INTRODUCTIONLong-term, high-dose corticosteroid therapy is well-known to cause systemic and ocular complications. A lesser known complication is chronic central serous chorioretinopathy (CSCR). Although idiopathic central serous chorioretinopathy (CSCR) is known to be mild with spontaneous recovery and minimal effects on the final visual acuity, chronic CSCR as a complication of long- term steroid therapy behaves differently, and may cause irreversible visual impairment.

CLINICAL PICTUREThree cases of chronic, recurrent CSCR were precipitated by longterm corticosteroids prescribed for post-renal transplant immunosuppressive therapy, postpituitary surgery and pemphigus vulgaris.

TREATMENT AND OUTCOMETwo cases resolved with tapering of corticosteroids while one case was treated by focal laser photocoagulation. Two eyes had severe impairment of vision as a result of subretinal scar formation while the other 4 eyes had mild reduction of visual acuity from retinal epithelium pigment atrophy.

CONCLUSIONLong-term corticosteroid therapy can be complicated by severe, chronic and recurrent CSCR and occasionally peripheral exudative retinal detachment. This may result in subretinal fibrosis and permanent loss of vision.

Adult ; Blindness ; chemically induced ; Choroid Diseases ; chemically induced ; diagnosis ; therapy ; Fluorescein Angiography ; Glucocorticoids ; adverse effects ; Humans ; Hydrocortisone ; adverse effects ; Male ; Middle Aged ; Prednisolone ; adverse effects ; Retinal Detachment ; chemically induced ; diagnosis ; therapy

A 53-year-old Asian woman was treated with hydroxychloroquine and chloroquine for lupus erythematosus. Within a few years, she noticed circle-shaped shadows in her central vision. Upon examination, the patient's visual acuity was 20 / 25 in both eyes. Humphrey visual field (HVF) testing revealed a central visual defect, and fundoscopy showed a ring-shaped area of parafoveal retinal pigment epithelium depigmentation. Fundus autofluorescence imaging showed a hypofluorescent lesion consistent with bull's eye retinopathy. Adaptive optics scanning laser ophthalmoscope (AO-SLO) revealed patch cone mosaic lesions, in which cones were missing or lost. In addition, the remaining cones consisted of asymmetrical shapes and sizes that varied in brightness. Unlike previous studies employing deformable mirrors for wavefront aberration correction, our AO-SLO approach utilized dual liquid crystal on silicon spatial light modulators. Thus, by using AO-SLO, we were able to create a photographic montage consisting of high quality images. Disrupted cone AO-SLO images were matched with visual field test results and functional deficits were associated with a precise location on the montage, which allowed correlation of histological findings with functional changes determined by HVF. We also investigated whether adaptive optics imaging was more sensitive to anatomical changes compared with spectral-domain optical coherence tomography.
Chloroquine/*adverse effects/therapeutic use ; Diagnosis, Differential ; Female ; Humans ; Image Enhancement/*methods ; Lupus Erythematosus, Systemic/drug therapy ; Macula Lutea/drug effects/*pathology ; Middle Aged ; Ophthalmoscopy/*methods ; Retinal Diseases/chemically induced/*diagnosis

