Long-term follow-up of idiopathic central serous chorioretinopathy by fluorescein angiography

Comparative efficacy of subthreshold micropulse laser therapy for chronic central serous chorioretinopathy: Navigated vs. non-navigated approach

PURPOSE

To evaluate the efficacy of navigated subthreshold micropulse laser (NSML) compared to subthreshold micropulse laser (SML) without navigation in the management of chronic central serous chorioretinopathy (CSCR).

MATERIALS AND METHODS

This retrospective study included patients diagnosed with chronic CSCR who underwent either NSML or SML without navigation. Patients meeting inclusion criteria presented with serous macular detachment and leakage at the level of the retinal pigment epithelium on fundus fluorescein angiography (FFA). The NSML group underwent treatment using the Navilas® Laser System 577s Prime, operating at a wavelength of 577 nanometers. Micropulse laser application targeted the leakage areas identified on mid-phase FFA images, which were imported into the laser device and aligned with the live image using an eye tracking system. The SML without navigation group underwent treatment using the 577-nanometer yellow laser, delivered through the area centralis laser lens. Laser therapy was guided by focal leaking points and areas of hyperpermeability identified on FFA.

RESULTS

A total of 34 patients underwent NSML, while 36 patients received SML without navigation. Both groups were similar in terms of demographic and clinical characteristics. No statistically significant difference was found in visual and anatomical outcomes between the NSML and SML groups at 1 and 3 months post-treatment (P>0.05). However, favorable outcomes were observed in both groups, with a cumulative probability of successful treatment reaching 73.5% in the NSML group and 63.8% in the SML group. Notably, no adverse events were reported in either group.

CONCLUSION

Both NSML and SML without navigation demonstrate efficacy and safety in treating CSCR, with improvements in visual and anatomical outcomes observed during the 3-month follow-up period. NSML emerges as a promising treatment option for facilitating the resolution of subretinal fluid in patients with chronic CSCR.

Central serous chorioretinopathy: An evidence-based treatment guideline

Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.

The role of inflammation in central serous chorioretinopathy: From mechanisms to therapeutic prospects

Central serous chorioretinopathy (CSC) is a leading cause of permanent vision loss, ranking fourth among macular diseases, trailing only age-related macular degeneration, diabetic retinopathy, and retinal vein obstruction. While mounting evidence implicates inflammation as a pivotal factor in the onset and advancement of CSC, the specific pathophysiological process and molecular mechanisms underlying inflammation remain incompletely understood. A complex network of cytokines, chemokines, and adhesion molecules interplay to trigger inflammatory and pathological cascades, highlighting the need for a comprehensive comprehension of the inflammation-related mechanisms behind CSC progression. In this piece, we examine the existing comprehension of CSC's pathology and pathogenesis. Additionally, we present an overview of the mechanisms underlying the onset and progression of CSC inflammation, followed by a thorough analysis and discussion of the potential of targeted inflammatory intervention for both preventing and treating CSC.

Central serous chorioretinopathy: Treatment

Central serous chorioretinopathy (CSC) is a pachychoroid spectrum disease characterized by serous detachment of the neurosensory retina with subretinal fluid in young and middle-aged adults. The pathogenesis of CSC is not yet fully understood. However, it is considered a multifactorial disease that is strongly associated with choroidal dysfunction or vascular engorgement. Although there is no consensus on the treatment of CSC, photodynamic therapy has been effectively used to manage serous retinal detachment (SRD) in CSC. Moreover, micropulse diode laser photocoagulation and focal laser treatment have also been used. Recently, oral medications, including mineralocorticoid receptor antagonists, have been proposed for the management of CSC. Multimodal imaging plays a significant role in the diagnosis and treatment of CSC. Optical coherence tomography angiography (OCTA) has the advantage of detecting vascular flow in the retina and choroid layer, allowing for a better understanding of the pathology, severity, prognosis, and chronicity of CSC. In addition, early detection of choroidal neovascularization in CSC is possible using OCTA. This review article aims to provide a comprehensive and updated understanding of CSC, focusing on treatment.

A multicentre study of the risk factors associated with recurrence of central serous chorioretinopathy

PURPOSE

To investigate potential clinical and multimodal imaging factors in central serous chorioretinopathy (CSC) recurrence.

METHODS

The study was performed at nine Japanese medical institutions for patients who had experienced an active CSC episode. Demographic data and medical history were reviewed retrospectively. Significant differences in chronic manifestation, leakage site, leakage point number, leakage intensity, choroidal hyperpermeability, central retinal thickness (CRT) and subfoveal choroidal thickness were analysed between the recurrence and non-recurrence groups.

RESULTS

In total, 538 eyes (538 patients) diagnosed with CSC (402 men, 136 women; mean age: 53.4 ± 11.9 years) were enrolled. Among them, 253 eyes (47.0%) developed ≥1 recurrence (follow-up: 15.9 ± 13.5 months, range 3-86 months). Univariate and multivariate analyses indicated that a history of corticosteroid use (odds ratio [OR], 5.52; 95% confidence interval [CI], 1.39-21.92; p = 0.015), bilateral disease (OR, 3.94; 95% CI, 1.47-10.6; p = 0.007), chronic manifestations (OR, 7.12; 95% CI, 2.93-17.28; p < 0.001), non-intense fluorescein leakage (OR, 3.34; 95% CI, 1.44-7.75; p = 0.005) and initial CRT (OR, 0.997; 95% CI, 0.993-0.999; p = 0.049) were significantly associated with CSC recurrence. Receiver operating characteristic curves were created, and the area under the curve for the multivariate logistic regression model of these five factors was 0.814.

CONCLUSION

Patients with CSC who received corticosteroids and had bilateral disease, chronic manifestation, non-intense fluorescein leakage on fluorescein angiography or a relatively thinner CRT should be closely monitored to identify whether they are at high risk of recurrence.

The Role of Optical Coherence Tomography and Optical Coherence Tomography Angiography in the Differential Diagnosis of Posterior Uveitis

PURPOSE

Modalities such as optical coherence tomography (OCT) and OCT angiography (OCTA) have improved the diagnostic utility of fundus imaging in management of uveitis. The purpose of this study is to review role of OCT and OCTA in differential diagnosis of certain posterior uveitic entities.

METHODS

Narrative review.

RESULTS

In this review, we have comprehensively summarized the utility of OCT and OCTA in helping the clinician diagnose common but challenging inflammatory conditions including ocular toxoplasmosis, viral retinitis, and vitreoretinal lymphoma, among others. OCT and OCTA can also be used to assess the choriocapillaris involvement in conditions such as multiple evanescent white dot syndrome, and choroidal granulomas in tubercular and sarcoid uveitis.

CONCLUSIONS

Fundus imaging with OCT and OCTA has assumed a significant role in establishing the diagnosis in uveitis apart from microbiological and other laboratory analysis. Advantages such as rapidity and non-invasiveness make these imaging modalities very useful and convenient.

577 nm subthreshold micropulse laser treatment for acute central serous chorioretinopathy: a comparative study

BACKGROUND

To assess the efficacy of 577 nm subthreshold micropulse laser (SML) treatment for acute central serous chorioretinopathy (CSC).

METHODS

This retrospective comparative case-series included 34 eyes of 34 patients with acute CSC who received either 577 nm SML treatment (SML group, n = 16 eyes) or were only monitored (observation group, n = 18 eyes). Acute CSC was defined as disease course < 3 months. Eyes with any history of treatment in the past were excluded. Data were collected over a period of 6 months. The best corrected visual acuity (BCVA), central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were observed.

RESULTS

SML group showed significantly greater improvement in the BCVA (logMAR) compared to observation group at 1 month (0.20 ± 0.10 vs 0.30 ± 0.12, P < 0.01), 3 months (0.13 ± 0.06 vs 0.21 ± 0.06, P < 0.01) and 6 months (0.01 ± 0.06 vs 0.09 ± 0.66, P < 0.01). The CMT reduction was significantly greater in the SML group at 1 month (337.19 ± 62.96 µm vs 395.11 ± 91.30 µm, P < 0.05), 3 months (312.94 ± 49.50 µm vs 364.50 ± 70.30 µm, P < 0.05) and 6 months (291.38 ± 26.46 µm vs 348.56 ± 54.65 µm, P < 0.05). In the SML group, the SFCT did not show a significant decrease at 1 month (468.88 ± 42.19 µm, P > 0.05) but showed a significant reduction at 3 months (451.75 ± 39.36 µm, P < 0.05) and 6 months (450.50 ± 34.24 µm, P < 0.05) from baseline (489.94 ± 45.86 µm). In the observation group, there was no significant change in SFCF during follow-up. No adverse events occurred in the SML group.

