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Dursun ME, Erdem S, Karahan M, Ava S, Hazar L, Dursun B, Keklikçi U. Evaluation of parafoveal vascular density using optical coherence tomography angiography in patients with central serous chorioretinopathy. Lasers Med Sci 2021; 37:1147-1154. [PMID: 34218316 DOI: 10.1007/s10103-021-03366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
Using optical coherence tomography angiography (OCTA), we sought to evaluate parafoveal vascular density (VD) in patients with central serous chorioretinopathy (CSCR). Our study included 43 patients with a diagnosis of CSCR and 40 healthy controls. Ophthalmologic examination findings and OCTA measurements of the participants were retrospectively analysed. Of the 43 patients with CSCR, 31 were males (72%) and 12 were females (28%); the control group was 30 males (75%) and 10 females (25%) (p = 0.657). There were significant differences between affected eyes, unaffected eyes and healthy control eyes for all parameters in the superficial capillary plexus (SCP) VD and deep capillary plexus (DCP) VD (p < 0.05 for all values). It was also determined that the affected eyes had lower SCP-VD and DCP-VD than the unaffected eyes and that the unaffected eyes had lower SCP-VD and DCP-VD than the healthy control eyes (p < 0.05 for all values). While there were no significant differences in the deep foveal avascular zone (FAZ) area, the superficial FAZ area was larger in affected eyes than in both unaffected eyes and healthy control eyes (p < 0.05). In most areas, the SCP-VD and DCP-VD values were lower and the FAZ larger in the chronic group than in the acute group (p < 0.05). Retinal vascular changes were found in patients with both acute and chronic CSCR, and the fellow eyes of these patients were also affected. OCTA can therefore be considered an easily applicable, non-invasive screening option for evaluating the microvascular structure in these patients.
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Affiliation(s)
- Mehmet Emin Dursun
- Department Ophthalmology, Medical Faculty, Dicle University, 21280, Diyarbakır, Turkey.
| | - Seyfettin Erdem
- Department Ophthalmology, Medical Faculty, Dicle University, 21280, Diyarbakır, Turkey
| | - Mine Karahan
- Department Ophthalmology, Medical Faculty, Dicle University, 21280, Diyarbakır, Turkey
| | - Sedat Ava
- Department Ophthalmology, Medical Faculty, Dicle University, 21280, Diyarbakır, Turkey
| | - Leyla Hazar
- Department Ophthalmology, Medical Faculty, Dicle University, 21280, Diyarbakır, Turkey
| | - Birgül Dursun
- Department Ophthalmology, Gazi Yasargil Education and Research Hospital, Diyarbakır, Turkey
| | - Uğur Keklikçi
- Department Ophthalmology, Medical Faculty, Dicle University, 21280, Diyarbakır, Turkey
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102
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Ersoz MG, Hocaoglu M, Sayman Muslubas I, Arf S, Karacorlu M. DEVELOPMENT OF PACHYCHOROID PIGMENT EPITHELIOPATHY AND TRANSFORMATION TO CENTRAL SEROUS CHORIORETINOPATHY AFTER INTRAVITREAL DEXAMETHASONE IMPLANTATION. Retin Cases Brief Rep 2021; 15:386-390. [PMID: 30260905 DOI: 10.1097/icb.0000000000000820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To report first case of sequential development of pachychoroid pigment epitheliopathy (PPE) and central serous chorioretinopathy (CSC) after repeated intravitreal dexamethasone implantations for diabetic macular edema treatment. METHODS We present a case of a 54-year-old man having intravitreal dexamethasone implant for bilateral diabetic macular edema. RESULTS We observed development of pachychoroid pigment epitheliopathy, seen as a small pigment epithelial detachment on optical coherence tomography after a fourth dexamethasone implantation. A fifth implantation caused transformation of pachychoroid pigment epitheliopathy to central serous chorioretinopathy. CONCLUSION Consecutive administration of dexamethasone implants may have a cumulative effect on retinal pigment epithelium, Bruch membrane, and choroid.
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103
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Fowler N, Mendez Martinez NR, Pallares BV, Maldonado RS. Acute-onset central serous retinopathy after immunization with COVID-19 mRNA vaccine. Am J Ophthalmol Case Rep 2021; 23:101136. [PMID: 34151047 PMCID: PMC8195685 DOI: 10.1016/j.ajoc.2021.101136] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/05/2021] [Accepted: 06/11/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose We report the case of a 33-year-old male who presented with unilateral central serous retinopathy three days after the injection of a COVID-19 vaccine. Observations A 33-year-old healthy Hispanic male referred to the ophthalmology service due to blurry vision and metamorphopsia in the right eye without any flashes, floaters, eye redness or pain. The patient reported that 69 hours prior to presentation he received the first dose of the Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine. He denied any past ocular history or pertinent medical history. He does not take any medicines and denies stressful factors in his life. The clinical examination and imaging tests were consistent with central serous retinopathy that resolved in three months. Conclusions and importance This is the first report of an ocular complication potentially associated with a COVID-19 vaccination. Our case contributes information of a side effect potentially related to this new vaccine.
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Affiliation(s)
- Nicholas Fowler
- Department of Ophthalmology, University of Kentucky, 110 Conn Terrace, Suite 550, Lexington, KY, USA
| | - Noe R Mendez Martinez
- Hospital "La Raza" IMSS, Mexico City, Mexico.,Escuela Superior de Medicina - Instituto Politecnico Nacional, Mexico City, Mexico
| | | | - Ramiro S Maldonado
- Department of Ophthalmology, University of Kentucky, 110 Conn Terrace, Suite 550, Lexington, KY, USA
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Genovese G, Meduri A, Muscatello MRA, Gangemi S, Cedro C, Bruno A, Aragona P, Pandolfo G. Central Serous Chorioretinopathy and Personality Characteristics: A Systematic Review of Scientific Evidence over the Last 10 Years (2010 to 2020). ACTA ACUST UNITED AC 2021; 57:medicina57060628. [PMID: 34208694 PMCID: PMC8235071 DOI: 10.3390/medicina57060628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 12/13/2022]
Abstract
Background and Objectives: to investigate the current state of art in the study of personality disorders in central serous chorioretinopathy (CSC), also taking into account the dimensional approach. Materials and Methods: this systematic review was conducted according to PRISMA guidelines. We included articles written in English or Italian, published in peer reviewed journals from 1 January 2010 to 31 December 2020. Results: after the screening, 10 studies were included. The results suggest that CSC patients are not characterized by the prevalence of a formal personality disorder, but they are better explained by typical personality traits that may alter their relationship with others. CSC patients seems to be characterized by high levels of aggressiveness and anxiety traits along with low sociability. We propose a model of disease where stress exacerbates prior specific traits in a vicious circle where some traits might be involved in disease progression and manifestation. Conclusions: maladaptive personality traits might be an essential feature of the disease and may represent a possible link between psychiatric symptoms, such as insomnia, anxiety, and depression, and endocrinological patterns. Further research should use a specific assessment scale evaluating both the level of interpersonal functioning and specific maladaptive traits.
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Affiliation(s)
- Giovanni Genovese
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (A.M.); (M.R.A.M.); (C.C.); (A.B.); (P.A.); (G.P.)
- Correspondence:
| | - Alessandro Meduri
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (A.M.); (M.R.A.M.); (C.C.); (A.B.); (P.A.); (G.P.)
| | - Maria Rosaria Anna Muscatello
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (A.M.); (M.R.A.M.); (C.C.); (A.B.); (P.A.); (G.P.)
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Policlinico “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy;
| | - Clemente Cedro
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (A.M.); (M.R.A.M.); (C.C.); (A.B.); (P.A.); (G.P.)
| | - Antonio Bruno
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (A.M.); (M.R.A.M.); (C.C.); (A.B.); (P.A.); (G.P.)
| | - Pasquale Aragona
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (A.M.); (M.R.A.M.); (C.C.); (A.B.); (P.A.); (G.P.)
| | - Gianluca Pandolfo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (A.M.); (M.R.A.M.); (C.C.); (A.B.); (P.A.); (G.P.)
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105
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Chen ZJ, Lu SY, Rong SS, Ho M, Ng DSC, Chen H, Gong B, Yam JC, Young AL, Brelen M, Tham CC, Pang CP, Chen LJ. Genetic associations of central serous chorioretinopathy: a systematic review and meta-analysis. Br J Ophthalmol 2021; 106:1542-1548. [PMID: 34039561 DOI: 10.1136/bjophthalmol-2021-318953] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/08/2021] [Indexed: 11/04/2022]
Abstract
AIMS To identify single-nucleotide polymorphisms (SNPs) associated with central serous chorioretinopathy (CSCR) by a systematic review and meta-analysis, and to compare the association profiles between CSCR, neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV). METHODS We searched the EMBASE, PubMed and Web of Science for genetic studies of CSCR from the starting dates of the databases to 12 September 2020. We then performed meta-analyses on all SNPs reported by more than two studies and calculated the pooled OR and 95% CIs. We also conducted sensitivity analysis and adopted the funnel plot to assess potential publication bias. RESULTS Totally 415 publications were reviewed, among them 10 were eligible for meta-analysis. We found 10 SNPs that have been reported at least twice. Meta-analysis and sensitivity analysis confirmed significant associations between CSCR and six SNPs in three genes, namely age-related maculopathy susceptibility 2 (ARMS2) (rs10490924, OR=1.37; p=0.00064), complement factor H (CFH) (rs800292, OR=1.44; p=7.80×10-5; rs1061170, OR=1.34; p=0.0028; rs1329428, OR=1.40; p=0.012; and rs2284664, OR=1.36; p=0.0089) and tumour necrosis factor receptor superfamily, member 10a (TNFRSF10A) (rs13278062, OR=1.34; p=1.44×10-15). Among them, only TNFRSF10A rs13278062 showed the same trend of effect on CSCR, nAMD and PCV, while the SNPs in ARMS2 and CFH showed opposite trends in the SNP associations. CONCLUSIONS This study confirmed the associations of ARMS2, CFH and TNFRSF10A with CSCR, and revealed that ARMS2, CFH and TNFRSF10A may affect different phenotypic expressions of CSCR, nAMD and PCV.
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Affiliation(s)
- Zhen Ji Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Shi Yao Lu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Shi Song Rong
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary Ho
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Danny Siu-Chun Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University, Shantou, China
| | - Bo Gong
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Marten Brelen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Joint Shantou International Eye Center, Shantou University, Shantou, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China .,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
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106
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Spaide RF, Gemmy Cheung CM, Matsumoto H, Kishi S, Boon CJF, van Dijk EHC, Mauget-Faysse M, Behar-Cohen F, Hartnett ME, Sivaprasad S, Iida T, Brown DM, Chhablani J, Maloca PM. Venous overload choroidopathy: A hypothetical framework for central serous chorioretinopathy and allied disorders. Prog Retin Eye Res 2021; 86:100973. [PMID: 34029721 DOI: 10.1016/j.preteyeres.2021.100973] [Citation(s) in RCA: 145] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 12/19/2022]
Abstract
In central serous chorioretinopathy (CSC), the macula is detached because of fluid leakage at the level of the retinal pigment epithelium. The fluid appears to originate from choroidal vascular hyperpermeability, but the etiology for the fluid is controversial. The choroidal vascular findings as elucidated by recent optical coherence tomography (OCT) and wide-field indocyanine green (ICG) angiographic evaluation show eyes with CSC have many of the same venous patterns that are found in eyes following occlusion of the vortex veins or carotid cavernous sinus fistulas (CCSF). The eyes show delayed choroidal filling, dilated veins, intervortex venous anastomoses, and choroidal vascular hyperpermeability. While patients with occlusion of the vortex veins or CCSF have extraocular abnormalities accounting for the venous outflow problems, eyes with CSC appear to have venous outflow abnormalities as an intrinsic phenomenon. Control of venous outflow from the eye involves a Starling resistor effect, which appears to be abnormal in CSC. Similar choroidal vascular abnormalities have been found in peripapillary pachychoroid syndrome. However, peripapillary pachychoroid syndrome has intervortex venous anastomoses located in the peripapillary region while in CSC these are seen to be located in the macular region. Spaceflight associated neuro-ocular syndrome appears to share many of the pathophysiologic problems of abnormal venous outflow from the choroid along with a host of associated abnormalities. These diseases vary according to their underlying etiologies but are linked by the venous decompensation in the choroid that leads to significant vision loss. Choroidal venous overload provides a unifying concept and theory for an improved understanding of the pathophysiology and classification of a group of diseases to a greater extent than previous proposals.
