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Maeda Y, Takata M, Gomi F. Choroidal Thickness is Increased following Restraint Stress in Rats. Curr Eye Res 2023; 48:506-511. [PMID: 36719150 DOI: 10.1080/02713683.2023.2171067] [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: 02/01/2023]
Abstract
PURPOSE Central serous chorioretinopathy is a stress-induced disease and often shows pachychoroid; however, the relationship between stress and choroid remains unlear. The purpose of this study was to investigate, using optical coherence tomography, whether the choroid thickens when rats are subjected to restraint stress. METHODS Eight-week-old male F334/Jcl rats were subjected to 30 min of restraint stress, and choroidal thickness was measured before and after stress loading using optical coherence tomography. In addition, salivary corticosterone levels were measured before and after stress loading. RESULTS Choroidal thickness was significantly increased from 30.1 ± 6.4 µm to 39.7 ± 9.2 µm just after stress loading (p = 0.001). Significant choroidal thickening was not observed on the next day. The salivary corticosterone concentration increased from 1575.3 ± 1040.6 pg/mL before stress loading to 6022.2 ± 6742.6 pg/mL after stress loading, but the difference was not significant (p = 0.10). CONCLUSIONS Choroidal thickness increased when rats were subjected to restraint stress, supporting the hypothesis that stress is one of the causes of pachychoroid spectrum disease, as exemplified by central serous chorioretinopathy.
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Affiliation(s)
- Yuki Maeda
- Department of Ophthalmology, Hyogo Medical University, Nishinomiya, Japan
| | - Masashi Takata
- Department of Ophthalmology, Hyogo Medical University, Nishinomiya, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo Medical University, Nishinomiya, Japan
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102
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Huang Y, Zheng W, Sun Z, Huang S, Lin B. Optical coherence tomography biomarkers as predictors of transition to chronic central serous chorioretinopathy after retinal laser photocoagulation. Ther Adv Chronic Dis 2023; 14:20406223221146721. [PMID: 36704642 PMCID: PMC9871971 DOI: 10.1177/20406223221146721] [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: 06/16/2022] [Accepted: 12/05/2022] [Indexed: 01/22/2023] Open
Abstract
Objectives To explore the optical coherence tomography (OCT) biomarkers to predict the transition to chronic central serous chorioretinopathy (cCSC) after retinal laser photocoagulation. Methods Patients enrolled in this study were from a 12-week clinical trial comparing the efficacy and safety of subthreshold micropulse laser (SML) with threshold conventional laser (TCL) for CSC and had extended follow-up for more than 1 year. They were divided into two groups, transited to cCSC group (cCSC group) and did not transited to cCSC group (non-cCSC group) according to fundus examination at the extended follow-up. Collect the best-corrected visual acuity (BCVA) and OCT characteristics of patients at baseline and 12 weeks after laser treatment. Results Twenty-seven patients were enrolled (42.6 ± 7.7 years old), and duration of follow-up was 178.9 ± 88.8 (57.0-312.0) weeks. Nine patients (33.3%) were assigned to cCSC group, and the other 18 patients (66.7%) were assigned to the non-cCSC group. Twelve weeks after the laser treatment, subretinal fluid (SRF) of 15 patients (83.3%) in non-cCSC group and 5 patients (55.6%) in cCSC group absorbed completely; the height of SRF had statistical difference between two groups (p = 0.035); rough RPE was less common in cCSC group (p = 0.030); hyper reflective mass (HRM) was more common in cCSC group (p = 0.024); more number of hyper reflective foci (HRF) in outer segment of photoreceptor layer were detected in cCSC group (p = 0.035). From baseline to 12 weeks after laser treatment, the number of HRF in outer segment photoreceptor layer did not change significantly in cCSC group (p = 0.665) but decreased significantly in non-cCSC group (p = 0.000). A total of five patients suffered binocular CSC, three of them in the non-cCSC group occurred later than the other two in the cCSC group (129.9-278.3 weeks vs 96.1-114.9 weeks after baseline). Conclusion SRF, rough RPE, HRM, and number of HRF in outer segment photoreceptor layer 12 weeks after laser treatment, and change in the number of HRF in outer segment photoreceptor layer from baseline to 12 weeks after laser treatment may predict the transition to cCSC.
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Affiliation(s)
- Ying Huang
- Eye Hospital and School of Ophthalmology and
Optometry, Wenzhou Medical University, Wenzhou, China
| | - Weiwei Zheng
- Eye Hospital and School of Ophthalmology and
Optometry, Wenzhou Medical University, Wenzhou, China
| | - Zuhua Sun
- Eye Hospital and School of Ophthalmology and
Optometry, Wenzhou Medical University, Wenzhou, China
| | - Shenghai Huang
- Eye Hospital and School of Ophthalmology and
Optometry, Wenzhou Medical University, Wenzhou, China
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Imanaga N, Terao N, Sonoda S, Sawaguchi S, Yamauchi Y, Sakamoto T, Koizumi H. Relationship Between Scleral Thickness and Choroidal Structure in Central Serous Chorioretinopathy. Invest Ophthalmol Vis Sci 2023; 64:16. [PMID: 36662534 PMCID: PMC9872835 DOI: 10.1167/iovs.64.1.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose Central serous chorioretinopathy (CSC) is a retinal disorder characterized by serous retinal detachment with or without pigment epithelial detachment in the posterior pole of the eye. We aimed to elucidate the relationship between scleral thickness and choroidal structure in CSC eyes. Methods This single-center retrospective study included 111 eyes of 111 CSC patients. Using swept-source optical coherence tomography, the horizontal cross-sectional images of the posterior choroid were converted to binary images by semiautomated software. The luminal and stromal areas of the choroid were measured, and the luminal/stromal (L/S) ratios of the whole choroid (WC), inner choroid, and outer choroid (OC) at 1500 µm, 3000 µm, and 7500 µm ranges centered on the fovea were calculated. Correlations of L/S ratio and age, spherical equivalent, axial length, subfoveal choroidal thickness (SCT), and scleral thickness were determined. Scleral thickness was measured vertically, 6 mm posterior to the scleral spur in four directions. Results SCT and mean scleral thickness were significantly positively correlated with the L/S ratio in all ranges of WC and OC. Multiple regression analysis found that SCT and mean scleral thickness were significantly correlated with the L/S ratio, and the strength of correlation of mean scleral thickness (WC: 0.386, P < 0.001; OC: 0.391, P < 0.001) was greater than that of SCT (WC: 0.368, P < 0.001; OC: 0.383, P < 0.001) in 7500 µm range. Conclusions Thick sclera appeared to play a role in an increase in the luminal component of the posterior choroid in CSC eyes.
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Affiliation(s)
- Naoya Imanaga
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Nobuhiro Terao
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shozo Sonoda
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shota Sawaguchi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yukihide Yamauchi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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104
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Zhang L, Van Dijk EHC, Borrelli E, Fragiotta S, Breazzano MP. OCT and OCT Angiography Update: Clinical Application to Age-Related Macular Degeneration, Central Serous Chorioretinopathy, Macular Telangiectasia, and Diabetic Retinopathy. Diagnostics (Basel) 2023; 13:diagnostics13020232. [PMID: 36673042 PMCID: PMC9858550 DOI: 10.3390/diagnostics13020232] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Similar to ultrasound adapting soundwaves to depict the inner structures and tissues, optical coherence tomography (OCT) utilizes low coherence light waves to assess characteristics in the eye. Compared to the previous gold standard diagnostic imaging fluorescein angiography, OCT is a noninvasive imaging modality that generates images of ocular tissues at a rapid speed. Two commonly used iterations of OCT include spectral-domain (SD) and swept-source (SS). Each comes with different wavelengths and tissue penetration capacities. OCT angiography (OCTA) is a functional extension of the OCT. It generates a large number of pixels to capture the tissue and underlying blood flow. This allows OCTA to measure ischemia and demarcation of the vasculature in a wide range of conditions. This review focused on the study of four commonly encountered diseases involving the retina including age-related macular degeneration (AMD), diabetic retinopathy (DR), central serous chorioretinopathy (CSC), and macular telangiectasia (MacTel). Modern imaging techniques including SD-OCT, TD-OCT, SS-OCT, and OCTA assist with understanding the disease pathogenesis and natural history of disease progression, in addition to routine diagnosis and management in the clinical setting. Finally, this review compares each imaging technique's limitations and potential refinements.
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Affiliation(s)
- Lyvia Zhang
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
| | | | - Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, 20132 Milan, Italy
| | - Serena Fragiotta
- Ophthalmology Unit, Department NESMOS, S. Andrea Hospital, University of Rome “La Sapienza”, 00189 Rome, Italy
| | - Mark P. Breazzano
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY 13088, USA
- Correspondence: ; Tel.: +1-(315)-445-8166
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Farrag M, Ait Eldjoudi D, González-Rodríguez M, Cordero-Barreal A, Ruiz-Fernández C, Capuozzo M, González-Gay MA, Mera A, Lago F, Soffar A, Essawy A, Pino J, Farrag Y, Gualillo O. Asprosin in health and disease, a new glucose sensor with central and peripheral metabolic effects. Front Endocrinol (Lausanne) 2023; 13:1101091. [PMID: 36686442 PMCID: PMC9849689 DOI: 10.3389/fendo.2022.1101091] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
Adipose tissue malfunction leads to altered adipokine secretion which might consequently contribute to an array of metabolic diseases spectrum including obesity, diabetes mellitus, and cardiovascular disorders. Asprosin is a novel diabetogenic adipokine classified as a caudamin hormone protein. This adipokine is released from white adipose tissue during fasting and elicits glucogenic and orexigenic effects. Although white adipose tissue is the dominant source for this multitask adipokine, other tissues also may produce asprosin such as salivary glands, pancreatic B-cells, and cartilage. Significantly, plasma asprosin levels link to glucose metabolism, lipid profile, insulin resistance (IR), and β-cell function. Indeed, asprosin exhibits a potent role in the metabolic process, induces hepatic glucose production, and influences appetite behavior. Clinical and preclinical research showed dysregulated levels of circulating asprosin in several metabolic diseases including obesity, type 2 diabetes mellitus (T2DM), polycystic ovarian syndrome (PCOS), non-alcoholic fatty liver (NAFLD), and several types of cancer. This review provides a comprehensive overview of the asprosin role in the etiology and pathophysiological manifestations of these conditions. Asprosin could be a promising candidate for both novel pharmacological treatment strategies and diagnostic tools, although developing a better understanding of its function and signaling pathways is still needed.
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Affiliation(s)
- Mariam Farrag
- SERGAS (Servizo Galego de Saude), NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Research Laboratory 9, IDIS (Instituto de Investigación Sanitaria de Santiago), Santiago University Clinical Hospital, Santiago de Compostela, Spain
- Euro-Mediterranean Master in neuroscience and Biotechnology, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Djedjiga Ait Eldjoudi
- SERGAS (Servizo Galego de Saude), NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Research Laboratory 9, IDIS (Instituto de Investigación Sanitaria de Santiago), Santiago University Clinical Hospital, Santiago de Compostela, Spain
| | - María González-Rodríguez
- SERGAS (Servizo Galego de Saude), NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Research Laboratory 9, IDIS (Instituto de Investigación Sanitaria de Santiago), Santiago University Clinical Hospital, Santiago de Compostela, Spain
- International PhD School of the University of Santiago de Compostela (EDIUS), Doctoral Program in Drug Research and Development, Santiago de Compostela, Spain
| | - Alfonso Cordero-Barreal
- SERGAS (Servizo Galego de Saude), NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Research Laboratory 9, IDIS (Instituto de Investigación Sanitaria de Santiago), Santiago University Clinical Hospital, Santiago de Compostela, Spain
| | - Clara Ruiz-Fernández
- SERGAS (Servizo Galego de Saude), NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Research Laboratory 9, IDIS (Instituto de Investigación Sanitaria de Santiago), Santiago University Clinical Hospital, Santiago de Compostela, Spain
- International PhD School of the University of Santiago de Compostela (EDIUS), Doctoral Program in Medicine Clinical Research, Santiago de Compostela, Spain
| | - Maurizio Capuozzo
- National Health Service, Local Health Authority ASL 3 Napoli Sud, Department of Pharmacy, Naples, Italy
| | - Miguel Angel González-Gay
- Hospital Universitario Marqués de Valdecilla, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - Antonio Mera
- SERGAS, Santiago University Clinical Hospital, Division of Rheumatology, Santiago de Compostela, Spain
| | - Francisca Lago
- SERGAS (Servizo Galego de Saude), IDIS (Instituto de Investigación Sanitaria de Santiago), Molecular and Cellular Cardiology Lab, Research Laboratory 7, Santiago University Clinical Hospital, Santiago de Compostela, Spain
| | - Ahmed Soffar
- Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Amina Essawy
- Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Jesus Pino
- SERGAS (Servizo Galego de Saude), NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Research Laboratory 9, IDIS (Instituto de Investigación Sanitaria de Santiago), Santiago University Clinical Hospital, Santiago de Compostela, Spain
| | - Yousof Farrag
- SERGAS (Servizo Galego de Saude), NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Research Laboratory 9, IDIS (Instituto de Investigación Sanitaria de Santiago), Santiago University Clinical Hospital, Santiago de Compostela, Spain
| | - Oreste Gualillo
- SERGAS (Servizo Galego de Saude), NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Research Laboratory 9, IDIS (Instituto de Investigación Sanitaria de Santiago), Santiago University Clinical Hospital, Santiago de Compostela, Spain
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Fung AT, Yang Y, Kam AW. Central serous chorioretinopathy: A review. Clin Exp Ophthalmol 2023; 51:243-270. [PMID: 36597282 DOI: 10.1111/ceo.14201] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/18/2022] [Accepted: 12/18/2022] [Indexed: 01/05/2023]
Abstract
Central serous chorioretinopathy (CSC) is the fourth most common non-surgical retinopathy associated with fluid leakage. The pathogenesis is not yet completely understood, but changes in the choroid, sclera and RPE have been described associated with venous congestion of choroidal outflow. CSC can be categorised into acute, chronic, and recurrent subtypes with recent classifications of simple and complex based on the area of RPE change seen on fundus autofluorescence. A multimodal imaging approach is helpful in the diagnosis and management of CSC and secondary complications such as type 1 neovascularisation. Although spontaneous resolution with relatively good visual outcomes is common, treatment should be considered in patients with persistent or recurrent SRF. Treatment options include laser, systemic medications, intravitreal therapy, and surgery. Of these, argon laser for focal extramacular fluid leaks and photodynamic therapy of leakage identified by indocyanine-green angiography currently have the greatest supportive evidence.