CONCLUSIONS

Although some patients with acute CSC show spontaneous healing, timely intervention with 577 nm SML can shorten the disease course, improve visual acuity, and reduce the risk of chronic transformation without adverse events.

Evaluation of the choriocapillaris after photodynamic therapy for chronic central serous chorioretinopathy. A review of optical coherence tomography angiography (OCT-A) studies

PURPOSE

Emerging evidence suggests that choroidal microcirculation and microstructural changes after verteporfin photodynamic therapy (vPDT) for chronic central serous chorioretinopathy (CSC) can be shown in detail using OCT-Angiography (OCT-A). The use of OCT-A for the examination of choriocapillaris (CC) has attracted significant attention as the technique offers potential explanations for the effects of vPDT on choroidal tissue.

METHODS

A meticulous literature search was performed in the PubMed database without restriction on year of publication until June 2021. The reference list of all electronically retrieved articles was carefully reviewed for potentially relevant articles that had not been identified.

RESULTS

We identified and reviewed 11 studies reporting a comprehensive update on microvasculature and morphologic changes of the CC layer as seen on OCT-A in chronic CSC. The reviewed articles extensively analyze both the qualitative and quantitative characteristics of the CC flow pattern after applying vPDT safety-enhanced protocols. The changes in the CC plexus indicate the potential of beneficial or deleterious treatment effect on choroidal tissue remodeling. The reviewed series have revealed variability of flow pattern, vessel density, and perfusion of the CC over time.

CONCLUSION

The CC plexus alterations during the post-vPDT period in chronic CSC may imply the treatment effect on choroidal tissue, indicating the potential of anatomical or functional recovery over time. The reviewed literature may confirm the diagnostic value of OCT-A in the assessment of the pathophysiology of eyes with CSC.

The Effect of Obstructive Sleep Apnea Treatment and Severity on Choroidal Thickness in Patients With Central Serous Chorioretinopathy

Purpose:

This work aimed to analyze the association of obstructive sleep apnea (OSA) with choroidal thickness (CT) in patients with central serous chorioretinopathy (CSC).

Methods:

We identified patients in the Stanford Research Repository with a diagnosis of CSC and OSA. Age- and sex-matched controls with either CSC or OSA only were also identified. CT was measured at 5 points (subfoveal, and 1500 and 3000 µm nasal and temporal) by 2 graders. In addition to OSA treatment and severity, we also investigated the association of Oxygen Desaturation Index and nocturnal oxygen saturation nadir with subfoveal CT (SFCT).

Results:

A total of 57 patients and 72 eyes met the study inclusion criteria. The mean SFCT was significantly different across the 3 groups: OSA-only was the thinnest, followed by CSC with OSA, and CSC-only was the thickest (194.2 μm, 295.1 μm, and 357.8 μm, respectively, P < .001). SFCT was thicker in CSC with OSA compared with those with only OSA ( P < .05). OSA treatment status and OSA severity did not show a significant difference in SFCT in multivariable modeling. Nocturnal oxygen saturation nadir was positively associated with SFCT, but this did not reach significance..

Conclusions:

SFCT is significantly different in patients with OSA alone, CSC with OSA, and CSC alone. While OSA treatment status did not demonstrate a significant difference in SFCT in this study, future studies should evaluate patients for OSA in patients known to have CSC and atypically thin CT to further investigate the novel metrics leveraged in this study.

Half-Dose Photodynamic Therapy Versus Eplerenone in Chronic Central Serous Chorioretinopathy (SPECTRA): A Randomized Controlled Trial

PURPOSE

To compare the efficacy and safety between half-dose photodynamic therapy (PDT) and eplerenone therapy for treating chronic central serous chorioretinopathy (cCSC).

DESIGN

This was a multicenter, open-label, randomized controlled trial.

METHODS

This investigator-initiated trial was conducted in 3 academic medical centers in the Netherlands. Eligible patients were randomized at a 1:1 ratio to receive either indocyanine green angiography-guided half-dose PDT or oral eplerenone for 12 weeks. Both anatomical and functional outcomes were evaluated at 3 months after the start of treatment.

RESULTS

A total of 107 patients were randomly assigned to receive either half-dose PDT (n = 53) or eplerenone treatment (n = 54). Thirteen patients (3 in the PDT group and 10 in the eplerenone group) did not adhere to the study protocol. At the 3-month evaluation visit, 78% of patients in the PDT group had complete resolution of subretinal fluid accumulation compared to only 17% of patients in the eplerenone group (P < .001). Mean best-corrected visual acuity in Early Treatment of Diabetic Retinopathy Study letters at the 3-month evaluation visit was 83.7 ± 10.8 and 82.8 ± 9.0 in the PDT and eplerenone groups, respectively (P = .555). In addition, mean retinal sensitivity on microperimetry was 25.4 ± 3.4 dB and 23.9 ± 4.0 dB in the PDT and eplerenone groups, respectively (P = .041). Finally, mean vision-related quality of life scores were 87.2 ± 8.5 and 83.8 ± 12.1 in the PDT and eplerenone groups, respectively (P = .094). Three patients (6%) in the PDT group experienced adverse events during the study compared to 18 patients (33%) in the eplerenone group.

CONCLUSIONS

Half-dose PDT is superior to oral eplerenone for cCSC with respect to both short-term safety and efficacy outcomes.

Dose-Related Structural Effects of Photodynamic Therapy on Rabbit Choroidal Structure

INTRODUCTION

Photodynamic therapy with verteporfin (vPDT) has been shown to be effective against central serous chorioretinopathy (CSC) and was the preferred therapeutic for CSC treatment. However, alterations in choroidal structure after PDT were reported, and these effects were dose-dependent. This study aimed to compare the changes in choroidal structure after PDT with different doses of verteporfin in rabbits and may provide individualized therapeutic guidance for patients who failed to respond to initial half-dose vPDT.

METHODS

The full dose of verteporfin used in CSC was 6 mg/m2, which was used in patients with neovascular age-related macular degeneration. Laser fluence was 50 J/cm2 (irradiance, 600 mW/cm2, 83 s). There were 4 different dose groups in this study (100%, 70%, 50%, and 30%). The alterations were examined at 1 day, 1 week, and 1 month after vPDT using color fundus imaging, indocyanine green angiography, and histopathology analysis.

RESULTS

Various degrees of choroidal alterations were demonstrated at different dose groups. Examinations on day 1 showed that gradually reduced verteporfin dose tended to decrease photochemical reactions to the choroid in terms of the number of occlusion vessels and area of the lesion. After 1 month, choroid vessel alteration persisted in high-dose groups (100% and 70%); nevertheless, alterations of low-dose groups (50% and 30%) returned to normal.

CONCLUSIONS

vPDT can induce photochemical reactions of the choroid, high dose causes permanent change, and low dose causes recoverable change. The dose-dependent alterations need to be considered for the individual therapeutic plan according to the situation of a patient with CSC.

THE ASSOCIATION BETWEEN CENTRAL SEROUS CHORIORETINOPATHY AND SLEEP APNEA: A Nationwide Population-Based Study

PURPOSE

To identify the association between sleep apnea (SA) and central serous chorioretinopathy (CSC).

METHODS

In this nationwide population-based study using the Taiwan National Health Insurance Database, we enrolled adult patients with a diagnosis of SA and matched each patient to 30 age- and gender-matched control subjects without any SA diagnosis. Using Poisson regression analyses, the incidence rate of CSC was compared between SA patients and control subjects.

RESULTS

A total of 10,753 SA patients and 322,590 control subjects were identified. After adjusting for age, gender, residency, income level, and comorbidities, the incidence rate of CSC was significantly higher in SA patients than in the control subjects (adjusted incident rate ratio for probable SA: 1.2 [95% CI: 1.1-1.4], P < 0.0001). Analyses of the propensity score-matched subpopulations also confirmed our findings. Risk factors for CSC in SA patients included male gender, age ≤50 years, higher income, presence of heart disease, absence of chronic pulmonary disease, and presence of liver disease. In SA patients, those who had received continuous positive airway pressure titration had a significantly lower incidence rate of CSC than the others.

CONCLUSION

Our study revealed a significantly higher incidence rate of CSC in SA patients compared with the control subjects.

