Prospective evaluation of fundus changes in patients with orbital mass lesions

PURPOSE

To study fundus changes associated with orbital mass lesions.

METHODS

In a prospective, interventional case series, 28 patients undergoing surgery for discrete orbital masses had detailed fundus examination under dilation using direct and indirect ophthalmoscopy. Preoperative visual acuity and the amount and duration of proptosis were noted. Fundus photographs were taken, and postoperative changes were documented. The main outcome measures were the frequency of various fundus changes and their correlation with other clinical features.

RESULTS

Nineteen (68%) of 28 patients had fundus changes; the commonest change was optic disk edema, seen in 14 patients (50%). The mean amount of proptosis +/- SD was 7.7 +/- 7.1 mm for patients with fundus changes and 4.22 +/- 2.1 mm for patients with normal fundus. Of 19 patients with fundus changes, 12 (63%) had an intraconal mass, and 11 (58%) had globe indentation. Twenty patients (71%) had diminished visual acuity preoperatively; of these patients, 8 (40%) had improvement in vision after surgery, 10 (50%) did not have any change in vision, and 2 (10%) had a postoperative decrease in visual acuity. Five (62%) of 8 patients with postoperative improvement in visual acuity had proptosis for < 2 years before surgery was undertaken, while only 1 (10%) of 10 patients retaining their preoperative vision had a duration of proptosis of < 2 years.

CONCLUSION

Fundus changes are frequently seen with orbital masses. An increased amount of proptosis, intraconal location, and globe indentation are associated with fundus changes. Postoperative improvement in visual acuity is less likely in patients with a longer duration of symptoms.

Prehypertension may be common in patients with central serous chorioretinopathy

PURPOSE

To test an observational hypothesis that patients with central serous chorioretinopathy (CSCR) may have a tendency towards hypertension compared with normal individuals.

METHODS

In this case-control study we evaluated resting blood pressure in 32 patients with CSCR and compared it with that in 32 healthy controls in a standard laboratory environment. Differences in resting systolic and diastolic blood pressure were measured.

RESULTS

Mean systolic blood pressure was 123.56+/-4.8 in the CSCR group and 113.63+/-12.62 in the control group. Mean diastolic blood pressure was 84.75+/-10.2 in the CSCR group and 76.75+/-0.4 in the control group. The difference in mean blood pressure values between the two groups was statistically significant.

CONCLUSION

Patients with CSCR may be predisposed to prehypertension. Hence they should be advised on lifestyle modification and followed up periodically for early detection of progression to stage 1 or 2 hypertension.

Choroidal Hemodynamic Changes during Isometric Exercise in Patients with Inactive Central Serous Chorioretinopathy

PURPOSE

Imaging studies suggest that the choroidal vasculature may be altered in central serous chorioretinopathy. Little is known, however, about the regulation of ocular blood flow in patients with central serous chorioretinopathy (CSC). The hypothesis for the present study was that choroidal blood flow changes during an increase in ocular perfusion pressure induced by isometric exercise may be altered in CSC.

METHODS

An observer-masked, two-cohort study was performed in 14 nonsmoking patients with chronic-relapsing but inactive CSC and in 14 healthy nonsmoking volunteers. Both groups were matched for age and sex. Subfoveal choroidal blood flow (CBF) was assessed with laser Doppler flowmetry, and ocular perfusion pressure (OPP) was calculated from mean arterial pressure (MAP) and intraocular pressure (IOP). Changes of CBF during isometric exercise over a period of 6 minutes were measured.

RESULTS

Whereas the increase of MAP, the pulse rate, and the OPP were comparable between the two study groups, subfoveal CBF increased significantly more in the group of patients with CSC (P < 0.001). IOP remained unchanged in both groups during isometric exercise. At an 85% increase in OPP, subfoveal CBF was approximately twice as high in the patients with CSC compared with the healthy control group.

CONCLUSIONS

The data indicate an abnormal subfoveal CBF regulation in patients with relapsing CSC compared with age-matched, nonsmoking, healthy volunteers during isometric exercise.

