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Editor,—We read with interest the report by Lipet al,1 describing a 43 year old Asian man with central serous chorioretinopathy (CSCR) complicated by massive bilateral subretinal haemorrhage. The authors attributed the massive haemorrhage to CSCR itself. As the authors have pointed out, massive subretinal macular haemorrhage could be due to several causes, including idiopathic polypoidal choroidal vasculopathy (IPCV). In their article, there is a colour fundus photograph of the left eye (Fig 3A) showing a small red nodule in the centre of fovea with surrounding subretinal hemorrhage. The lesion corresponds to the hyperfluorescent spot in the fluorescein angiogram (FA) and indocyanine green angiogram (ICGA) in the same figure (Fig 3B, C). These clinical pictures are still compatible with the diagnosis of IPCV, although the presence of massive subretinal haemorrhage precludes the visualisation of other classic features of IPCV. Recently, we have had the opportunity of examining a similar patient presented with massive subretinal haemorrhage in one eye, with a history of CSCR documented by FA. ICG of the other eye showed the presence of classic signs of IPCV including dilated choroidal vessels with terminal polyps.2 As CSCR and IPCV are both choroidal vascular diseases, their presence in the same eye or same patient is possible.
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Editor,—We thank Kwok et al for their observations. Kwok et alfelt that the case presented by us was compatible with a diagnosis of idiopathic polypoidal choroidal vasculopathy (IPCV). We have recently described the indocyanine green angiographic (ICG) findings in a group of patients with IPCV, its different modalities of treatment and follow up over a period of 6 years.
The polyps in IPCV persist following recurrent haemorrhages, and only disappear following laser ablation. Ophthalmic imaging, before onset of the submacular haemorrhage, in this patient showed classic features of central serous retinopathy. There were no polypoidal lesions (including the fellow eye) seen before or after the submacular haemorrhage in our patient. The hyperfluorescent spot, shown on the fluorescein angiogram and the ICG, bears no resemblance to polypoidal lesion in IPCV. In addition, a solitary lesion is not a characteristic of IPCV.
We agree with Kwok et al that IPCV is a cause of massive submacular haemorrhage; the coexistence of two diseases in one patient is certainly possible. In this case, however, we feel there is no evidence that our patient had IPCV.