This 33YO male presented with recent central blurred vision in his right eye. He is a powerlifter and self-injects testosterone with possible anabolic steroids. Vision was 20/70 OD.
Triton color fundus photography shows a large serous macular detachment. Triton swept-source OCT shows a large serous neurosensory retinal detachment with an underlying shallow RPE detachment.
Optos fluorescein angiography shows classic findings for idiopathic central serous chorioretinopathy (ICSC), including peripheral blot leaks and a more central smokestack leak. Fluorescein leaks through a physiologic break in the RPE and accumulates in the subretinal space, giving rise to the smokestack, which is found in only 10% of cases. The fluorescein dye then diffuses and pools within the subretinal space, highlighting the extent of the serous detachment. Fluorescein also pools beneath the PED. In this case, subretinal pooling is almost always associated with an RPE detachment.
Most cases of central serous chorioretinal atrophy have a single unilateral leak. Multifocal cases are commonly associated with systemic steroids.
Our patient underwent PDT therapy, and vision returned to 20/20 two months later with dramatic resolution of the subretinal fluid and RPE detachment. Since he is asymptomatic with good vision in this eye, we continue to observe. He is trying to lower the amount of injected testosterone to lower the risk of recurrent ICSC.
