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JAMA Ophthalmology Clinical Challenge
April 2015

Serous Macular Detachment Following a Systemic Corticosteroid Injection

Author Affiliations
  • 1Ocular Oncology Service, Bascom Palmer Eye Institute and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
JAMA Ophthalmol. 2015;133(4):473-474. doi:10.1001/jamaophthalmol.2014.5237

A 38-year-old woman developed acute painless blurred vision in her right eye 3 weeks after receiving a single injection of corticosteroid in her deltoid for stenosing tenosynovitis. Her medical history was significant for stage II breast carcinoma with positive lymph nodes, which was diagnosed and treated 5 years prior. Subsequent annual metastatic surveillance test results had been negative for recurrence.

Visual acuity was 20/60 OD and 20/20 OS. Ophthalmoscopy of the right eye revealed a 6 × 6-mm circumscribed serous macular detachment with turbid subretinal fluid. Similar lesions were present in the nasal and inferior midperiphery (Figure, A and B). The left eye was unremarkable. Fluorescein angiography (FA) showed hyperfluorescent pinpoint hot spots with interspersed hypofluorescent patches in the areas of the lesions (Figure, C-F). Notably absent on FA were retinal pigment epithelium (RPE) leakage, a smokestack pattern of subretinal leakage, or RPE gutter defects. B-scan ultrasonography demonstrated choroidal thickening nasal to the optic disc (Figure, G); vascularity could not be assessed. Optical coherence tomography (OCT) showed a localized serous macular detachment with a focal area of choriocapillaris infiltration and thickening near the nasal edge of the detachment (Figure, H).

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