Bullous Central Serous Chorioretinopathy Associated With JAK Inhibitor Use.

Abstract

Purpose: To report a case of bullous central serous chorioretinopathy (CSCR) after starting a Janus kinase (JAK) inhibitor and describe the results of focal laser treatment. Methods: A single case was evaluated. Results: A 54-year-old man with rheumatoid arthritis presented with a 2-week history of left superior field loss. His medications included prednisone 10 mg and upadacitinib, which was added to his regimen 3 weeks previously. His visual acuity (VA) was 20/25 OD and 20/30 OS. An ophthalmic examination of the left eye found an ill-defined white lesion of 2 × 3 disc diameters at the macula with an inferior retinal detachment (RD). Optical coherence tomography showed subretinal fibrin with subretinal fluid (SRF) and a pigment epithelial detachment. After a diagnosis of bullous CSCR was made, focal laser application was performed. One year later, the patient's VA recovered to 20/20 with resolved SRF. Conclusions: Bullous CSCR with a serous RD is an uncommon subtype of pachychoroid disease. Upadacitinib may be associated with its occurrence through disequilibrium of the coagulation cascade. Focal laser treatment offers a favorable outcome for this disease.