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Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, NY, USA.
| | | | - Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Japan.
| | | | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | | | | | | | | | | | | | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA.
| | - Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.
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107
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Shinojima A, Ozawa Y, Uchida A, Nagai N, Shinoda H, Kurihara T, Suzuki M, Minami S, Negishi K, Tsubota K. Assessment of Hypofluorescent Foci on Late-Phase Indocyanine Green Angiography in Central Serous Chorioretinopathy. J Clin Med 2021; 10:jcm10102178. [PMID: 34069984 PMCID: PMC8157827 DOI: 10.3390/jcm10102178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
To assess the hypofluorescent foci (HFF) on late-phase indocyanine green angiography (ICGA) in central serous chorioretinopathy (CSC) using short-wavelength fundus autofluorescence (SW-FAF), near-infrared autofluorescence (NIR-AF), and fluorescein angiography (FA). The HFF area on late-phase ICGA for at least 20 min was compared with the area of abnormal foci on SW-FAF, NIR-AF, and FA. In 14 consecutive patients (12 men, including 1 with bilateral CSC; and 2 women with unilateral CSC), four kinds of images of 27 eyes were acquired. The mean age ± standard deviation (range) was 46 ± 9.2 years (31–69 years). The HFF on late-phase ICGA were found in 23 eyes (in all 15 CSC eyes and the contralateral 8 eyes). From the results of simple regression analysis, we obtained the following three formulas. The HFF area on ICGA = 1.058 × [abnormal SW-FAF area] + 0.135, the HFF area on ICGA = 1.001 × [abnormal NIR-AF area] + 0.015, and the HFF area on ICGA = 1.089 × [abnormal FA area] + 0.135. Compared to SW-FAF and FA, NIR-AF was found to be the easiest method to detect the HFF on late-phase ICGA, which may indicate melanin abnormalities, especially a decrease, in the retinal pigment epithelium.
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Affiliation(s)
- Ari Shinojima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.U.); (N.N.); (H.S.); (T.K.); (M.S.); (S.M.); (K.N.); (K.T.)
- Correspondence: (A.S.); or (Y.O.); Tel.: +81-3-5313-4132 (A.S.); +81-3-35415151 (Y.O.); Fax: +81-3-5363-3274 (A.S.); +81-03-3542-2565 (Y.O.)
| | - Yoko Ozawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.U.); (N.N.); (H.S.); (T.K.); (M.S.); (S.M.); (K.N.); (K.T.)
- Department of Ophthalmology, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan
- Department of Ophthalmology, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
- Correspondence: (A.S.); or (Y.O.); Tel.: +81-3-5313-4132 (A.S.); +81-3-35415151 (Y.O.); Fax: +81-3-5363-3274 (A.S.); +81-03-3542-2565 (Y.O.)
| | - Atsuro Uchida
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.U.); (N.N.); (H.S.); (T.K.); (M.S.); (S.M.); (K.N.); (K.T.)
| | - Norihiro Nagai
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.U.); (N.N.); (H.S.); (T.K.); (M.S.); (S.M.); (K.N.); (K.T.)
| | - Hajime Shinoda
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.U.); (N.N.); (H.S.); (T.K.); (M.S.); (S.M.); (K.N.); (K.T.)
| | - Toshihide Kurihara
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.U.); (N.N.); (H.S.); (T.K.); (M.S.); (S.M.); (K.N.); (K.T.)
| | - Misa Suzuki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.U.); (N.N.); (H.S.); (T.K.); (M.S.); (S.M.); (K.N.); (K.T.)
- Department of Ophthalmology, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Sakiko Minami
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.U.); (N.N.); (H.S.); (T.K.); (M.S.); (S.M.); (K.N.); (K.T.)
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.U.); (N.N.); (H.S.); (T.K.); (M.S.); (S.M.); (K.N.); (K.T.)
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.U.); (N.N.); (H.S.); (T.K.); (M.S.); (S.M.); (K.N.); (K.T.)
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108
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Morya AK, Gogia S, Gupta A, Prakash S, Solanki K, Naidu AD. Motherhood: What every ophthalmologist needs to know. Indian J Ophthalmol 2021; 68:1526-1532. [PMID: 32709768 PMCID: PMC7640830 DOI: 10.4103/ijo.ijo_2033_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this review article is to summarize the available literature on physiologic and pathologic ocular changes during pregnancy and the effect of diseases in pregnancy. A literature search was conducted using PUBMED, MEDLINE, and Cochrane library in English. In addition, the cited references in the published articles were manually reviewed for the relevant results. Pregnancy encompasses a multitude of changes in all body systems, including the visual system of the female. The changes can be physiological, i.e., changes occurring in the lids and adnexa, cornea, conjunctiva, changes in tear film composition and intraocular pressure, retina, choroid, and visual field. Pathological changes in a pregnant woman's eye include changes related to preeclampsia and eclampsia, central serous chorioretinopathy, retinal artery or vein occlusions, and disseminated intravascular coagulation. Preexisting diseases like diabetic retinopathy, Graves' disease, idiopathic intracranial hypertension, various inflammatory conditions can undergo changes in their course during pregnancy. Ophthalmic medications can have an effect on both mother and the baby and hence should be used cautiously. In addition, intrauterine infections play a major role in causing inflammation in the eye of the baby. Hence, vaccination of the mother prior to pregnancy plays an important role in preventing intrauterine infections in the neonate. A regular eye examination in the perinatal period plays a vital role in recognizing ophthalmic pathologies which might require a prompt medical intervention. Pathological ocular diseases should be discriminated from physiologic changes to establish an individualized treatment or preventive plan. This approach to ocular benefits of treatment to the mother should always weigh against the potential harm to the fetus.
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Affiliation(s)
- Arvind K Morya
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Sonalika Gogia
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Arushi Gupta
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Sujeet Prakash
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Kanchan Solanki
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
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109
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Pauleikhoff L, Agostini H, Lange C. [Central serous chorioretinopathy]. Ophthalmologe 2021; 118:967-980. [PMID: 33861376 DOI: 10.1007/s00347-021-01376-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Laurenz Pauleikhoff
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - Hansjürgen Agostini
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - Clemens Lange
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
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110
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van Dijk EHC, Boon CJF. Serous business: Delineating the broad spectrum of diseases with subretinal fluid in the macula. Prog Retin Eye Res 2021; 84:100955. [PMID: 33716160 DOI: 10.1016/j.preteyeres.2021.100955] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/14/2021] [Accepted: 02/19/2021] [Indexed: 02/08/2023]
Abstract
A wide range of ocular diseases can present with serous subretinal fluid in the macula and therefore clinically mimic central serous chorioretinopathy (CSC). In this manuscript, we categorise the diseases and conditions that are part of the differential diagnosis into 12 main pathogenic subgroups: neovascular diseases, vitelliform lesions, inflammatory diseases, ocular tumours, haematological malignancies, paraneoplastic syndromes, genetic diseases, ocular developmental anomalies, medication-related conditions and toxicity-related diseases, rhegmatogenous retinal detachment and tractional retinal detachment, retinal vascular diseases, and miscellaneous diseases. In addition, we describe 2 new clinical pictures associated with macular subretinal fluid accumulation, namely serous maculopathy with absence of retinal pigment epithelium (SMARPE) and serous maculopathy due to aspecific choroidopathy (SMACH). Differentiating between these various diseases and CSC can be challenging, and obtaining the correct diagnosis can have immediate therapeutic and prognostic consequences. Here, we describe the key differential diagnostic features of each disease within this clinical spectrum, including representative case examples. Moreover, we discuss the pathogenesis of each disease in order to facilitate the differentiation from typical CSC.
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Affiliation(s)
- Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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111
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Cheong KX, Barathi VA, Teo KYC, Chakravarthy U, Tun SBB, Busoy JM, Ho CEH, Agrawal R, Takahashi K, Cheung CMG. Choroidal and Retinal Changes After Systemic Adrenaline and Photodynamic Therapy in Non-Human Primates. Invest Ophthalmol Vis Sci 2021; 62:25. [PMID: 33729474 PMCID: PMC7980042 DOI: 10.1167/iovs.62.3.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose To determine the tomographic, angiographic, and histologic changes in the choroid and retina of cynomolgus monkeys after systemic adrenaline and verteporfin photodynamic therapy (vPDT). Methods Six cynomolgus monkeys (12 eyes) were treated with vPDT only (n = 2), adrenaline only for eight weeks (n = 2), adrenaline for eight weeks with vPDT at week 4 (n = 4), and adrenaline for 12 weeks and vPDT at week 8 (n = 4). Spectral-domain optical coherence tomography, angiography, and autofluorescence were performed at baseline and every 14 days thereafter until 28 days after adrenaline therapy or vPDT. Choroid parameters included choroidal thickness (CT) changes and structural changes using semiautomated image binarization. Histology with light and electron microscopy was performed. Results Adrenaline resulted in subfoveal CT increase at week 4 compared with baseline (3.4%, P = 0.010), with further increase at week 8 (3.9%, P = 0.007). This correlated with choroidal luminal area increase (16.0% at week 8 compared with baseline, P = 0.030). Outer retinal changes included subretinal fluid, ellipsoid zone (EZ) disruption, photoreceptor elongation, and sub/intraretinal bright dots. Hypocyanescent spots surrounded by leakage was observed. Histology showed dilated choroidal vessels, intracytoplasmic vacuoles, and retinal pigment epithelium (RPE) enlarged basal infoldings. The vPDT decreased subfoveal CT at four weeks after vPDT (−7.5%, P = 0.007). This correlated with choroidal stromal area decrease (−18.0%, P < 0.010). Within the treatment spot, there was outer retinal atrophy, EZ disruption, irregular RPE thickening, intense hypoautofluorescence, hyperfluorescence, and hypocyanescence. On histology, there were outer retina, RPE, and choroid changes. Conclusions Adrenaline induces choroidal vessel dilation and CT increase. The vPDT decreases CT because of a reduction in choroidal stromal component.
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Affiliation(s)
- Kai Xiong Cheong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Veluchamy Amutha Barathi
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Usha Chakravarthy
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, United Kingdom
| | - Sai Bo Bo Tun
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Joanna Marie Busoy
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Candice Ee Hua Ho
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Rupesh Agrawal
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Kanji Takahashi
- Department of Ophthalmology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
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112
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Central serous chorioretinopathy in active endogenous Cushing's syndrome. Sci Rep 2021; 11:2748. [PMID: 33531597 PMCID: PMC7854641 DOI: 10.1038/s41598-021-82536-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/15/2021] [Indexed: 02/07/2023] Open
Abstract
Multiple case series have provided evidence for a relatively high incidence of central serous chorioretinopathy (CSC) in patients with active Cushing’s syndrome (CS). We describe the ophthalmological status in detail of consecutive patients with active endogenous CS (either de novo or recurrent active endogenous CS) in this prospective cohort study. All patients underwent complete ophthalmological examination, including multimodal imaging, which was performed shortly after establishing the diagnosis of active CS in hypercortisolemic state. Eleven CS patients (4 men, 7 women) with active hypercortisolism were included. Abnormalities reminiscent of (subclinical) CSC were found in 3 patients. Optical coherence tomography (OCT) revealed macular subretinal fluid in 1 patient, who was diagnosed as having active CSC and was successfully treated with half-dose photodynamic therapy. Two other patients showed CSC-like abnormalities: an unilateral pseudovitelliform lesion on OCT and hyperfluorescent changes on fluorescein angiography in one patient, and unilateral leakage on fluorescein angiography in the other patient. Mean subfoveal choroidal thickness on enhanced depth imaging OCT was 270 ± 40 μm (range, 178 – 357 μm). Retinal abnormalities resembling (subclinical) CSC may be more common than previously thought in patients with active CS, and may exist even in patients without visual complaints. Clinicians should have a low threshold for ophthalmological evaluation in case of a CS patient with visual symptoms since there may be therapeutic opportunities to prevent vision loss.