ACUTE CENTRAL SEROUS CHORIORETINOPATHY AND FUNDUS AUTOFLUORESCENCE

OBJECTIVES

To describe fundus autofluorescence (FAF) in a series of patients with acute central serous chorioretinopathy (CSC).

METHODS

Nine eyes of six patients with acute CSC were evaluated with fluorescein angiography (FA) and FAF imaging to evaluate the nature of the focal retinal pigment epithelial (RPE) leak evident with FA.

RESULTS

All nine eyes in this series demonstrated hypo-autofluorescence corresponding precisely to the site of the focal RPE leak seen on FA.

CONCLUSIONS

In this group of patients, the acute focal RPE leaks seen with FA corresponded precisely to an area of hypo-autofluorescence imaged with FAF. This observation supports the concept that a mechanical defect or absence of the RPE accounts for the leakage from the inner choroid to the sub-neurosensory space in CSC. FAF is also a useful noninvasive diagnostic adjunct to identify the focal RPE leak in patients with acute CSC.

Comparison of achromatic and blue-on-yellow perimetry in patients with resolved central serous chorioretinopathy

Central serous chorioretinopathy (CSCR) is a disorder characterized by the serous detachment of the sensory retina in the posterior pole. Although CSCR usually resolves spontaneously, the patients may notice residual visual deficits, despite recovering normal visual acuity. The aim of this study is to compare the blue-on-yellow perimetric parameters with conventional automated perimetric parameters in the detection of visual deficits in patients with resolved CSCR. Eighteen patients who had spontaneous recovered from CSCR were enrolled this study. All subjects were examined twice with each type of perimetry. Wilcoxon test was used for statistical analysis. The achromatic perimetric mean deviation values were significantly higher in patients with CSCR than in the control group, while statistically a significant difference was determined for all of blue-on-yellow perimetric values. In conclusion the loss of central retinal sensitivity remains after resolution of the CSCR even if the visual acuity has recovered to normal. Blue-on-yellow perimetry is more sensitive than achromatic perimetry to reveal this central sensitivity loss.

Effect of optimal dietary therapy upon visual function in children with long-chain 3-hydroxyacyl CoA dehydrogenase and trifunctional protein deficiency

The objective of this prospective cohort study was to determine if dietary therapy including docosahexaenoic acid (DHA; C22:6omega-3) supplementation prevents the progression of the severe chorioretinopathy that develops in children with long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) or trifunctional protein (TFP) deficiency. Physical, biochemical, and ophthalmological evaluations, including electroretinogram (ERG) and visual acuity by evoked potential (VEP), were performed at baseline and annually following the initiation of 65-130 mg/day DHA supplementation and continued treatment with a low-fat diet. Fourteen children with LCHAD or TFP deficiency, 1-12 years of age at enrollment, were followed for 2-5 years. Three subjects with TFP beta-subunit mutations had normal appearance of the posterior pole of the ocular fundi at enrollment and no changes over the course of the study. Eleven subjects who were homozygote and heterozygote for the common mutation, c.1528G>C, had no change to severe progression of atrophy of the choroid and retina with time. Of these, four subjects had marked to severe chorioretinopathy associated with high levels of plasma hydroxyacylcarnitines and decreased color, night and/or central vision during the study. The plasma level of long-chain 3-hydroxyacylcarnitines, metabolites that accumulate as a result of LCHAD and TFP deficiency, was found to be negatively correlated with maximum ERG amplitude (Rmax) (p=0.0038, R2=0.62). In addition, subjects with sustained low plasma long-chain 3-hydroxyacylcarnitines maintained higher ERG amplitudes with time compared to subjects with chronically high 3-hydroxyacylcarnitines. Visual acuity, as determined with the VEP, appeared to increase with time on DHA supplementation (p=0.051) and there was a trend for a positive correlation with plasma DHA concentrations (p=0.075, R2=0.31). Thus, optimal dietary therapy as indicated by low plasma 3-hydroxyacylcarnitine and high plasma DHA concentrations was associated with retention of retinal function and visual acuity in children with LCHAD or TFP deficiency.

