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—Dr Wakakura suggests that the administration of systemic corticosteroids may have been a contributing factor to the development of serous retinal detachments (SRD) in two patients with thrombotic thrombocytopenia purpura (TTP).' While this possibility cannot be absolutely excluded, it seems unlikely for the following reasons.Central serous chorioretinopathy (CSR) and the SRD associated with TTP have differing clinical characteristics and mechanisms of pathogenesis. For example, fluorescein angiography typically demonstrates a few sites of late leakage without detectable abnormalities in the choroid in CSR, whereas the choroidopathy accompanying TTP and SRD is associated with multiple sites of late leakage and patches of choroidal nonperfusion. In addition, histopathologic studies have revealed widespread occlusive disease of the small choroidal vessels in patients with TTP and SRD, while similar changes have not been reported in those with CSR.2 Since CSR and the SRD associated with TTP differ in several important respects,
Lambert SR. Serous Retinal Detachment in Thrombotic Thrombocytopenic Purpura and Corticosteroid Therapy-Reply. Arch Ophthalmol. 1986;104(2):178. doi:10.1001/archopht.1986.01050140029009