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113
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Giannopoulos K, Gazouli M, Chatzistefanou K, Bakouli A, Moschos MM. The Genetic Background of Central Serous Chorioretinopathy: A Review on Central Serous Chorioretinopathy Genes. J Genomics 2021; 9:10-19. [PMID: 33456587 PMCID: PMC7806452 DOI: 10.7150/jgen.55545] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/19/2020] [Indexed: 12/15/2022] Open
Abstract
Central serous chorioretinopathy is characterized by neurosensory detachment of the central retina secondary to fluid leakage through the retinal pigment epithelium. Though it has an incidence of 9,9 per 100.000 in men and 1,7 per 100.000 in women, it is the fourth most common retinal disorder. Central serous chorioretinopathy patients present with blurred vision, central scotoma, metamorphopsia, micropsia and mild color discrimination. It is usually a self-limited disorder with nearly none or minimal visual impairment but in some patients the disease persists and may cause severe visual impairment. Central serous chorioretinopathy pathophysiology is not well understood. Choroid, retinal pigment epithelium and hormonal pathways seem to play important roles in central serous chorioretinopathy pathophysiology. Also, familial cases of the disease indicate that there is a genetic background. The identification of certain disease genes could lead to the development of better diagnostic and therapeutic approaches for central serous chorioretinopathy patients.
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Affiliation(s)
- Konstantinos Giannopoulos
- First Department of Ophthalmology, Gennimatas General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.,Department of Ophthalmology, General Hospital of Sitia, Sitia, Greece
| | - Maria Gazouli
- Department of Basic Medical Sciences, Laboratory of Biology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Klio Chatzistefanou
- First Department of Ophthalmology, Gennimatas General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Anthi Bakouli
- Department of Ophthalmology, Elpis General Hospital, Athens, Greece
| | - Marilita M Moschos
- First Department of Ophthalmology, Gennimatas General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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114
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Hipolito-Fernandes D, Luís ME, Flores R, Anjos R. Non-central serous chorioretinopathy in a patient with systemic lupus erythematosus and hydroxychloroquine retinopathy. BMJ Case Rep 2021; 14:14/1/e237243. [PMID: 33462009 PMCID: PMC7813357 DOI: 10.1136/bcr-2020-237243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Subretinal fluid accumulation in a patient with systemic lupus erythematosus (SLE) may represent a diagnostic challenge. We present a case of a 43-year-old man with baseline diagnosis of SLE and hydroxychloroquine-associated maculopathy who reported progressive vision loss on the right eye, associated with corticosteroids use for an arthritic crisis. Ophthalmological examination did not reveal any acute finding. On optical coherence tomography, subretinal fluid in the perifoveal area was visible on the right eye, with corresponding enlargement of the visual field defect. An increased choroidal thickness was also visible. Fluorescein angiography revealed, on the right eye, two pinpoint areas of leakage and indocyanine green angiography signs of choroidal vascular hyperpermeability. Considering a diagnosis of a non-central central serous chorioretinopathy, corticosteroids use was interrupted, with resolution of the subretinal fluid. This case illustrates the relevance of a multimodal imaging approach to guide the diagnosis of patient with an SLE with subretinal fluid.
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Affiliation(s)
| | - Maria Elisa Luís
- Ophthalmology, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Rita Flores
- Ophthalmology, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Rita Anjos
- Ophthalmology, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
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115
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Sesar AP, Sesar A, Bucan K, Sesar I, Cvitkovic K, Cavar I. Personality Traits, Stress, and Emotional Intelligence Associated with Central Serous Chorioretinopathy. Med Sci Monit 2021; 27:e928677. [PMID: 33423036 PMCID: PMC7805417 DOI: 10.12659/msm.928677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the relationship between personality traits, stress, emotional intelligence, and central serous chorioretinopathy (CSCR). MATERIAL AND METHODS This prospective case-control study included 57 patients with acute CSCR and 57 age- and sex-matched controls with refractive errors. Inclusion criteria for CSCR group were acute unilateral onset of visual disturbances within 2 weeks until the first visit to the ophthalmologist and ophthalmoscopic finding of a round or oval macular detachment confirmed by optical coherence tomography as a dome-shaped serous neuroretinal elevation. RESULTS Using the Sixteen Personality Factor Questionnaire (16 PF), patients with CSCR achieved slightly higher scores on primary characteristics such as warmth (P=0.612) and perfectionism (P=0.137) when compared to the control subjects. Mean scores measured with the Social Readjustment Rating Scale (SRRS) were significantly higher in patients with CSCR (P=0.004), which means that these patients had notably elevated average reactivity to stressful life events. In addition, the number of patients with a high stress level was higher in the CSCR group than in the control group. Considering the level of emotional intelligence measured with the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), patients with CSCR achieved significantly lower scores on well-being (P=0.003) and sociability (P=0.011) factors, as well as on total score (P=0.014). CONCLUSIONS A higher level of perceived stress is the most important psychological risk factor for CSCR. According to our results, a low level of emotional intelligence may be an additional factor that contributes to the occurrence of CSCR.
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Affiliation(s)
- Anita Pusic Sesar
- Department of Ophthalmology, University Clinical Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - Antonio Sesar
- Department of Ophthalmology, University Clinical Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - Kajo Bucan
- Department of Ophthalmology, University Hospital of Split, Split, Croatia
| | - Irena Sesar
- Department of Ophthalmology, University Clinical Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - Katarina Cvitkovic
- Department of Ophthalmology, University Clinical Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - Ivan Cavar
- Department of Physiology, School of Medicine University of Mostar, Mostar, Bosnia and Herzegovina
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Altınel MG, Acikalin B, Gunes H, Demir G. Optical coherence tomography parameters as predictors of treatment response to a 577-nm subthreshold micropulse laser in chronic central serous chorioretinopathy. Lasers Med Sci 2021; 36:1505-1514. [PMID: 33409750 DOI: 10.1007/s10103-020-03225-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/16/2020] [Indexed: 12/01/2022]
Abstract
To determine the relation between retinal microstructural changes and the response to 577-nm subthreshold micropulse laser (SML) treatment in chronic central serous chorioretinopathy (cCSC). This retrospective study included 39 eyes of 39 patients with cCSC, treated with the 577-nm SML. The eyes were evaluated in three groups: complete remission, partial remission, and failure groups. The presence of some baseline retinal microstructural changes, thickness of the outer nuclear layer (ONL), status of the ellipsoid zone (EZ), and retinal pigment epithelium (RPE) were evaluated. The changes in central macular thickness (CMT), subretinal fluid (SRF) height, and best-corrected visual acuity (BCVA) were calculated. There were 14, 13, and 12 eyes in the complete remission, partial remission, and failure group, respectively. The baseline EZ and RPE were found intact in 71.4% and 64.3% of the eyes in the complete remission group, respectively; however, these rates were respectively 25% and 16.7% in the failure group (p < 0.05). Extrafoveal foci were present in 35.7% of the eyes in the complete remission group, but none was found in the failure group (p < 0.05). Although there was no statistically significant difference, the baseline ONL thickness was higher, and the hyperreflective dots, retinal bumps, subretinal fibrinous exudates, and PEDs were seen less in the complete remission group. The changes of the BCVA were not significant in any of the groups at the last visit (p > 0.05). The presence of baseline intact EZ and RPE, and extrafoveal foci can potentially be used as predictors of the SML treatment success in cCSC.
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Affiliation(s)
- Meltem Guzin Altınel
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Saglik Bilimleri University, 34752, Istanbul, Turkey.
| | - Banu Acikalin
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Saglik Bilimleri University, 34752, Istanbul, Turkey
| | - Hasan Gunes
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Saglik Bilimleri University, 34752, Istanbul, Turkey
| | - Gokhan Demir
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Saglik Bilimleri University, 34752, Istanbul, Turkey
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117
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Hoffmann A, Kleniewska P, Pawliczak R. Antioxidative activity of probiotics. Arch Med Sci 2021; 17:792-804. [PMID: 34025850 PMCID: PMC8130477 DOI: 10.5114/aoms.2019.89894] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 03/28/2018] [Indexed: 12/17/2022] Open
Abstract
Probiotics are defined as live microorganisms that have a beneficial effect on health by exhibiting quantitative and qualitative effects on intestinal microflora and/or modification of the immune system. A strain is considered probiotic if it demonstrates a series of clinically proven health benefits. In recent years, the number of studies related to the antioxidant properties of probiotics has significantly increased. Antioxidants are substances that inhibit the degree of oxidation of molecules and cause the transformation of radicals into inactive derivatives. The incorrect or inefficient antioxidant mechanisms results in oxidative stress and may occur in the course of many diseases such as diabetes, atherosclerosis, inflammatory bowel disease or damage to the heart, brain or transplanted organs. Correct functioning of antioxidant mechanisms seems to be crucial for the proper functioning of our body; therefore, probiotics should be carefully investigated for potential antioxidant properties.
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Affiliation(s)
- Arkadiusz Hoffmann
- Department of Immunopathology, Faculty of Biomedical Sciences and Postgraduate Training, Medical University of Lodz, Lodz, Poland
| | - Paulina Kleniewska
- Department of Immunopathology, Faculty of Biomedical Sciences and Postgraduate Training, Medical University of Lodz, Lodz, Poland
| | - Rafał Pawliczak
- Department of Immunopathology, Faculty of Biomedical Sciences and Postgraduate Training, Medical University of Lodz, Lodz, Poland
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118
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Billoir P, Michon A, Darnige L. Central serous chorioretinopathy and antiphospholipid syndrome: Three cases report. Lupus 2020; 30:514-517. [PMID: 33307985 DOI: 10.1177/0961203320979736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antiphospholipid syndrome (APS) is an acquired autoimmune disease characterized by recurrent venous or arterial thrombotic events and pregnancy morbidity, with persistently presence of antiphospholipid antibodies (aPL). We report three cases of central serous chorioretinopathy (CSC) associated with APS.
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Affiliation(s)
- Paul Billoir
- Vascular Hemostasis Unit, Rouen University Hospital, Normandie Univ, UNIROUEN, INSERM U1096, Rouen, France
| | - Adrien Michon
- Service de médecine interne, hôpital européen Georges-Pompidou, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, 20, Paris, France
| | - Luc Darnige
- Service d'hématologie Biologique, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.,INSERM UMR-S1140, Paris, France
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119
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Parajuli A, Joshi P. Factors influencing the episode duration and the anatomical and functional outcome in cases of acute central serous chorioretinopathy. BMJ Open Ophthalmol 2020; 5:e000540. [PMID: 33305002 PMCID: PMC7709512 DOI: 10.1136/bmjophth-2020-000540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/21/2020] [Accepted: 11/08/2020] [Indexed: 11/04/2022] Open
Abstract
Objective To investigate the factors affecting the duration of subretinal fluid (SRF) resolution and their correlation with the final anatomical and functional outcome in cases of treatment naïve acute central serous chorioretinopathy (CSCR). Methods and analysis We retrospectively studied 93 eyes of 93 patients diagnosed with treatment naïve acute CSCR presenting within 30 days of onset of symptoms. The eyes were divided into two groups (1 and 2) based on the duration of SRF resolution; which was ≤3 months in group 1 and >3 months in group 2. Demographic and medical history, and spectral domain optical coherence tomography features were noted and their association with duration for SRF resolution, final central macular thickness (CMT) and final best-corrected visual acuity (BCVA) were studied. All the patients were prescribed topical non-steroidal anti-inflammatory drug for 1 month at the diagnosis of CSCR. Results Longer duration of symptoms, female gender and baseline OCT factors like hyper-reflective dots and retinal pigment epithelial bumps were associated with longer duration for SRF resolution (p<0.001, p=0.04, p=0.001 and p=0.01, respectively). The SRF resolution time had strong correlations with the final CMT (r=-0.589, p<0.001) and final BCVA in logarithm of minimum angle of resolution (LogMAR) (r=+0.599, p<0.001). Group 2 eyes had worse final BCVA and thinner final CMT than Group 1 (both p<0.001). The final CMT of the patients of Group 1 was statistically thinner than the normal population (p<0.001). Conclusion Patient's baseline clinicodemographic and OCT features can be used to predict the course and visual outcome in cases of treatment naïve acute idiopathic CSCR.