Pulsatile Blood Flow in the Polypoidal Choroidal Vasculopathy

OBJECTIVE

To describe patients with pulsatile polypoidal vessels in polypoidal choroidal vasculopathy (PCV).

DESIGN

Retrospective, observational case series.

PARTICIPANTS

Eighty-four eyes of 74 patients with PCV.

METHODS

The medical records of patients diagnosed with PCV between 1998 and 2004 at Kagoshima University Hospital were reviewed.

MAIN OUTCOME MEASURES

A pulsatile polypoidal vessel (PV) on indocyanine green angiography (ICGA).

RESULTS

Seven of 74 patients (9.5%) had PVs in the macula. Four eyes revealed pulsatile PVs on the day the diagnosis of PCV was first made, and PVs in the other 3 eyes showed pulsatile movement during the follow-up period. Two patterns of pulsatile movement were observed on ICGA: (1) a rhythmic variation in the caliber of a choroidal vessel (caliber variation pattern) and (2) a pulsatile blood flow in a tortuous and relatively narrow choroidal vessel (pulsatile blood flow pattern). Both patterns of pulsatile PVs appeared in the early frames of the ICGA, and some of them were observable even during the first 15 minutes after the ICG dye injection. The pulsatile movement disappeared spontaneously without treatment in some patients, and the period in which pulsatile PVs was detectable on ICGA was limited in each patient.

CONCLUSIONS

We report the features of pulsatile PV in PCV. It is a unique and important characteristic that has not been reported with any other chorioretinal diseases and may provide a clue to understanding the pathogenesis of PCV.

Long-term macular function in eyes with central serous chorioretinopathy

BACKGROUND

This study aimed to investigate the long-term effects of central serous chorioretinopathy (CSCR) on macular function.

METHODS

Sixty-two eyes of 31 patients were included in this study. All patients were diagnosed with unilateral CSCR at the Retina Unit of the Ophthalmology Department, Trakya University Medical Faculty, and had a post-attack bilateral visual acuity of 6/6 and a follow-up period of a minimum of 6 months. Visual function was assessed using the Amsler grid, 40-hue colour discrimination test, visual field examination by means of Octopus automatic perimeter and Cambridge contrast sensitivity tests.

RESULTS

Of the 31 patients, 71% were men and 29% were women, with a mean age of 39.3 +/- 7.6 years. The patients had a mean follow-up period of 50.6 +/- 40.5 months after the acute attack. Metamorphopsia was observed in 67.7% of the cases with CSCR. A colour discrimination defect was found in 48.4% of the CSCR eyes and in 54.8% of the fellow eyes. As compared with the fellow eyes, the mean deviation in the central 10 degrees of visual field was significantly higher (t = 2.9, P = 0.007) and the mean contrast sensitivity score was significantly lower (t = -3.2, P = 0.004) in the CSCR eyes.

DISCUSSION

Patients with unilateral CSCR were observed to have long-term bilateral colour discrimination defects, and eyes with clinical CSCR were determined to have central relative scotoma and loss of contrast sensitivity.

[Specificity of functional changes of visual system at the early stage of involutional central chorioretinal dystrophy]

Involutional central chorioretinal dystrophy (ICCD) represents a disease of central zone of the retina in the persons of elderly and senile age that is characterized by bilateral affection and is one of the most widespread reasons for sight inability all over the world. The purpose of our research was to reveal specific symptoms of functional disturbance of the visual system at the early stage of ICCD. Clinical studies were based on the analysis of results 75 patients (142 eyes), at the age from 50 to 70 years with visual acuity 0.7-1.0., with "firm" drusen in 44 eyes, "soft" drusen in 51 eyes, "soft confluent" drusen in 47 eyes. Along with the routine ophtalmological methods of investigation, the psychophysical methods were used in order to study spatial contrast sensitivity (SCS) and color contrast sensitivity ("ON-OFF"). Specific functional changes of visual system at an early stage of ICCD are characterized by a reduction of spatial localization, infringement of topography of color and on-off contrast sensitivity. Possible explanation of the given fact is disturbance of fine exchange processes in a complex of photoreceptor-pigmentary epithelium, leading to the disturbance of the function of the retina's central cones. Thus, disturbance of spatial contrast, color and contrast sensitivity is a reliable diagnostic criterion allowing revealing the change of function of the retina's cone apparatus already at the early of ICCD.