Clinical course after the onset of choroidal neovascularization in eyes with central serous chorioretinopathy

Chronic central serous chorioretinopathy (CSC) can be complicated with choroidal neovascularization (CNV); however, the timing of its occurrence and its clinical significance are not well understood. This study aimed to observe the time of choroidal neovascularization detection after CSC diagnosis and determine whether clinical features and prognosis differed in patients with chronic CSC or age-related retinal degeneration.In this retrospective study, medical records of CSC patients complicated with CNV who visited Seoul St. Mary's hospital of Korea between October 2009 and December 2020 were reviewed. The presence of CNV was determined using fluorescein, indocyanine green, or optical coherent tomography angiography (OCTA). Based on the patients' medical records, we observed the change of clinical pattern, best-corrected visual acuity (BCVA) and central macular thickness (CMT) at CNV detection and at 6 months, 1 year, 3 years, and 5 years following CNV detection.Thirty eyes of 30 patients (male: female ratio of 13:17) were enrolled. Mean age at diagnosis of CSC was 54.0 ± 8.5 years (mean ± standard deviation). On average, CNV was detected 1.65 ± 2.30 years after the diagnosis of CSC. The mean CMT was significantly decreased at 6 months, 1 year, and 3 years after choroidal neovascularization detection (P < .001, P < .001, P = .001 respectively). BCVA tend to improve after CNV detection, but there was no statistical significance at 6 months, 1 year, 3 years, and 5 years (all with P > .05). There were no clinical findings suggesting age-related macular degeneration such as intraretinal, subretinal hemorrhage or drusen in any of the case during follow-up. None of the subjects had severe visual acuity loss of 1.0 logarithm of the minimum angle of resolution (logMAR) (20/200 Snellen equivalent) or greater. Among the subjects, 6 patients (20%) did not require any treatment during observation, while 24 other patients required anti-vascular endothelial growth factor (anti-VEGF) or photodynamic therapy. At the last visit, 22 patients (73.3%) remained stable for more than 6 months, without subretinal fluid recurrence.Choroidal neovascularization was detected earlier than previously reported. There was no rapid deterioration of visual acuity or clinical features even after CNV detection.

CHOROIDAL NEOVASCULARIZATION SECONDARY TO PHOTODYNAMIC THERAPY FOR CENTRAL SEROUS CHORIORETINOPATHY: Incidence, Risk Factors, and Clinical Outcomes

PURPOSE

To investigate the incidence, risk factors, and clinical outcomes of complicated choroidal neovascularization (CNV) after reduced-fluence photodynamic therapy (PDT) for central serous chorioretinopathy.

METHODS

This is a retrospective consecutive interventional study including 559 eyes from 520 patients treated by reduced-fluence PDT for central serous chorioretinopathy. The incidence of complicated CNV within 3 months after PDT was calculated. Baseline demographics and ocular findings were investigated to identify risk factors. The clinical course of complicated CNV was analyzed.

RESULTS

Seven cases experienced development of active CNV after PDT within 3 months with a median interval of 4 weeks (range, 2-12 weeks). The incidence was estimated as 1.25% (95% CI, 0.55-2.62%). Complicated CNV developed in 6 among 138 eyes (4.35%) with flat irregular pigment epithelial detachment and in 1 among 421 eyes (0.24%) without flat irregular pigment epithelial detachment (P < 0.001, Fisher's exact test). The median best-corrected visual acuity recovered from 20/100 at the time of CNV development to 20/20 after anti-vascular endothelial growth factor injections (median, 3 times).

CONCLUSION

In approximately 1%, reduced-fluence PDT for central serous chorioretinopathy may be complicated by CNV, which can be well controlled with anti-vascular endothelial growth factor injection. Flat irregular pigment epithelial detachment increases the risk of secondary CNV following PDT.

Subthreshold Micropulse Laser vs. Conventional Laser for Central Serous Chorioretinopathy: A Randomized Controlled Clinical Trial

Purpose: To investigate the effectiveness and safety of 577-nm subthreshold micropulse laser (SML) on acute central serous chorioretinopathy (CSC). Methods: One hundred and ten patients with acute CSC were randomized to receive SML or 577-nm conventional laser (CL) treatment. Optical coherence tomography and best-corrected visual acuity (BCVA) were performed before and after treatment. Results: At 3 months, the complete resolution of subretinal fluid (SRF) in 577-nm SML group (72.7%) was lower than that in CL group (89.1%) (Unadjusted RR, 0.82; P = 0.029), but it was 85.5 vs. 92.7% at 6 months (unadjusted RR, 0.92; P = 0.221). The mean LogMAR BCVA significantly improved, and the mean central foveal thickness (CFT) significantly decreased in the SML group and CL group (all P < 0.001) at 6 months. But there was no statistical difference between the two groups (all P > 0.05). In the SML group, obvious retinal pigment epithelium (RPE) damage was shown only in 3.64% at 1 month but 92.7% in the CL group (P < 0.001). Conclusions: Although 577-nm SML has a lower complete absorption of SRF compared with 577-nm CL for acute CSC at 3 months, it is similarly effective as 577-nm CL on improving retinal anatomy and function at 6 months. Importantly, 577-nm SML causes less damage to the retina.

Quantitative evaluation of photoreceptor density in chronic central serous chorioretinopathy using the Spectralis High Magnification Module

PURPOSE

To quantitatively evaluate the photoreceptor density in patients with chronic central serous chorioretinopathy (cCSC) using the Spectralis High Magnification Module (HMM).

METHODS

Twenty-four eyes of 24 patients with resolved cCSC, 24 fellow eyes from 24 other patients with unilateral cCSC, and 24 normal eyes of 24 healthy clients were enrolled in this observational case study. Photoreceptor densities of the retina in the nasal, temporal, superior, and inferior areas 500 μm from the central fovea were counted manually through the High Magnification Module (HMM) images using ImageJ software, and the average values were taken for further analysis.

RESULTS

The mean photoreceptor density 500 μm from the central fovea in the normal eyes (17,217 ± 1144 cells/mm²) was significantly higher than that of both affected eyes (9721 ± 1699 cells/mm²) and fellow eyes (15,667 ± 1909 cells/mm²) (P < 0.001; P = 0.002, respectively). The mean photoreceptor density was significantly correlated with logMAR visual acuity (r = -0.432, P = 0.035), duration of symptoms (r = -0.537, P = 0.007), retinal sensitivity and fixation stability P2 in eyes with resolved cCSC (r = 0.430, P = 0.036; r = 0.420, P = 0.041, respectively).

CONCLUSIONS

The HMM images revealed significant photoreceptor loss in patients with cCSC. The findings suggest that early intervention of the affected eyes, with short duration and good visual function, might be beneficial in preserving photoreceptor cells. As a novel imaging modality producing fast, high-resolution images, HMM shows great potential to detect microstructural impairments in retinal diseases.

Correlation of sectoral choroidal vascularity with angiographic leakage in central serous chorioretinopathy

PURPOSE

To correlate sectoral choroidal vascularity with angiographic leakage in eyes with central serous chorioretinopathy (CSCR).

METHODS

This was a retrospective, cross-sectional study including patients with active CSCR. Multimodal imaging including fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were performed to identify leakage site and obtain choroidal measurements, respectively. An automated algorithm was used to perform shadow compensation, choroidal boundary localization and binarization, three (3-D) dimensional mapping, and early treatment of diabetic retinopathy study (ETDRS) grid based choroidal quantification that is, choroidal thickness (CT) and choroidal vascularity index (CVI). Nested analysis of variance (ANOVA) was performed to compare CT and CVI in different sectors.

RESULTS

Thirty-two eyes with active CSCR were analyzed. CT values varied significantly among the sectors (range, 450.27-482.63 µm; p = 0.005) and rings (range, 459.71-480.45 µm; p < 0.001), however, CVI failed to show significant variation among various segments (sectors, rings, and quadrants; range, 0.53-0.54; all p values > 0.05). Among 25 leaking spots in 25 different sectors, 12 (48%) had an increased CT compared to the overall CT whereas only 24% had increased CVI compared to overall CVI. Mean CT and CVI of the sectors with leakage (427.1 ± 81.1 µm; 0.51 ± 0.05) and remaining sectors without leakage (411.3 ± 73.9 µm; 0.53 ± 0.04) were not statistically different (p = 0.48; p = 0.12, respectively).

CONCLUSION

Though CT varied in different segments and increased CT corresponded to leakage points on FFA in 48% of eyes, CVI changes were more diffusely spread and local changes in CVI were not predictive of leakage location in eyes with active CSCR.

