To evaluate the reproducibility in measuring the velocities of perifoveal hyperfluorescent dots, we analyzed fluorescein angiographs of 24 eyes[24 patients]which had central serous retinopathy. Fluorescein angiography was performed with a scanning laser ophthalmoscope[SLO, Rodenstock, Mnchen, Germany]Distances between 5 moving hyperfluorescent dots in a perifoveal capillary were measured at each consecutive frame[interval 1/30 sec]. And then velocities of 5 fluorescent dots were measured with image analysis program by converting the distances to real retinal size using the Littmann's curve in 20 eyes. In the other 4 eyes, the velocities between 5 fluorescent dots of each 2 to 4 capillaries were measured. Perifoveal capillary mean blood flow velocity and standard deviation were 2.08 +/-0.36 mm/sec, and mean coefficient of variation of the velocities measured in a vessel of one patient was 12.58%. However, reliability of the velocities of 2 to 4 capillaries on the 4 eyes was relatively low. In conclusion, the measurement of velocities between perifoveal fluorescent dots with scanning laser ophthalmoscope may be a reproducible method for a perifoveal capillary. However, reliability of measuring velocities was not sufficient enough to use the velocity of one perifoveal capillary as macular blood flow.
Blood Flow Velocity ; Capillaries ; Central Serous Chorioretinopathy ; Fluorescein Angiography* ; Fluorescein* ; Humans ; Ophthalmoscopes* ; Retinaldehyde

PURPOSE: To compare the levels of serum cortisol and testosterone in acute and chronic central serous chorio-retinopathy (CSC). METHODS: Serum cortisol and testosterone levels in 30 patients with either acute or chronic CSC were evaluated using chemiluminescent immunoassay. RESULTS: The mean age was 42.43 +/- 6.37 years (range, 32 to 56 years). The mean 8:00 to 9.00 a.m. serum cortisol level was 12.61 +/- 4.74 microg/dL (range, 6.58 to 27.42 microg/dL). The mean serum testosterone level was 5.88 +/- 1.57 ng/dL (range, 2.81 to 9.94 ng/dL). The mean visual acuity was 20 / 65.07 +/- 40.56 (range, 20 / 25 to 20 / 200). There was no statistically significant difference in the mean levels of serum cortisol and testosterone between the acute and chronic cases (p > 0.05), but there was a statistically significant difference in the mean presenting visual acuity in the two groups (p < 0.05). CONCLUSIONS: All except one patient in the acute group had normal levels of serum cortisol. Testosterone levels were within the normal range in both the acute and chronic cases of CSC. There is unlikely to be any statistically significant difference in the mean levels of serum cortisol and testosterone between the acute and chronic cases, but there may be a statistically significant difference in the mean presenting visual acuity in these groups.
Acute Disease ; Adult ; Central Serous Chorioretinopathy/*blood ; Chronic Disease ; Female ; Humans ; Hydrocortisone/*blood ; Luminescent Measurements ; Male ; Middle Aged ; Testosterone/*blood ; Visual Acuity/physiology

PURPOSE: To describe a patient who presented with central serous chorioretinopathy after 2 months of tadalafil administration without any other underlying disease or medication. CASE SUMMARY: A 49-year-old male patient was transferred from a local clinic with metamorphopsia and decreased visual acuity in the right eye. His visual acuity was 6/20 in the right eye and 18/20 in the left eye. The fundus examination showed a large serous detachment between the superior and inferior blood vessel arcades in the right retina. In his medical history, he used tadalafil three times a week for 2 months. His medication was then stopped, and a follow-up examination was scheduled. After 2 months, a fundus examination showed resolution of the subretinal fluid, and his corrected visual acuity recovered to 20/20. CONCLUSIONS: Tadalafil (Cialis®) is a phosphodiesterase (PDE)-5 inhibitor and predominantly prescribed for the treatment of erectile dysfunction. PDE–5 inhibitors may be potent vasodilators in the retina and choroid, and may induce choroidal vessel engorgement leading to leakage across the retinal pigment epithelium and accumulation of subretinal fluid in selected patients. When making a diagnosis as central serous chorioretinopathy, the physician should confirm the causative drugs that are easy to miss, by performing a thorough review of the patient's medical history and promptly terminating the causative drugs.
Blood Vessels ; Central Serous Chorioretinopathy ; Choroid ; Diagnosis ; Erectile Dysfunction ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retina ; Retinal Pigment Epithelium ; Subretinal Fluid ; Tadalafil ; Vasodilator Agents ; Vision Disorders ; Visual Acuity

PURPOSE: To compare clinical, angiographic, and optical coherence tomographic characteristics between eyes with acute Vogt-Koyanagi-Harada (VKH) disease and eyes with acute bilateral central serous chorioretinopathy (CSC), and to demonstrate distinguishing features between the two diseases in confusing cases. METHODS: The medical records of 35 patients with VKH disease and 25 patients with bilateral CSC were retrospectively reviewed. Characteristics according to slit-lamp biomicroscopy, ophthalmoscopy, fundus photography, fluorescein angiography, indocyanine green angiography, and spectral-domain optical coherence tomography were compared between the two diseases. RESULTS: Five of 35 patients (10 of 70 eyes, 14.3%) with VKH disease were initially misdiagnosed as CSC patients, and six of 25 patients (12 of 50 eyes, 24%) with bilateral CSC were initially misdiagnosed as patients with VKH disease. Pigment epithelial detachment in CSC and optic disc hyperemia in VKH disease show the highest positive predictive values of 100% for each disease. CONCLUSIONS: Optic disc hyperemia in VKH disease and pigment epithelial detachment in bilateral CSC are the most specific clinical manifestations of each disease at initial patient presentation.
Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Central Serous Chorioretinopathy/*diagnostic imaging ; Female ; Fluorescein Angiography ; Humans ; Hyperemia/diagnosis ; Indocyanine Green/administration & dosage ; Male ; Middle Aged ; Multimodal Imaging ; Ophthalmoscopy ; Optic Disk/blood supply ; Photography ; Retinal Detachment/diagnosis ; Retinal Pigment Epithelium/pathology ; Retrospective Studies ; Slit Lamp Microscopy ; Tomography, Optical Coherence ; Uveomeningoencephalitic Syndrome/*diagnostic imaging ; Young Adult