Long-term follow-up of patients with birdshot retinochoroidopathy treated with corticosteroid-sparing systemic immunomodulatory therapy

PURPOSE

To evaluate the outcomes of patients with birdshot retinochoroidopathy (BSRC) treated with corticosteroid-sparing systemic immunomodulatory therapy (IMT).

DESIGN

Retrospective, noncomparative, interventional case series.

PARTICIPANTS

Thirty-five patients with BSRC evaluated at the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary from 1980 through 2003.

METHODS

Data on age, gender, follow-up time, delay to diagnosis or referral, treatment before and during follow-up, complications of BSRC or treatment, Snellen visual acuities (VAs), and electroretinograms (ERGs) were recorded from patient charts.

MAIN OUTCOME MEASURES

Disease progression as determined by Snellen VAs and serial ERGs, ocular complications of BSRC or corticosteroids, and complications of systemic IMT.

RESULTS

Twenty-eight patients with a mean follow-up of 81.2 months were included. None of the patients had sufficient control of their inflammation before referral. All patients were treated with corticosteroid-sparing systemic IMT at some point during their follow-up: 92.9% were treated with cyclosporine, 67.9% with mycophenolate mofetil, 17.9% with azathioprine, 10.7% with oral methotrexate, and 7.1% with daclizumab. Ocular complications of BSRC and/or corticosteroids were cataract (53.6%), cystoid macular edema (35.7%), glaucoma (21.4%), epiretinal membrane (10.7%), and retinal detachment (3.6%). Average Snellen VAs at the time of initial visit were 0.64 (right eye) and 0.59 (left eye). Average final Snellen VAs were 0.74 (right eye) and 0.71 (left eye). (Logarithm of the minimum angle of resolution equivalents were -0.23, right eye initial; -0.19, right eye final; -0.38, left eye initial; and -0.31, left eye final.) In the right eye, 78.6% of patients and, in the left eye, 89.3% of patients had either the same or improved VA at the end of the follow-up. The 30-hertz flicker implicit time was prolonged in 58.3% of initial ERGs and in 62.5% of final ERGs. The bright scotopic amplitude was abnormal in 45.5% of initial and final ERGs.

CONCLUSIONS

Long-term preservation of visual function is attainable with systemic corticosteroid-sparing IMT for patients with BSRC. Prompt treatment with systemic IMT may offer the best hope of maintaining retinal function in what is often thought of as a chronically progressive disease resistant to treatment.

Association of Helicobacter pylori with central serous chorioretinopathy: hypotheses regarding pathogenesis

Central serous chorioretinopathy (CSC) is a serous macular detachment that usually affects young people and leads fortunately to a spontaneous resolution and a good visual prognosis in most patients. Nevertheless, although in a small percentage of subjects only, it may also develop a chronic or progressive disease with widespread decompensation of the retinal pigment epithelium (RPE) and severe vision loss. The aetiopathogenesis of the disease is still not completely understood and no effective treatment is available at this time. However, an interesting association has been recently highlighted between CSC and the Helicobacter pylori infection. In particular, in a first case report recurrences of the disease were always associated with HP-positivity whereas improvements of both retinal findings and visual acuity were significantly correlated with a successful eradication of the bacterium using the conventional antimicrobial triple-therapy. In a second study, the prevalence of HP infection was found to be significantly higher in CSC-affected subjects compared to age- and sex-matched controls from the same country. Much speculation surrounds the role potentially played by HP in determining CSC. In particular, CSC seems not to be more a merely RPE disease but the final result of a general involvement of the choroidal microcirculation. In fact, several vascular abnormalities, such as localized vasoconstriction and impaired fibrinolysis, have been demonstrated during CSC whose "end-points" might be a focal occlusion of the choriocapillaries with decreased foveal choroidal blood flow, secondary RPE defects and serous macular detachment. Moreover, a HP-dependent immune mechanism, based on a "molecular mimicry" between pathogenic antigens expressed on the bacterium and homologous host proteins (e.g., those of the endothelial vascular wall), might also be involved in the pathophysiology of CSC. In this case, a genetically determined susceptibility of the subject could be an important and limiting factor. Although further multicenter, randomized, case-control trials are necessary to confirm the role potentially played by the HP infection in the pathogenesis of CSC, if this hypothesis would be confirmed in the near future, a novel antimicrobial approach to the disease might be possible waiting for a successful vaccine therapy that will surely stimulate the scientific interest of many authors.