A 53-year-old Asian woman was treated with hydroxychloroquine and chloroquine for lupus erythematosus. Within a few years, she noticed circle-shaped shadows in her central vision. Upon examination, the patient's visual acuity was 20 / 25 in both eyes. Humphrey visual field (HVF) testing revealed a central visual defect, and fundoscopy showed a ring-shaped area of parafoveal retinal pigment epithelium depigmentation. Fundus autofluorescence imaging showed a hypofluorescent lesion consistent with bull's eye retinopathy. Adaptive optics scanning laser ophthalmoscope (AO-SLO) revealed patch cone mosaic lesions, in which cones were missing or lost. In addition, the remaining cones consisted of asymmetrical shapes and sizes that varied in brightness. Unlike previous studies employing deformable mirrors for wavefront aberration correction, our AO-SLO approach utilized dual liquid crystal on silicon spatial light modulators. Thus, by using AO-SLO, we were able to create a photographic montage consisting of high quality images. Disrupted cone AO-SLO images were matched with visual field test results and functional deficits were associated with a precise location on the montage, which allowed correlation of histological findings with functional changes determined by HVF. We also investigated whether adaptive optics imaging was more sensitive to anatomical changes compared with spectral-domain optical coherence tomography.
Chloroquine/*adverse effects/therapeutic use ; Diagnosis, Differential ; Female ; Humans ; Image Enhancement/*methods ; Lupus Erythematosus, Systemic/drug therapy ; Macula Lutea/drug effects/*pathology ; Middle Aged ; Ophthalmoscopy/*methods ; Retinal Diseases/chemically induced/*diagnosis

A 63-year-old man with a history of liver transplantation presented to our clinic complaining of visual disturbance. He had been receiving tacrolimus (FK 506) for 30 months (6 mg/day for 2 years and 3 mg/day for 6 months); he reported that the visual disturbance began while taking tacrolimus. A full ophthalmologic examination and electrophysiologic and imaging studies were performed. The best corrected visual acuity was 0.1 in both eyes. There were no abnormal finding in the anterior segment, pupillary reflexes were normal and, there was no swelling in either optic disc. Although the foveal reflex was slightly decreased, fluorescein angiography revealed non-specific signs, with the exception of a window defect. A multifocal electro-retinogram revealed decreased amplitude of the central ring. A Swedish interactive threshold algorithm-standard 10-2 visual field test revealed a central scotoma. These findings suggest that tacrolimus may result in maculopathy. Therefore, careful ophthalmologic examination is necessary in the patients taking tacrolimus.
Electroretinography ; Evoked Potentials, Visual ; Fundus Oculi ; Humans ; Immunosuppressive Agents/*adverse effects/therapeutic use ; Liver Transplantation ; Macula Lutea/*drug effects ; Male ; Middle Aged ; Postoperative Care ; Reaction Time ; Retinal Diseases/*chemically induced/diagnosis ; Scotoma/chemically induced/diagnosis ; Tacrolimus/*adverse effects/therapeutic use ; Tomography, Optical Coherence

INTRODUCTIONThe aim of this study was to analyse the thickness of the retinal nerve fibre layer (RNFL) of pulmonary tuberculosis patients on ethambutol and isoniazid.

MATERIALS AND METHODSThis was a prospective cohort study where patients with newly diagnosed pulmonary tuberculosis requiring chemotherapy, including ethambutol and isoniazid, were imaged using scanning laser polarimetry. Their mean baseline RNFL thickness and various scanning laser polarimetry parameters of both eyes were measured 2 weeks after the commencement of chemotherapy. The measurements were repeated at 3 months and 6 months after treatment. The various parameters of the baseline and the follow-up measurements were compared using paired sample t-test with Bonferroni correction.

RESULTSTwenty-four patients (16 males and 8 females; mean age, 51.0 +/- 17.6 years) were recruited. There was no statistically significant difference between the baseline and the follow-up measurements in RNFL thickness and all other scanning laser polarimetry parameters.

CONCLUSIONIn this cohort of subjects, there was no subclinical change in RNFL thickness detected by scanning laser polarimetry in pulmonary tuberculosis patients on chemotherapy, including ethambutol and isoniazid, after 6 months of treatment.

Adult ; Aged ; Aged, 80 and over ; Antitubercular Agents ; adverse effects ; therapeutic use ; Diagnostic Techniques, Ophthalmological ; Ethambutol ; adverse effects ; therapeutic use ; Female ; Humans ; Isoniazid ; adverse effects ; therapeutic use ; Lasers ; Male ; Middle Aged ; Prospective Studies ; Retinal Diseases ; chemically induced ; diagnosis ; Tuberculosis, Pulmonary ; drug therapy