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Affiliation(s)
| | - Purushottam Joshi
- Retina, Pediatric Ophthalmolgy and Strabismus, Cataract, Mechi Eye Hospital, Birtamode, Nepal
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120
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Singh SR, Iovino C, Zur D, Masarwa D, Iglicki M, Gujar R, Lupidi M, Maltsev DS, Bousquet E, Bencheqroun M, Amoroso F, Lima LH, Padhy SK, Govindahari V, Chandra K, Souied EH, Rodriguez FJ, Daza LA, Rios HA, Cagini C, Peiretti E, Behar-Cohen F, Chhablani J. Central serous chorioretinopathy imaging biomarkers. Br J Ophthalmol 2020; 106:553-558. [PMID: 33288526 DOI: 10.1136/bjophthalmol-2020-317422] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/21/2020] [Accepted: 11/18/2020] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Sumit Randhir Singh
- Jacobs Retina Center, University of California San Diego, La Jolla, California, USA
| | - Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, Università degli studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dua Masarwa
- Department of Ophthalmology, Barzilai University Medical Center, Ashkelon, Israel
| | - Matias Iglicki
- Private Retina Service, University of Buenos Aires, Buenos Aires, Argentina
| | - Ramkailash Gujar
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Marco Lupidi
- Department of Ophthalmology, University of Perugia, Perugia, Italy
| | - Dmitrii S Maltsev
- Ophthalmology, Military Maedical Academy, Saint Petersburg, Russian Federation
| | | | - Mehdi Bencheqroun
- Ophtalmopôle, Cochin Hospital, Paris Descartes University, Paris, France
| | - Francesca Amoroso
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Creteil, France
| | - Luiz H Lima
- Ophthalmology, Federal University of Sao Paulo, São Paulo, Brazil
| | | | - Vishal Govindahari
- Retina and Uveitis Service, L V Prasad Eye Institute, MTC Campus, Bhubaneswar, India
| | - Khushboo Chandra
- Dept. of Vitreoretina, Disha Eye Hospitals Pvt Ltd, Kolkata, India
| | - Eric H Souied
- Ophthalmology, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | | | - Laura A Daza
- Fundacion Oftalmologica Nacional, Universidad del Rosario, Bogota, Colombia
| | - Hernan A Rios
- Fundacion Oftalmologica Nacional, Universidad del Rosario, Bogota, Colombia
| | - Carlo Cagini
- Department of Biomedical and Surgical Sciences, University of Perugia School of Medicine and Surgery, Perugia, Italy
| | - Enrico Peiretti
- Eye Clinic, Universita degli Studi di Cagliari, Cagliari, Italy
| | | | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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121
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Choriorétinopathie séreuse centrale et minoxidil 2 %. J Fr Ophtalmol 2020; 43:e369-e370. [DOI: 10.1016/j.jfo.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/02/2020] [Accepted: 03/12/2020] [Indexed: 11/19/2022]
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122
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Karapapak M, Güven D, Demir M, Tiryaki Demir S, Uslu Dogan C. Optical coherence tomography angiography of central serous chorioretinopathy patients' response to breath-holding manoeuvre. Acta Ophthalmol 2020; 98:787-794. [PMID: 32996704 DOI: 10.1111/aos.14625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/28/2020] [Accepted: 08/28/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To demonstrate through the use of optical coherence tomography angiography (OCTA) that normal vasoreactivity cannot be monitored in central serous chorioretinopathy (CSR) patients in the presence of vasoactive stimuli owing to hypoxia caused by the breath-holding manoeuvre (BHM). METHODS This cross-sectional study included a total of 210 eyes, including 70 CSR patients (70 symptomatic eyes, 70 asymptomatic eyes) and 70 control group. Images of the macula (3 × 3 mm) and the optic disc (4.5 × 4.5 mm) were obtained at the baseline and after BHM using OCTA. The change in vascular parameters in the OCTA after BHM was evaluated in CSR patients and the control group. RESULTS In the symptomatic eyes of CSR patients, the mean whole image vessel density (VD) in the superficial capillary plexus decreased from 48.0 ± 3.5% under baseline conditions to 46.0 ± 4.5% after BHM (p < 0.01), and the mean whole VD in the deep capillary plexus decreased from 47.9 ± 8.0% under baseline conditions to 46.9 ± 6.7% after BHM (p < 0.01). The OCTA after BHM revealed a decrease in the mean whole image VD of the optic disc in both symptomatic (50.4 ± 2.1% to 49.6 ± 2.0%, p < 0.05) and asymptomatic (50.9 ± 1.8% to 50.4 ± 1.9%, p < 0.05) eyes of CSR patients. No difference for any mean VD of the control group was seen between the baseline and after BHM. Outer retinal flow areas increased significantly after BHM compared with the baseline in both eyes of CSR patients. CONCLUSION These results suggest that CSR pathogenesis is related to an imbalance in local vascular regulation and the sympathetic activity of the autonomic nervous system. This technique constitutes a new way of studying retinal vascular changes and may be applied to CSR patients.
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Affiliation(s)
- Murat Karapapak
- Department of Ophthalmology Basaksehir Cam and Sakura City Hospital Istanbul Turkey
| | - Dilek Güven
- Department of Ophthalmology Sisli Hamidiye Etfal Training and Research Hospital University of Health Sciences Istanbul Turkey
| | - Mehmet Demir
- Department of Ophthalmology Sisli Hamidiye Etfal Training and Research Hospital University of Health Sciences Istanbul Turkey
| | - Semra Tiryaki Demir
- Department of Ophthalmology Sisli Hamidiye Etfal Training and Research Hospital University of Health Sciences Istanbul Turkey
| | - Ceylan Uslu Dogan
- Department of Ophthalmology Sisli Hamidiye Etfal Training and Research Hospital University of Health Sciences Istanbul Turkey
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Han JY, Choi EY, Lee CS. Therapeutic Effects and Safety of Spironolactone for Central Serous Chorioretinopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.11.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Altinel MG, Kanra AY, Totuk OMG, Ardagil A, Kabadayi K. Comparison of half-dose versus half-fluence versus standard photodynamic therapy in chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2020; 33:102081. [PMID: 33157327 DOI: 10.1016/j.pdpdt.2020.102081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the efficacy and safety of half-dose vs. half-fluence vs. standard photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (cCSC). METHODS This retrospective study included 64 eyes of 61 patients with cCSC who were treated with half-dose PDT (verteporfin 3 mg/m2 and light energy 50 J/cm2), half-fluence PDT (verteporfin 6 mg/m2 and light energy 25 J/cm2) or standard PDT (verteporfin 6 mg/m2 and light energy 50 J/cm2). The complete resorption of subretinal fluid (SRF) and changes of best corrected visual acuity (BCVA) and central retinal thickness (CRT) over the follow-up period were also assessed. RESULTS Fifteen eyes (65.2 %) in the half-dose PDT group, 12 eyes (80 %) in the half-fluence PDT group, and 20 eyes (76.9 %) in the standard PDT group showed complete resolution of SRF. There were no statistically significant differences in the mean BCVA improvement, CRT and SRF height reduction, number of PDT sessions, complete success, and recurrence rates between groups (p > 0.05). None of the eyes with intact EZ showed failure. There were positive correlations between higher mean CRT values of the last visit, 1st, 3rd, 6th months and failure. None of the treated eyes (0%) developed any systemic or local adverse events. CONCLUSION Half-dose, half-fluence or standard PDTs are all effective and safe treatment choices in cCSC with similar BCVA improvements and CRT reductions. The higher mean CRT values of the follow-up period were correlated with failure, and in eyes with intact EZ showed no failure.
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Affiliation(s)
- Meltem Guzin Altinel
- Saglik Bilimleri University Fatih Sultan Mehmet Training and Research Hospital, Ophthalmology Department, 34752, Atasehir, Istanbul, Turkey.
| | | | | | - Aylin Ardagil
- Atakoy Dunyagoz Hospital, 34158, Bakirkoy, Istanbul, Turkey.
| | - Kerem Kabadayi
- Bahcesehir University, Faculty of Medicine, 34734, Kadikoy, Istanbul, Turkey.
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125
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Kaye R, Chandra S, Sheth J, Boon CJF, Sivaprasad S, Lotery A. Central serous chorioretinopathy: An update on risk factors, pathophysiology and imaging modalities. Prog Retin Eye Res 2020; 79:100865. [PMID: 32407978 DOI: 10.1016/j.preteyeres.2020.100865] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/02/2020] [Accepted: 04/27/2020] [Indexed: 02/08/2023]
Abstract
Central serous chorioretinopathy (CSC) is a common form of vision loss, typically seen in working-age men. The pathophysiology behind CSC still eludes us, however significant advances have been made in understanding this disease over the last decade using information from genetic and cell-based studies and imaging modalities. This review aims to give an overview of the current pathophysiology hypotheses surrounding CSC in addition to future directions in cellular work from human induced pluripotent stem cell derived choroidal endothelial cells from CSC patients. Furthermore, this review will provide the reader with an update on the clinical aspects of CSC including risk factors, diagnostic challenges and findings from multimodal imaging.
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Affiliation(s)
- Rebecca Kaye
- Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, SO16 6YD, United Kingdom
| | - Shruti Chandra
- NIHR Moorfields Biomedical Research Centre, 162, City Road, London, EC1V 2PD, United Kingdom
| | - Jay Sheth
- Surya Eye Institute and Research Center, Mumbai, India
| | - Camiel J F Boon
- Leiden University Medical Centre, Department of Ophthalmology, P.O. Box 9600, 2300 RC, Leiden, the Netherlands; Amsterdam University Medical Centers, Department of Ophthalmology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, 162, City Road, London, EC1V 2PD, United Kingdom
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, SO16 6YD, United Kingdom.
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Castro-Navarro V, Behar-Cohen F, Chang W, Joussen AM, Lai TYY, Navarro R, Pearce I, Yanagi Y, Okada AA. Pachychoroid: current concepts on clinical features and pathogenesis. Graefes Arch Clin Exp Ophthalmol 2020; 259:1385-1400. [PMID: 33057904 PMCID: PMC8166704 DOI: 10.1007/s00417-020-04940-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/28/2020] [Accepted: 09/17/2020] [Indexed: 01/02/2023] Open
Abstract
PURPOSE The term "pachychoroid" refers to a newly described phenotype in which functional and structural choroidal changes are thought to play a key pathogenic role in a spectrum of related retinal disorders. A more detailed understanding of how the choroid is involved within this spectrum and a better knowledge of the most relevant clinical signs of the pachychoroid phenotype are important to differentiate these disorders from other retinal conditions. Our objectives are to provide a literature review of pachychoroid and the commonalities that may be present across pathologies included in the spectrum, and to provide details on the examination, monitoring, and management of these disorders. METHODS We searched the PubMed web platform to identify relevant studies using the following keywords: pachychoroid, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, aneurysmal type 1 neovascularization, focal choroidal excavation, peripapillary pachychoroid syndrome, vasculopathy pachysclera, pachychoroid geographic atrophy, and pachydrusen. We selected 157 publications and identified the most important features related to pachychoroid. RESULTS The presence of hypertrophic or congested vessels in the choroid, not thickened choroid per se, under an area of reduced or absent choriocapillaris in the posterior pole seems to be the most salient feature of pachychoroid. However, other qualitative/quantitative features are needed to differentiate the uncomplicated pachychoroid from the pathological pachychoroid clinical spectrum, which may be associated with exudation, neovascularization, and/or retinal pigment epithelium and photoreceptor atrophy. CONCLUSIONS The most salient feature of pachychoroid appears to be the presence of large vessels under an area of reduced or absent choriocapillaris. Knowledge of the features and pathogenesis of the different disorders in the pachychoroid spectrum may assist in the management of patients.
