Simultaneous bullous and neovascular variants of atypical central serous chorioretinopathy: a case of asymmetric bilateral involvement

This report describes a diagnostically challenging case of bilateral atypical central serous chorioretinopathy (CSCR) in a 33-year-old man who presented with two distinct phenotypes. The left eye demonstrated bullous serous retinal detachment (SRD) with large retinal pigment epithelium (RPE) tears, while the right eye exhibited choroidal neovascularization and pigment epithelial detachment (PED) associated with subretinal scar tissue. The patient was initially misdiagnosed with unilateral Vogt–Koyanagi–Harada (VKH) disease at other hospitals and had received systemic corticosteroids, which may have precipitated an RPE tear and exacerbated SRD in the left eye. Multimodal imaging confirmed asymmetric atypical CSCR bilaterally. Following corticosteroid tapering, the patient received intravitreal ranibizumab and focal laser photocoagulation. Bullous SRD and RPE tears resolved, and both eyes remained stable for over 20 months. The absence of bullous SRD in the right eye may have been attributed to fibrosis overlying the PED. This case highlights the need to distinguish atypical CSCR from VKH disease.