[Central serous chorioretinopathy]

Central serous chorioretinopathy (CSC) is the fourth most common disease of the macula after age-related macular degeneration, diabetic retinopathy and retinal vein occlusion and a cause of irreversible visual loss. This article gives an overview of the epidemiology, risk factors, pathophysiology, clinical presentation, multimodal imaging and discusses current therapeutic options for CSC.

Characteristics and treatment responses of cystoid retina associated with central serous chorioretinopathy

PURPOSE

To detect the characteristics of cystoid retina associated with central serous chorioretinopathy (CSC) using multimodal imaging and to evaluate anatomical and functional responses for treatment.

STUDY DESIGN

A retrospective case series METHOD: This retrospective study included 21 eyes of 17 patients with the treatment for combined cystoid retinal changes and submacular fluid associated with CSC. Multimodal imaging analysis including cross-sectional OCT, en face OCT, fluorescein and indocyanine green angiography, and fundus autofluorescence were performed to assess the characteristics of cystoid changes. In 21 eyes of 17 patients, clinical courses after treatment were reviewed.

RESULTS

Fourteen of 17 patients were men (82.4%), and the mean age was 63.2. Fluorescein angiography revealed one or more focal leakages in all eyes, and intense leakage, due to peripapillary atrophy and from areas showing retinal pigment epithelial atrophy, was observed in 11 eyes and 12 eyes respectively. En face OCT visualized cystoid retinal changes as honey-comb like areas, and this was observed in the papillomacular region in 16 eyes (76.2%). After reduced-fluence photodynamic therapy (PDT), combination of anti-VEGF and PDT, or photocoagulation, subretinal fluid resolved in 20 eyes (95.2%), and complete resolution of cystoid retinal changes was obtained in 13 eyes (61.9%).

CONCLUSION

Cystoid retinal changes can be associated with patchy retinal pigment epithelial atrophy and with peripapillary atrophy in CSC eyes. Laser treatment is beneficial for resolving cystoid retina as well as subretinal fluid.

Morphological Changes and Prognostic Factors before and after Photodynamic Therapy for Central Serous Chorioretinopathy

Central serous chorioretinopathy (CSC) is a disease of unknown etiology, but half-dose photodynamic therapy (hPDT) is well known to be effective for CSC. Infrared reflectance (IR) has been shown to be effective for detecting retinal pigmented epithelial and choroidal lesions, but no reports have focused on chorioretinal changes using IR images after as compared to before hPDT. This study aimed to clarify the features of IR images as well as retinal and choroidal morphological changes before and after treatment with verteporfin hPDT for CSC. We also examined prognostic factors associated with CSC treatment. This was a retrospective study that included 140 eyes of 140 patients (male/female ratio 122:18, mean age 53.4 ± 10.8 years) diagnosed with CSC who underwent hPDT in our hospital during the period from April 2015 to December 2018. We determined changes in visual acuity, therapeutic efficacy, central retinal thickness (CRT), central choroidal thickness (CCT), and IR images at one and three months after hPDT as compared to before treatment. Dry macula was defined as a complete resolution of serous retinal detachment after hPDT. History of smoking, disease duration, presence of drusen, presence of retinal pigment epithelium abnormalities, type of fluorescein angiographic leakage, and presence of choroidal vascular hyperpermeability were investigated as prognostic factors associated with treatment efficacy. CRT and CCT were measured using optical coherence tomography (Spectralis HRA-2; Heidelberg Engineering), and IR images after versus before treatment were compared using ImageJ software (version 1.52) to calculate the mean luminance for a 3 × 3 mm area in the macula. Compared with the values before treatment, CCT, CRT, and visual acuity showed significant improvements at one and three months after treatment, and the mean luminance of IR images was also significantly increased. Furthermore, the luminance on IR images tended to rise, though the values at one month and three months after treatment did not differ significantly. Disease duration was significantly associated with dry macula one month after treatment, and visual acuity and CRT before hPDT were both significantly related to dry macula three months after treatment. IR images tended to improve over time, from before treatment through one and three months after hPDT.

Short-term effect of anti-VEGF for chronic central serous chorioretinopathy according to the presence of choroidal neovascularization using optical coherence tomography angiography

Purpose

To analyze the short-term therapeutic efficacy of intravitreal injection of bevacizumab (IVB) for chronic central serous chorioretinopathy (CSC) according to the presence of choroidal neovascularization (CNV) using optical coherence tomography angiography (OCTA).

Methods

A retrospective chart review was perfomed on cases of CSC with CNV (Group 1: n = 31) and an age-matched cases of CSC without CNV (Group 2: n = 30). The response to IVB was evaluated by changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), choroidal thickness (CT), and pachyvessel diameter. Univariate and multivariate linear regression analyses were performed to identify factors associated with the visual outcome of chronic CSC with CNV after IVB.

Results

At baseline, the CT values differed significantly between Groups 1 and 2 (371.55 ± 67.09 vs. 417.33 ± 71.32 μm, p = 0.01). In Group 1, BCVA improved significantly (p < 0.001), and CMT (p < 0.001), CT (p = 0.001) and pachyvessel diameter (p = 0.045) decreased significantly, after IVB. In Group 2, only pachyvessel diameter (p = 0.001) was significantly smaller after IVB. Univariate analysis showed that the initial CT (B = 0.002, p = 0.026) and pachyvessel diameter (B = 0.002, p = 0.001) significantly affected visual outcome. In multivariate analysis, the initial pachyvessel diameter exhibited significant results (B = 0.002, p = 0.001).

Conclusions

IVB showed less effective short-term outcomes in chronic CSC patients without CNV than in patients with CNV. In chronic CSC with CNV, the short-term visual outcome after IVB was better in patients with a thinner choroid and smaller pachyvessels.

Central serous chorioretinopathy imaging biomarkers

PURPOSE

To identify the factors predicting the visual and anatomical outcomes in eyes with central serous chorioretinopathy (CSCR) through 12 months.

METHODS

Patients with diagnosis of CSCR, either acute or chronic, were included in this multicentric, retrospective study. Demographic factors; systemic risk factors; central macular thickness (CMT), subfoveal choroidal thickness (SFCT), linear extent of ellipsoid zone (EZ) and interdigitation zone damage on optical coherence tomography; details of leak on fluorescein angiography and indocyanine green angiography were included as predictors of anatomical and visual outcomes. Regression analysis was performed to correlate the changes in best corrected visual acuity (BCVA) and resolution of disease activity.

RESULTS

A total of 231 eyes of 201 patients with a mean age (49.7±11.8 years) were analysed. A total of 97 and 134 eyes were classified as acute and chronic CSCR. BCVA (0.35±0.31 to 0.24±0.34; p<0.001), baseline optical coherence tomography (OCT) parameters including CMT (p<0.001), subretinal fluid (SRF) height (p<0.001) and SFCT (p=0.05) showed a significant change through 12 months. Multivariate regression analysis showed change in CMT (p≤0.01) and SRF height at baseline (p=0.05) as factors predictive of good visual outcome. Logistic regression analysis revealed changes in both CMT (p=0.009) and SFCT (p=0.01) through 12 months to correlate with the resolution of disease.

CONCLUSION

OCT parameters such as changes in both CMT and SFCT along with subfoveal EZ damage can be predictive of disease resolution whereas changes in CMT and baseline SRF height correlate well with changes in BCVA through 12 months.

