Hello, this is Dr. Ameen Marashi retina specialist from Aleppo Syria. This course is about clinical changes in RPE; this presentation is about a case report series - part three.

•A 63 years old lady phakic
•BCVA OD 20/25 OS 20/35, Complains from a reduction of central vision in OS.
•Fundus exam shows subretinal fluid OS.


Fundus examination shows granular RPE changes along with subretinal fluid and PED.

OCT shows central subretinal fluid with PED and granular RPE changes, along with elongation of photoreceptor cells and increased the thickness of the choroid and diametric of Hallers.

Fluorescein angiogram in early phase shows hyperfluorescence from granular RPE changes which increase and become more prominent in a mid-phase with hyperfluorescence from PED
wherein the late phase shows granular hyperfluorescence, sub-RPE, and subretinal Dye pooling.

The diagnosis is chronic Central serous retinopathy.

This patient managed with oral spironolactone 25 mg/day And rifampicin 300 mg a day. In addition to the subthreshold laser, the rationale behind combining the treatment is due to the exact mechanism is unknown behind CSR formation.
Treating central serous retinopathy is a clinical challenge, but it can resolve spontaneously with good prognosis
however better treatment response to selective mineralocorticoid receptor antagonists such as eplerenone, or non-selective such as spironolactone, However, potassium levels and liver enzymes levels should monitor under the supervision of an internist
another treatment option is rifampicin as it leads to suppression of cortisol secretions and when it combined with mineralocorticoid receptor antagonists a half dose used

Acetazolamide has used to enhance RPE pump function which may shorten the time for subjective and objective clinical resolution, but has no effect on either final visual acuity or recurrence rate of the disease.
Another treatment option is laser photocoagulation which now there are trends toward subthreshold laser which has stimulation effect on RPE and safer profile,
In chronic cases, a half dose PDT can utilize if the above treatment failed to resolve subretinal fluid.
The prognosis of CSR is good if it didn’t complicate into a choroidal neovascular membrane; intravitreal AntiVEGF can be used if there is Choroidal neovascular membrane only.



An eight years old girl phakic
BCVA OD HM OS 20/40, Complains from a reduction of central vision in both eyes.

Fundus exam shows golden sheen of the macula with Diffuse RPE atrophy and Pigmentary changes at the periphery.

OCT scan shows diffuse ellipsoid zone disruption and RPE atrophy inducing increased reflectivity of the choroid, although the fovea appears with normal contours the boundaries between retinal layers are not clear

This case is an example of RPE atrophy due to cone-rod dystrophy.

This patient has bad BCVA of HM due to cone-rod dystrophy, which can be autosomal recessive, dominant or X-linked disease which they usually suffer from dyschromatopsia and photophobia, in late-stage cone-rod dystrophy can cause legal blindness.

By that, we reach the end of this course of clinical changes in RPE which discussed mainly the RPE changes in AMD and most common macular diseases
; I hope you find this course is beneficial in your clinical practice.
Thank you for listening

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