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Affiliation(s)
- Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Yi Yang
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Andrew W Kam
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital, Sydney, New South Wales, Australia
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107
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Hung JH, Yang CM, Yang CH, Ho TC, Lai TT, Hsieh YT. Dilated choroidal vascular channels in pachychoroid neovasculopathy. Clin Exp Ophthalmol 2023; 51:44-57. [PMID: 36258650 DOI: 10.1111/ceo.14178] [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: 07/01/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND To elucidate the pattern of the choroidal vasculature in exudative pachychoroid neovasculopathy (PNV) and its correlation with the clinical course and treatment outcomes. METHODS The retrospective study included consecutive patients in National Taiwan University Hospital between 2014 and 2020 who fulfilled the criteria for exudative PNV defined as active type 1 macular neovascularization (MNV) on optical coherence tomography angiography (OCTA) and with leakage on fluorescein angiography (FA) or indocyanine green angiography (ICGA) associated with pachychoroid features. The corrected distance visual acuity (CDVA), FA, ICGA, and OCT images obtained by Optovue (Optovue Inc, Freemont CA, USA) spectral domain OCT were evaluated at baseline and various time points during the 12-month treatment period. The correlations between the choroidal vascular patterns, specifically those with or without dilated choroidal vascular channels (DCVC) revealed by ICGA, and baseline characteristics and treatment outcomes were evaluated using multiple regression models. RESULTS The study enrolled 34 eyes of 31 patients. The average age was 59.0 ± 9.3 years, and 20 participants were men. ICGA revealed DCVCs in 21 eyes, while the remaining 13 eyes did not have DCVCs. At baseline, DCVC group was older (p = 0.03) and had a longer duration of visual symptoms (p = 0.02), with a higher vessel density (defined as the percentage of the measured area occupied by flow area) of MNV (p = 0.04), higher proportion of ellipsoid zone disruption (p = 0.01), and poorer CDVA (p = 0.03). After the 12-month treatment period, the frequency of requirement of anti-VEGF injections (p < 0.01) was higher, and the risk for CDVA <20/40 was higher (adjusted OR: 5.29, 95% CI: 1.24-22.48, p = 0.02) in eyes with DCVCs. CONCLUSIONS For PNV, eyes with DCVCs were associated with higher vessel density of macular neovascularization and poorer CDVA at baseline, and had poorer visual and anatomical outcomes although more anti-VEGF injections were given.
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Affiliation(s)
- Jia-Horung Hung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzo-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
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108
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Lee GW, Kim YY, Choi KJ, Kang SW. Factors related to changes in visual symptoms after successful photodynamic therapy in central serous chorioretinopathy. PLoS One 2023; 18:e0284899. [PMID: 37083728 PMCID: PMC10121034 DOI: 10.1371/journal.pone.0284899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/01/2023] [Indexed: 04/22/2023] Open
Abstract
To investigate biomarkers related to visual symptom and best corrected visual acuity (BCVA) improvement after photodynamic therapy (PDT) for central serous chorioretinopathy. This retrospective cross-sectional study involved 42 consecutive eyes, from 42 patients who underwent successful PDT, divided into two groups according to improvement in subjective visual complaints: complete (20 eyes) and incomplete recovery (22 eyes). The clinical characteristics of each group, including central foveal thickness (CFT), foveal avascular zone (FAZ) area, and degree of change in signal voiding of the choriocapillaris on optical coherence tomography angiography, were compared. Correlations between best-corrected visual acuity (BCVA) and baseline clinical features were investigated. At baseline, CFT and FAZ areas showed significant differences between the two groups (all p < 0.05). Multiple binary logistic regression analysis revealed that greater CFT predicted complete recovery from visual complaints (p = 0.002). Reduction or disappearance of signal voiding in the choriocapillaris 6 months post-PDT occurred more frequently in the complete recovery group (p < 0.05). FAZ area before PDT correlated with BCVA before and 6 months after PDT and BCVA improvement during the study period (all p < 0.05). CFT and FAZ area before PDT correlated with completeness of visual symptom recovery after PDT. Smaller FAZ area before PDT correlated with better BCVA before and after treatment.
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Affiliation(s)
- Geun Woo Lee
- Department of Ophthalmology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Yun Young Kim
- Department of Ophthalmology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Kyung Jun Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Funatsu R, Sonoda S, Terasaki H, Shiihara H, Mihara N, Horie J, Sakamoto T. Effect of photodynamic therapy on choroid of the medial area from optic disc in patients with central serous chorioretinopathy. PLoS One 2023; 18:e0282057. [PMID: 36809529 PMCID: PMC9942968 DOI: 10.1371/journal.pone.0282057] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE To explore the effect of photodynamic therapy (PDT) on the choroid of medial area from optic disc and factors correlated with treatment outcomes, we evaluated choroidal changes using ultra-widefield optical coherence tomography (UWF-OCT) after PDT for central serous chorioretinopathy (CSC). METHODS In this retrospective case-series, we included CSC patients who received a standard-dose of full-fluence PDT. UWF-OCT were examined at baseline and 3 months after treatment. We measured choroidal thickness (CT), classified into central, middle, and peripheral sectors. We examined CT changes after PDT by sectors and treatment outcome. RESULTS Twenty-two eyes of 21 patients (20 males; mean age 58.7 ± 12.3 years) were included. CT reduction after PDT was significant in all sectors, including peripheral areas: supratemporal, 330.5 ± 90.6 μm vs. 237.0 ± 53.2 μm; infratemporal, 240.0 ± 89.4 μm vs. 209.9 ± 55.1 μm; supranasal, 237.7 ± 59.8 vs 209.3 ± 69.3 μm; infranasal, 172.6 ± 47.2 μm vs. 155.1 ± 38.2 μm (P < 0.001, for all). In patients with retinal fluid resolution, despite no apparent difference in baseline CT, there was more significant reduction after PDT in supratemporal and supranasal peripheral sectors, compared with patients without resolution: supratemporal, 41.9 ± 30.3 μm vs. -1.6 ± 22.7 μm; supranasal, 24.7 ± 15.3 μm vs. 8.5 ± 3.6 μm (P < 0.019, for both). CONCLUSIONS Whole CT decreased after PDT, including in medial areas from optic disc. This may be associated with the treatment response of PDT for CSC.
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Affiliation(s)
- Ryoh Funatsu
- 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
- * E-mail:
| | - Hideki Shiihara
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Naohisa Mihara
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Gibson CR, Mader TH, Lipsky W, Brown DM, Jennings R, Law J, Sargsyan A, Brunstetter T, Danilichev SN, Maezawa Y. Implantable Collamer Lens Use in a Spaceflight Participant During Short Duration Spaceflight. Aerosp Med Hum Perform 2023; 94:48-50. [PMID: 36757221 DOI: 10.3357/amhp.6150.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND: The purpose of this report is to document the first use of a single piece, posterior chamber phakic implantable collamer lens (ICL) with a central port in the right eye (OD) of a spaceflight participant (SFP) during a 12-d Soyuz mission to the International Space Station (ISS). We also briefly document the stability of a pre-existing pachychoroid pigment epitheliopathy (PPE) in the macula of his left eye (OS) during this mission.CASE REPORT: Ocular examination, including refraction, slit lamp examination, macular examination by optical coherence tomography (OCT), and tonometry were performed before and after his mission and he was questioned regarding visual changes during each portion of his flight.DISCUSSION: We documented no change in ICL position during his spaceflight. He reported stable vision during liftoff, entry into microgravity, 12 d on the ISS, descent, and landing. Our results suggest that the modern ICL with a central port is stable, effective, and well tolerated during short duration spaceflight. His PPE also remained stable during this mission as documented by OCT.Gibson CR, Mader TH, Lipsky W, Brown DM, Jennings R, Law J, Sargsyan A, Brunstetter T, Danilichev SN, Maezawa Y. Implantable collamer lens use in a spaceflight participant during short duration spaceflight. Aerosp Med Hum Perform. 2023; 94(1):48-50.
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Sacconi R, Fragiotta S, Sarraf D, Sadda SR, Freund KB, Parravano M, Corradetti G, Cabral D, Capuano V, Miere A, Costanzo E, Bandello F, Souied E, Querques G. Towards a better understanding of non-exudative choroidal and macular neovascularization. Prog Retin Eye Res 2023; 92:101113. [PMID: 35970724 DOI: 10.1016/j.preteyeres.2022.101113] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/14/2022] [Accepted: 08/03/2022] [Indexed: 02/01/2023]
Abstract
Non-exudative macular and choroidal neovascularization (MNV and CNV) usually refers to the entity of treatment-naïve type 1 neovascularization in the absence of associated signs of exudation. Histopathological studies, dating back in the early 70s, identified the presence of non-exudative MNV, but the first clinical report of this finding was in the late 90s using indocyanine green angiography in eyes with age-related macular degeneration (AMD). With more advanced retinal imaging, there has been an ever increasing appreciation of non-exudative MNV associated with AMD and CNV with other macular disorders. However, consensus regarding the exact definition and the clinical management of this entity is lacking. Furthermore, there may be variation in the imaging features and clinical course suggesting that a spectrum of disease may exist. Herein, we review the large body of published work that has provided a better understanding of non-exudative MNV and CNV in the last decade. The prevalence, multimodal imaging features, clinical course, and response to treatment are discussed to elucidate further key insights about this entity. Based on these observations, this review also proposes a new theory about the origin and course of different sub-types of non-exudative MNV/CNV which can have different etiologies and pathways according to the clinical context of disease.
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Affiliation(s)
- Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Fragiotta
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA; Greater Los Angeles VA Healthcare Center, Los Angeles, CA, United States
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, CA, United States; Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, United States
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, United States; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, United States
| | | | - Giulia Corradetti
- Doheny Eye Institute, Los Angeles, CA, United States; Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Diogo Cabral
- Vitreous Retina Macula Consultants of New York, New York, NY, United States; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, United States
| | - Vittorio Capuano
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | | | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eric Souied
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Gonçalves AN, Messias A, Chaves L, de Azeredo Bastos TM, Jorge R. Safety of intravitreal metoprolol in eyes with central serous chorioretinopathy. Doc Ophthalmol 2022; 145:211-219. [PMID: 36333649 DOI: 10.1007/s10633-022-09895-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To investigate ocular safety of intravitreal metoprolol in eyes with central serous chorioretinopathy. METHODS Five eyes of five patients diagnosed with chronic central serous chorioretinopathy (cCSC) previously treated unsuccessfully with oral spironolactone, micropulse laser and intravitreal anti-vascular endothelial growth factor agents were enrolled and received off-label intravitreal metoprolol (50 µg/0.05 ml). Baseline and follow-up examinations included measurement of best-corrected visual acuity (BCVA), intraocular pressure, anterior chamber cellular/flare scores, vitritis classification, fluorescein and indocyanine green angiography, spectral domain optical coherence tomography and electroretinography (ERG), recorded by means of DTL electrodes and following the standard suggested by the International Society for Clinical Electrophysiology of Vision (ISCEV). The total follow-up period was 4 weeks. RESULTS There were no significant differences between baseline and follow-up ERG parameters: scotopic or photopic, a- and b-wave amplitude and implicit time, nor oscillatory potentials amplitude, or whatsoever. No intraocular inflammation sign was observed. In addition, BCVA showed small improvement in 4 or kept baseline values in 1 patient. The subretinal and/or intraretinal fluid volume reduced in all patients at 1 month after treatment. CONCLUSION Patients with refractory cCSC treated with intravitreal 50 µg/0.05 ml metoprolol showed no signs of acute ocular toxicity, along with intraretinal fluid reduction and slight BCVA improvement 1 month after injection. This data suggest that intravitreal metoprolol may be a safe alternative for cCSC.