Oral Treatment of Central Serous Chorioretinopathy Patients Using Propranolol Tablets

Purpose: To evaluate the pharmacological effects of propranolol treatment of patients with central serous chorioretinopathy (CSCR) over 4 months. Results: Among the 89 male and 31 female patients, the mean BCVA decreased to 0.42 ± 0.08 logMAR during CSCR attacks. Oral propranolol showed good effectiveness in reducing CSCR signs after at least 4 months of treatment. The final BCVA of the patients in groups 1 and 2 was 0.09 ± 0.01 and 0.19 ± 0.03 logMAR, respectively (p < 0.05). Moreover, the mean complete remission time in groups 1 and 2 was 1.9 and 3.5 months, respectively (p < 0.05), while the “success” rate in groups 1 and 2 was 95.0% (57/60) and 78.3% (47/60), respectively (p < 0.05). The recurrence rate in groups 1 and 2 was 5.3% (3/57) and 25.5% (12/47) after a further 5 months of follow-up, respectively (p < 0.05). Materials and Methods: One hundred and twenty patients were enrolled and randomly divided into two groups that both underwent a visual acuity test and optical coherence tomography (OCT) scanning, between April and December 2017. The 60 patients in group 1 were requested to take propranolol for 4 months, while the other 60 subjects (group 2) received placebo therapy during the same period. The best-corrected visual acuity (BCVA) of every volunteer and an OCT image of each patient were checked and recorded at the beginning of the study and each week thereafter. If the signs of CSCR disappeared completely from the OCT scans, the case was considered a “success” and treatment stopped at once. However, the “success” subjects were further evaluated in follow-ups throughout the next 5 months to determine the rate of recurrence in groups 1 and 2. The time of total complete remission of CSCR from the OCT scans was also measured in groups 1 and 2. Conclusion: CSCR patients revealed an excellent prognosis and success rate of 95.0% after taking propranolol. The treatment was able to enhance subretinal fluid (SRF) absorption, shorten the time to total complete remission, and significantly decrease CSCR recurrence. As such, we suggest that taking propranolol may be an alternative and viable choice for CSCR patients, given that the new method was shown to be safe, cheap, effective, well tolerated and convenient.

Long-term treatment response after intravitreal bevacizumab injections for patients with central serous chorioretinopathy

Purpose

To investigate long-term treatment response after intravitreal bevacizumab injections (IVBIs) for central serous chorioretinopathy (CSC).

Methods

This retrospective, interventional study investigated the medical records of 45 eyes of 44 patients with CSC who underwent IBVIs and completed at least 2-year follow-up period. Complete resolution (CR) was defined as complete resolution of subretinal fluid at least 3 months after the last IVBI. Thick-choroid CSC was defined as mean subfoveal choroidal thickness more than 300.0 μm. The main outcome measure was long-term treatment outcome after IVBIs in patients with CSC.

Results

Thirty-five patients (79.5%) were male, and their mean age was 45.5 ± 9.6 years. The mean follow-up period was 35.1 ± 11.5 months. Twenty-two eyes (48.9%) had acute CSC, and 40 eyes (88.9%) achieved CR. Twenty eyes (50.0%) developed recurrence, the mean number of IVBIs to achieve the first CR was not significantly different between eyes with and without recurrences (2.6 ± 1.6 vs. 2.9 ± 1.9; P = 0.658). Thick-choroid CSC was significantly difference between the eyes with and without recurrence (17 eyes, 85.0% vs. eyes, 50.0%; P = 0.020). Among the baseline characteristics, serous pigment epithelial detachment (B = - 2.580, P = 0.032) and thick-choroid (B = 1.980, P = 0.019) were significantly associated with recurrence.

Conclusion

Eyes with CSC treated with IVBI and achieving complete resolution of subretinal fluid have 50% chance of recurrence in the long term. Thinner choroid and serous pigment epithelial detachment appear protective for recurrences.

The efficacy of subthreshold micropulse yellow laser (577 nm) in chronic central serous chorioretinopathy

Central serous chorioretinopathy (CSC) is a disease characterized by a well-defined serous detachment of the neurosensory retina. Therapeutic options in chronic cases are limited, and side effects can result in a limited response. The aim of this article is to assess the efficacy of subthreshold micropulse laser therapy in patients with chronic central serous chorioretinopathy. The study included 20 eyes of 19 patients who had a history of chronic or chronic recurrent CSC and who underwent subthreshold micropulse laser therapy between January 2015 and June 2018. Twenty eyes of 19 patients with a mean age of 48.9 ± 9.40 years were included. The mean visual acuity was 0.24 ± 0.28 logMAR before laser, 0.19 ± 0.25 logMAR 3 months after laser, and 0.18 ± 0.27 logMAR after 6 months. A statistically significant difference was determined in terms of visual acuity before and after treatment (p = 0.0001). The mean central retinal thickness was 308.10 ± 95.25 μm before laser, 233.65 ± 81.17 μm 3 months after laser, and 203.88 ± 72.79 μm at 6 months. A statistically significant relationship was present between visual acuity and the duration of disease (p = 0.001), between visual acuity and the outer nuclear layer thickness (p = 0.005), and between the outer nuclear layer thickness and the duration of disease in chronic cases (p = 0.008). There was no evidence of retinal pigment epithelium or retinal damage on optical coherence tomography or fundus autofluorescence secondary to subthreshold micropulse laser therapy. Visual acuity appears to be more associated with the duration of disease and with changes in the outer nuclear layer thickness in chronic CSC. Subthreshold micropulse laser therapy seems to be effective at treating chronic CSC, while it increases success during early period of the disease before the development of permanent retinal damage.

Fluorescein angiography as a primary guide for reduced-fluence photodynamic therapy for the treatment of chronic central serous chorioretinopathy

PURPOSE

The aim of this study is to investigate the results of fluorescein angiography (FA)-guided reduced-fluence photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSCR), with the hypothesis that indocyanine green angiography (ICGA) guidance is avoidable in some cases.

METHODS

This retrospective study includes a consecutive nonrandomized series of chronic CSCR cases. All eyes were examined with FA and the ones that had discrete active leakage areas or points had undergone reduced-fluence PDT.

RESULTS

The study included 45 eyes of 41 patients with a mean age of 48.8 ± 10.7. The main duration of last chronic CSCR episode was 13.0 ± 11.9 months. Thirty-nine (86.7%) out of 45 consecutive eyes had active leakage area(s) on FA, which enabled them to be treated with PDT. Remaining six eyes had undergone ICGA examination and had received an ICGA-guided PDT. In FA-guided eyes, the mean BCVA improved from 0.44 ± 0.25 Snellen lines to 0.63 ± 0.32 lines in the last control visit (p < 0.001). Both central macular thickness and subfoveal choroidal thickness decreased significantly in treated eyes. Thirty-eight eyes (97.4%) in FA-guided group and six eyes (100.0%) in ICGA-guided group had total resorption of subretinal fluid.

CONCLUSION

This study provides basis to support the hypothesis that FA-guided half-fluence PDT may be justified as an alternative method of treatment in appropriate cases of chronic CSCR without compromising the therapeutic success.

Comparison of Focal and Conventional Verteporfin Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

Purpose

To evaluate the efficacy of focal verteporfin photodynamic therapy (PDT) in patients diagnosed with chronic central serous chorioretinopathy (CSC).

Methods

This study enrolled 52 eyes of 52 patients with chronic CSC who had received verteporfin PDT. The laser spot size of 26 eyes covering only the localized hyperfluorescent area in indocyanine green angiography was classified as focal PDT. The PDT spot size of the other 26 eyes covered the total area of retinal pigment epithelial detachment including the leaking point and was defined as conventional PDT. The central subfield thickness and subfoveal choroidal thickness were measured using Heidelberg Spectralis optical coherence tomography before PDT and at months 1, 3, 6, and 12 after PDT.

Results

The mean spot size of the PDT was 1,995 µm in the focal group and 2,995 µm in the conventional group. Central subfield thickness steadily decreased in both groups. The mean baseline subfoveal choroidal thickness for the two groups was 334.95 and 348.35 µm, respectively, with no significant difference (p = 0.602). Subfoveal choroidal thickness decreased significantly to 304.20 µm at 1 month, 284.85 µm at 3 months, 271.60 µm at 6 months, and 265.95 µm at 12 months in the focal group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively, compared with baseline). In the conventional group, subfoveal choroidal thickness decreased significantly to 318.75, 300, 284, and 272 µm at 1, 3, 6, and 12 months, respectively (p < 0.001, p < 0.001, p < 0.001 and p < 0.001 compared with baseline). There were no significant differences between the two groups in subfoveal choroidal thickness based on PDT spot size at 1, 3, 6, and 12 months (p = 0.633, p = 0.625, p = 0.676, and p =0.755, respectively).

Conclusions

Focal verteporfin PDT for CSC significantly decreased the subretinal fluid and sufoveal choroidal thickness to the same extent as conventional PDT.

A randomized clinical trial comparing prompt photodynamic therapy with 3 months observation in patients with acute central serous chorioretinopathy with central macular leakage

PURPOSE

The purpose of the study was to demonstrate whether photodynamic therapy in patients with acute central serous chorioretinopathy, with the leakage point within one optic disk diameter from the fovea, can be safely deferred.

METHODS

A single-center, randomized, controlled trial was conducted. Patients were randomized to photodynamic therapy within a week after presentation (Group I, 26 patients) or observation during 3 months (Group II, 26 patients). If leakage or subretinal fluid was observed during any control visit, photodynamic therapy was performed (again) within a week.

