Macular serous retinal detachment caused by subretinal leakage in tilted disc syndrome

Objective: To describe a previously unreported complication of tilted disc syndrome: serous retinal detachment, caused by subretinal leakage, that mimics chronic idiopathic central serous chorioretinopathy (ICSC). Design: Retrospective cohort study. Participants: Five patients (five eyes) participated. Main Outcome Measures: Fluorescein angiographic features were measured. Results: All patients presented with visual loss and metamorphopsia, Fundus examination showed features typical of tilted disc syndrome, including obliquely directed long axis of the disc, situs inversus, retinal pigment epithelium conus, hypopigmentation and staphylomatous ectasia inferonasal to the optic disc, as well as a serous retinal detachment. Fluorescein angiography showed a site of leakage or multiple focal areas of staining and atrophy of the retinal pigment epithelium that correlated to the linear pigmentary changes observed at the junction with the inferior staphyloma, The fluorescein angiographic pattern was very similar to that of chronic ICSC, Spontaneous healing occurred in one case, and successful photocoagulation of the site of leakage was applied in two cases; two eyes could not be photocoagulated because of diffuse leakage in the macular region. Conclusions: To the authors' knowledge, macular serous retinal detachment due to subretinal leakage has not been reported as a complication of tilted disc syndrome. The authors hypothesize that choriocapillary and pigment epithelial disturbances at the junction of the inferior staphyloma permit the subretinal leakage, but the pathogenesis of this complication remains unclear. A study of larger series of such patients is needed to identify the most appropriate management of these cases, which first need to be differentiated from a chronic form of ICSC.