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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

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

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).