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Affiliation(s)
- Annelise Nicotti Gonçalves
- Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, 3900, Bandeirantes Avenue, Ribeirão Preto, SP,, 14049-900, Brazil
| | - André Messias
- Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, 3900, Bandeirantes Avenue, Ribeirão Preto, SP,, 14049-900, Brazil.
| | - Leandro Chaves
- Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, 3900, Bandeirantes Avenue, Ribeirão Preto, SP,, 14049-900, Brazil
| | - Thaís Marino de Azeredo Bastos
- Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, 3900, Bandeirantes Avenue, Ribeirão Preto, SP,, 14049-900, Brazil
| | - Rodrigo Jorge
- Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, 3900, Bandeirantes Avenue, Ribeirão Preto, SP,, 14049-900, Brazil
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Brinks J, van Dijk EHC, Meijer OC, Schlingemann RO, Boon CJF. Choroidal arteriovenous anastomoses: a hypothesis for the pathogenesis of central serous chorioretinopathy and other pachychoroid disease spectrum abnormalities. Acta Ophthalmol 2022; 100:946-959. [PMID: 35179828 PMCID: PMC9790326 DOI: 10.1111/aos.15112] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 12/30/2022]
Abstract
The pachychoroid disease spectrum (PDS) includes several chorioretinal diseases that share specific choroidal abnormalities. Although their pathophysiological basis is poorly understood, diseases that are part of the PDS have been hypothesized to be the result of venous congestion. Within the PDS, central serous chorioretinopathy is the most common condition associated with vision loss, due to an accumulation of subretinal fluid in the macula. Central serous chorioretinopathy is characterized by distinct risk factors, most notably a high prevalence in males and exposure to corticosteroids. Interestingly, sex differences and corticosteroids are also strongly associated with specific types of arteriovenous anastomoses in the human body, including dural arteriovenous fistula and surgically created arteriovenous shunts. In this manuscript, we assess the potential of such arteriovenous anastomoses in the choroid as a causal mechanism of the PDS. We propose how this may provide a novel unifying concept on the pathophysiological basis of the PDS, and present cases in which this mechanism may play a role.
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Affiliation(s)
- Joost Brinks
- Department of OphthalmologyLeiden University Medical CentreLeidenThe Netherlands
| | - Elon H. C. van Dijk
- Department of OphthalmologyLeiden University Medical CentreLeidenThe Netherlands
| | - Onno C. Meijer
- Department of Medicine, Division of Endocrinology and MetabolismLeiden University Medical CentreLeidenThe Netherlands
| | - Reinier O. Schlingemann
- Department of Ophthalmology, Amsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands,Department of OphthalmologyUniversity of Lausanne, Jules‐Gonin Eye Hospital, Fondation Asile des AveuglesLausanneSwitzerland
| | - Camiel J. F. Boon
- Department of OphthalmologyLeiden University Medical CentreLeidenThe Netherlands,Department of Ophthalmology, Amsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
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Piccolino FC, Fruttini D, Eandi C, Nicolò M, Mariotti C, Tito S, Lupidi M. Vigorous Physical Activity as a Risk Factor for Central Serous Chorioretinopathy. Am J Ophthalmol 2022; 244:30-37. [PMID: 35948087 DOI: 10.1016/j.ajo.2022.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To evaluate whether frequent vigorous physical activity (PA) is significantly associated with active central serous chorioretinopathy (CSCR) and may represent a risk factor for CSCR. DESIGN Case-control study. METHODS This was a multicenter study. The patient population comprised consecutive patients with active CSCR and a comparable control group of healthy participants. Both groups were interrogated about their PA using a shortened version of the International Physical Activity Questionnaire. The Ainsworth Compendium of Physical Activities was taken as a reference for the activities requiring vigorous effort and to quantify the energy expended, expressed in metabolic equivalent of task (MET). As a main outcome measure, a moderate/high practice of vigorous PA was opposed to an absent/low practice of vigorous PA in the 2 groups. RESULTS A total of 105 patients with CSCR and 105 healthy controls were included in the study. Moderate/high vigorous PA was observed in 63.5% of the patients with CSCR and in 26% of the controls (P = .0001). The MET values of vigorous PA were 2173.2 ± 2081.5 in the CSCR group and 1216.3 ± 524 in the control group (P = .029). The potential risk of disease associated with moderate/high vigorous PA was 5.58 (odds ratio; 95% confidence interval 3.01-10.69, P = .0001). CONCLUSIONS This study demonstrates a significant association of vigorous PA with CSCR, indicating an increased probability of disease by 5.58 times. Frequent and intense PA, with the hypertensive episodes that it entails, can break the precarious hemodynamic balance in the choroid of individuals predisposed to CSCR, thereby favoring choroidal vascular decompensation and active disease.
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Affiliation(s)
- Felice Cardillo Piccolino
- Fondazione per la Macula Onlus (F.C.P., S.T., M.L.), Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, Genova, Italy.
| | - Daniela Fruttini
- Department of Medicine and Surgery (D.F.), University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Chiara Eandi
- Department of Ophthalmology (C.E.), University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland Centre de l'Odéon, Paris, France; Department of Surgical Sciences (C.E.), Eye Clinic, University of Torino, Torino, Italy
| | - Massimo Nicolò
- Clinica Oculistica (M.N.), DiNOGMI, Università di Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Cesare Mariotti
- Eye Clinic (C.M., M.L.), Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Silvia Tito
- Fondazione per la Macula Onlus (F.C.P., S.T., M.L.), Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, Genova, Italy
| | - Marco Lupidi
- Fondazione per la Macula Onlus (F.C.P., S.T., M.L.), Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, Genova, Italy; Clinica Oculistica (M.N.), DiNOGMI, Università di Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Fernández-Vigo JI, Gómez Calleja V, de Moura Ramos JJ, Novo-Bujan J, Burgos-Blasco B, López-Guajardo L, Donate-López J, Ortega-Hortas M. Prediction of the response to photodynamic therapy in patients with chronic central serous chorioretinopathy based on optical coherence tomography using deep learning. Photodiagnosis Photodyn Ther 2022; 40:103107. [PMID: 36070850 DOI: 10.1016/j.pdpdt.2022.103107] [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: 07/03/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the prediction of the response to photodynamic therapy (PDT) in chronic central serous chorioretinopathy (CSCR) based on spectral-domain optical coherence tomography (SD-OCT) images using deep learning (DL). METHODS Retrospective study including 216 eyes of 175 patients with CSCR and persistent subretinal fluid (SRF) who underwent half-fluence PDT. SD-OCT macular examination was performed before (baseline) and 3 months after treatment. Patients were classified into groups by experts based on the response to PDT: Group 1, complete SRF resorption (n = 100); Group 2, partial SRF resorption (n = 66); and Group 3, absence of any SRF resorption (n = 50). This work proposes different computational approaches: 1st approach compares all groups; 2nd compares groups 1 vs. 2 and 3 together; 3rd compares groups 2 vs. 3. RESULTS The mean age was 55.6 ± 10.9 years and 70.3% were males. In the first approach, the algorithm showed a precision of up to 57% to detect the response to treatment in group 1 based on the initial scan, with a mean average accuracy of 0.529 ± 0.035. In the second model, the mean accuracy was higher (0.670 ± 0.046). In the third approach, the algorithm showed a precision of 0.74 ± 0.12 to detect the response to treatment in group 2 (partial SRF resolution) and 0.69 ± 0.15 in group 3 (absence of SRF resolution). CONCLUSION Despite the high clinical variability in the response of chronic CSCR to PDT, this DL algorithm offers an objective and promising tool to predict the response to PDT treatment in clinical practice.
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Affiliation(s)
| | | | - José Joaquim de Moura Ramos
- VARPA Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), CITIC, Universidad da Coruña, A Coruña, Spain
| | - Jorge Novo-Bujan
- VARPA Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), CITIC, Universidad da Coruña, A Coruña, Spain
| | | | | | - Juan Donate-López
- Retina Unit, Ophthalmology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Marcos Ortega-Hortas
- VARPA Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), CITIC, Universidad da Coruña, A Coruña, Spain
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Gonçalves AN, Scott IU, Jorge R. Alternative management of central serous chorioretinopathy using intravitreal metoprolol. Int J Retina Vitreous 2022; 8:50. [PMID: 35879809 PMCID: PMC9310426 DOI: 10.1186/s40942-022-00400-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Beta-blockers may counteract the effect of catecholamines on central serous chorioretinopathy (CSC) pathology and accelerate the improvement of neurosensory retinal detachment. Oral propranolol has been associated with decreased duration of CSC in some studies. We describe two patients with visually symptomatic chronic CSC (cCSC) treated successfully with intravitreal metoprolol. Case presentations After obtaining the patients’ informed consent, two eyes of two 43-year-old men diagnosed with cCSC treated unsuccessfully with oral spirolactone, micropulse laser and intravitreal anti‐vascular endothelial growth factor (anti-VEGF) agents were treated with one off-label intravitreal injection of metoprolol (50 µg/0.05 ml). Baseline (pre-injection) and follow-up examinations (at 1 month post-injection) included best-corrected visual acuity (BCVA), anterior and posterior segment biomicroscopy, fundus autofluorescence, spectral domain optical coherence tomography (Spectralis, Heidelberg), and electroretinogaphy (ERG) according to International Society for Clinical Electrophysiology of Vision (ISCEV) full-field scotopic and photopic standard protocols. ERG results at baseline (pre-injection) and at 1 month post-injection were compared using paired t-tests. Results There was no significant difference in any of the ISCEV recommended ERG parameters with respect to a- and b-wave amplitude and implicit time, and oscillatory potentials maximal amplitude. BCVA improved in both patients. Neither patient developed clinical evidence of intraocular inflammation. Subretinal and/or intraretinal fluid had improved in both patients at 1 month after the metoprolol injection. Conclusion These preliminary findings suggest that intravitreal metoprolol may be a safe alternative therapy for patients with cCSC.
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Anderson WJ, Smith BT. Bilateral bullous central serous chorioretinopathy treated with PDT and eplerenone. Am J Ophthalmol Case Rep 2022; 28:101739. [DOI: 10.1016/j.ajoc.2022.101739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
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Zheng C, Wang K, Zhang M, Tao Q, Li X, Zhang X. Outcomes of retinal pigment epithelial detachment in Vogt-Koyanagi-Harada disease: a longitudinal analysis. BMC Ophthalmol 2022; 22:446. [PMID: 36401187 PMCID: PMC9675062 DOI: 10.1186/s12886-022-02675-6] [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: 07/08/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background The aim of this study was to report the clinical profile and outcomes of retinal pigment epithelial detachment (PED) in Vogt-Koyanagi-Harada (VKH) disease, and to evaluate the correlation between PED and the subsequent development of central serous chorioretinopathy (CSC) throughout the whole corticosteroid treatment course. Methods The retrospective study enrolled a total of 470 eyes with VKH, and 12 eyes with VKH and PED were recruited. Patients were divided into two groups according to the CSC onset or not throughout the whole course (the CSC group and non-CSC group). Best-corrected visual acuity (BCVA) improvement, and PED angle (PEDA, the angle between the two lines of the vertex of the lifted retinal pigment epithelium to the two edge points of the Bruch membrane) were compared between the two groups. Results CSC developed at the site of the PED in 5 of the 12 eyes with PED, while in the remaining 7 eyes PED gradually resolved following therapy. The prevalence of PED and CSC in VKH was 2.55% (12/470) and 1.06% (5/470), respectively. BCVA improvement in the non-CSC group was greater than that in the CSC group, but without a statistical difference (P = 0.25). PEDA was significantly smaller in the CSC group than in the non-CSC group (P = 0.03). Conclusion PEDA is an ideal parameter to reflect hydrostatic pressure and stretches for RPE. As PED predisposes to the development of CSC in selected VKH eyes, PEDA may be a valuable predictive factor for the development of classic CSC in VKH cases.