[Choroidal detachment--pathogenesis, etiology and clinical features]

Serous choroidal detachment is characterized by exudative detachment of the retina and choroid following leakage of fluid from the choriocapillaris into suprachoroidal space. This accumulation of fluid has been known to be a complication of various intraocular surgeries (cataract, glaucoma and retinal detachment surgery), where hypotony is combined with postoperative inflammation. Among other non surgical conditions associated with uveal effusion are idiopathic (uveal effusion syndrome, microphthalmia) and inflammatory diseases (scleritis, sympathic ophthalmia, pars planitis, Harada's disease). Idiopathic serous detachment of choroids is caused by scleral abnormalities associated with hypoplasia or partial absence of the vortex venous system. The most cases of postoperative choroidal detachment resolve spontaneously. Resolution is usually associated with rapid normalization of the intraocular pressure and reduction of intraocular inflammation. The natural course of idiopathic condition is variable but tends to be prolonged with remissions and exacerbations. Surgical management involving vortex vein decompression and/or sclerotomy is the most effective treatment in this patients.

CHOROIDAL VASCULAR OCCLUSION IN INTERNAL CAROTID ARTERY OBSTRUCTION

PURPOSE

To determine choroidal vascular abnormalities in eyes with internal carotid artery obstruction (ICO).

METHODS

We examined eight eyes with ICO with wide-angle indocyanine green (ICG) video-angiography beginning in the posterior fundus. Another angiography was performed in three eyes to observe the arterial phase of the temporal peripheral fundus. ICG angiography was done until the late choroidal venous phase or for more than 10 minutes.

RESULTS

Slow dye filling in the choroidal arteries and delayed filling of the posterior watershed zone occurred in all eyes. Delayed perfusion or multiple patchy occlusions of choriocapillaris was seen in all eyes. There were delayed perfusion and/or occlusion in the peripheral watershed zone in the examined three eyes. The super-late-phase angiograms showed hyperfluorescent lines corresponding to choroidal veins.

CONCLUSION

Elongated arm-to-choroid circulation and delayed intrachoroidal circulation times suggest severe choroidal hypoperfusion. Choroidal hypoperfusion resulted in multiple occlusions of the choriocapillaris and attenuated choroidal vessels. Slow filling or nonperfusion of the peripheral watershed zone was another characteristic finding. Linear hyperfluorescence may reflect severely damaged choroidal venous walls. These findings are useful to understand choroidal angiopathy in ICO or high-grade stenosis, and to diagnose ocular ischemic syndrome.

[Dependence of the efficiency of low-intensity laser therapy in involution chorioretinal dystrophy on a used wavelength]

Seventy-five patients (75 eyes) with central involution chorioretinal dystrophy (non-exudative type at the progression stage) were followed up. All of them received low-intensity laser therapy. Irradiation of 890 nm, 644 nm and 500 nm was used in groups 1, 2 and 3, respectively. The study purpose was to compare the efficiency of wavelengths. Visual acuity and retinal sensitivity were determined. The results were evaluated immediately after treatment and in 3 months. The maximal improvement in visual acuity and retinal sensitivity was in those who received 890 nm laser therapy; 500 nm irradiation--a less pronounced effect and 640 nm--the lowest one. We attribute such distribution of efficiency to a proliferation type of each irradiation range in the macular zone.