PRIMARY OUTCOME

Primary outcome was change of visual acuity (Early Treatment Diabetic Retinopathy Study) after 12 months. Secondary outcomes were visual acuity, central foveal thickness, metamorphopsia, and color discrimination.

RESULTS

Photodynamic therapy procedures: group I, 26 at baseline, 2 retreatments at 3 months; group II, 10 at 3 months, 1 at 6 months (2 subjects refusing treatment), 2 retreatments at 6 months. At 12 months, mean visual acuity of all patients had improved by 6.5 letters (P < 0.001), mean central foveal thickness was 172 µm less (P < 0.001). After photodynamic therapy, visual acuity recovered faster and metamorphopsia significantly improved (3 months, P < 0.001). Differences between groups at 12 months were not significant.

CONCLUSION

The (intended) number of photodynamic therapy (re)treatments in group II (n = 15) was 46% less than in group I (n = 28). Visual acuity and central foveal thickness at 12 months were similar. Therefore, the preferred management of acute central serous chorioretinopathy at presentation appears to be observation for 3 months.

The significance of pigment epithelial detachment in central serous chorioretinopathy

PURPOSE

To investigate the significance of the presence and form of pigment epithelial detachment in the course of central serous chorioretinopathy as well as corticosteroid use as a risk in our patient cohort.

MATERIAL AND METHODS

Retrospective, single center study of central serous chorioretinopathy patients between January 2013 and January 2019 recording corticosteroid use prior to onset and presence and type of pigment epithelial detachment (flat-irregular, dome-shaped, none) in relationship to disease course.

RESULTS

We analyzed 53 eyes of 53 consecutive central serous chorioretinopathy patients treated in our department. Mean patient age was 53 ± 13 years. A flat-irregular pigment epithelial detachment was associated with either chronic or recurrent central serous chorioretinopathy, whereas the absence of a pigment epithelial detachment correlated positively with acute central serous chorioretinopathy (chi-square test, p < 0.05). Of the 53 patients, 10 reported corticosteroid use, 40 denied steroid use, and 3 patients failed to make a clear statement. Corticosteroid use was not correlated with the onset of central serous chorioretinopathy (Student's t-test, p = 0.0001, chi-square test, p < 0.005).

CONCLUSION

A small, flat-irregular pigment epithelial detachment could be a marker for chronic or recurrent central serous chorioretinopathy, whereas the absence of pigment epithelial detachment could favor acute central serous chorioretinopathy. Advanced imaging studies may provide more information on the exact characteristics and nature of pigment epithelial detachments. Corticosteroid use as possible disease trigger was not confirmed in this study.

Choroidal Neovascularization Secondary to Central Serous Chorioretinopathy: OCT Angiography Findings and Risk Factors

Purpose

To identify the clinical characteristics and risk factors for secondary choroidal neovascularization (CNV) in central serous chorioretinopathy (CSC).

Methods

In this retrospective study, we included a total of 108 eyes in 106 CSC patients. Group A was defined as patients initially diagnosed with CSC who developed secondary CNV, and group B was defined as patients who did not develop secondary CNV. Clinical and demographic characteristics, optical coherence tomography (OCT) findings at CSC diagnosis and OCT angiography (OCTA) at the time of secondary CNV diagnosis, were compared between the groups.

Results

Thirty-one eyes had CNV (group A) and 77 eyes did not (group B). The mean age of group A was higher than that of group B (52.28 ± 6.87 vs. 46.78 ± 9.45 years; P < 0.001). Although there was no difference in pigment epithelial detachment (PED) height, group A had larger PED width than group B at CSC diagnosis. The foveal and parafoveal choriocapillary flow densities were significantly lower in group A than group B (P < 0.001). Although there was no difference in pigment epithelial detachment (PED) height, group A had larger PED width than group B at CSC diagnosis. The foveal and parafoveal choriocapillary flow densities were significantly lower in group A than group B (P < 0.001). Although there was no difference in pigment epithelial detachment (PED) height, group A had larger PED width than group B at CSC diagnosis. The foveal and parafoveal choriocapillary flow densities were significantly lower in group A than group B (

Conclusion

We identified that older age, wider PED width at diagnosis, and recurrent episodes of CSC were independent risk factors for development of secondary CNV. Therefore, patients with these risk factors should be monitored to allow early detection and prompt treatment of secondary CNV.

Long-term results of focal laser photocoagulation and photodynamic therapy for the treatment of central serous chorioretinopathy

PURPOSE

To evaluate the long-term results of focal laser photocoagulation and photodynamic therapy (PDT) for treatment of central serous chorioretinopathy (CSC).

STUDY DESIGN

Retrospective chart review.

METHODS

Sixty-two patients with CSC, thirty-three of whom were treated with focal laser photocoagulation, and 29 with PDT and who were followed up for > 6 months, were enrolled. The focal laser was performed at sites of focal leakage (but not subfoveal leaks) shown in fluorescein angiography. PDT was performed at sites of subfoveal or juxtafoveal focal leakage or not definite focal leakages. Best corrected visual acuity (BCVA), central macular thickness (CMT), resolution of subretinal fluid (SRF) and recurrence were analyzed.

RESULTS

The follow-up duration of the focal laser group was 35.2 ± 22.6 and of the PDT group, 46.4 ± 21.5 months. Time to resolution of SRF was 1.8 ± 1.5 months for the focal laser group and 1.2 ± 0.5 months for the PDT group. SRF was rapidly absorbed in the PDT group. In both groups, the CMT was decreased 1 month after treatment. The BCVA improved significantly 1 month after treatment in the focal laser group and 3 months after treatment in the PDT group. However, there was no significant difference in CMT reduction and BCVA improvement between the two groups. It subsequently remained similar for up to 3 years. Ten patients (30.3%) in the focal laser group and three patients (10%) in the PDT group recurred during the follow-up period.

CONCLUSIONS

PDT showed early resolution of the SRF compared to focal laser. In CSC patients, both the CMT and BCVA remained stable for 3 years after treatment. After 3 or more years of follow-up, PDT showed a lower recurrence rate than focal laser.

Chorioretinal response to intravitreal aflibercept injection in acute central serous chorioretinopathy

AIM

To evaluate chorioretinal responses to intravitreal aflibercept injection (IAI) in patients with acute central serous chorioretinopathy (CSC).

METHODS

Seventy-one eyes from 71 patients with symptomatic CSC for less than six months were included. Thirty-five eyes received a single IAI and 36 eyes were observed without treatment. Best-corrected visual acuity (BCVA), central subfield foveal thickness (CSFT), and subfoveal choroidal thickness (SFCT) were assessed at baseline and at 1, 2, and 3mo.

RESULTS

The mean SFCT in the IAI group decreased at 1mo, rebounded at 2mo and remained stable at 3mo compared to the baseline, while significant change was not noted in the observation group. The mean CSFT decreased significantly during the 3-month study period in both groups, and was significantly lower in the IAI group at 1mo (P<0.001). A rebound of CSFT between 1 and 2mo was noted in 14 eyes (40.0%) in the IAI group and in 1 eye (2.8%) in the observation group (P<0.001). The significant visual improvement was achieved from 1mo in the IAI group, and from 2mo in the observation group. The rate of complete absorption of subretinal fluid at 3mo did not differ between the two groups. (45.7% vs 41.7%, P=0.813).

CONCLUSION

A single IAI for acute CSC induce a transient decrease in SFCT and CSFT, which implies that IAI may have a pharmacological effect on the underlying hyperpermeable choroid in acute CSC.

Pharmacotherapy of Central Serous Chorioretinopathy: A Review of the Current Treatments

BACKGROUND

Central serous chorioretinopathy (CSC) is the fourth most frequent retinal disorder in terms of prevalence. It typically occurs in young subjects and affects men more often than women. CSC is characterized by serous retinal detachment (SRD) involving mainly the macular area. The clinical course is usually selflimited, with spontaneous resolution within 3 months. The persistence of SRD or multiple relapse may result in a chronic form of CSC distinguished by permanent retinal pigment epithelium (RPE) and photoreceptor damage. As the pathogenetic mechanism of CSC primarily involves RPE and choroidal vascularization, the current therapeutic approaches aim to restore the normal functions of RPE and normal choroidal vascular permeability. In this review, the authors aim to summarize the current therapeutic approach to CSC.