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Affiliation(s)
- Chuanzhen Zheng
- grid.412729.b0000 0004 1798 646XTianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fu Kang Road, Tianjin, 300384 China
| | - Kaixuan Wang
- grid.412729.b0000 0004 1798 646XTianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fu Kang Road, Tianjin, 300384 China
| | - Mi Zhang
- grid.412729.b0000 0004 1798 646XTianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fu Kang Road, Tianjin, 300384 China
| | - Qingqin Tao
- grid.412729.b0000 0004 1798 646XTianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fu Kang Road, Tianjin, 300384 China
| | - Xiaorong Li
- grid.412729.b0000 0004 1798 646XTianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fu Kang Road, Tianjin, 300384 China
| | - Xiaomin Zhang
- grid.412729.b0000 0004 1798 646XTianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fu Kang Road, Tianjin, 300384 China
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DeepPDT-Net: predicting the outcome of photodynamic therapy for chronic central serous chorioretinopathy using two-stage multimodal transfer learning. Sci Rep 2022; 12:18689. [PMID: 36333442 PMCID: PMC9636239 DOI: 10.1038/s41598-022-22984-6] [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: 05/26/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Central serous chorioretinopathy (CSC), characterized by serous detachment of the macular retina, can cause permanent vision loss in the chronic course. Chronic CSC is generally treated with photodynamic therapy (PDT), which is costly and quite invasive, and the results are unpredictable. In a retrospective case-control study design, we developed a two-stage deep learning model to predict 1-year outcome of PDT using initial multimodal clinical data. The training dataset included 166 eyes with chronic CSC and an additional learning dataset containing 745 healthy control eyes. A pre-trained ResNet50-based convolutional neural network was first trained with normal fundus photographs (FPs) to detect CSC and then adapted to predict CSC treatability through transfer learning. The domain-specific ResNet50 successfully predicted treatable and refractory CSC (accuracy, 83.9%). Then other multimodal clinical data were integrated with the FP deep features using XGBoost.The final combined model (DeepPDT-Net) outperformed the domain-specific ResNet50 (accuracy, 88.0%). The FP deep features had the greatest impact on DeepPDT-Net performance, followed by central foveal thickness and age. In conclusion, DeepPDT-Net could solve the PDT outcome prediction task challenging even to retinal specialists. This two-stage strategy, adopting transfer learning and concatenating multimodal data, can overcome the clinical prediction obstacles arising from insufficient datasets.
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Quantitative analysis of choroidal vasculature in central serous chorioretinopathy using ultra-widefield swept-source optical coherence tomography angiography. Sci Rep 2022; 12:18427. [PMID: 36319689 PMCID: PMC9626581 DOI: 10.1038/s41598-022-23389-1] [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: 06/03/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to quantitatively compare the choroid blood flow and choroid thickness at the periphery among eyes with central serous chorioretinopathy (CSC), fellow eyes and healthy eyes using ultra-widefield swept-source optical coherence tomography angiography (UWF SS-OCTA). Retrospective analysis of 49 patients with CSC (98 eyes, including unaffected fellow eyes) and 49 age and sex matched controls were included. We obtained 3-dimensional data of vertical 20 mm × horizontal 24 mm × scan depth 6 mm, comprising 9 subfields (superotemporal, upper, superonasal, temporal, central, nasal, inferotemporal, lower, inferonasal regions). CSC eyes presented with greater density of large-vessel choroidal layer in all the 9 subfields compared with controls. Compared with normal eyes, CSC eyes had greater choroidal thickness (superotemporal, upper, superonasal, temporal, central, nasal, inferotemporal, and inferonasal subfields) and choroidal volume (superotemporal, upper, superonasal, temporal, central, and nasal subfields). Compared with control eyes, the choriocapillaris density in the superotemporal, inferotemporal and inferonasal subfields was greater in patients with CSC. Our study may provide further evidence for the congestion of vortex vein in the pathogenesis of CSC. UWF SS-OCTA can be used to evaluate the abnormalities of the choroidal structures even at the periphery in eyes with CSC.
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Iovino C, Di Iorio V, Paolercio L, Giordano C, Testa F, Simonelli F. Navigated 577-nm subthreshold micropulse retinal laser treatment for peripapillary pachychoroid syndrome. Am J Ophthalmol Case Rep 2022; 28:101757. [DOI: 10.1016/j.ajoc.2022.101757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/20/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022] Open
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Sirks MJ, van Dijk EHC, Rosenberg N, Hollak CEM, Aslanis S, Cheung CMG, Chowers I, Eandi CM, Freund KB, Holz FG, Kaiser PK, Lotery AJ, Ohno-Matsui K, Querques G, Subhi Y, Tadayoni R, Wykoff CC, Zur D, Diederen RMH, Boon CJF, Schlingemann RO. Clinical impact of the worldwide shortage of verteporfin (Visudyne®) on ophthalmic care. Acta Ophthalmol 2022; 100:e1522-e1532. [PMID: 35388619 PMCID: PMC9790583 DOI: 10.1111/aos.15148] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/23/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Since July 2021, a worldwide shortage of verteporfin (Visudyne®) occurred: an essential medicine required for photodynamic therapy (PDT). PDT with verteporfin has a broad range of indications in ophthalmology, including chronic central serous chorioretinopathy, polypoidal choroidal vasculopathy and choroidal haemangioma. For these disorders, PDT is either the first-choice treatment or regarded as a major treatment option. MATERIALS AND METHODS A questionnaire was sent to key opinion leaders in the field of medical retina throughout the world, to assess the role of PDT in their country and the effects of the shortage of verteporfin. In addition, information on the application of alternative treatments during shortage of verteporfin was obtained, to further assess the impact of the shortage. RESULTS Our questionnaire indicated that the shortage of verteporfin had a major impact on ophthalmic care worldwide and was regarded to be a serious problem by most of our respondents. However, even though there is ample evidence to support the use of PDT in several chorioretinal diseases, we found notable differences in its use in normal patient care throughout the world. Various alternative management strategies were noted during the verteporfin shortage, including lowering the dose of verteporfin per patient, the use of alternative treatment strategies and the use of a centralized system for allocating the remaining ampoules of verteporfin in some countries. CONCLUSION The shortage of verteporfin has had a large effect on the care of ophthalmic patients across the world and may have resulted in significant and irreversible vision loss. Mitigation strategies should be developed in consultation with all stakeholders to avoid future medication shortages of verteporfin and other unique ophthalmic medications. These strategies may include mandatory stock keeping, compulsory licensing to an alternative manufacturer or incentivizing the development of competition, for example through novel public-private partnerships.
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Affiliation(s)
- Marc J Sirks
- Department of Ophthalmology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Noa Rosenberg
- Medicine for Society, Platform at Amsterdam University Medical Centres - University of Amsterdam, Amsterdam, The Netherlands.,Department of Endocrinology and Metabolism, Amsterdam UMC - University of Amsterdam, Amsterdam, The Netherlands
| | - Carla E M Hollak
- Medicine for Society, Platform at Amsterdam University Medical Centres - University of Amsterdam, Amsterdam, The Netherlands.,Department of Endocrinology and Metabolism, Amsterdam UMC - University of Amsterdam, Amsterdam, The Netherlands.,Sphinx, Amsterdam Lysosome Center, Amsterdam, The Netherlands
| | | | - Chui Ming Gemmy Cheung
- Singapore National Eye Center, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore
| | - Itay Chowers
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Chiara M Eandi
- Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile Des Aveugles, Lausanne, Switzerland.,Department of Surgical Sciences, University of Turin, Turin, Italy
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, USA.,Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Andrew J Lotery
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Giuseppe Querques
- IRCCS San Raffaele Scientific Institute, University Vita Salute San Raffaele, Milan, Italy
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ramin Tadayoni
- University of Paris, Paris, France.,Hôpital Lariboisière, AP-HP, Paris, France.,Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Charles C Wykoff
- Retina Consultants of Texas, Retina Consultants of America, Houston, Texas, USA.,Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Dinah Zur
- Ophthalmology Division, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.,Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.,Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile Des Aveugles, Lausanne, Switzerland
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Muacevic A, Adler JR, Pappaterra-Rodriguez M, Ayala Rodríguez SC, Puebla G, Nieves I, Oliver AL. Aflibercept as a Treatment for Secondary Central Serous Chorioretinopathy in a Patient With Myasthenia Gravis. Cureus 2022; 14:e31287. [PMID: 36514621 PMCID: PMC9733583 DOI: 10.7759/cureus.31287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
We report on a case of central serous chorioretinopathy (CSCR) secondary to chronic steroid use that showed sustained improvement when treated with an aflibercept intravitreal injection. A 44-year-old woman presented with decreased visual acuity of the left eye (OS). The patient had a recent history of myasthenia gravis and was being treated with systemic corticosteroids and immunosuppressants. At presentation, her visual acuity was 20/80 OS; an examination (using fluorescein angiography) of the left fundus revealed a serous retinal detachment of the posterior pole that extended to the mid-periphery and multiple areas of leakage, which findings were consistent with CSCR. The patient also had a history of unresolved strabismic amblyopia in her right eye. The patient's CSCR was managed with one injection of intravitreal aflibercept (2 mg/0.05 mL). One month following treatment, her visual acuity improved to 20/20 OS, and the serous retinal detachment had resolved. Ten months following treatment, an examination revealed a sustained improvement, with a visual acuity of 20/20 OS. Concomitantly, the patient's amblyopic eye revealed an improved visual acuity of 20/20. Our case suggests that some cases of secondary CSCR may respond to treatment with intravitreal aflibercept. This case also suggests that the CSCR imposed a unique form of occlusion therapy that helped improve the amblyopia of the contralateral eye in this adult patient.
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Han R, Xu G, Ding X. COVID-19 Vaccine-Related Vogt-Koyanagi-Harada Disease Complicated by Central Serous Chorioretinopathy during Treatment Course: Case Report and Literature Review. Vaccines (Basel) 2022; 10:1792. [PMID: 36366301 PMCID: PMC9698606 DOI: 10.3390/vaccines10111792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 09/22/2023] Open
Abstract
With the promotion of mass COVID-19 vaccination in the elimination of the SARS-CoV-2 pandemic, new side effects, including ocular complications, are emerging. In this study, we report on a 62-year-old Chinese man who developed Vogt-Koyanagi-Harada (VKH) disease six days after his third dose of an inactivated COVID-19 vaccine, with a preceding severe headache and tinnitus. His medical history included tuberculosis 20 years prior and hypertension. Systemic prednisone was administered, resulting in completely relieved inflammation and improved visual acuity. Another three and a half months later, the visual acuity of his right eye slightly decreased due to complicated central serous chorioretinopathy (CSC) disease. By gradually replacing prednisone with cyclosporine within 2 months, the subretinal fluid was completely absorbed at the last visit. Steroid-related CSC during the treatment course of VKH disease after COVID-19 vaccination has never been reported before. By reviewing relative literature, we discuss the mechanism of CSC onset in our case and the potential therapeutic strategies. Complicated CSC may develop in the eyes with vaccine-related VKH after steroid treatment. Ophthalmologists should be aware of this condition, carefully distinguish complicated CSC with inflammation relapse, and adjust the medication in a timely manner.
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Affiliation(s)
- Ruyi Han
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
| | - Xinyi Ding
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
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125
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Meng Y, Xu Y, Li L, Su Y, Zhang L, Chen C, Yi Z. Wide-field OCT-angiography assessment of choroidal thickness and choriocapillaris in eyes with central serous chorioretinopathy. Front Physiol 2022; 13:1008038. [PMID: 36338482 PMCID: PMC9634072 DOI: 10.3389/fphys.2022.1008038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/06/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose: To assess wide-field changes in choroidal thickness and choriocapillaris in eyes with central serous chorioretinopathy (CSC) compared with the fellow eyes and eyes from healthy individuals using wide-field swept-source (SS) OCT-Angiography (OCTA). Methods: A cross-sectional study in which 68 eyes from 34 individual patients affected by unilateral CSC and 32 eyes of 32 age- and sex-matched healthy subjects were evaluated. All subjects underwent wide-field SS-OCTA examination to quantify choroidal thickness and vascular density of the choriocapillaris. To assess the wide-field changes, we developed five 4-by-4 mm square regions located in the posterior pole and in the four quadrants of the peripheral retina (superotemporal, inferotemporal, superonasal, and inferonasal subfields, respectively). Results: The choroidal thickness of eyes with CSC was greater than that of the fellow eyes in the central and inferonasal subfields (p < 0.001 for the central subfield and p = 0.006 for the inferonasal subfield, respectively). Compared with the choroidal thickness of healthy eyes, that of patients with CSC were significantly greater in all the subfields (p < 0.05 for the fellow eyes and p < 0.05 for eyes with CSC, respectively). Compared with that of healthy eyes, the vascular density of choriocapillaris in eyes of patients with CSC were significantly greater in the central and superotemporal subfields (p < 0.05 for the fellow eyes and p < 0.05 for eyes with CSC, respectively). In the central region, the vascular density of choriocapillaris of the fellow eyes was greater than eyes with CSC (p = 0.023). Conclusion: CSC appears to be a bilateral disease with asymmetric manifestations. Local factors of the diseased eyes may play an important role in the development of CSC, during which dynamic and regional changes in the choriocapillaris may have happened. Wide-field swept-source OCTA provided a useful tool to study the pathogenesis of CSC.
