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Various ocular complications of anaemia including hard exudates, cottonwool patches, frame-shaped haemorrhages, and Roth spots, have been documented as anaemic retinopathy for many years. In addition, it has been reported that retinal venous tortuosity is directly related to severity of anaemia.1 However, bilateral serous macular detachment has never been reported to be complicated with anaemic retinopathy. Bilateral serous detachment of the macula has been reported in some patients with systemic or ocular disorders, including lymphoma,2 leukaemia, Vogt-Koyanagi-Harada syndrome, age related macular degeneration, and idiopathic central chorioretinopathy (ICSC).3,4 ICSC demonstrates central serous sensory detachments associated with leaks at the level of the retinal pigment epithelium. The classic features of ICSC are well known; this condition most commonly affects young or middle aged men between 30 and 50 years of age, occurs unilaterally and frequently in patients who have had a preceding stressful event, and has good visual prognosis.5 We describe an anaemic cancer patient with bilateral serous macular detachment similar to ICSC. We are unaware of other published reports similar to this case.
A 69 year old man admitted to the Kesennuma county hospital presented with mildly decreased vision and micropsia in the left eye for 1 week. Ocular history was unremarkable. Medical history was notable for gall bladder cancer diagnosed 2 months before presentation, for which the patient underwent surgery 6 weeks before presentation, and for anaemia. His haemoglobin had fallen to 8.0 g/dl secondary to the cancer 5 months before presentation. On consultation, his haemoglobin was 11.0 g/dl. The histological examination of the tumour showed undifferentiated carcinoma of the gall bladder.
Upon ophthalmological examination, best corrected visual acuity was 0.4 in the left eye and 0.6 in the right. Intraocular pressure was right eye 12 and left eye 14. Slit lamp examinations revealed no evidence of anterior chamber or vitreous inflammation in either eye. Both fundi showed serous macular retinal detachment and multiple intraretinal haemorrhages including several Roth spots and mild venous dilation (Fig 1, top). In both eyes, fluorescein angiography revealed macular leakage in the early phases and round subretinal pools in the late phases (Fig 1, bottom).
We observed the patient conservatively and, 1 week later, his visual acuity recovered by one line in both eyes. Furthermore, his visual function was recovering gradually without any particular therapy such as systemic steroid treatment. Two months after his first visit to our department, best corrected visual acuity was 1.0 in both eyes. Fundi were almost normal except for several vanishing intraretinal haemorrhages (Fig 2, top). Bilateral serous macular detachment disappeared completely and fluorescein angiography showed no macular leakage and no subretinal pools (Fig 2, bottom). However, his anaemia was still unimproved at the time.
Bilateral central serous detachment similar to ICSC was resolved and vision recovered spontaneously, but the patient’s anaemia did not improve. Although the pathogenesis of the bilateral serous macular detachment is unclear and histological proof is lacking in our case, pigment epithelial cell dysfunction of the bilateral macula and disruption of the blood-retinal barrier may occur as a result of anaemia or an idiopathic phenomenon. A case of bilateral serous retinal detachment resembling central serous chorioretinopathy (CSC) was reported to follow cervical steroid injection for treatment of chronic upper back pain. No drugs given to the patient in our department or the surgery department are known to cause serous macular detachment.6
This case highlights two points: that anaemic retinopathy from cancer is rarely complicated with bilateral serous macular detachment, which causes the patient moderate visual loss; and that a good return of vision may be possible spontaneously even if anaemia does not improve.
Proprietary interests, none.