Rawi Jongpipatchai¹,², Chinnapat Montrisuksirikun¹

The authors report a case of a 46-year-old man with bilateral bullous central serous chorioretinopathy (bCSC). The patient experienced sequential vision loss in both eyes, occurring six months apart. He denied any comorbidities and steroid use. During active disease in the right eye (OD), the visual acuity (VA) was 20/100 in OD and 20/20 in the left eye (OS). The anterior segment appeared normal. Fundus examination and macular optical coherence tomography (OCT) revealed pigment epithelial detachment (PED) with subretinal fluid (SRF). The patient was initially diagnosed with macular neovascularization and received intravitreal bevacizumab injections. Two weeks after the third injection, VA declined to hand motion, and the fundus examination revealed the inferior bullous retinal detachment and subretinal fibrosis extending from PED. Ruling out rhegmatogenous retinal detachment, the patient underwent vitrectomy with gas tamponade. No retinal break was detected intraoperatively, and retinal attachment was successfully achieved. Six months later, the VA in OS declined from 20/20 to 20/60. Fundus examination showed inferior bullous detachment with ripped retinal pigment epithelium (RPE) and exudates. Fundus angiography revealed diffuse RPE leakages. The diagnosis was revised to bilateral bCSC. Due to a shortage of verteporfin and ongoing disease progression after observation, the patient was prescribed oral spironolactone, which led to SRF resolution. During the 6-month follow-up, VA was 20/25 (OD) and 20/20 (OS), with the disease remaining inactive. In conclusion, vitrectomy with internal drainage and spironolactone may serve as an effective alternative treatment for bCSC in the context of verteporfin shortage.

Received 20 February 2025 | Revised 11 May 2025 | Accepted 15 May 2025

DOI: 10.35755/jmedassocthai.2025.6.506-511-02737