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Affiliation(s)
- Yang Meng
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yishuang Xu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lu Li
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yu Su
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lu Zhang
- Department of Ophthalmology, The Central Hospital of Wuhan, Wuhan, China
| | - Changzheng Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Changzheng Chen, ; Zuohuizi Yi,
| | - Zuohuizi Yi
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Changzheng Chen, ; Zuohuizi Yi,
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126
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Clemente L, Cennamo G, Montorio D, Fossataro F, Passaro ML, Costagliola C. OCT-A in chronic central serous chorioretinopathy treated with oral eplerenone and half-fluence photodynamic therapy: A comparative study. Eur J Ophthalmol 2022; 33:11206721221131129. [PMID: 36214140 DOI: 10.1177/11206721221131129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
PURPOSE To evaluate retinal and choriocapillary vessel density (VD) changes in patients with chronic central serous chorioretinopathy (CSC) treated with half-fluence verteporfin photodynamic therapy (vPDT) or eplerenone, using optical coherence tomography angiography (OCTA). METHODS Patients affected by CSC and treated with vPDT and eplerenone were retrospectively studied. At baseline and 3 months after each treatment, all patients underwent a complete ophthalmological examination, including an evaluation of best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, fundus examination, fluorescein angiography (FA), indocyanine green angiography (ICGA), spectral-domain optical coherence tomography (SD-OCT) and OCTA. RESULTS Forty-eight eyes of patients with CSC were analysed. Twenty-four eyes were placed in the vPDT group, and 24 eyes formed the eplerenone group. In both groups, OCTA showed a significant improvement in the VD of deep capillary plexus (DCP) and choriocapillaris (CC) after treatments with respect to baseline (p < 0.001), whereas the VD of superficial capillary plexus (SCP) did not show significant differences (p > 0.05). The PDT group demonstrated a statistically significant increase in the VD of DCP and CC with respect to the eplerenone group (DCP p = 0.012; CC p = 0.004). A statistically significant reduction with respect to baseline in subfoveal choroidal thickness (SFCT) (p = 0.001 for vPDT group; p = 0.001 for eplerenone group) and in central foveal thickness (CFT) (p = 0.001 for vPDT group; p = 0.001 for eplerenone group) was also found. The SFCT was significantly thinnest in the PDT group with respect to the eplerenone group (p = 0.021). CONCLUSION OCTA allowed us to study retinal and choriocapillary vascular changes in patients with CSC treated with vPDT and eplerenone.
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Affiliation(s)
- Lidia Clemente
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
| | - Gilda Cennamo
- Eye Clinic, Public Health Department, 9307University of Naples "Federico II", Naples, Italy
| | - Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
| | - Federica Fossataro
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
| | - Maria Laura Passaro
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
| | - Ciro Costagliola
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
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127
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Crossover to Half-Dose Photodynamic Therapy or Eplerenone in Chronic Central Serous Chorioretinopathy Patients. Ophthalmol Retina 2022; 6:930-938. [PMID: 35470085 DOI: 10.1016/j.oret.2022.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the efficacy and safety of crossover treatment to half-dose photodynamic therapy (PDT) and eplerenone treatment after the failure of primary treatment in patients with chronic central serous chorioretinopathy (cCSC). DESIGN Multicenter crossover clinical trial. SUBJECTS At 3 months after the baseline visit of the SPECTRA (Half-Dose Photodynamic Therapy Versus Eplerenone: Treatment Trial for Chronic Central Serous Chorioretinopathy) randomized controlled trial, either half-dose PDT or eplerenone treatment was evaluated for each patient, and patients who still demonstrated subretinal fluid (SRF) were included in the current study, the SPECS (Central Serous Chorioretinopathy Treated with Half-Dose PDT or Eplerenone Crossover Study) trial. METHODS At the baseline visits for the current SPECS trial, crossover treatment was performed for patients who still demonstrated SRF. These patients received either half-dose PDT or oral eplerenone for 12 weeks. Both anatomic and functional parameters were evaluated 3 months after crossover treatment. MAIN OUTCOME MEASURES Complete resolution of SRF on OCT. RESULTS Forty-nine patients were included in the SPECS trial (38 received primary eplerenone treatment; 11 received half-dose PDT). At 3 months after crossover treatment, 32 of 37 (86.5%) in the crossover to half-dose PDT group and 2 of 9 (22.2%) in the crossover to eplerenone group had complete SRF resolution (P = 0.030). The mean foveal sensitivity increased significantly more in the crossover to half-dose PDT group (mean, +3.08 dB) compared with the crossover to eplerenone group (mean, -0.27 dB; P = 0.009). CONCLUSIONS Patients with cCSC with the persistence of SRF after primary eplerenone treatment can benefit from half-dose PDT, which can induce a relatively fast and complete SRF resolution, along with an improvement in foveal sensitivity.
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128
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Yu J, Ye X, Li L, Jiang C, Chang Q, Xu G. Threshold thickness of foveal outer nuclear layer associated with outcomes of photodynamic therapy in central serous chorioretinopathy. Eye (Lond) 2022; 36:1884-1889. [PMID: 34480115 PMCID: PMC9500008 DOI: 10.1038/s41433-021-01762-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/28/2021] [Accepted: 08/16/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To investigate the threshold thickness of the foveal outer nuclear layer (ONL) associated with favourable visual outcome after half-dose photodynamic therapy (PDT) in patients with central serous chorioretinopathy (CSC). METHODS The CSC patients were divided into two groups according to whether their best-corrected visual acuity (BCVA) at 1 year after half-dose PDT was 20/20 or worse than 20/20. Three multivariable logistic regression models were respectively created to determine the prognostic value of the pre-PDT foveal ONL thickness, the pre- and the post-PDT foveal ONL thickness ratio, which was defined as the foveal ONL thickness in the CSC eye to that in the normal contralateral eye, for predicting the outcome of half-dose PDT. The areas under the receiver operating characteristic curves (AUCs) were compared and the best cut-off values were determined, respectively. RESULTS Totally, 134 patients were included. The pre-PDT foveal ONL thickness, the pre-PDT and the post-PDT foveal ONL thickness ratios were all independent predictors of the outcome after half-dose PDT in their respective model (all P < 0.05). The AUC of the post-PDT foveal ONL thickness ratio was significantly higher than the AUCs of the other two parameters (0.940 vs 0.840 and 0.882, DeLong test: both P < 0.05), with the cut-off value of 0.81. CONCLUSIONS The threshold of the foveal ONL thickness ratio is 0.81. Active CSC eyes with a foveal ONL thickness ratio of 0.81 or more could probably retain BCVA of 20/20 after half-dose PDT. They were considered reasonable to wait for spontaneous resolution of sub-retinal fluid.
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Affiliation(s)
- Jia Yu
- Department of Ophthalmology, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaofeng Ye
- Department of Ophthalmology, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Lei Li
- Department of Ophthalmology, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Chunhui Jiang
- Department of Ophthalmology, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Qing Chang
- Department of Ophthalmology, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Gezhi Xu
- Department of Ophthalmology, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
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129
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Zeng Q, Yao Y, Li S, Yang Z, Qu J, Zhao M. Comparison of swept-source OCTA and indocyanine green angiography in central serous chorioretinopathy. BMC Ophthalmol 2022; 22:380. [PMID: 36138392 PMCID: PMC9502960 DOI: 10.1186/s12886-022-02607-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background To compare swept-source optical coherence tomography angiography (SS-OCTA) and indocyanine green angiography (ICGA) in patients with central serous chorioretinopathy (CSC). Methods SS-OCTA and ICGA images of 39 eyes with symptomatic CSC were collected and aligned. Spatial overlap of the annotations of the coarse granulated high reflective area on choriocapillary OCTA and the hyperfluorescence area on mid-phase ICGA was calculated according to the Jaccard index (JI). SS-OCTA findings of fellow eyes and changes in SS-OCTA abnormalities during the follow-up were also analyzed. Results Three main types of abnormalities in choriocapillaris SS-OCTA images were found: type A, coarse granulated high reflective area (39 eyes [100%]); type B, roundish dark halo around Type A (32 eyes [82.1%]); and type C, coarse granulated low reflective area (39 eyes [100%]). The mean JI of type A on SS-OCTA and the hyperfluorescence area on ICGA were 0.55 ± 0.15 for grader 1 and 0.49 ± 0.15 for grader 2. The mean area of type A abnormalities on SS-OCTA and hyperfluorescence on ICGA was 3.976 (IQR, 2.139–8.168) and 3.043 (IQR, 1.408–4.909) mm2 (P = 0.199). The areas of type A, B and C abnormalities on SS-OCTA after laser treatment or observation were 3.36mm2 (IQR, 2.399–9.312), 2.9mm2 (IQR, 2.15–3.7), and 0.19mm2 (IQR, 0.08–0.23), respectively, which was smaller than those in the baseline (7.311mm2 (IQR 3.788–11.209), P < 0.001; 4.3mm2 (IQR, 2.8–9.8), P = 0.002;0.33mm2 (IQR, 0.23–0.38), P < 0.001). The change in the type A, B or C area was not significantly different between the two groups (P = 0.679, 0.732, and 0.892). Conclusion The coarse granulated high reflective area in SS-OCTA corresponded well with the hyperpermeability area in ICGA. SS-OCTA promotes noninvasive visualization and follow-up quantifications of the choroidal vasculature in CSC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02607-4.
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Affiliation(s)
- Qiaozhu Zeng
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yuou Yao
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Siying Li
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Zhi Yang
- TowardPi (Beijing) Medical Technology, Beijing, China
| | - Jinfeng Qu
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Mingwei Zhao
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China. .,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China.
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130
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Association of Fundus Autofluorescence Abnormalities and Pachydrusen in Central Serous Chorioretinopathy and Polypoidal Choroidal Vasculopathy. J Clin Med 2022; 11:jcm11185340. [PMID: 36142987 PMCID: PMC9500611 DOI: 10.3390/jcm11185340] [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: 08/15/2022] [Revised: 08/24/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
A specific form of drusen, known as pachydrusen, has been demonstrated to be associated with pachychoroid eye diseases, such as central serous chorioretinopathy (CSC) and polypoidal choroidal vasculopathy (PCV). These pachydrusen have been found in up to 50% of eyes with CSC and PCV and may affect the disease progression and treatment response. This study aims to investigate the association between pachydrusen and changes in fundus autofluorescence (FAF) in eyes with CSC and PCV. A total of 65 CSC patients and 32 PCV patients were evaluated. Pachydrusen were detected using both color fundus photography and spectral-domain optical coherence tomography. The relationships between pachydrusen and FAF changes were then investigated. The prevalence of pachydrusen in CSC and PCV eyes was 16.7% and 61.8%, respectively. The mean age of patients with pachydrusen was significantly older than those without pachydrusen (CSC: 56.3 vs. 45.0 years, p < 0.001; PCV: 68.8 vs. 59.5 years, p < 0.001). No significant difference was found in the mean subfoveal choroidal thickness between eyes with or without pachydrusen. Eyes with pachydrusen were significantly associated with more extensive FAF changes in both CSC and PCV (p < 0.001 and p = 0.037, respectively). The study demonstrated that pachydrusen are more prevalent in PCV than CSC. Increasing age and more extensive abnormalities in FAF are associated with the presence of pachydrusen, suggesting that dysfunction of retinal pigment epithelial cells is associated with pachydrusen.
