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69-year-old man was seen in the office on 1/22/2010. He has had blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months. VISUAL ACUITY: Vision OD is 20/80, OS is 20/20. IOP: 13 OU. SLIT LAMP EXAM: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is a posterior vitreous separation and 1+ epiretinal membrane. OS: Vertical C/D ratio is 0.5. There is a posterior vitreous separation and some pigment irregularities inferior to the optic nerve. OCT SCAN: The OCT scan of the right eye shows a serous macular detachment and it also suggests a macular pucker. The left eye has a normal foveal OCT scan. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: The FA shows an interesting pattern of hyperfluorescence in each eye, suggesting chronic juxtapapillary central serous retinopathy in both eyes. There is hyperfluorescence adjacent to the optic nerve which tracts into the inferior periphery in a typical guttering pattern as you see in patients with central serous retinopathy and reaches the equator in each eye. Also, the hyperfluorescence does not involve the fovea. In the right eye, there is an area just adjacent to the optic nerve with increasing hyperfluorescence, but it is not striking and there is no filling of the fluorescein under the fovea in the late frames. IMPRESSION: 1. CHRONIC NONFOVEAL CENTRAL SEROUS RETINOPATHY – BOTH EYES 2. NEW EPISODE OF ACUTE CENTRAL SEROUS RETINOPATHY – RIGHT EYE 3. MACULAR PUCKER – RIGHT EYE DISCUSSION: I explained to the patient that he does, indeed, have central serous retinopathy in the right eye and now affecting the macula. Also, interestingly angiographically he has evidence of nonfoveal chronic central serous retinopathy in both eyes. I assured him that the chance of this healing itself is high. I suggested he return for check in two to three months if he is in the area, or even four months. If at that time it is no better, photodynamic laser could be considered to that area adjacent to the optic nerve.

chroniccsredru_28129.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne266 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne147 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru_28329.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne124 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru_28429.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne176 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru_28529.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne110 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru_28629.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne88 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru_28729.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne120 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru_28829.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne165 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne271 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru_28929.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne131 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru_281029.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne125 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru_281129.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne89 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru_281229.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne115 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru_281329.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne104 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru_281429.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne87 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru_281529.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne76 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru_281629.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne81 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsredru.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne96 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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OCT_OD_10DEG.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne138 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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OCT_OD_90DEG.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne101 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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OCT_OS_350DEG.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne145 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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OCT_OS_90DEG.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - Visudyne157 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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chroniccsrpostpdt.jpg
Chronic Central Serous Retinopathy - Gutter in Both Eyes - Treated with PDT - POST PDT Line Scan224 views69-year-old man with blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months.

VISUAL ACUITY: Vision OD is 20/80
FU: Treated with PDT after 6 months of observation with success. Treatment was done to area between nerve and fovea at 1/2 fluence.
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69-year-old man was seen in the office on 1/22/2010. He has had blurred vision in the right eye for about three weeks. He had a similar episode about twenty years ago which lasted about six weeks. He is not taking any steroids. He takes Lupron injections for his prostate cancer every three months. VISUAL ACUITY: Vision OD is 20/80, OS is 20/20. IOP: 13 OU. SLIT LAMP EXAM: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is a posterior vitreous separation and 1+ epiretinal membrane. OS: Vertical C/D ratio is 0.5. There is a posterior vitreous separation and some pigment irregularities inferior to the optic nerve. OCT SCAN: The OCT scan of the right eye shows a serous macular detachment and it also suggests a macular pucker. The left eye has a normal foveal OCT scan. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: The FA shows an interesting pattern of hyperfluorescence in each eye, suggesting chronic juxtapapillary central serous retinopathy in both eyes. There is hyperfluorescence adjacent to the optic nerve which tracts into the inferior periphery in a typical guttering pattern as you see in patients with central serous retinopathy and reaches the equator in each eye. Also, the hyperfluorescence does not involve the fovea. In the right eye, there is an area just adjacent to the optic nerve with increasing hyperfluorescence, but it is not striking and there is no filling of the fluorescein under the fovea in the late frames. IMPRESSION: 1. CHRONIC NONFOVEAL CENTRAL SEROUS RETINOPATHY – BOTH EYES 2. NEW EPISODE OF ACUTE CENTRAL SEROUS RETINOPATHY – RIGHT EYE 3. MACULAR PUCKER – RIGHT EYE DISCUSSION: I explained to the patient that he does, indeed, have central serous retinopathy in the right eye and now affecting the macula. Also, interestingly angiographically he has evidence of nonfoveal chronic central serous retinopathy in both eyes. I assured him that the chance of this healing itself is high. I suggested he return for check in two to three months if he is in the area, or even four months. If at that time it is no better, photodynamic laser could be considered to that area adjacent to the optic nerve.