Helicobacter pylori and idiopathic central serous chorioretinopathy

Idiopathic central serous chorioretinopathy (ICSC) is a disease that typically affects middleaged adults and involves the sensory retina, the retinal pigment epithelium (RPE) and the choroid. Patients usually have mild visual loss. ICSC generally resolves without therapy, although the disease can become chronic with ensuing RPE decompensation. Some patients, particularly older adults, can also develop choroidal subretinal neovascularisations (CNV), which may lead to a severe loss in visual acuity. Although the aetiopathogenesis of the disease is still incompletely understood, a correlation with psychophysical stress supports the idea that the disease may be "adrenergically conditioned", leading to the development of one or several defects in the RPE, with subsequent focal leakage of serous fluid and its retention in the subretinal space. An association between ICSC and the Helicobacter pylori (HP) infection has also been recently documented, suggesting that this organism may possibly be involved in the development of some cases of ICSC. Pathogenetic mechanisms that may explain the contribution of HP in the development of ICSC are postulated.

Optical coherence tomographic findings in pregnancy-associated central serous chorioretinopathy

PURPOSE

To report the presence and disappearance of subretinal fibrinous exudate in pregnancy-induced central serous chorioretinopathy studied with optical coherence tomography (OCT).

METHODS

Case report. A 32-year-old woman was referred for ophthalmoscopic evaluation in her 32nd week of pregnancy, complaining of reduced vision in her right eye.

RESULTS

The funduscopic examination revealed a serous detachment of the macula with subretinal exudative deposits in the right eye and a peripapillary serous detachment in the left eye. OCT sections through the right macula demonstrated serous elevation of the retina and the presence of highly reflective material in the subretinal space. Two weeks after delivery, OCT showed resolution of subretinal fluid and the disappearance of submacular exudate in the right eye.

CONCLUSION

During pregnancy and immediately after delivery, OCT may provide information reflecting the relationship between the retina, subretinal space, and retinal pigment epithelium without any known adverse effects to the infant. In a patient with pregnancy-associated central serous chorioretinopathy, a highly reflective material, presumably fibrin, was detected spanning the subretinal space that was subsequently shown to disappear. This information may help us better understand the pathological retinal changes that may occur during pregnancy.

Visual outcome after discontinuation of corticosteroids in atypical severe central serous chorioretinopathy

PURPOSE

To elucidate the effect of discontinuation of corticosteroids in patients with atypical severe central serous chorioretinopathy (CSC) on retinal reattachment, resolution of retinal pigment epithelium (RPE) leaks, and improvement in visual acuity (VA).

DESIGN

Prospective, noncomparative, observational case series.

PARTICIPANTS

Twenty-four eyes of 17 patients who were being treated with corticosteroids for atypical severe CSC. Of these 17 patients, 16 were treated inappropriately with corticosteroids for their ocular condition; presumably, these patients' conditions were misdiagnosed, and they were thought to have choroiditis, Harada's syndrome, or similar entities, and not central serous chorioretinopathy.

INTERVENTION

Observation or laser photocoagulation.

MAIN OUTCOME MEASURES

Reattachment of the retina, obliteration of RPE leaks on fundus fluorescein angiography, and improvement in Snellen VA.

RESULTS

Discontinuation of corticosteroids resulted in reattachment of the retina in 21 eyes (87.5%), with median time to reattachment of 49 days (range, 32-400); only 3 eyes required laser photocoagulation. Fundus fluorescein angiography showed obliteration of RPE leaks at a median period of 75 days (range, 32-400) in the observed eyes; the median VA improved from 20/80 to 20/30. The mean follow-up was 16.5 months.

CONCLUSIONS

Discontinuation of corticosteroids in atypical CSC helped in obliteration of RPE leaks and retinal reattachment in 87.5% of the eyes without laser treatment, and improvement in VA was observed.

Plasticity of polypoidal lesions in polypoidal choroidal vasculopathy

PURPOSE

The aim of this study was to describe the clinical course in a patient with polypoidal choroidal vasculopathy (PCV).

METHODS

A 68-year-old man with PCV in the left eye was followed up by means of routine examinations including fluorescein angiography and indocyanine green angiography for over 60 months.