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Affiliation(s)
| | - Francine Behar-Cohen
- Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Ophtalmopole, Paris, France.,Centre de Recherche des Cordeliers UMRS1138, INSERM, Paris, France
| | | | | | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Ian Pearce
- Royal Liverpool University Hospital, Liverpool, UK
| | - Yasuo Yanagi
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan.,Singapore National Eye Centre, Singapore, Singapore
| | - Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan.
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127
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Pan CK, Vail D, Bhattacharya J, Cao M, Mruthyunjaya P. The Effect of Obstructive Sleep Apnea on Absolute Risk of Central Serous Chorioretinopathy. Am J Ophthalmol 2020; 218:148-155. [PMID: 32574769 PMCID: PMC10710904 DOI: 10.1016/j.ajo.2020.05.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine the incidence of central serous chorioretinopathy (CSC) stratified by age, sex, and diagnosis with obstructive sleep apnea (OSA), and to determine whether some patients with newly diagnosed CSC may be candidates for OSA evaluation. DESIGN Retrospective cohort study. METHODS We used the IBM MarketScan database to select 59,016,145 commercially insured patients in the United States between 2007 and 2016. We identified patients' first diagnosis with CSC, and defined patients as having OSA if they had a diagnosis following a sleep study. We specified Cox proportional hazard models with interactions between age, sex, and OSA status to determine patients' risk of developing CSC. We estimated the positive predictive value (PPV) that a new diagnosis of CSC would have in predicting a subsequent diagnosis of OSA. RESULTS Risk of CSC increased with age in years (hazard ratio [HR] = 1.030, P < .001) and OSA diagnosis (HR = 1.081, P < .033), and was lower in women (HR = 0.284, P < .001). We estimated the annual incidence of CSC was 9.6 and 23.4 per 100,000 women and men, respectively. Incidence was higher in women and men with OSA (17.2 and 40.8 per 100,000). The PPV of CSC diagnosis as a predictor of OSA was highest in the fifth decade of life. CONCLUSION The incidence of CSC in our patient sample is higher than previously reported. Risk of CSC is higher in men than in women, and OSA increases risk of CSC in both men and women. Some patients, particularly older male patients, may be good candidates for OSA evaluation following a CSC diagnosis.
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Affiliation(s)
- Carolyn K Pan
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, California, USA
| | - Daniel Vail
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, California, USA
| | - Jayanta Bhattacharya
- Primary Care Outcomes Research, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Michelle Cao
- Stanford Sleep Medicine Clinic, Stanford University, Palo Alto, California, USA
| | - Prithvi Mruthyunjaya
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, California, USA.
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Gamulescu MA. [Gender medicine in ophthalmology : The "small difference" between women and men]. Ophthalmologe 2020; 117:831-842. [PMID: 32699941 DOI: 10.1007/s00347-020-01174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Gender-specific or sex-specific medicine is part of "personalized" medicine. After differences in heart diseases between women and men were first identified and increasingly published in the field of cardiology since the 1980s, differences between the sexes have also become the focus of interest in other disciplines. Immunological and hormonal aspects indicate significant differences, e.g. in the severity of the disease or the response to treatment. Even in ophthalmology epidemiological differences in some diseases are known but so far these do not lead to a different approach in the practical treatment of patients. This CME article aims to raise awareness of gender medicine also in the field of ophthalmology and at the same time to promote understanding of these differences by presenting the fundamental differences between the sexes.
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Affiliation(s)
- M-A Gamulescu
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Deutschland.
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Nicolò M, Ferro Desideri L, Vagge A, Traverso CE. Current Pharmacological Treatment Options for Central Serous Chorioretinopathy: A Review. Pharmaceuticals (Basel) 2020; 13:ph13100264. [PMID: 32977380 PMCID: PMC7597965 DOI: 10.3390/ph13100264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 12/22/2022] Open
Abstract
Central serous chorioretinopathy (CSC) is a common cause of visual impairment in patients generally aged 20 to 60 and it is characterized by acute or chronic neurosensory detachments of the retina. Although CSC resolves spontaneously in most cases, in some patients it may cause permanent visual impairment in the working population; for this reason, several approaches, including photodynamic therapy (PDT), subthreshold micropulse laser treatment and oral mineralocorticoid receptor antagonists, have been studied as first-line treatment options for CSC. To date, half-dose PDT has provided the most encouraging results in this regard, supported by large, multicenter, randomized clinical trials such as the “Prospective Randomized Controlled Treatment Trial for Chronic Central Serous Chorioretinopathy” (PLACE) trial; however, the role of novel possible non-invasive treatment options is attracting interest. This review article aims to discuss the current pharmacological treatment options investigated for the management of CSC, including aspirin, ketoconazole, beta blockers, rifampicin and many others. In particular, further evidence about oral mineralocorticoid receptor antagonists, firstly seen as promising non-invasive alternatives for treating CSC, will be provided and discussed in light of the recent “Eplerenone for chronic central serous chorioretinopathy in patients with active, previously untreated disease for more than 4 months” (VICI) trial results, which have largely resized their role as possible first-line oral treatment options for treating CSC.
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Affiliation(s)
- Massimo Nicolò
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, 16132 Genoa, Italy; (L.F.D.); (A.V.); (C.E.T.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16148 Genoa, Italy
- Macula Onlus Foundation, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-010-555-4191
| | - Lorenzo Ferro Desideri
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, 16132 Genoa, Italy; (L.F.D.); (A.V.); (C.E.T.)
| | - Aldo Vagge
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, 16132 Genoa, Italy; (L.F.D.); (A.V.); (C.E.T.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16148 Genoa, Italy
| | - Carlo Enrico Traverso
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, 16132 Genoa, Italy; (L.F.D.); (A.V.); (C.E.T.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16148 Genoa, Italy
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130
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Nkrumah G, Paez-Escamilla M, Singh SR, Rasheed MA, Maltsev D, Guduru A, Chhablani J. Biomarkers for central serous chorioretinopathy. Ther Adv Ophthalmol 2020; 12:2515841420950846. [PMID: 32923941 PMCID: PMC7448152 DOI: 10.1177/2515841420950846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/27/2020] [Indexed: 01/25/2023] Open
Abstract
Central serous chorioretinopathy (CSCR) is a common chorioretinal disease characterized by serous retinal detachment that most commonly involves the macular region. Although the natural history of the acute form shows a self-limiting course, a significant number of patients suffer from recurrent episodes leading to chronic disease, often leaving patients with residual visual impairment. Visual morbidity is often worsened by a delay in the diagnosis due to the incorrect understanding of the particular biomarkers of the disease. The aim of this review is to provide clinical understanding of the biomarkers of CSCR with an emphasis on the most recent findings in patient demographics, risk factors, clinical imaging findings, and management options. Patients with these biomarkers, age 30–44 years, male gender, increased stress levels, hypercortisolism (endogenous and exogenous exposures), sleep disturbance, pregnancy, and genetic predisposition have increased susceptibility to CSCR. Also, biomarkers on optical coherence tomography (OCT) such as choroidal thickness (CT) and choroidal vascularity index (CVI) showed good diagnostic and prognostic significance in the management of CSCR. There are nonspecific features of CSCR on OCT and OCT angiography such as choroidal neovascularization, photoreceptor alteration/cone density loss, and flat irregular pigment epithelium detachment. We described rare complications of CSCR such as cystoid macular edema (CME) and cystoid macular degeneration (CMD). Patients with CME recovered some vision when treated with anti-vascular endothelial growth factors (anti-VEGFs). Patients with CMD had irreversible macular damage even after treatment with anti-VEGFs.
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Affiliation(s)
- Gideon Nkrumah
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sumit Randhir Singh
- Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, CA, USA
| | | | - Dmitri Maltsev
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Abhilash Guduru
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
| | - Jay Chhablani
- Faculty-Clinician, UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA 15213, USA
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Kilic D, Karahan M, Vural E, Dursun ME, Demirtaş AA. Abnormal retrobulbar blood flow variables in central serous chorioretinopathy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:405-409. [PMID: 31943277 DOI: 10.1002/jcu.22812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/20/2019] [Accepted: 01/02/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE To evaluate if the retrobulbar blood flow variables were deteriorated in central serous chorioretinopathy (CSC) patients. METHODS We included 25 CSC patients and 25 healthy subjects. We used color Doppler ultrasonography to assess the ophthalmic artery (OA), the central retinal artery (CRA), and the posterior ciliary arteries (PCA) for peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI). RESULTS Mean ages of the patients and controls were 42.3 ± 8.5 and 41.3 ± 9.4 years, respectively (P = .853). There were no significant differences between the two groups with regard to the values of PSV, EDV, and RI of CRA (P = .406, P = .627, P = .227) and PCA (P = .785, P = .403, P = .935, respectively). The PSV and EDV of OA were lower in the CSC patients (P = .005, P = .024, respectively). Whereas the RI of OA was not significantly different (P = .729). Submacular choroidal thickness (SCT) was greater in CSC patients (P < .001). There was a negative correlation between SCT and PSV of PCA (P = .022, r = -0.457) and between SCT and EDV of PCA (P = .004, r = -0.560) in CSC patients. CONCLUSION Hemodynamic changes in OA and a negative correlation between PCA values and SCT suggest ocular circulatory dysfunction in patients with CSC.
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Affiliation(s)
- Deniz Kilic
- Department of Ophthalmology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Mine Karahan
- Department of Ophthalmology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Esra Vural
- Department of Ophthalmology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Mehmet E Dursun
- Department of Ophtalmology, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Atılım A Demirtaş
- Department of Ophtalmology, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
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Central Serous Chorioretinopathy: Multimodal Imaging and Management Options. Case Rep Ophthalmol Med 2020; 2020:8890404. [PMID: 32855831 PMCID: PMC7443246 DOI: 10.1155/2020/8890404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 01/27/2023] Open
Abstract
Central serous chorioretinopathy (CSCR) is an idiopathic maculopathy characterized by thickened choroid, retinal pigment epithelial detachment, and variable subretinal fluid. CSCR predominantly affects young men, with risk factors including corticosteroid use, the type A behavior pattern, and psychological stress. While usually self-limited with a good visual prognosis, recurrent and persistent CSCR can lead to outer retinal and/or retinal pigment epithelial atrophy, choroidal neovascularization, and visual loss. This article reviews current multimodal imaging and treatment options, which include observation, mineralocorticoid receptor antagonists, thermal laser photocoagulation, and off-label photodynamic therapy with verteporfin.
