Abstract 1: Steroid induced recurrent central serous chorioretinopathy in thyroid orbitopathy

Introduction: Central serous chorioretinopathy (CSCR) is an underdiagnosed retinal disorder characterized by well-definedmacular neurosensory retinal detachment and/or detachment of retinal pigment epithelium. However, it is quitesurprising that, we found only one case report in previous literatures describing CSCR in a patient who receivedsteroid therapy for GO. We report two cases where patients developed recurrent CSCR while under systemicsteroid therapy for severe thyroid ophthalmopathy. Case 1: A 34 years old man with severe thyroid orbitopathy complained of profound reduction in vision in right eyemore than left eye within one month of start of intravenous methylprednisolone (IVMP). He completed 12 cycles of weekly IVMP followed by rituximab infusion because of inadequate response to steroids. His bestcorrected visual acuity (BCVA) in both eyes dropped from 6/6 to 1/60. Fundus examination showed small andhyperemic optic nerve head with thickened nerve fibre layer in both eyes and right serous macular detachmentwith punctate yellow sub-retinal deposits. Optical coherence tomography (OCT) confirmed the diagnosis ofCSCR in right eye. Finally Orbital radiation was advised to save remaining vision in both eyes. His BCVA improved to right eye 6/18 and left eye 6/6. Case 2: A 34 years old man with Grave's disease of 6 months duration complicated by severe orbitopathy presentedwith blurring of vision and central scotoma of left eye after 2 weeks of start of oral prednisolone 80 mg/day intapering doses. His BCVA in left eye dropped from 6/6 to 6/9 with marginal improvement in orbitiopathy andsubjective symptom. Fundus examination showed a ring reflex with subretinal fluid at fovea in the left eye. OCT revealed typical lesions consistent with CSCR in left eye. There was marked improvement in proptosisafter decompression surgery with stable BCVA of 6/6 both eyes over the next follow ups. Conclusion: As it is a frequently encountered sight threatening disorder related to systemic GCs. It's important forendocrinologists and ophthalmologists to be mindful about the possible complication of CSCR while treatingGrave's Orbitopathy.