Central Serous Chorioretinopathy as a Cause of Acute Vision Loss in Multiple Sclerosis.

Seyed Hossein Abtahi1 *

  1. Ophthalmic Research Center , Shahid Beheshti University of Medical Sciences; Tehran; Iran · Department of Ophthalmology; Labbafinejad Medical Center.

Abstract: Neurologists are well aware of visual disturbances associated with multiple sclerosis (MS) among which, ‘Idiopathic demyelinating optic neuritis’ (IDON) is almost always the cause. Our practice in Isfahan, Iran, has the highest rate of MS in Asia and Oceania [2]. We have observed MS patients with episodes of vision loss diagnosed incorrectly as a relapse of IDON. Some have been treated inappropriately with intravenous corticosteroids (IVCS). We have witnessed several instances of acute/subacute central serous chorioretinopathy (CSCR) misdiagnosed as IDON. Surprisingly, no quantitative data are available about the frequency of CSCR as a cause of acute visual loss in MS.

Methods: The Isfahan computerized MS cohort registry consists of patients diagnosed between April 2003 and July 2013. Their demographics are detailed elsewhere; but in brief, comprises 4536 subjects, 3508 females and 1028 males. Excluding presenting symptoms, we searched the clinical records from July 2013 (start date of our computerized surveillance recording) to July 2016.

Results: We identified 12 episodes of vision loss due to CSCR (ten unilateral and two bilateral cases) in 12 patients (eight males and four females). We estimated the annual frequency rate of CSCR in our MS population at 66.14 (95% CI: 13.64-193.16), with 28.51 (95% CI: 7.22-158.72) for females and 194.55 (95% CI: 23.57- 701.01) for males per 100,000, respectively. The frequency is not known for CSCR neither in the general Iranian population nor in other Middle Eastern countries, but based on a single paper a frequency of 9.9/100,000 for males and 1.7/100,000 for females is reported [3]. We calculated the odds ratio of CSCR frequency in Isfahan MS population to that in the general population of males and females at 19.68 (95% CI: 18.46-20.99; χ = 16693.82; P<0.0001), and, 16.77 95% (95% CI: 14.33- 19.64; χ = 2379.62; P<0.0001), respectively.

Conclusion: Taken together, acute/subacute vision loss in an MS case with history of corticosteroids administration should be subjected to full ophthalmologic examination and consultation with an ophthalmologist. A clue in favor of CSCR is the complaint of visual distortion such as micropsia or metamorphopsia in the absence of a relative afferent pupillary defect. A useful diagnostic tool is OCT which may show a typical blister over the macular area. This not only provides a window into the global MS disease process but can help exclude CSCR [5].





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