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133
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Romano MR, Parolini B, Allegrini D, Michalewska Z, Adelman R, Bonovas S, Bopp S, Tekin K, Fiser I, Boon CJF, Dijk ECH, Donvito G, Güngel H, Özdoğan Erkul S, Ünsal E, Osmanbaşoğlu Ö, Dinçer N, Erçalık NY, Yenerel NM, Amar J, Ennemoser A, Besozzi G, Sallam AAB, Ellabban AA, Chang W, Eandi CM, Demir M, Lee J, Pak K, Arrevola L, Sloka A, Morawski K, Kulig ‐ Stochmal A, Romanowska ‐ Dixon B, Striebe N, Feltgen N, Hoerauf H, Inan UU, Tanev I, Dyrda A, Schüler A, Lucke K, Brix A, Pape S, Kusserow‐Napp C, Loo PA, Kanra AY, Ardagil Akçakaya A, Arı Yaylalı S, Bae SH, Kim HK, Kim SJ, Han JR, Nam WH, Odrobina D, Lavaque E, Bertelli E, Coser S, Ziemssen F, Forlini M, Benatti C, Cavallini GM, Stefanickova J, Berrod J, Saksonov S, Lytvinchuk L, Moussa M, Stefaniotou M, Christodoulou E, Zayed MA, Oz O, Tassinari P, Koch P, Declercq C, Johnston R, Rusnak S, Penas S, Ozdek S, Ucgul Y, Cisiecki S, Dziegielewski K, Klimczak D, Michalewska Z, Michalewski J, Nawrocka Z, Nawrocki J, Ornafel K, Pikulski Z, Maciej M, Acar N, Elshafei MM, Hamon F, Soyeur R, Badat I, Brousseau B, Hermouet E, Peiretti E, Lee J, Ferreira N, Yoon H, Alkhars WI, Dudani A, Minu R, Telang O, MorePatil VG, Furtado MJ, Jo Y, Piccolino FC, Finzi A. An international collaborative evaluation of central serous chorioretinopathy: different therapeutic approaches and review of literature. The European Vitreoretinal Society central serous chorioretinopathy study. Acta Ophthalmol 2020; 98:e549-e558. [PMID: 31808315 DOI: 10.1111/aos.14319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 11/02/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To study and compare the efficacy of different therapeutic options for the treatment of central serous chorioretinopathy (CSCR). METHODS This is a nonrandomized, international multicentre study on 1719 patients (1861 eyes) diagnosed with CSCR, from 63 centres (24 countries). Reported data included different methods of treatment and both results of diagnostic examinations [fluorescein angiography and/or optical coherent tomography (OCT)] and best-corrected visual acuity (BCVA) before and after therapy. The duration of observation had a mean of 11 months but was extended in a minority of cases up to 7 years. The aim of this study is to evaluate the efficacy of the different therapeutic options of CSCR in terms of both visual (BCVA) and anatomic (OCT) improvement. RESULTS One thousand seven hundred nineteen patients (1861 eyes) diagnosed with CSCR were included. Treatments performed were nonsteroidal anti-inflammatory eye drops, laser photocoagulation, micropulse diode laser photocoagulation, photodynamic therapy (PDT; Standard PDT, Reduced-dose PDT, Reduced-fluence PDT), intravitreal (IVT) antivascular endothelial growth factor injection (VEGF), observation and other treatments. The list of the OTHERS included both combinations of the main proposed treatments or a variety of other treatments such as eplerenone, spironolactone, acetazolamide, beta-blockers, anti-anxiety drugs, aspirin, folic acid, methotrexate, statins, vitis vinifera extract medication and pars plana vitrectomy. The majority of the patients were men with a prevalence of 77%. The odds ratio (OR) showed a partial or complete resolution of fluid on OCT with any treatment as compared with observation. In univariate analysis, the anatomical result (improvement in subretinal fluid using OCT at 1 month) was favoured by age <60 years (p < 0.005), no previous observation (p < 0.0002), duration less than 3 months (p < 0.0001), absence of CSCR in the fellow eye (p = 0.04), leakage outside of the arcade (p = 0.05) and fluid height >500 μm (p = 0.03). The OR for obtaining partial or complete resolution showed that anti-VEGF and eyedrops were not statistically significant; whereas PDT (8.5), thermal laser (11.3) and micropulse laser (8.9) lead to better anatomical results with less variability. In univariate analysis, the functional result at 1 month was favoured by first episode (p = 0.04), height of subretinal fluid >500 μm (p < 0.0001) and short duration of observation (p = 0.02). Finally, there was no statistically significant difference among the treatments at 12 months. CONCLUSION Spontaneous resolution has been described in a high percentage of patients. Laser (micropulse and thermal) and PDT seem to lead to significant early anatomical improvement; however, there is little change beyond the first month of treatment. The real visual benefit needs further clarification.
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Affiliation(s)
- Mario R Romano
- Department of Ophthalmology, Gavazzeni - Castelli Hospital, Humanitas University, Rozzano, Italy
| | - Barbara Parolini
- Department of Ophthalmology, Istituto Clinico S. Anna, Brescia, Italy
| | - Davide Allegrini
- Department of Ophthalmology, Gavazzeni - Castelli Hospital, Humanitas University, Rozzano, Italy
| | | | - Ron Adelman
- Department of Ophthalmology, Yale University, New Haven, Connecticut, USA
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Silvia Bopp
- Department of Ophthalmology & Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
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Zhang B, Chou Y, Zhao X, Yang J, Chen Y. Efficacy of mineralocorticoid receptor antagonist for central serous chorioretinopathy: a meta-analysis. Int Ophthalmol 2020; 40:2957-2967. [PMID: 32632615 DOI: 10.1007/s10792-020-01479-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the efficacy of mineralocorticoid receptor antagonist (MRA) for patients with central serous chorioretinopathy (CSCR). METHODS The Pubmed, Embase, and the Cochrane Central Register of Controlled Trials were comprehensively searched up to February 2020, to identify the studies comparing the efficacy of MRA with placebo/observation or photodynamic therapy (PDT) for CSCR. The primary outcomes were maximal subretinal fluid height and central macular thickness (CMT). The secondary outcomes included subfoveal choroidal thickness (SFCT) and best-corrected visual acuity (BCVA). Data of interest were extracted and analyzed by R version 3.6.0. The weighted mean difference and their 95% confidence intervals were used to assess the strength of the association. RESULTS Ten studies including 284 affected eyes were involved, with 168 undergoing MRA treatment, 60 taking placebo/observation, and 56 receiving PDT. The pooling results showed that MRA was significantly more effective in resolving maximal subretinal fluid height (P < 0.01) and diminishing CMT (P < 0.01) than placebo/observation, while PDT could achieve significantly better CMT reduction than MRA (P = 0.03). For BCVA improvement and SFCT reduction, no statistical difference was detected among the groups of MRA, observation, placebo, or PDT (P > 0.05). CONCLUSION MRA is an effective therapy for the management of CSCR, which is only slightly inferior to PDT in terms of CMT reduction. For patients who could not afford PDT, MRA could function as an alternative treatment with acceptable efficacy and safety.
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Affiliation(s)
- Bilei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, No.9 Dongdansantiao, Dongcheng District, Beijing, 100730, China
| | - Yuyu Chou
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, No.9 Dongdansantiao, Dongcheng District, Beijing, 100730, China
| | - Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, No.9 Dongdansantiao, Dongcheng District, Beijing, 100730, China
| | - Jingyuan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, No.9 Dongdansantiao, Dongcheng District, Beijing, 100730, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China. .,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, No.9 Dongdansantiao, Dongcheng District, Beijing, 100730, China.
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135
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Dhurandhar DS, Singh SR, Sahoo NK, Goud A, Lupidi M, Chhablani J. Identifying central serous chorioretinopathy biomarkers in coexisting diabetic retinopathy: a multimodal imaging study. Br J Ophthalmol 2020; 104:904-909. [PMID: 31563867 DOI: 10.1136/bjophthalmol-2019-314077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 08/15/2019] [Accepted: 09/15/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND To describe clinical and imaging characteristics of patients presenting with diabetic retinopathy (DR) with coexisting acute or chronic central serous chorioretinopathy (CSCR). METHODS This was a cross-sectional study which included 54 eyes of 27 patients with coexisting DR and CSCR. Demographic details, prior history of laser, best-corrected visual acuity (BCVA), central macular thickness (CMT), height of neurosensory detachment (NSD), subfoveal choroidal thickness (SFCT), subfoveal large choroidal vessel layer thickness (SF-LCVT), fluorescein angiography and indocyanine green angiography features were recorded. Subanalysis was done for patients with unilateral CSCR. Data was evaluated using Student t-test for quantitative data and χ2 test for qualitative data. CSCR between different grades of DR was analysed using analysis of variance. RESULTS Prevalence of coexistent CSCR in eyes with DR was 0.4%. Mean age was 53.96±8.79 years, with 25 males. Mean CMT was 349.2±258 μm. Mean SFCT and SF- LCVT of 38 eyes were 376.40±86 μm and 178.80±62.8 μm, respectively. Fifteen eyes had centre involving diabetic macular oedema. Subanalysis of patients with unilateral CSCR showed that the loss of inner segment-outer segment (IS-OS) integrity (p=0.001), photoreceptor footplates at the NSD roof (p=0.001) on optical coherence tomography and dilated choroidal vessels (p=0.05) on indocyanine green angiography were found more often in the CSCR eyes compared with their fellow eyes. Features of CSCR among the different grades of DR were not significantly different between the groups. CONCLUSION Our study describes features of a unique subset of patients presenting with coexistent DR and CSCR. Such coexistent nature needs special attention by the clinicians as this may change the treatment approach and alter outcomes.
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Affiliation(s)
| | | | | | - Abhilash Goud
- Vitreo-retina, L V Prasad Eye Institute, Hyderabad, India
| | - Marco Lupidi
- Department of Ophthalmology, University of Perugia, Perugia, Italy
| | - Jay Chhablani
- Vitreo-retina, L V Prasad Eye Institute, Hyderabad, India
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Azad AD, Zhou M, Afshar AR, Bakri SJ, Pershing S. Systemic Corticosteroid Use after Central Serous Chorioretinopathy Diagnosis. Ophthalmology 2020; 128:121-129. [PMID: 32619546 DOI: 10.1016/j.ophtha.2020.06.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To analyze the frequency of systemic corticosteroid prescriptions before and after central serous chorioretinopathy (CSC) diagnosis. DESIGN Retrospective claims-based analysis. PARTICIPANTS A nationally representative sample of commercial insurance beneficiaries who received care between 2007 and 2015. METHODS We limited the study population to beneficiaries with incident CSC diagnosed by an eye care provider, excluding those with other major ophthalmologic comorbidities. We developed a non-CSC comparison cohort matched to CSC patients by age, sex, general health (Charlson Comorbidity Index), and geographic region. We compared systemic corticosteroid prescriptions before and after CSC diagnosis and by diagnosing provider (optometrist vs. ophthalmologist) and evaluated likelihood of steroids treatment among CSC versus matched control patients using logistic and Cox proportional hazard regression models. MAIN OUTCOME MEASURES Systemic corticosteroid prescription frequency among CSC patients within 12 months pre-diagnosis and at 6, 12, and 24 months post-diagnosis, median time to steroid initiation and discontinuation, and odds of receiving steroids post-diagnosis among CSC and control patients. RESULTS We identified 3418 CSC patients. Nearly 39% (n = 1326) were prescribed systemic steroids at some point during the analysis period, versus 23% of controls (4033 of 17 178 patients). Over 12% of CSC patients (n = 430) within 1 year pre-diagnosis, and nearly 12% (n = 404) within 1 year post-diagnosis. Most patients who received steroids after diagnosis were steroid naive (n = 231). Among those receiving steroids, CSC patients demonstrated longer median time to first post-diagnosis steroid prescription (1.82 years vs. 0.50 years for non-CSC patients) and longer time to last steroid prescription (1.62 years vs. 0.35 years for non-CSC patients). Although CSC patients were significantly less likely to receive steroids within 6 months post-diagnosis compared with non-CSC patients (odds ratio, 0.72; 95% confidence interval, 0.59-0.89), they were significantly more likely to receive steroids by 2 years post-diagnosis. Prescribing patterns were similar for patients diagnosed by an ophthalmologist versus optometrist. CONCLUSIONS Despite evidence showing that steroids contribute to CSC development, many patients continue to be prescribed systemic corticosteroids after CSC diagnosis. Our results suggest a need for greater communication and collaboration among providers to ensure that clinical practice reflects evidence-based recommendations.
