PMC6324152_01
(a) Fundus photograph of the right eye showing multifocal areas of yellowish subretinal exudation with inferior exudative retinal detachment. (b) Fundus photograph of the left eye showing multiple variably sized grayish yellowish lesions with a loss of foveal transparency. (c) Optical coherence tomography line scan passing through macula of the right eye revealing outer retinal fluid nasally and subretinal hyperreflective deposits temporal to the fovea. (d) Optical coherence tomography line scan passing through the macula in the left eye showing the presence of a streak of subretinal fluid
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F1
Slit-lamp biomicroscopic examination revealed the presence of multiple pockets of subretinal fluid in OU along with yellowish subretinal deposits and inferior exudative retinal detachment in OD [Fig. 1].
Fluorescein angiography (FA) at baseline. Early phase of FA revealing multiple hyperfluorescent dots with some areas of transmission hyperfluorescence in the right (a) and the left eye (b). Late phase of FA showing expanding dot sign and smoke-stack pattern in the right eye with pooling of the dye in the right eye (c) and expanding dot sign in the left eye as well (d)
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F2
Fluorescein angiography showed multifocal leaks in early phase with pooling of the dye in the late-phase OU [Fig. 2].
Follow-up at 6 weeks following focal laser treatment. (a) Fundus photograph of the right eye showing worsening of exudative detachment which had progressed to a bullous retinal detachment. (b) Fundus photograph of the left eye revealing pockets of subretinal fluid in the macular region. Optical coherence tomography line scan passing through the fovea showing increase in the subretinal fluid in the right (c) and the left eye (d)
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F3
At the 6-week follow-up, the BCVA had further deteriorated to counting fingers at 3 m in OD and 6/24 in OS with worsening of exudative retinal detachment in OD [Fig. 3].
Follow-up after 6 weeks of therapy with oral eplerenone (25 mg once a day). Fundus photograph of the right eye showing significant resolution of the exudative retinal detachment (a) with improvement in the retinal transparency and appearance of yellowish subretinal precipitates in the left eye (b). Optical coherence tomography line scan passing through the fovea showing decrease in the subretinal fluid in the right (c) and the left eye (d)
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F4
At 3-month follow-up (after 6 weeks of therapy with oral eplerenone), his BCVA improved to 6/36 in OD and 6/18 in OS [Fig. 4].
Follow-up after 12 weeks of therapy with oral eplerenone (25 mg once a day). Fundus photograph of the right eye shows complete resolution of the bullous exudative retinal detachment (a). Fundus photograph of the left eye (b) shows good retinal transparency and disappearance of the yellowish subretinal precipitates. Optical coherence tomography line scan passing through the fovea shows complete resolution of subretinal fluid in the right (c) and the left eye (OS) (d)
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F5
At 6-month follow-up (after 12 weeks of therapy with oral eplerenone), his BCVA had improved to 6/24 (parts) in OD and 6/12 in OS with complete resolution of the exudative retinal detachment in OD and total resolution of subretinal fluid in OS [Fig. 5].