RESULTS

Throughout the follow-up period, the patient experienced repeated lesions in the macula, such as serosanguineous detachment of the retinal pigment epithelium and neurosensory retina, but retained good visual acuity. Indocyanine green angiography disclosed spontaneous regression of polypoidal vessels followed by significant changes in the choroidal circulation: a group of polypoidal structures disappeared, and after several months a small choroidal vessel became apparent that was distant from the previously observed polypoidal structure rather than representing an extension of the original lesion.

CONCLUSION

The clinical observation suggests that in some cases of PCV the choroidal vasculature may be altered with time, in that some vessels in the inner choroid and even the choriocapillaris may close and collateral vessels and/or new vessels may develop to form complex such as that described here.

An association between central serous chorioretinopathy and gastroesophageal reflux disease

PURPOSE

To explore a clinically observed association between central serous chorioretinopathy (CSC) and gastroesophageal reflux disease (GERD) DESIGN: A retrospective case-control study.

PARTICIPANTS AND CONTROLS

Sixty-nine consecutive patients diagnosed with CSC were compared with a control group of 55 non-CSC patients.

METHODS

The records of 69 patients with CSC were retrospectively reviewed and compared with the records of 55 controls. All patients and controls were examined in a referral setting.

RESULTS

Patients with CSC were significantly more likely to have GERD compared with controls (odds ratio 6.05; 95% confidence interval 2.14-17.11; P =.0003). Central serous chorioretinopathy patients were also more likely than controls to have used oral corticosteroid medications (odds ratio 16.30; 95% confidence interval 2.09-127.33; P =.0006) and antacid/antireflux medications (odds ratio 15.00; 95% confidence interval 1.91-117.58; P =.001).

CONCLUSIONS

This study identifies an association between CSC and GERD. There are biochemical factors common to both diseases that support this association, giving further insight into the pathogenesis of CSC.

Five to 15 year follow-up of resolved idiopathic central serous chorioretinopathy

PURPOSE

To recognize the long-term sequelae of resolved idiopathic central serous chorioretinopathy (ICSC) in relation to visual acuity, contrast sensitivity, and lesion size between time elapsed since disease onset.

METHODS

Patients were recruited from fluorescein angiogram records between January 1985 and December 1995 with confirmed ICSC. Visual acuity, contrast sensitivity, and digital fundus photographs were recorded on follow-up. Comparison with the initial red-free photographs were made.

RESULTS

There was no statistically significant deterioration of visual acuity over time compared to eyes with ICSC after initial resolution and the normal eyes. The change of lesion size over time was also statistically insignificant. Contrast sensitivity compared to visual acuity showed positive correlation in both ICSC and normal eyes, but the results were statistically insignificant. Lesion size correlates negatively with visual acuity and contrast sensitivity although this was statistically insignificant.

CONCLUSION

This study shows little, if any, correlation between time and progression of retinal pigment epitheliopathy following resolution of ICSC. Visual acuity did not seem to worsen over time. Our data were not statistically significant, but it does give insight into the natural history of what is still a relatively poorly understood disease.

LASER-INDUCED MACULAR HOLES DEMONSTRATE IMPAIRED CHOROIDAL PERFUSION

PURPOSE

To evaluate choroidal perfusion following creation of a laser-induced macular hole in a nonhuman primate model.

METHODS

Six rhesus monkeys underwent macular exposures delivered by a Q-switched Nd:YAG laser. The lesions were evaluated with fluorescein angiography and indocyanine green angiography using scanning laser ophthalmoscopy.

RESULTS

Each lesion produced vitreous hemorrhage and progressed to a full-thickness macular hole. Indocyanine green angiography revealed no perfusion of the choriocapillaris beneath the lesion centers. Fluorescein angiography demonstrated mild enlargement of the foveal avascular zone due to loss of perifoveal capillaries. Histopathologic evaluation showed replacement of the choriocapillaris with fibroblasts and connective tissue.

CONCLUSIONS

Nd:YAG laser-induced macular holes result in long-term impairment of choroidal perfusion at the base of the hole due to choroidal scarring and obliteration of the choriocapillaris. Evaluation of choroidal perfusion may be useful in assessment of laser-injured patients. Impairment in choroidal perfusion may have functional implications for surviving photoreceptors.