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Affiliation(s)
- Amee D Azad
- Stanford University School of Medicine, Palo Alto, California
| | - Maggie Zhou
- Stanford University School of Medicine, Palo Alto, California
| | - Armin R Afshar
- Retina Service, Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Sophie J Bakri
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Suzann Pershing
- Byers Eye Institute, Stanford University, Palo Alto, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
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137
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Walkden A, Atkinson O, Linton E, Bull A, Abraham L, Chhabra R. Visual and anatomical outcomes of central serous chorioretinopathy patients presenting to a tertiary unit: a prospective analysis. Ther Adv Ophthalmol 2020; 12:2515841420923192. [PMID: 32529171 PMCID: PMC7263120 DOI: 10.1177/2515841420923192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/03/2020] [Indexed: 11/17/2022] Open
Abstract
Aim The aim of this study was to prospectively define the characteristics and outcomes of a cohort of central serous chorioretinopathy patients using optical coherence tomography imaging to determine anatomical disease resolution. Much of the literature available on the characteristics of central serous chorioretinopathy patients pre date the advent of OCT imaging, with conclusive epidemiological evidence being scarce. We describe a cohort of patients presenting to a large centre over the course of a year. Methods Prospective data collection was undertaken for all patients diagnosed with central serous chorioretinopathy at our unit over the course of 1 year. All patients underwent thorough history taking and optical coherence tomography imaging. Results In total, 59 eyes from 51 patients were diagnosed with central serous chorioretinopathy between April 2017 and April 2018; 23 (45.1%) patients had optical coherence tomography evidence of complete anatomical resolution within a year, with three (5.88%) patients suffering a worse visual acuity compared with that at presentation at 1-year end point; and three patients developed secondary choroidal neovascular membranes. Conclusion Our study reports much-needed prospective outcomes of patients with central serous chorioretinopathy, which helps to guide clinicians when deciding treatment strategies, as well as better informing patients of their prognosis for visual improvement.
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Affiliation(s)
- Andrew Walkden
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Olivia Atkinson
- Manchester Royal Eye Hospital, Manchester University Foundation Trust, Manchester, UK
| | - Emma Linton
- Manchester Royal Eye Hospital, Manchester University Foundation Trust, Manchester, UK
| | - Adam Bull
- Manchester Royal Eye Hospital, Manchester University Foundation Trust, Manchester, UK
| | - Laina Abraham
- Manchester Royal Eye Hospital, Manchester University Foundation Trust, Manchester, UK
| | - Ramandeep Chhabra
- Manchester Royal Eye Hospital, Manchester University Foundation Trust, Manchester, UK
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Shiihara H, Sonoda S, Terasaki H, Kakiuchi N, Yamashita T, Uchino E, Murao F, Sano H, Mitamura Y, Sakamoto T. Quantitative analyses of diameter and running pattern of choroidal vessels in central serous chorioretinopathy by en face images. Sci Rep 2020; 10:9591. [PMID: 32533066 PMCID: PMC7293258 DOI: 10.1038/s41598-020-66858-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/27/2020] [Indexed: 12/17/2022] Open
Abstract
This study was to investigate the choroidal vessels in eyes with central serous chorioretinopathy (CSC) quantitatively. We studied 41 CSC eyes and their fellow eyes, and 41 normal eyes of 41 age-adjusted individuals. En-face optical coherence tomography image of the top 25% slab of Haller’s layer was analyze. The mean vessel area, vessel length, and vessel diameter were calculated. The running pattern of the vessels was quantified and used to determine the degree of symmetry, the “symmetry index”. The vessel area of CSC eyes was not significantly different from that of fellow eyes but significantly larger than that of normal eyes. The vessel length of CSC eyes was not significantly different from fellow eyes but significantly shorter than that of normal eyes. The mean vessel diameter was larger in CSC eyes than in the fellow eyes and the normal eye. The symmetry index was not significantly different in CSC eyes from that of their fellow eyes but was smaller than that of normal eyes. The quantitative analysis showed that eyes with CSC had larger choroidal vessels and asymmetrical vessels running in Haller’s layer.
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Affiliation(s)
- Hideki Shiihara
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shozo Sonoda
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroto Terasaki
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Naoko Kakiuchi
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takehiro Yamashita
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Eisuke Uchino
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Fumiko Murao
- Department of Ophthalmology, Tokushima University Graduate School of Medicine, Tokushima, Japan
| | - Hiroki Sano
- Department of Ophthalmology, Tokushima University Graduate School of Medicine, Tokushima, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Tokushima University Graduate School of Medicine, Tokushima, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
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COMPARISON OF VISUAL/ANATOMICAL OUTCOMES AND RECURRENCE RATE BETWEEN ORAL SPIRONOLACTONE AND PHOTODYNAMIC THERAPY FOR NONRESOLVING CENTRAL SEROUS CHORIORETINOPATHY. Retina 2020; 40:1191-1199. [DOI: 10.1097/iae.0000000000002507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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140
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Fusi-Rubiano W, Saedon H, Patel V, Yang YC. Oral medications for central serous chorioretinopathy: a literature review. Eye (Lond) 2020; 34:809-824. [PMID: 31527760 PMCID: PMC7182569 DOI: 10.1038/s41433-019-0568-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/04/2019] [Accepted: 07/27/2019] [Indexed: 02/08/2023] Open
Abstract
Central serous chorioretinopathy (CSCR) is characterised by acute or chronic neurosensory detachments of the retina, usually in the posterior pole, with or without associated detachments of retinal pigment epithelium. Although the condition often resolves spontaneously, chronic and recurrent cases can lead to significant visual loss in the working population and it is thus increasingly recognised as an important public health issue. The uncertainty regarding the underlying cause of CSCR has led to a wide range of therapies being tried for this condition including photodynamic therapy, laser photocoagulation, anti-VEGF injections and a multitude of oral agents. This article aims to review the current evidence for oral agents that have been used for treatment of CSCR. A systematic literature search was conducted for articles published between 1980 to July 2018. A total of 73 articles were included. These studied the following oral medications: eplerenone, spironolactone, beta blockers, H. pylori agents, omeprazole, rifampicin, methotrexate, aspirin, acetazolamide, mifepristone, melatonin, finasteride, ketoconazole, antioxidants and curcumin phospholipid. Although none of the studies showed robust evidence of efficacy, the mineralocorticoid receptor antagonists, particularly eplerenone, appear to demonstrate the highest quality evidence for use in this condition. The review aims to give the reader an overview of the current available evidence for oral medications used in the treatment of CSCR in order to provide an evidence-based discussion with the patient and guide through possible options for treatment.
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Affiliation(s)
- William Fusi-Rubiano
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK.
| | - Habiba Saedon
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK
| | - Vijay Patel
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK
| | - Yit C Yang
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK
- School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, UK
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141
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Scarinci F, Patacchioli FR, Palmery M, Pasquali V, Costanzo E, Ghiciuc CM, Parravano M. Diurnal trajectories of salivary cortisol and α-amylase and psychological profiles in patients with central serous chorioretinopathy. Chronobiol Int 2020; 37:510-519. [PMID: 31842621 DOI: 10.1080/07420528.2019.1702553] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It has been hypothesized that the occurrence of central serous chorioretinopathy (CSC) might be associated with stress. Therefore, our purpose was to investigate the diurnal trajectories of salivary cortisol and α-amylase (α-Amy) - markers of hypothalamic-pituitary-adrenal (HPA) axis and sympathetic-adrenal-medullary (SAM) system activity, respectively - and psychological profiles in idiopathic acute CSC. This cross-sectional observational case-control study, which included self-reported psychometric questionnaires, was formally approved by the Ethics Committee. Written informed consent was obtained from all participants. Home diurnal saliva collection was scheduled at several timepoints: at awakening, 30 and 60 min later, and at approximately 13:00 h and 20:00 h. Twenty consecutive male subjects with first-episode CSC attending the outpatient clinic of the Retina Medical Service at the Bietti Foundation were enrolled in the study. Twenty age-matched subjects were recruited as controls. After their initial enrollment, 3 subjects per group were excluded. The production of cortisol and α-Amy and the scores on the negative subscale of the Positive/Negative Affect Schedule, the Daily Hassles and Stress Scale and the Beck Depression Inventory were higher in the CSC group than in the control group. To estimate the diurnal trends in the production of salivary cortisol and α-Amy, an equation was derived for each group of the study population. The equations describing the interpolated regression lines gave salivary cortisol and salivary α-Amy slopes that were determined to be significantly different by Student's t-test (cortisol: t = 3.533, p < .001; α-Amy: t = 2.382, p = .018). Furthermore, the area under the curve with respect to the ground (AUCG) was calculated to summarize repeated salivary biomarker measurements from 07:00 h to 08:00 h for assessment of the cortisol awakening response (CAR) and the α-Amy awakening response (AR). The diurnal cortisol AUCG and diurnal α-Amy AUCG were calculated from 07:00 h to 20:00 h. The CAR AUCG values of the CSC patients were significantly higher than those of the controls. No differences between the two groups were detected for the α-Amy AR AUCG. The present study adds novel information to the growing body of data suggesting that abnormal diurnal activity of the HPA axis and the SAM system is associated with CSC in susceptible individuals, providing ophthalmologists with a new chronobiological approach for these patients.
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Affiliation(s)
| | | | - Maura Palmery
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | | | | | - Cristina Mihaela Ghiciuc
- Department of Pharmacology, School of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
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Chronopoulos A, Kakkassery V, Strobel MA, Fornoff L, Hattenbach LO. The significance of pigment epithelial detachment in central serous chorioretinopathy. Eur J Ophthalmol 2020; 31:556-565. [PMID: 32122162 DOI: 10.1177/1120672120904670] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Argyrios Chronopoulos
- Department of Ophthalmology, Hospital of Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany
| | - Vinodh Kakkassery
- Department of Ophthalmology, University of Luebeck, Luebeck, Germany
| | - Marc Andre Strobel
- Department of Ophthalmology, Hospital of Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany
| | - Luise Fornoff
- Department of Ophthalmology, Hospital of Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany
| | - Lars-Olof Hattenbach
- Department of Ophthalmology, Hospital of Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany
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143
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Wong RLM, Singh SR, Rasheed MA, Goud A, Chhablani G, Samantaray S, AnkiReddy S, Vupparaboina KK, Chhablani J. En-face choroidal vascularity in central serous chorioretinopathy. Eur J Ophthalmol 2020; 31:536-542. [PMID: 32103680 DOI: 10.1177/1120672120908719] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To evaluate the choroidal vascularity index of eyes for acute and chronic central serous chorioretinopathy patients using swept-source optical coherence tomography generated en-face scans. METHODS This was a retrospective study, in which slabs of en-face optical coherence tomography scans, at 5 μm intervals, spanning from the retina to choroid, were binarized using a validated algorithm to calculate choroidal vascularity index. The choroidal vascularity index was defined as the ratio between the choroidal vascular luminal area and the total choroidal area. Choroidal vascularity index was calculated for all the slabs of every subject in both the groups. RESULTS A total of 30 eyes for each acute and chronic central serous chorioretinopathy groups were recruited. The mean choroidal vascularity index of the acute group was 45.21% ± 2.25% at the choriocapillaris, which increased to the maximal value of 48.35% ± 2.06% at 75% depth of the choroidal thickness and 45.31% ± 3.27% at the choroidoscleral interface; whereas for the chronic group, the mean choroidal vascularity index was 44.76% ± 2.60% at the choriocapillaris, which maximized at 50% choroidal depth (48.70% ± 1.32%) and then returned to 45.41% ± 6.02% at the choroidoscleral interface. CONCLUSION For both groups, the choroidal vascularity index increased from choriocapillaris to maximum values at mid-choroid and returned to almost the choriocapillaris value at the choroidoscleral interface.
