Traumatic central serous chorioretinopathy.

Dear Sir,

We read with keen interest, the article - traumatic serous chorioretinopathy, which has described the successful management of central serous chorioretinopathy 1 day posttrauma in the left eye.[1] However, we have certain questions to make the article more pertinent.

Why were so many investigations carried out?

The patient presented with anterior nongranulomatous uveitis and serous macular detachment, which was obviously due to trauma. There are certain uveitic entities which can have serous detachments such as VKH syndrome, scleritis, birdshot chorioretinopathy, and sympathetic ophthalmitis,[2] but the clinical appearance in this patient was not suggestive of any of these entities. Hence, so many tests were unnecessary in our opinion, especially in the era where doctors are trying to reduce health care costs.

Why was fundus fluorescein angiography (FFA) not done on presentation?

This test would have confirmed whether there was an actual leak or whether there was diffuse leakage from choroidal vessels which could result in serous elevation of the macula.[3] FFA was done after 3 weeks which revealed no active leak.

Central serous retinopathy (CSR) is an ocular manifestation of a systemic abnormality such as type A personality, Cushing's syndrome, and use of systemic steroids.[4] CSR like pictures have been described in post organ transplant patients, and in cases of trauma as well as Gass has described CSR occurring in predisposed patients after trauma[3] and this is most likely to be due to the stress induced by trauma rather than the local trauma itself. Serous detachments can occur immediately after trauma, but the pathogenesis is different.[5] It could be due to leakage from choroidal vessels which can resemble CSR.

To summarize, serous elevations have been reported after trauma but whether they can be called CSR is questionable. CSR is a specific entity with characteristic FFA appearance and without a well-known cause. Posttraumatic serous elevation should rightly be called Traumatic choroidopathy and not clubbed with CSR.

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