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131
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Zhao C, Huang Y, Chen L, Ye S, Liu XQ. The Association Between Circulating Sex Hormones and Central Serous Chorioretinopathy: A Case-Control Study. Ther Clin Risk Manag 2022; 18:855-865. [PMID: 36046103 PMCID: PMC9423108 DOI: 10.2147/tcrm.s370133] [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: 04/20/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Central serous chorioretinopathy (CSC) is preferential cocurated in males, however the associations between sex hormones and CSC incidence or progression remains unclear. The sex hormone concentration assessments in CSC cases and healthy controls will update the knowledge in CSC management. Methods This case-control study included 59 CSC cases and 30 healthy controls, from January 2019 to December 2020. The CSC cases would be defined as spontaneous resolved if the subretinal fluid were absorbed within three months. The concentrations of total testosterone (TT), free testosterone (FT), estradiol (E2), sex hormone-binding globulin (SHBG), progesterone, leuteinizing hormone (LH) and dehydroepiandrosterone sulfate (DHEA-S) were detected in all the participants. The relationships between sex hormone concentrations and CSC-related characteristics were analyzed with Pearson correlation analyses. Results Significantly increased TT, FT, FT/E2 ratio, SHBG concentrations as well as decreased DHEA-S level were detected in non-resolved CSC group compared with the control group. Comparing with the resolved ones, it was found that TT, FT and SHBG concentrations were increased in the non-resolved CSC. A significant positive correlation between TT concentrations and CMT (R2=0.168, P=0.031) as well as SRF height (R2=0.146, P=0.045) were detected in the non-solved CSC group. Conclusion Different concentrations of TT, FT, FT/E2 ratio, DHEA-S and SHBG were detected in resolved and non-resolved CSC cases. Sex hormones were related to CSC symptom durations and related parameters.
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Affiliation(s)
- Chun Zhao
- Department of Ophthalmology, Tenth People's Hospital Affiliated to Shanghai Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Yan Huang
- Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, People's Republic of China
| | - Lei Chen
- Department of Ophthalmology, Tenth People's Hospital Affiliated to Shanghai Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Sheng Ye
- Department of Ophthalmology, Tenth People's Hospital Affiliated to Shanghai Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Xiao-Qiang Liu
- Department of Ophthalmology, Tenth People's Hospital Affiliated to Shanghai Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
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Feenstra HMA, Hensman J, Gkika T, Lipkova V, Hoyng CB, Diederen RMH, Schlingemann RO, Downes SM, van Dijk EHC, Boon CJF. Spontaneous Resolution of Chronic Central Serous Chorioretinopathy: "Fuji Sign". Ophthalmol Retina 2022; 6:861-863. [PMID: 35533974 DOI: 10.1016/j.oret.2022.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jonathan Hensman
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Theodora Gkika
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Veronika Lipkova
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
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133
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Arora S, Chhablani J, Hariprasad SM. Acute Versus Chronic Central Serous Chorioretinopathy: Classification Strategies and Management. Ophthalmic Surg Lasers Imaging Retina 2022; 53:418-420. [PMID: 35951715 DOI: 10.3928/23258160-20220725-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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134
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Yu S, Cui K, Wu P, Wu B, Lu X, Huang R, Tang X, Lin J, Yang B, Zhao J, He Q, Liang X, Xu Y. Melatonin prevents experimental central serous chorioretinopathy in rats. J Pineal Res 2022; 73:e12802. [PMID: 35436360 DOI: 10.1111/jpi.12802] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
Central serous chorioretinopathy (CSC) is a vision-threatening disease with no validated treatment and unclear pathogenesis. It is characterized by dilation and leakage of choroidal vasculature, resulting in the accumulation of subretinal fluid, and serous detachment of the neurosensory retina. Numerous studies have demonstrated that melatonin had multiple protective effects against endothelial dysfunction, vascular inflammation, and blood-retinal barrier (BRB) breakdown. However, the effect of melatonin on CSC, and its exact pathogenesis, is not well understood thus far. In this study, an experimental model was established by intravitreal injection of aldosterone in rats, which mimicked the features of CSC. Our results found that melatonin administration in advance significantly inhibited aldosterone-induced choroidal thickening and vasodilation by reducing the expression of calcium-activated potassium channel KCa2.3, and attenuated tortuosity of choroid vessels. Moreover, melatonin protected the BRB integrity and prevented the decrease in tight junction protein (ZO-1, occludin, and claudin-1) levels in the rat model induced by aldosterone. Additionally, the data also showed that intraperitoneal injection of melatonin in advance inhibited aldosterone-induced macrophage/microglia infiltration, and remarkably diminished the levels of inflammatory cytokines (interleukin-6 [IL-6], IL-1β, and cyclooxygenase-2), chemokines (chemokine C-C motif ligand 3, and C-X-C motif ligand 1), and matrix metalloproteinases (MMP-2 and MMP-9). Luzindole, as the nonselective MT1 and MT2 antagonist, and 4-phenyl-2-propionamidotetraline, as the selective MT2 antagonist, neutralized the melatonin-induced inhibition of choroidal thickening and choroidal vasodilation, indicating that melatonin might exert the effects via binding to its receptors. Furthermore, the IL-17A/nuclear factor-κB signaling pathway was activated by intravitreal administration of aldosterone, while it was suppressed in melatonin-treated in advance rat eyes. This study indicates that melatonin could serve as a promising safe therapeutic strategy for CSC patients.
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Affiliation(s)
- Shanshan Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Kaixuan Cui
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Peiqi Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Benjuan Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xi Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Rong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xiaoyu Tang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Jianqiang Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Boyu Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Jinfeng Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Qingjing He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xiaoling Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yue Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
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Superficial Retinal Microvasculature and Choriocapillaris Alterations after Photodynamic Therapy in Chronic Central Serous Chorioretinopathy. J Ophthalmol 2022; 2022:4024603. [PMID: 35957744 PMCID: PMC9357694 DOI: 10.1155/2022/4024603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To compare superficial retinal vascular, choriocapillaris (CC), and choroidal thickness changes in chronic central serous chorioretinopathy (CSCR) patients after half-dose photodynamic therapy (PDT). Method In this prospective interventional case series study, fifteen eyes of 14 patients with chronic CSCR undergoing half-dose PDT treatment were enrolled. All patients underwent enhanced depth imaging optical coherence tomography angiography (EDI-OCT) and optical coherence tomography angiography (OCTA) at baseline and 3 months after treatment. Best-corrected visual acuity (BCVA), superficial retinal vascular density, CC vessel density, foveal avascular zone (FAZ), central macular thickness (CMT), and choroidal thickness were compared. Results Mean BCVA before and after PDT was 0.34 ± 0.26 and 0.19 ± 0.25 logMAR, respectively (p=0.011). Mean FAZ before treatment was 410.21 ± 117.00 μm2, which increased to 433.50 ± 116.76 μm2 (P=0.253). Mean vessel density at superficial capillary plexus (SCP) was 38.93 ± 11.12 at baseline, which increased to 39.04 ± 11.43 (P=0.886). Mean CC vessel density was 53.21 ± 4.14 at baseline, which significantly decreased to 51.85 ± 4.21 (P=<0.001). BCVA has no significant correlation with FAZ (P=0.282) and vessel density (P=0.0.241) at SCP. CMT significantly decreased from 380.87 ± 41.66 μ at baseline to 268.20 ± 28.07 μ at 3 months (P=0.132). We did not find any correlation between CMT and FAZ (P=0.040) and vessel density (P=0.686) at SCP. Mean subfoveal choroidal thickness reduced from 411 ± 171 μm before treatment to 372 ± 117 μm (P=0.106). Conclusion PDT treatment can affect retinal and choroidal structural parameters, but we could not find any significant influence on retinal vascular parameters, including FAZ area and vessel densityonly mean CC vessel density and subfoveal choroidal thickness decreased.
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136
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Arora S, Stea BD, Hamilton RJ, Chhablani J. Brachytherapy for Central Serous Chorioretinopathy. Ophthalmol Ther 2022; 11:1611-1616. [PMID: 35793036 PMCID: PMC9437158 DOI: 10.1007/s40123-022-00543-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 12/24/2022] Open
Abstract
Brachytherapy is widely used for the treatment of choroidal melanoma and has recently been explored for the treatment of wet age-related macular degeneration. We propose the use of low dose radiation via episcleral brachytherapy in refractory cases of central serous chorioretinopathy (CSCR). The pathogenesis of CSCR involves dilatation and hyperpermeability of large choroidal vessels. Low dose radiation can induce intimal proliferation in large choroidal vessels and decrease their hyperpermeability. Concerns about the use of brachytherapy in CSCR include damage to the choriocapillaris or the retinal vessels. This can be addressed with the use of a specialized device through which a very precise and appropriate dose can be delivered. The dose of the radiation delivered decreases exponentially at a depth of approximately 0.5–1.5 mm from the devise–sclera interface. Considering an increased choroidal thickness in cases of CSCR, delivery of a safe dose can be assured.
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Statement of the Professional Association of Ophthalmologists in Germany (BVA), the German Society of Ophthalmology (DOG) and the German Retina Society (RG) on central serous chorioretinopathy : Status 18 October 2021. DIE OPHTHALMOLOGIE 2022; 119:108-122. [PMID: 35384482 DOI: 10.1007/s00347-022-01614-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 01/25/2023]
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138
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Subthreshold Micropulse Treatment Laser versus Half-Dose Photo Dynamic Therapy for the Chronic Central Serous Chorioretinopathy with Parafoveal or Subfoveal Leakage STML versus PDT for Treatment of Chronic CSC. J Ophthalmol 2022; 2022:3627903. [PMID: 35814483 PMCID: PMC9262565 DOI: 10.1155/2022/3627903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/16/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose. The study aimed to compare the efficacy and safety outcomes of a subthreshold micropulse treatment laser (SMTL) versus half-dose photodynamic therapy (PDT) for treatment of chronic central serous chorioretinopathy (cCSC) with parafoveal or subfoveal leakage to persistent subretinal fluid. Methods. One hundred and forty-eight patients (148 eyes) with persistent cCSC were enrolled in this retrospective study and treated with SMTL or half-dose PDT. All patients were diagnosed according to clinical characteristics and findings on multimodal imaging. The medical records including patients with a minimum follow-up period of 3 months were reviewed. The patients were divided into two groups according to the application of the SMTL or PDT. The group of the SMTL or PDT was also divided into two subgroups according to parafoveal or subfoveal leakage. The primary outcomes included best-corrected visual acuity (BCVA) and central retinal thickness (CRT) before and 1, 2, and 3 months after treatment. The repeat treatment and resolution of subretinal fluid were also collected. Results. Seventy-nine patients (79 eyes) treated with half-dose PDT and 69 Patients (69 eyes) treated with the STML were included. The mean age was 44.20 ± 7.42 years and 80% were male. No significant difference in age, gender, baseline logMAR BCVA or CRT between the half-dose PDT group and the SMTL group (
; 0.051) can be defined. The BCVA of the SMTL group improved at 1, 2, and 3 months after treatment, while that of the half-dose PDT group improved like the SMTL group. There were no significant differences between the SMTL and the PDT group at 1, 2, and 3 months (
; 0.139; 0.896). The CRT for the SMTL group decreased at 1, 2, and 3 months after treatment, while that of the half-dose PDT group changed like the SMTL group. However, there were significant differences between the SMTL group and the PDT group at 1and 3 months (
; 0.009). 13/69 (18.84%) and 9/79 (11.39%) patients underwent treatment at least twice in the SMTL and half-dose PDT group, respectively, and achieved resolution of SRF after treatment. The results of subgroups analysis showed no significant differences between the logMAR BCVA of the SMTL and PDT group which were divided into parafoveal and subfoveal leakage groups after treatment, but significant difference in CRT between subgroups can be found after treatment at 1and 3 months (
; 0.04). Conclusions. The SMTL can be an effective candidate for the treatment of persistent cCSC where leakage occurred at parafoveal or subfoveal and improvement of logMAR BCVA, but half-dose PDT has been more effective for resolution of SRF.
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Zhang X, Zhuang X, Dong J, Fu B, Xu L. Factors for recurrence in acute central serous chorioretinopathy patients underwent one-third dose verteporfin photodynamic therapy. Photodiagnosis Photodyn Ther 2022; 39:102984. [PMID: 35753673 DOI: 10.1016/j.pdpdt.2022.102984] [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: 05/18/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the factors of recurrence in acute central serous chorioretinopathy (aCSC) patients underwent one-third dose verteporfin photodynamic therapy (PDT). MATERIALS AND METHODS A retrospective study was performed in aCSC patients treated with one-third dose PDT and followed up for 36 months. Demographic information and clinical features were compared. A logistic regression model was used to evaluate the associated factor of aCSC recurrence. RESULTS There were 162 patients with aCSC included in current study. 36-month after one-third dose PDT, good recovery was identified in 131 patients (80.86%), whereas 31 cases (19.14%) developed recurrence. Significant between-group differences were observed in baseline age, the right, left and both eyes, best-corrected visual acuity (BCVA), presenting with pigment epithelium detachment (PED), retinal pigment epithelium (RPE) damage and subfoveal choroidal thickness (SCT) level (P = 0.005, P < 0.001, P < 0.001, P < 0.001, P = 0.006, and P < 0.001, respectively). The recurrence of aCSC was associated with presenting with PED (odds ratio = 1.78; 95% CI, 1.45 - 1.98; P < 0.001), RPE damage (OR = 1.13; 95%CI: 1.08 - 1.23; P < 0.001), baseline BCVA (OR = 0.96; 95%CI: 0.95 - 0.99; P = 0.001), and SCT level (OR = 1.18; 95%CI: 1.02 - 1.20; P < 0.001). CONCLUSION In acute CSC after treatment of one-third dose PDT, recurrence is associated with RPE damage, baseline BCVA and SCT level. Our findings will assist clinicians to evaluate aCSC in clinical practice and provide insights into the prevention of recurrence.