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Affiliation(s)
- Raymond Lai-Man Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shenzhen, China
| | - Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Mohammed Abdul Rasheed
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India.,School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Gunjan Chhablani
- Department of Computer Science, BITS Pilani, K.K. Birla Goa Campus, Goa, India
| | | | - Samantha AnkiReddy
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India.,University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Increased Risk of Central Serous Chorioretinopathy among Patients with Nonorganic Sleep Disturbance. J Ophthalmol 2020; 2020:1712503. [PMID: 32104592 PMCID: PMC7038385 DOI: 10.1155/2020/1712503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/06/2020] [Accepted: 01/18/2020] [Indexed: 02/01/2023] Open
Abstract
Purpose Patients with central serous chorioretinopathy (CSC) typically present with acute visual impairment and metamorphopsia. The disease previously has been associated with psychological stress. Population-based cohort studies on the risk of CSC among patients with nonorganic sleep disturbance (NOSD) are limited. An early sign of psychiatric disorder was probably sleep disturbance. Furthermore, psychological stress may be caused by sleep disturbance. We investigated the relationship between NOSD and the incidence of CSC. Design Longitudinal cohort study. Participants. We used the Longitudinal Health Insurance Database and collected the data of 53,743 NOSD patients without CSC between 2000 and 2005 as the study group. Four-fold controls were selected randomly from those without neither sleep disturbance nor a CSC history with frequency matching of age, sex, and index-year. Methods The difference in sex, age group, comorbidities, and steroid use between the two groups was analyzed by the χ 2 test. Cox-proportional hazard regression was utilized to estimate the hazard ratio (HR) and 95% confidence intervals (95% CI) for comparison of the two groups. Kaplan-Meier analysis was applied to measure the cumulative incidence of CSC. Furthermore, the log-rank test was used to test the incidence difference between the two groups. Main Outcome Measures. The incidence rate of CSC in the following years until 2011 was detected. Results During a mean follow-up of 7.36 ± 2.88 years, NOSD patients had a higher incidence of CSC than the controls (3.10 vs. 1.86 per 10,000 person-years; adjusted HR, 1.65; 95% CI, 1.34-2.02). Men had a higher risk of CSC than women. Sensitivity analyses stratified by sex, age group, or comorbidity condition showed consistently that NOSD patients had a higher risk of CSC than their controls. Dose-response showed that higher NOSD severity had even higher CSC risk. Conclusions NOSD is an independent indicator for the increased risk of subsequent CSC development.
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Karska-Basta I, Pociej-Marciak W, Chrząszcz M, Żuber-Łaskawiec K, Sanak M, Romanowska-Dixon B. Quality of life of patients with central serous chorioretinopathy - a major cause of vision threat among middle-aged individuals. Arch Med Sci 2020; 17:724-730. [PMID: 34025843 PMCID: PMC8130458 DOI: 10.5114/aoms.2020.92694] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/27/2019] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was designed to measure the vision-related quality of life (QoL). We aimed to assess the effect of disease duration, disease type (i.e., acute vs. chronic and unilateral vs. bilateral), and selected sociodemographic data on the QoL of patients with central serous chorioretinopathy (CSC). MATERIAL AND METHODS The study included 79 patients diagnosed with CSC. The QoL was assessed using the NEI VFQ-25. The statistical analysis was performed using IBM SPSS Statistics 24. RESULTS A significant positive correlation was found between deterioration in peripheral vision as assessed by the NEI VFQ-25 and duration of CSC (r = -0.22, p = 0.046). Compared with women, men obtained higher scores on the scales assessing general health, mental health, ocular pain and role limitations (p = 0.018, p = 0.027, p = 0.009 and p = 0.007, respectively). Patients with acute CSC reported higher levels of social functioning as compared with those with chronic CSC (p = 0.04). There were no differences in any of the scales between patients with unilateral and bilateral CSC. Elderly patients obtained lower scores on 9 of the 12 analyzed scales, as compared with younger patients (p < 0.05). CONCLUSIONS Patients with CSC do not assess their QoL in negative terms, which may be related to the fact that the disease presents with transient symptoms. However, the QoL deteriorated with longer disease duration. Men with CSC have better vision-related QoL than women.
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Affiliation(s)
- Izabella Karska-Basta
- Clinic of Ophthalmology and Ocular Oncology, Department of Ophthalmology, Jagiellonian University, Krakow, Poland
| | - Weronika Pociej-Marciak
- Clinic of Ophthalmology and Ocular Oncology, Department of Ophthalmology, Jagiellonian University, Krakow, Poland
| | - Michał Chrząszcz
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, Krakow, Poland
| | - Katarzyna Żuber-Łaskawiec
- Clinic of Ophthalmology and Ocular Oncology, Department of Ophthalmology, Jagiellonian University, Krakow, Poland
| | - Marek Sanak
- Division of Molecular Biology and Clinical Genetics, Department of Internal Medicine, Jagiellonian University, Krakow, Poland
| | - Bożena Romanowska-Dixon
- Clinic of Ophthalmology and Ocular Oncology, Department of Ophthalmology, Jagiellonian University, Krakow, Poland
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Association of Irregular Pigment Epithelial Detachment in Central Serous Chorioretinopathy with Genetic Variants Implicated in Age-related Macular Degeneration. Sci Rep 2020; 10:1203. [PMID: 31988359 PMCID: PMC6985219 DOI: 10.1038/s41598-020-57747-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/31/2019] [Indexed: 01/06/2023] Open
Abstract
We evaluated phenotype and genotype correlation of central serous chorioretinopathy (CSC) patients with or without irregular pigment epithelial detachment (PED) on optical coherence tomography (OCT). For CSC, a flat, irregular protrusion of retinal pigment epithelium (RPE) with hyper-reflective sub-RPE fluid on OCT was defined as an irregular PED. Participants were classified into 5 subgroups; (1) total CSC (n = 280) (2) CSC with irregular PED (n = 126) (3) CSC without irregular PED (n = 154) (4) typical choroidal neovascularization (CNV) (n = 203) and (5) polypoidal choroidal vasculopathy (PCV) (n = 135). Ten known major AMD-associated single-nucleotide polymorphisms (SNPs) were analyzed. Age, sex adjusted logistic regression was performed for the association between subgroups. Association analysis between CSC without irregular PED and CNV revealed that significant difference for rs10490924 in ARMS2, rs10737680 in CFH, and marginally significant difference for rs800292 in CFH. Between CSC without irregular PED and PCV, rs10490924, rs10737680, and rs800292 were significantly different. In contrast, CSC with irregular PED and CNV revealed no SNP showing significant difference. Between CSC with irregular PED and PCV, only rs10490924 was significantly different. CSC with irregular PED and CSC without irregular PED revealed significant difference for rs800292, and marginal difference for rs10737680. These findings suggest CSC patients with irregular PED are genetically different from those without irregular PED and may have genetic and pathophysiologic overlap with AMD patients.
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147
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Morikawa M, Mayama M, Saito Y, Nakagawa-Akabane K, Umazume T, Chiba K, Kawaguchi S, Cho K, Watari H. Severe proteinuria as a parameter of worse perinatal/neonatal outcomes in women with preeclampsia. Pregnancy Hypertens 2020; 19:119-126. [PMID: 31972468 DOI: 10.1016/j.preghy.2019.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The present study aimed to determine the relationship between the severity of proteinuria and maternal/neonatal outcomes among women with preeclampsia. STUDY DESIGN Proteinuria severity was measured at preeclampsia diagnosis and at delivery in 94 women with preeclampsia (among 2904 women with singleton pregnancies, who delivered after 22 gestational weeks). Preeclampsia was defined as hypertension with proteinuria. MAIN OUTCOME MEASURES Protein:creatinine (P/C) ratio to worse the maternal outcome was 4.8 among women with preeclampsia. RESULTS The frequencies of HELLP syndrome and maternal pulmonary edema in women with a P/C ratio ≥5.0 (35.5% and 35.5%, respectively) were significantly higher than those in women with a P/C ratio <5.0 (12.7%, P = 0.014 and 6.4%, P < 0.001, respectively). The best P/C ratio cutoff value to determine early-onset preeclampsia and early preterm birth (EPB) was 4.1 (P < 0.001 and P < 0.001, respectively). The best P/C ratio cutoff values to determine the interval between the preeclampsia diagnosis and delivery <7 days and the need to undergo cesarean section were 1.8 and 1.5, respectively. The best P/C ratio cutoff value to determine maternal pulmonary edema and central serous chorioretinopathy (CSC) was 4.8 (P = 0.020 and P = 0.014, respectively). Finally, the best P/C ratio cutoff values to determine EPB and maternal CSC in women with preeclampsia were 4.1 (odds ratio, 10.9; 95% confidence interval; 4.08 to 29.2, P < 0.0001) and 4.8 (odds ratio, 17.6; 95% confidence interval; 0.898 to 344, P = 0.0008), respectively, according to the multivariate analysis. CONCLUSIONS A higher P/C ratio at delivery in women with preeclampsia might cause EPB and CSC.
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Affiliation(s)
- Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Michinori Mayama
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoshihiro Saito
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kinuko Nakagawa-Akabane
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kentaro Chiba
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Kawaguchi
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazutoshi Cho
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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148
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Chung SR, Jeong JG, Lee TE, You IC, Ahn M, Cho NC. Oral Spironolactone Treatment in Chronic Central Serous Chorioretinopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.3.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sae Rom Chung
- Department of Ophthalmology, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jin Gu Jeong
- Department of Ophthalmology, Jeonbuk National University Medical School, Jeonju, Korea
| | - Tae Eun Lee
- Department of Ophthalmology, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Korea
| | - In Cheon You
- Department of Ophthalmology, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Korea
| | - Min Ahn
- Department of Ophthalmology, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Korea
| | - Nam Chun Cho
- Department of Ophthalmology, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Korea
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149
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Kumari E, Baidya K, Khan R. Efficacy of Drug Eplerenone in the Management of Chronic Central Serous Chorioretinopathy. ACTA ACUST UNITED AC 2019. [DOI: 10.18410/jebmh/2019/687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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150
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Hosoda Y, Miyake M, Schellevis RL, Boon CJF, Hoyng CB, Miki A, Meguro A, Sakurada Y, Yoneyama S, Takasago Y, Hata M, Muraoka Y, Nakanishi H, Oishi A, Ooto S, Tamura H, Uji A, Miyata M, Takahashi A, Ueda-Arakawa N, Tajima A, Sato T, Mizuki N, Shiragami C, Iida T, Khor CC, Wong TY, Yamada R, Honda S, de Jong EK, Hollander AID, Matsuda F, Yamashiro K, Tsujikawa A. Genome-wide association analyses identify two susceptibility loci for pachychoroid disease central serous chorioretinopathy. Commun Biol 2019; 2:468. [PMID: 31872073 PMCID: PMC6908630 DOI: 10.1038/s42003-019-0712-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/26/2019] [Indexed: 11/09/2022] Open
Abstract
The recently emerged pachychoroid concept has changed the understanding of age-related macular degeneration (AMD), which is a major cause of blindness; recent studies attributed AMD in part to pachychoroid disease central serous chorioretinopathy (CSC), suggesting the importance of elucidating the CSC pathogenesis. Our large genome-wide association study followed by validation studies in three independent Japanese and European cohorts, consisting of 1546 CSC samples and 13,029 controls, identified two novel CSC susceptibility loci: TNFRSF10A-LOC389641 and near GATA5 (rs13278062, odds ratio = 1.35, P = 1.26 × 10-13; rs6061548, odds ratio = 1.63, P = 5.36 × 10-15). A T allele at TNFRSF10A-LOC389641 rs13278062, a risk allele for CSC, is known to be a risk allele for AMD. This study not only identified new susceptibility genes for CSC, but also improves the understanding of the pathogenesis of AMD.
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Affiliation(s)
- Yoshikatsu Hosoda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Rosa L. Schellevis
- Department of Ophthalmology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Camiel J. F. Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Carel B. Hoyng
- Department of Ophthalmology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Akiko Miki
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akira Meguro
- Department of Ophthalmology and Visual Sciences, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yoichi Sakurada
- Department of Ophthalmology, University of Yamanashi, Faculty of Medicine, Yamanashi, Japan
| | - Seigo Yoneyama
- Department of Ophthalmology, University of Yamanashi, Faculty of Medicine, Yamanashi, Japan
| | - Yukari Takasago
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideo Nakanishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoko Ueda-Arakawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Atsushi Tajima
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Ishikawa Japan
| | - Takehiro Sato
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Ishikawa Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Sciences, Yokohama City University School of Medicine, Yokohama, Japan
| | - Chieko Shiragami
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Chiea Chuen Khor
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- Division of Human Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ryo Yamada
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shigeru Honda
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Ophthalmology and Visual Sciences, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Eiko K. de Jong
- Department of Ophthalmology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anneke I. den Hollander
- Department of Ophthalmology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Ophthalmology, Otsu Red-Cross Hospital, Otsu, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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