuity, fundus fluorescein angiography, and optical coherence tomography were recorded and the patients were followed up. Resolution of subretinal fluid and improvement in visual acuity were the main outcome measures. Recurrence of subretinal fluid was noted. Any adverse reaction to the drug was monitored.

Results:

Nine eyes of eight patients were included in the study. The average age of the patients was 41.90 years (range 32–52 years). Mean duration of symptoms was 16 months (range 3–60 months). Mean duration of follow-up was 10.11 months (range 3–33 months). Fluorescein angiography showed four eyes with subfoveal leaks and five eyes with diffuse retinal pigment epitheliopathy. Complete resolution of subretinal fluid was achieved in four of the nine eyes – two patients at the end of 1 month, one patient each at the end of 2 and 3 months, respectively. Visual acuity improvement was noted in four of the nine eyes. Three patients had one-line improvement and one patient had a two-line visual improvement. None of the patients had severe adverse events for which the drug had to be discontinued. None of the patients had recurrence of subretinal fluid after the discontinuation of the drug.

Conclusion:

Oral rifampicin could provide a useful, effective, and cost-effective alternative for treatment of patients with chronic central serous choroidopathy and evidence of healthier retinal pigment epithelium, those with focal leakage. It was not effective in eyes with diffuse retinal pigment epitheliopathy.