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Affiliation(s)
- Xinyue Zhang
- Department of Ophthalmology, Shenyang Fourth People's Hospital, Shenyang, 110031, China; Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaotong Zhuang
- Department of Ophthalmology, Shenyang Fourth People's Hospital, Shenyang, 110031, China
| | - Jie Dong
- Department of Ophthalmology, Shenyang Fourth People's Hospital, Shenyang, 110031, China
| | - Bo Fu
- Department of Ophthalmology, Shenyang Fourth People's Hospital, Shenyang, 110031, China
| | - Li Xu
- Department of Ophthalmology, Shenyang Fourth People's Hospital, Shenyang, 110031, China.
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140
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Zheng F, He J, Su Z, Liu Y, Xu Y, Liu L, Ye P. OCT biomarkers related to subthreshold micropulse laser treatment effect in central serous chorioretinopathy. BMC Ophthalmol 2022; 22:252. [PMID: 35668416 PMCID: PMC9172075 DOI: 10.1186/s12886-022-02472-1] [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: 04/01/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background To identify the OCT biomarkers related to the anatomical outcomes in eyes with central serous chorioretinopathy (CSCR) after subthreshold micropulse laser (SML) treatment. Methods Patients with CSCR underwent SML were enrolled in this retrospective study. Only patients who underwent enhanced depth imaging optical coherence tomography (EDI-OCT) examination before and after SML were selected. Patients were divided into two groups based on whether subretinal fluid (SRF) absorbed or not after SML. Group 1 was the SRF resolved group, and Group 2 was the SRF non-resolved group. Factors including age and gender, duration of symptoms, CSCR history, the height of SRF at baseline, retinal pigment epithelium (RPE) /inner choroid alterations, as well as subfoveal choroidal thickness (SFCT) of the affected eye and the fellow eye before and after SML were recorded and compared between two groups. Longitudinal change of SFCT of a subgroup of patients were analyzed. Results A total of 58 eyes of 58 patients were involved in this study. SRF of 31 eyes got completely absorbed, and SRF of 27 eyes was retained after SML. Logistic regression analysis revealed baseline SFCT of the affected eye (OR = 1.007, 95% CI: 1.001–1.012, P = 0.019) and RPE/inner choroid alterations (OR = 25.229, 95% CI: 2.890–220.281, P = 0.004) were correlated with SML efficacy. Thirty-three eyes of 33 patients were enrolled in the subgroup analysis. A significant difference of SFCT changes between two groups were demonstrated (P = 0.001). The difference of SFCT between baseline and three months after SML was also related to SRF resolution (OR = 0.952, 95% CI: 0.915–0.990, P = 0.014). Conclusion Baseline SFCT, change of SFCT at 3-month after treatment, and RPE/inner choroid alterations were the OCT biomarkers related to SRF resolution after SML treatment.
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Affiliation(s)
- Fang Zheng
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, No.88, Jiefang Road, Hangzhou, 310009, China
| | - Jingliang He
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, No.88, Jiefang Road, Hangzhou, 310009, China
| | - Zhitao Su
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, No.88, Jiefang Road, Hangzhou, 310009, China
| | - Ye Liu
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, No.88, Jiefang Road, Hangzhou, 310009, China
| | - Yufeng Xu
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, No.88, Jiefang Road, Hangzhou, 310009, China
| | - Lei Liu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Panpan Ye
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, No.88, Jiefang Road, Hangzhou, 310009, China.
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Felipe CQ, Biancardi AL, Civile VT, Carvas Junior N, Serracarbassa PD, Koike MK. Mineralocorticoid receptor antagonists for chronic central serous chorioretinopathy: systematic review and meta-analyses. Int J Retina Vitreous 2022; 8:34. [PMID: 35672807 PMCID: PMC9172176 DOI: 10.1186/s40942-022-00385-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mineralocorticoid receptor antagonists (MRAs) are widely used for chronic central serous chorioretinopathy (cCSCR), but their effectiveness remains unclear. This research was conducted to evaluate the efficacy of this drugs for cCSCR. METHODS This is a review of randomized clinical trials (RCT) comparing MRAs to placebo in adults with cCSCR, using the effects of MRAs on best-corrected visual acuity (BCVA) and adverse events as primary outcomes and the effects of MRAs on anatomical parameters as secondary outcomes: central subfield thickness (CST), subretinal fluid height (SFH) and central choroidal thickness (CCT). Our all-language online search included Medline (via PubMed), Central, Embase, Lilacs, Ibecs, and RCT registers platforms, as late as May 2021. We used the Cochrane risk-of-bias tool (version 2) to assess the methodological quality of each study and synthesized the results in meta-analyses using a random-effects model. RESULTS The search identified 302 records, five of which were eligible, totaling 225 cCSCR patients (aged 45-62 years; M/F ratio 3.1:1) treated for 1 to 12 months with spironolactone (50 mg/day) or eplerenone (50 mg/day) vs. placebo. Moderate-certainty evidence suggests MRAs result in little to no improvement in BCVA compared to placebo (SMD 0.22; 95% CI - 0.04 to 0.48; studies = 5; comparisons = 6; participants = 218; I2 = 0%). Very low-certainty evidence suggests that, when compared to placebo, MRAs have a very uncertain impact on adverse effects (no meta-analysis was performed), and CST (MD 18.1; 95% CI - 113.04 to 76.84; participants = 145; studies = 2; I2 = 68%). MRAs also result in little to no difference in SFH (SMD - 0.35; 95% CI - 0.95 to 0.26; studies = 5; comparisons = 6; participants = 221; I2 = 76%; moderate certainty) and CCT (MD - 21.23; 95% CI - 64.69 to 22.24; participants = 206; studies = 4; comparisons = 5; I2 = 85%; low certainty). CONCLUSION MRAs have little to no effect on BCVA. Evidence for adverse events and CST is very uncertain. MRAs also have little to no effect on SFH and CCT. These findings should be considered when prescribing MRAs for cCSCR. This research was previous registration in the PROSPERO platform (CRD42020182601).
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Affiliation(s)
- Camila Q. Felipe
- Postgraduate Program in Health Sciences, Institute of Medical Care for Civil Servants in the State of São Paulo (IAMSPE), São Paulo, Brazil
| | - Ana Luiza Biancardi
- Laboratory of Infectious Diseases in Ophthalmology, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Vinicius T. Civile
- Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Nelson Carvas Junior
- Cochrane Brazil and Department of Physiotherapy, Paulista University, São Paulo, Brazil
| | | | - Marcia K. Koike
- Postgraduate Program in Health Sciences, IAMSPE and Laboratory of Medical Investigation 51 (LIM-51), University of São Paulo, São Paulo, Brazil
- Postgraduate Program in Health Sciences of the Institute of Medical Care for Civil Servants in the State of São Paulo (IAMSPE), Avenida Ibirapuera 981, 2 andar, Vila Clementino, São Paulo, SP CEP 04029-000 Brazil
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Effectiveness of Reduced-fluence Photodynamic Therapy for Chronic Central Serous Chorioretinopathy. OPHTHALMOLOGY SCIENCE 2022; 2:100152. [PMID: 36249695 PMCID: PMC9560560 DOI: 10.1016/j.xops.2022.100152] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/20/2022]
Abstract
Purpose Design Participants Methods Main Outcome Measures Results Conclusions
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143
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Kiraly P, Smrekar J, Jaki Mekjavić P. Morphological parameters predicting subthreshold micropulse laser effectiveness in central serous chorioretinopathy. Lasers Med Sci 2022; 37:3129-3136. [PMID: 35579726 DOI: 10.1007/s10103-022-03574-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this prospective study was to predict the effectiveness of subthreshold micropulse laser (SML) based on morphological parameters in patients with central serous chorioretinopathy (CSC). METHODS Thirty-one patients were examined at presentation, 3 months, and 6 months after the disease onset. In patients with persistent subretinal fluid (SRF) at 3 months, SML was performed. The following morphological parameters were observed just before treatment: central retinal thickness (CRT), maximal SRF, choroidal thickness (CT), pigment epithelial detachment (PED) height and width, number of hyperreflective foci (HF) at fovea and leakage site, secondary choroidal neovascularization (CNV), and severity of retinal pigment epithelium (RPE) alterations using multimodal imaging. RESULTS Good response was associated with lower SRF (p = 0.038), narrower PED (p = 0.078), and decreasing number of HF at fovea (difHFf) (p = 0 .016) just before the treatment. From a bivariate and multivariate point of view, the two groups differed significantly in the pair (SRF, PED width) (p = 0.048) and in the triple (SRF, PED width, difHFf) (p = 0.026). CONCLUSION Lower SRF, narrower PED, and decreasing HF could be associated with good response to SML in CSC patients.
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Affiliation(s)
- Peter Kiraly
- Eye Hospital, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jaka Smrekar
- Faculty of Mathematics and Physics, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Polona Jaki Mekjavić
- Eye Hospital, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia. .,Faculty of Medicine, University of Ljubljana, 1000, Ljubljana, Slovenia. .,Institute Jožef Stefan, 1000, Ljubljana, Slovenia.
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Hanhart J, Roditi E, Wasser LM, Barhoum W, Zadok D, Brosh K. Central serous chorioretinopathy following the BNT162b2 mRNA vaccine. J Fr Ophtalmol 2022; 45:597-602. [PMID: 35577701 PMCID: PMC9099405 DOI: 10.1016/j.jfo.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/16/2022]
Abstract
Background and purpose Methods Results Conclusions
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Affiliation(s)
- J Hanhart
- Department of Ophthalmology Shaare-Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel.
| | - E Roditi
- Department of Ophthalmology Shaare-Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel
| | - L M Wasser
- Department of Ophthalmology Shaare-Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel
| | - W Barhoum
- Carmel Medical Center, Haifa, Israel
| | - D Zadok
- Department of Ophthalmology Shaare-Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel
| | - K Brosh
- Department of Ophthalmology Shaare-Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel
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145
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Kanda P, Gupta A, Gottlieb C, Karanjia R, Coupland SG, Bal MS. Pathophysiology of central serous chorioretinopathy: a literature review with quality assessment. Eye (Lond) 2022; 36:941-962. [PMID: 34654892 PMCID: PMC9046392 DOI: 10.1038/s41433-021-01808-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/15/2021] [Accepted: 10/01/2021] [Indexed: 01/31/2023] Open
Abstract
The pathogenesis of central serous chorioretinopathy (CSCR), a pachychoroid disease, is poorly understood. While choroid hyperpermeability and retinal pigment epithelium dysfunction are cornerstones for developing CSCR, the mechanisms at the retinal, vascular, retinal pigment epithelium, and cellular level continue to be an enigma. A few preclinical studies and the development of small-sized, poorly controlled clinical trials have resulted in limited insight into the disease mechanism. Effective treatments for CSCR are still lacking as current trials have produced inconsistent results for functional and structural gains. Thus, critically evaluating the literature to explore disease mechanisms and provide an up-to-date understanding of pathophysiology can provide valuable information and avenues to new treatments. In this study, a comprehensive summary of the mechanistic insight into CSCR is presented while highlighting the shortcomings of current literature. The mechanism was divided into seven sub-categories including mechanical obstruction, inflammation, oxidative stress, paracrine factors, autonomic dysfunction, mineralocorticoid receptors activation, and medications. We implemented validated tools like the JBI and CAMARADES to objectively analyze the quality of both clinical and preclinical studies, respectively. Overall, our analysis of the literature showed that no single mechanism was populated with a large number of sufficiently sized and good-quality studies. However, compiling these studies gave hints not only to CSCR pathogenesis but also pachychoroid disease in general while providing suggestions for future exploration.
