Acitretin-Associated Maculopathy

set of CSCR following periocular corticosteroid injection with confirmation by OCT imaging. Periocular corticosteroids may be administered for the treatment of uveitis as well as postoperative CME. The presence of intraocular inflammation secondary to uveitis may affect the retinal pigment epithelial barrier and increase susceptibility to local periocular corticosteroid effects. A similar mechanism has been proposed in a small series that reported CSCR following systemic corticosteroid therapy for uveitis that occurred secondary to bird-shot chorioretinopathy, Vogt-KoyanagiHarada disease, and scleritis. A variety of contributing factors may account for the paucity of reports linking CSCR and the common procedure of periocular corticosteroid injection. In eyes with uveitis, clinical features such as synechiae, pupil constriction, or media opacity severe enough to warrant periocular corticosteroid administration may preclude visualization of distinct macular details. Subtle fluid from CSCR that is related to a periocular corticosteroid injection may be interpreted as CME or may be overshadowed by features of coexisting CME. Visual symptoms from secondary CSCR may be attributed to the primary diagnosis of uveitis, and thus the fundus examination that is required to detect this entity may be omitted. Optical coherence tomographic imaging may be especially helpful in this scenario to differentiate between the features of CSCR and CME. It is unlikely that the topical corticosteroid drops played a role in the development of CSCR because of the relatively brief time of administration and the lack of posteriorsegment penetration, especially in this patient with phakic eyes. In contrast, periocular corticosteroids are injected directly behind the globe to induce a posterior pole effect. Because almost every other route of corticosteroid administration, including local intra-articular injection, has been linked with CSCR thus far, it appears logical that the periocular depot corticosteroid injection would be associated with development of this disorder. The periocular route should be included in the suggested etiologic association between corticosteroid therapy and development or exacerbation of CSCR.