METHODS

A comprehensive review of the literature was conducted in PubMed by searching for relevant studies on the current therapeutic options for CSC, including simple observation, conventional laser treatment, subthreshold laser treatment (SLT), photodynamic therapy (PDT) with verteporfin, treatment with mineralocorticoid receptor (MR) antagonists and treatment with anti-vascular endothelial growth factor drugs.

RESULTS

Since most cases resolve spontaneously, the most common initial CSC treatment is observation. Current evidence suggests that PDT and SLT are valuable in improving visual acuity, reducing subretinal fluid and maintaining long-term effectiveness. No clear evidence of efficacy has been achieved for anti-VEGF. MR antagonists might be a viable choice for the treatment of chronic CSC.

CONCLUSION

The pathophysiology of CSC remains poorly understood and as a consequence, the gold standard of care for CSC is yet to be defined. To date, PDT and SLT continue to offer good clinical outcomes. Positive preliminary results seem to emerge from the studies of MR antagonists.

Central serous chorioretinopathy: Towards an evidence-based treatment guideline

Central serous chorioretinopathy (CSC) is a common cause of central vision loss, primarily affecting men 20-60 years of age. To date, no consensus has been reached regarding the classification of CSC, and a wide variety of interventions have been proposed, reflecting the controversy associated with treating this disease. The recent publication of appropriately powered randomised controlled trials such as the PLACE trial, as well as large retrospective, non-randomised treatment studies regarding the treatment of CSC suggest the feasibility of a more evidence-based approach when considering treatment options. The aim of this review is to provide a comprehensive overview of the current rationale and evidence with respect to the variety of interventions available for treating CSC, including pharmacology, laser treatment, and photodynamic therapy. In addition, we describe the complexity of CSC, the challenges associated with treating CSC, and currently ongoing studies. Many treatment strategies such as photodynamic therapy using verteporfin, oral mineralocorticoid antagonists, and micropulse laser treatment have been reported as being effective. Currently, however, the available evidence suggests that half-dose (or half-fluence) photodynamic therapy should be the treatment of choice in chronic CSC, whereas observation may be the preferred approach in acute CSC. Nevertheless, exceptions can be considered based upon patient-specific characteristics.

A patient misdiagnosed with central serous chorioretinopathy: A case report

BACKGROUND

Due to some similarities in the manifestations between central serous chorioretinopathy (CSC) and polypoidal choroidal vasculopathy (PCV), PCV may be misdiagnosed as CSC. More attention should be paid to distinguishing these two disorders.

CASE SUMMARY

A 52-year-old woman presented to our hospital with blurred vision in her left eye for approximately 1 wk. Anterior segment and intraocular pressure findings were normal in both eyes. Fundus photography of the left eye showed a seemingly normal adult oculus fundus without any obvious hard exudate or hemorrhage. Optical coherence tomography exhibited a hypo-reflective space beneath both the neurosensory retina and the pigment epithelium layer. The late phase of fluorescein angiography revealed increased leakage. The patient was initially diagnosed with CSC. At follow-up, however, the final diagnosis turned out to be PCV.

CONCLUSION

CSC and PCV are two different retinal entities. Lipid deposition and hemorrhage are the most important elements that lead to confusion between these two entities. Indocyanine green angiography should be performed to make a definitive diagnosis, especially in cases with suspected PCV.

Abnormal choroidal flow on optical coherence tomography angiography in central serous chorioretinopathy

IMPORTANCE

Analysing choroidal flow in central serous chorioretinopathy (CSC) with novel device.

BACKGROUND

To examine the abnormal morphology of choriocapillary flow with optical coherence tomography angiography (OCTA) according to the presence of subretinal fluid (SRF) in CSC.

DESIGN

A hospital-based retrospective study.

PARTICIPANTS

We analysed OCTA results of 68 eyes (68 patients) diagnosed as CSC with or without SRF (active and resolved CSC, respectively) at the Asan Medical Center.

METHODS

We classified OCTA choriocapillary images into three pattern groups: mixed perfusion, hyper-perfusion and normal perfusion. Data analysis included age, follow-up duration, treatment modalities, number of treatments, subfoveal choroidal thickness and SRF height.

MAIN OUTCOME MEASURES

The relationship between CSC activity and choriocapillary pattern.

RESULTS

Abnormal choroidal flow (mixed and hyper-perfusion) was more frequently found in eyes with active CSC (100%) than resolved CSC (47.5%, P < 0.001). In active CSC eyes, mixed perfusion was predominant (71.4%), while hyper-perfusion was predominant in those with resolved CSC (73.7%). Eyes with recently resolved CSC (SRF absorption present for <2 months) had abnormal choriocapillary flow more often than the remaining eyes with resolved CSC (83.3% vs 32.1%, P = 0.005). Resolved CSC eyes with abnormal choriocapillary flow demonstrated more recurrence than eyes with normal choriocapillary flow (42.1% vs 9.5%, P = 0.017).

CONCLUSIONS AND RELEVANCE

The pattern of choriocapillary flow abnormalities on OCTA can indicate CSC disease activity. Because eyes with resolved CSC showing abnormal choroidal flow have a high recurrence rate, they should be carefully followed-up.

Long-term Visual Outcomes and Causes of Vision Loss in Chronic Central Serous Chorioretinopathy

PURPOSE

To evaluate the long-term visual outcomes and causes of vision loss in chronic central serous chorioretinopathy (CSC).

DESIGN

Retrospective, longitudinal study.

PARTICIPANTS

A total of 133 participants (217 eyes) with chronic CSC.

METHODS

A retrospective review of clinical and multimodal imaging data of patients with chronic CSC managed by 3 of the authors between May 1977 and March 2018. Multimodal imaging comprised color photography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence (FAF), and OCT.

MAIN OUTCOME MEASURES

Best-corrected visual acuity (BCVA) at the final visit; change in BCVA between first visit and 1-, 5-, and 10-year follow-up visits; and causes of vision loss at final visit.

RESULTS

Data from 6228 individual clinic visits were analyzed. Mean age of patients at the first visit was 60.7 years, and mean period of follow-up from first to last visit was 11.3 years. The cohort included 101 male patients (75.9%). At the final visit, 106 patients (79.7%) maintained driving-standard vision with BCVA of 20/40 or better in at least 1 eye, and 17 patients (12.8%) were legally blind with BCVA of 20/200 or worse in both eyes. Mean BCVA at first visit was not significantly different from mean BCVA at 1- or 5-year follow-up visits (both P ≥ 0.65) but was significantly better than the mean BCVA at the 10-year follow-up visit (P = 0.04). Seventy-nine percent of eyes with 20/40 or better vision at the first visit maintained the same level of vision at the 10-year follow-up visit. Ninety-two percent of eyes with 20/200 or worse vision at the first visit maintained the same level of vision at the 10-year follow-up visit. Cystoid macular degeneration, choroidal neovascularization (CNV), outer retinal disruption on OCT, and FAF changes were associated with poorer vision at the final visit (all P ≤ 0.001). Multivariable analysis revealed that greater age at first visit was associated with greater BCVA change at the 10-year follow-up visit (P = 0.001).

CONCLUSIONS

Chronic CSC can be a sight-threatening disease leading to legal blindness. Age at presentation and outer retinal changes on multimodal imaging were associated with long-term BCVA changes and may be predictors of long-term visual outcomes.

Clinical Features of Central Serous Chorioretinopathy With Type 1 Choroidal Neovascularization

PURPOSE

To evaluate the type 1 choroidal neovascularization (CNV) incidence and associated factors in eyes with central serous chorioretinopathy (CSC).

DESIGN

Retrospective case series.

METHODS

Records of 363 eyes (324 patients) with CSC were reviewed. Age, sex, CSC type, choroidal vascular hyperpermeability (CVH), best-corrected visual acuity (BCVA), subfoveal choroidal thickness (SCT), and systemic hypertension (HT) were assessed and compared between subjects with and without neovascular CSC.

RESULTS

We identified 219 and 144 eyes with chronic and acute CSC, respectively. The mean participant age was 55.2 ± 12.0 years, and 58 (15.6%) eyes had neovascular CSC. Age (no CNV: 54.8 ± 12.1 years, CNV: 57.3 ± 10.9 years; P = .118) and SCT (no CNV: 388.0 ± 104.5 μm, CNV: 377.4 ± 108.9 μm; P = .487) were comparable between eyes with and without CNV. However, BCVA (logarithm of the minimum angle of resolution) was significantly worse in subjects with CNV (0.28 ± 0.33 [20/38] vs 0.15 ± 0.29 [20/28]; P = .014). Neovascular CSC occurred more often in women (72 [23.6%] vs 20 [34.5%], P = .099) and in cases of chronic CSC (171 [56.1%] vs 48 [82.8%], P < .001), CVH (205 [67.2%] vs 58 [100%], P < .001), and HT (91 [29.8%] vs 24 [41.4%], P = .092). Chronic CSC (P = .001), female sex (P = .075), and poor BCVA (P = .091) were associated with neovascular CSC (multiple regression).

