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The European VitreoRetinal Society and Dibya Prabha
This healthy 43YO male presented with gradual bilateral blurring. Vision was 20/20 in his normal OD and 20/30 OS.
Color photography shows an elevated, glistening, inner retinal yellow-white mulberry-like lesion in the inferior midperiphery. Surrounding subretinal pigmentary changes are noted. OCT through this lesion shows a markedly thickened, disorganized, hyperreflective retina. Retinoschisis is noted nasally. The lesion is markedly hyperreflective on B-scan ultrasonography and hyper-autofluorescent on fundus autofluorescence.
Learning Points:
Retinocytomas are fleshy, opalescent, benign tumors that are felt to represent spontaneously regressed retinoblastoma (RB). They appear identical to previously radiated RB tumors. The risk of a germline RB1 mutation in sporadic unilateral retinoblastoma or retinocytoma is about 10-20%.
Clinically, retinocytomas can resemble astrocytic hamartomas. However, retinocytomas often have underlying RPE changes and chorioretinal scarring (as in our patient), which would not be present with astrocytic hamartomas.
The brain MRI was normal, and observation was recommended.
Surv Ophthalmol. 2026 Sep-Oct;71(5):1249-1260. doi: 10.1016/j.survophthal.2026.03.008.
Acute ICSC: PDT effective; Anti-VEGF transient 1-month decreased fluid without sustained VA or anatomic benefits — Systematic review and meta-analysis
Acute central serous chorioretinopathy (CSC) may resolve spontaneously, but risks progression to chronic disease with visual impairment. We performed a PRISMA-compliant meta-analysis evaluating photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF) agents versus observation in acute CSC (<6 months), searching PubMed, EMBASE, and CENTRAL (October 2014 – May 2025) for comparative studies. Eleven studies (5 randomized, 6 non-randomized; 464 eyes) were included. PDT demonstrated robust superiority over observation, achieving significant best-corrected visual acuity gains and sustained central macular thickness reductions at 1, 3, and 12 months. Notably, PDT-treated eyes were nearly 4 times more likely to achieve complete fluid resolution at 1 month, a benefit maintained across all follow-up intervals. Conversely, anti-VEGF therapy provided only a transient anatomical reduction at 1 month, without significant visual improvement or sustained benefit. Both interventions were well tolerated. In conclusion, half-dose PDT provides durable anatomical and functional improvements for acute CSC, significantly accelerating fluid resolution and visual recovery. While observation remains a valid initial approach, early PDT is practically advantageous for patients requiring rapid visual rehabilitation or to mitigate permanent photoreceptor damage from persistent fluid. Anti-VEGF therapy offers limited, transient anatomical effects without functional benefit and should be reserved for atypical cases or when PDT is unavailable.
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