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Affiliation(s)
- Pushpinder Kanda
- grid.28046.380000 0001 2182 2255Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON Canada
| | - Arnav Gupta
- grid.28046.380000 0001 2182 2255Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Chloe Gottlieb
- grid.28046.380000 0001 2182 2255Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Rustum Karanjia
- grid.28046.380000 0001 2182 2255Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108Ottawa Hospital Research Institute, Ottawa, ON Canada ,grid.280881.b0000 0001 0097 5623Doheny Eye Institute, Los Angeles, CA 90033 USA ,grid.19006.3e0000 0000 9632 6718Doheny Eye Centers UCLA, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA 91105 USA
| | - Stuart G. Coupland
- grid.28046.380000 0001 2182 2255Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Manpartap Singh Bal
- grid.511274.4Queen’s University School of Medicine, Department of Ophthalmology, Kingston Health Science Centre, Kingston, ON Canada
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146
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Efficacy of Navigated Laser Photocoagulation for Chronic Central Serous Chorioretinopathy: A Retrospective Observational Study. DISEASE MARKERS 2022; 2022:7792291. [PMID: 35465265 PMCID: PMC9021991 DOI: 10.1155/2022/7792291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
Background. No consensus has been reached regarding the management of central serous chorioretinopathy (CSCR). We aimed to investigate the efficacy of navigated laser treatment for chronic CSCR and changes in the morphology of the retinal pigment epithelium (RPE). In this retrospective observational study, 19 patients with subjective symptoms admitted to the Nanjing Medical University Affiliated Eye Hospital were included between January 2021 and August 2021. All patients underwent visual acuity and optical coherence tomography (OCT) examination during follow-up. Fluorescein angiography (FA) was performed at baseline and at the final follow-up to confirm the dye leakage sites. The mean logMAR BCVA at baseline and at the end of follow-up was 0.49 ± 0.24 and 0.24 ± 0.15, respectively. The mean logMAR BCVA 3 months after treatment was significantly better than that before treatment (p = 0.002). Significant improvements were observed in central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) after navigated laser photocoagulation (p < 0.0001). Subretinal fluid was completely resolved in 13 (68%) of 19 eyes at 3 months. RPE lesions on OCT images showed RPE detachment in 17 eyes (61.5%), small protrusion of the RPE layer in 5 eyes (7.5%), and a rough RPE layer in 4 eyes (31%). After laser treatment, 9 points (35%) showed retinal detachment, and 10 (38.5%) regions showed an irregular RPE layer. An irregularly protruded RPE layer was also observed in different regions of the leakage spot in 5 (19%) eyes, and RPE defects were seen in 2 (7.5%) eyes. Navigated laser photocoagulation for chronic CSCR can achieve substantial anatomical and visual improvement. OCT outcomes may provide new information to facilitate understanding of the mechanism of chronic CSCR. Navigated laser photocoagulation should be chosen as an optimal treatment option in patients with chronic CSCR who cannot afford photodynamic therapy.
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147
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Zhou X, Komuku Y, Araki T, Terasaki H, Miki A, Kuwayama S, Nishi T, Kinoshita T, Gomi F. Risk factors and characteristics of central serous chorioretinopathy with later development of macular neovascularisation detected on OCT angiography: a retrospective multicentre observational study. BMJ Open Ophthalmol 2022; 7:bmjophth-2022-000976. [PMID: 35537029 PMCID: PMC9016399 DOI: 10.1136/bmjophth-2022-000976] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/23/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To identify the risk factors and characteristics of central serous chorioretinopathy (CSC) with subsequent macular neovascularisation (MNV) detected on optical coherence tomography angiography (OCTA). Methods and analysis We included patients from six institutions who were initially diagnosed with CSC and subsequently did or did not develop MNV detected by OCTA. Potential influencing factors were identified by evaluating the patients’ baseline demographics, multimodal fundus imaging, treatment options, recurrence and outcomes in both groups. Results We enrolled 176 eyes in 152 patients (112 men, 40 women; mean age: 52.1±10.4 years) with a mean follow-up of 30.4±16.3 months. Secondary MNV was present in 23 eyes (13.1%), and non-MNV was observed in 153 eyes (86.9%) by OCTA. Multivariate analysis revealed that older age (OR 1.06; 95% CI 1.01 to 1.11; p=0.014), chronic CSC (OR 3.05; 95% CI 1.12 to 8.30; p=0.029), leakage sites within the fovea on fluorescein angiography (OR 7.60; 95% CI, 1.89 to 30.48; p=0.004) and recurrent fluid within the first year (OR 5.12; 95% CI 1.66 to 15.77; p=0.012) were risk factors for subsequent MNV. Moreover, eyes with CSC complicated with MNV were characterised by poor visual acuity and low complete fluid resolution rates. Conclusion The factors associated with MNV secondary to CSC were older age, higher rates of chronic CSC and recurrence, and foveal leakage points on fluorescein angiography.
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Affiliation(s)
- Xiaoyin Zhou
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
| | - Yuki Komuku
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
| | - Takashi Araki
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
| | - Hiroto Terasaki
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
- Department of Ophthalmology, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Akiko Miki
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
- Department of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Soichiro Kuwayama
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomo Nishi
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
- Department of Ophthalmology, Nara Medical University, Kashihara, Nara, Japan
| | - Takamasa Kinoshita
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
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148
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Iovino C, Peiretti E, Tatti F, Querques G, Borrelli E, Sacconi R, Chhablani J, Agrawal H, Boon CJF, van Dijk EHC, Cennamo G, Lupidi M, Muzi A, Di Iorio V, Iglicki M, Smadar L, Loewenstein A, Zur D. Photodynamic therapy as a treatment option for peripapillary pachychoroid syndrome: a pilot study. Eye (Lond) 2022; 36:716-723. [PMID: 33824506 PMCID: PMC8956648 DOI: 10.1038/s41433-021-01515-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/11/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To investigate the anatomical and functional results in eyes with peripapillary pachychoroid syndrome (PPS) undergoing photodynamic therapy (PDT). METHODS A total of 25 eyes from 23 patients with PPS treated with PDT were retrospectively evaluated in this multicentric study. Main outcome measure was the proportion of eyes that achieved treatment success, defined as a decrease in both subretinal fluid (SRF) height and central subfield thickness (CST), at 3 months after PDT compared to baseline. Secondary outcomes were the change in CST, SRF, and best-corrected visual acuity (BCVA) 3 months after treatment and predictive factors for treatment success. When available, data between 3 and 12 months were also reviewed. RESULTS Treatment success was achieved in 16 eyes (64%). In the total cohort, CST decreased significantly from 356 ± 118 µm at baseline to 282 ± 90 µm and 270 ± 91 µm at 1 and 3 months, respectively (p < 0.001). Maximal SRF height decreased significantly from 102 ± 83 µm at baseline to 38 ± 46 µm and 32 ± 42 µm at 1 and 3 months, respectively (p < 0.001), and remained stable at month 6 (29 ± 44 µm) and month 12 (23 ± 35 µm). BCVA improved significantly from baseline to month 3 (p = 0.021). CONCLUSIONS PDT can be considered an efficacious treatment option in patients with PPS. Prospective data with longer follow-up in a bigger cohort are needed in order to determine the optimal treatment algorithm in this relatively novel disease.
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Affiliation(s)
- Claudio Iovino
- grid.9841.40000 0001 2200 8888Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Enrico Peiretti
- grid.7763.50000 0004 1755 3242Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Filippo Tatti
- grid.7763.50000 0004 1755 3242Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Giuseppe Querques
- grid.18887.3e0000000417581884Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Enrico Borrelli
- grid.18887.3e0000000417581884Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Riccardo Sacconi
- grid.18887.3e0000000417581884Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Jay Chhablani
- grid.21925.3d0000 0004 1936 9000UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA USA
| | - Hitesh Agrawal
- grid.417748.90000 0004 1767 1636LV Prasad Eye Institute, Hyderabad, India
| | - Camiel J. F. Boon
- grid.10419.3d0000000089452978Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands ,grid.7177.60000000084992262Department of Ophthalmology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Elon H. C. van Dijk
- grid.10419.3d0000000089452978Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gilda Cennamo
- grid.4691.a0000 0001 0790 385XEye Clinic, Public Health Department, University of Naples Federico II, Naples, Italy
| | - Marco Lupidi
- grid.9027.c0000 0004 1757 3630Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Alessio Muzi
- grid.9027.c0000 0004 1757 3630Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Valentina Di Iorio
- grid.9841.40000 0001 2200 8888Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Matias Iglicki
- grid.7345.50000 0001 0056 1981Private Retina Practice, University of Buenos Aires, Buenos Aires, Argentina
| | - Lital Smadar
- grid.12136.370000 0004 1937 0546Division of Ophthalmology, Tel Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- grid.12136.370000 0004 1937 0546Division of Ophthalmology, Tel Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dinah Zur
- grid.12136.370000 0004 1937 0546Division of Ophthalmology, Tel Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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149
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Chhablani J, Behar-Cohen F. Validation of central serous chorioretinopathy multimodal imaging-based classification system. Graefes Arch Clin Exp Ophthalmol 2022; 260:1161-1169. [PMID: 34669028 DOI: 10.1007/s00417-021-05452-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Validation of a recently described central serous chorioretinopathy (CSCR) classification system and assessment of levels of agreement among 10 retina physicians. METHODS This was a cross-sectional (inter-reader agreement) study. Ten retina physicians (assigned a role of masked grader) were provided with a comprehensive dataset of 61 eyes of 34 patients of presumed CSCR. Relevant clinical details and multimodal imaging (fundus autofluorescence, fluorescein and indocyanine green angiography, optical coherence tomography) of both involved and fellow eye were electronically shared. Later, only the fellow eye images were resent to understand the influence of affected eye on the grading of the fellow eye. Multiple inter-grader agreement using Fleiss Kappa was performed to determine the level of agreement among the 10 graders. p value of ≤ 0.05 was considered statistically significant. RESULTS Sixty-one eyes of 34 patients were evaluated. There was moderate agreement for major criteria with Fleiss Kappa value of 0.50 (p < 0.0001) with a single outlier observer. After excluding that observer, the Fleiss Kappa value increased to 0.57 (p < 0.0001) with statistically significant p values among all categories, i.e., simple CSC ([Formula: see text] = 0.575), complex CSC ([Formula: see text] = 0.621), and no CSC ([Formula: see text] = 0.452). Overall, moderate to substantial agreement was noted among the subtypes (primary, recurrent, and resolved). The influence of the affected eye on fellow eye grading was studied. The global Fleiss Kappa coefficient ([Formula: see text] = 0.642, p < 0.0001) showed substantial agreement when observers were aware of the affected eye grading. However, without prior available information on the affected eye, the inter-grader agreement was significantly lower (global [Formula: see text] = 0.255, p < 0.0001). CONCLUSION A fair-moderate inter-grader agreement among the masked graders suggests a need for further refinement of this novel classification system. Disease grading should include both eyes as lack of information on affected eye has a bearing on fellow eye grading and inter-grader agreement as shown by a significant difference in global [Formula: see text] values.
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Affiliation(s)
- Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh Eye and Ear Institute, PA, Pittsburgh, USA.
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150
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Feenstra HMA, Hahn LC, van Rijssen TJ, Tsonaka R, Breukink MB, Keunen JEE, Peters PJH, Dijkman G, Souied EH, MacLaren RE, Querques G, Downes SM, Fauser S, Hoyng CB, van Dijk EHC, Boon CJF. EFFICACY OF HALF-DOSE PHOTODYNAMIC THERAPY VERSUS HIGH-DENSITY SUBTHRESHOLD MICROPULSE LASER FOR TREATING PIGMENT EPITHELIAL DETACHMENTS IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY. Retina 2022; 42:721-729. [PMID: 34864802 DOI: 10.1097/iae.0000000000003363] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Comparing the effect of half-dose photodynamic therapy and high-density subthreshold micropulse laser treatment on retinal pigment epithelial detachments (PEDs) in chronic central serous chorioretinopathy. METHODS This study included data from the PLACE trial, a prospective randomized controlled trial comparing half-dose photodynamic therapy and high-density subthreshold micropulse laser treatment in chronic central serous chorioretinopathy. Main outcome measurements were changes in both the foveal PED and the highest PED within the macula at baseline compared with first and final evaluation visit. RESULTS At baseline, a macular PED was detected in 76.9% of patients (123/160), and a PED within 1,500 µm from the foveal center in 37.5% of patients (60/160). In the half-dose photodynamic therapy arm (61 patients), there was a significantly larger decrease in the highest macular PED compared with the high-density subthreshold micropulse laser treatment arm (62 patients) at both first and final evaluation visits (P < 0.001 and P = 0.012, respectively). The decrease of highest foveal PED was significant at first visit (P = 0.025). CONCLUSION Half-dose photodynamic therapy is superior to high-density subthreshold micropulse laser treatment with regard to a statistically significant reduction in the height of macular PEDs in active chronic central serous chorioretinopathy. These findings may also have implications for other diseases within the pachychoroid disease spectrum that can present with PEDs.
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Affiliation(s)
- Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Leo C Hahn
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Thomas J van Rijssen
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Roula Tsonaka
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Myrte B Breukink
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jan E E Keunen
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Petrus J H Peters
- Department of Ophthalmology, Bergman Clinics B.V., Velp, the Netherlands
| | - Greet Dijkman
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil University Paris Est, Creteil, France
| | - Robert E MacLaren
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Giuseppe Querques
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil University Paris Est, Creteil, France
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany; and
- F. Hoffmann-La Roche, Basel, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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