CONCLUSIONS

Chronic CSC, female sex, CVH, and poor BCVA are risk factors for CNV in eyes with CSC.

Central Serous Chorioretinopathy in African Americans at Wilmer Eye Institute

OBJECTIVE

To evaluate the frequency of central serous chorioretinopathy (CSC) in African Americans/blacks within an academic center in a predominantly African American city, as the current belief is that CSC is rare in this population.

METHODS

A retrospective review of all patients' charts diagnosed with CSC at Wilmer Eye Institute/Johns Hopkins University from August 2009-August 2015 was conducted via an electronic health record search (EPIC). The charts were categorized by self-reported race and gender. The diagnosis was confirmed by multiple physician consensus through chart and imaging review. Fluorescein angiograms were classified as single versus multiple point leakage. OCTs were evaluated for subfoveal thickness, location of fluid, presence or absence of pigment epithelial detachment. Color photos were categorized as to the extent of retinal pigment epithelial changes.

RESULTS

Of the 590 charts identified via EPIC as CSC patients, 407 were confirmed as CSC through chart and imaging review. 45 patients (11.1%) were African Americans and 298 patients (73.2%) were Caucasians. Of all patients seen during the study period, 0.09% of African Americans at Wilmer had CSC and 0.18% of Caucasians had CSC. While three fold more Caucasians were seen during the study period as compared to African Americans, this study's prevalence rate in African Americans/blacks at Wilmer Eye Institute was half of that in Caucasian/whites.

CONCLUSIONS

CSC has been reported as exceedingly rare in African Americans, but our study suggests that CSC may be underestimated in this population. A large nationally representative population based study is needed to determine true racial prevalence to ensure that the diagnosis of CSC is not overlooked in African Americans.

Visual outcomes and anatomic changes after sub-threshold micropulse yellow laser (577-nm) treatment for chronic central serous chorioretinopathy: long-term follow-up

PurposeTo analyze the long-term efficacy of 577 nm sub-threshold micropulse yellow laser (SMYL) in the treatment of chronic central serous chorioretinopathy (CCSC) and to evaluate the anatomic outcome, visual results and safety profile of the treatment.Patients and methodsThis prospective study assessed 39 eyes of 39 patients with non-resolving CCSC lasting more than three months. All eyes were treated by using 577 nm SMYL system with 5% duty cycle (DC) and each patients was monitored monthly. The main outcome measures were best-corrected visual acuity (BCVA), contrast sensitivity (CS) and subretinal fluid (SRF) height, central macular thickness (CMT), central macular volume (CMV), total macular volume (TMV), and subfoveal choroidal thickness (SFCT) measured by spectral domain optical coherence tomography (SD-OCT).ResultsThe median follow-up time period was 17.82±0.42 (13-23 months) months. The BCVA was improved significantly at final follow-up in comparison of baseline visit (P<0.01) in 35 eyes (89.7%) and in 4 eyes (10.3%) was stable. The median CMT, CMV, TMV before treatment was 369 μm, 0.30 mm3, and 9.86 mm3, in comparison to 250 μm, 0.19 mm3, and 8.76 mm3 at final follow-up, respectively (P<0.01 for all these parameters). Initial median SFCT was recorded as 364 μm and 342 μm at the final follow-up (P<0.001).DiscussionResults suggest that SMYL treatment is an effective method as response was rapid and procedure is safe to manage the non-resolving CCSC eyes.

Yellow (577 nm) micropulse laser versus half-dose verteporfin photodynamic therapy in eyes with chronic central serous chorioretinopathy: results of the Pan-American Collaborative Retina Study (PACORES) Group

PURPOSE

To compare the functional and anatomical outcomes of eyes with chronic central serous chorioretinopathy treated with yellow micropulse (MP) laser versus half-dose verteporfin photodynamic therapy (PDT).

METHODS

This is a multicentre, retrospective comparative study of 92 eyes treated with yellow MP laser (duty cycle of 5%, zero spacing between spots, spot size varied from 100 to 200 µm, power varied from 320 to 660 mW, and the pulse burst duration was 200 ms) and 67 eyes treated with PDT (half-dose verteporfin (3 mg/m²) infused over 10 min), followed by laser activation for 83 s. Spot sizes varied from 400 to 2000 µm.

RESULTS

In the MP group, at 12 months of follow-up, the mean best corrected visual acuity (BCVA) improved from the logarithm of the minimum angle of resolution (logMAR) of 0.41±0.27 at baseline to 0.21±0.26 (P<0.0001), 48.9% (45/92) of eyes had an improvement of ≥3 lines of BCVA from baseline, 48.9% (45/92) of eyes remained within 2 lines of baseline BCVA, and only 2.2% (2/92) of eyes lost ≥3 lines of BCVA from baseline. In the PDT group, at 12 months of follow-up, the mean BCVA changed from logMAR of 0.50±0.34 at baseline to 0.47±0.34 (P=0.89), 19% (13/67) of eyes had an improvement of ≥3 lines of BCVA from baseline, 73% (49/67) of eyes remained within 2 lines of baseline BCVA, and 7% (5/67) of eyes lost ≥3 lines of BCVA from baseline. There were no adverse events attributable to the yellow MP laser treatment. One eye in the PDT group developed choroidal neovascularisation, which was treated with three intravitreal bevacizumab injections.

CONCLUSIONS

Both PDT and MP are effective in restoring the macular anatomy. In places where PDT is not available, yellow MP laser may be an adequate treatment alternative.

Antiretinal antibodies in central serous chorioretinopathy: prevalence and clinical implications

PURPOSE

To investigate the possible role of autoimmune reactions directed against retinal tissue in central serous chorioretinopathy (CSC), by analysing the presence of serum antiretinal antibodies (ARAs) and establishing their clinical relevance.

METHODS

Sixty-three patients with CSC were included, and clinical characteristics were collected. Serum samples of all patients with CSC, 101 uveitis patients and 60 healthy donors were analysed for the presence of ARAs by indirect immunofluorescence. Furthermore, all CSC serum samples were analysed on Western blot. Correlations between laboratory findings and clinical features of CSC were determined by logistic regression.

RESULTS

Antiretinal antibodies (ARAs) were present in 54% of the patients with CSC, in 46% of uveitis patients (p = 0.153) and in 17% of healthy controls (p < 0.001). The majority of ARAs in CSC were directed against photoreceptors (27%), which occurred significantly more often compared to uveitis patients (15%, p = 0.039) and to healthy controls (5%, p = 0.003). No associations between clinical CSC characteristics and the presence of ARAs were found.

CONCLUSION

Serum ARAs are present in more than half of the patients with CSC, and especially, ARAs directed against photoreceptors were detected more frequently compared to both healthy controls and uveitis patients. Further research is warranted to unravel the role of ARAs in the pathogenesis of CSC.

Pattern of Contrast Sensitivity Changes in Acute Central Serous Chorioretinopathy

Purpose

To evaluate contrast sensitivity (CS) changes in acute central serous chorioretinopathy (CSC).

Methods

Visual acuity (VA), CS, and subretinal fluid (SRF) were evaluated monthly for 6 months. Treatment was considered at 3 months in case of persistent SRF.

Results

Twelve of 20 eyes (60%) had spontaneous SRF resolution within 4 months. Five of 8 patients with delayed SRF resolution received either focal laser or photodynamic therapy. The CS was impaired in all spatial frequencies at baseline. There was a negative correlation between the baseline SRF thickness and CS at 3 and 6 cycles per degree (cpd). The CS improved significantly at the time of fluid resolution (p = 0.001) and continued to improve in 3 and 6 cpd. The CS at 6 cpd did not recover if compared to a normal fellow eye at 6 months (p = 0.018). The CS of 12 cpd at 6 months was superior in the spontaneous resolution group.

Conclusion

The impaired CS gradually improved as the SRF reduced at all spatial frequencies. CS at 3 and 12 cpd continued to improve after complete fluid resolution. Despite an excellent final VA, the CS at 6 months did not regain its normal value.