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Zhang X, Lim CZF, Chhablani J, Wong YM. Central serous chorioretinopathy: updates in the pathogenesis, diagnosis and therapeutic strategies. EYE AND VISION (LONDON, ENGLAND) 2023; 10:33. [PMID: 37430344 DOI: 10.1186/s40662-023-00349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 06/12/2023] [Indexed: 07/12/2023]
Abstract
Central serous chorioretinopathy (CSCR), first described by Albrecht von Graefe in 1866, is characterized by focal serous detachment of the neural retina and/or retinal pigment epithelium (RPE) in the posterior pole. CSCR is the first ever described pachychoroid disease. Most recently, hypothetical venous overload choroidopathy is also proposed due to its distinguished morphological and pathological characteristics, including choroidal thickening, choriocapillaris hyperpermeability, remodelling, and intervortex venous anastomoses. Identification of genetic variants is necessary to comprehend the pathophysiology of CSCR. The novel multimodality imaging platforms, including the ultra-widefield imaging system, flavoprotein fluorescence, fluorescence lifetime imaging ophthalmoscopy, and multispectral imaging system, have been used for diagnosing and managing CSCR. Half-dose photodynamic therapy (PDT) remains the mainstay of clinical practice, with about 95% of patients with chronic CSCR improving to visual acuity (VA) of 20/30 or better. The use of oral eplerenone for routine clinical care remains controversial, and long-term randomized clinical trials are warranted to investigate its efficacy in acute and chronic CSCR. While CSCR has generally been recognized as a self-limiting disease with good prognosis, the underlying pathogenesis is still not fully understood, and treatments are often not fully effective. With new evidence emerging about pachydrusen being a disease precursor in both CSCR and polypoidal choroidal vasculopathy (PCV), it would be interesting to investigate whether CSCR can be a precursor to PCV. In this review, we highlighted the currently available evidence on the pathogenesis, diagnosis, multimodality imaging features, and management strategies, including recent findings related to CSCR.
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Affiliation(s)
- Xinyuan Zhang
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Tongren Hospital, Capital Medical University, Beijing University of Medical Science, Beijing, 100730, People's Republic of China.
| | - Connie Zhi Fong Lim
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Tongren Hospital, Capital Medical University, Beijing University of Medical Science, Beijing, 100730, People's Republic of China
| | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
| | - Yew Meng Wong
- Southern Specialist Eye Center SDN, BHD, Malacca, Malaysia
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Abdin AD, Suffo S, Fries FN, Kaymak H, Seitz B. [Uniform classification of the pachychoroid spectrum disorders]. Ophthalmologe 2021; 118:865-878. [PMID: 33900429 DOI: 10.1007/s00347-021-01379-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/28/2022]
Abstract
Pachychoroid spectrum disorders are characterized by a thickening of the choroid. The spectrum includes pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CCS), pachychoroid neovasculopathy (PNV), polypoidal choroidal vasculopathy (PCV)/aneurysmal type 1 choroidal neovascularization (ACNV-1), focal choroidal excavation (FCE) and peripapillary pachychoroid syndrome (PPS). If the choroid is thickened and there is a pathological alteration in the retinal pigment epithelium, the diagnosis is PPE; if the thickened choroid is accompanied by subretinal fluid, the diagnosis is CCS; if choroidal neovascularization is present, the diagnosis is PNV; if accompanied by aneurysms, the diagnosis is ACNV‑1. The PPE, CCS, PNV and ACNV‑1 were formerly regarded as independent disease entities but can be classified into four forms of a single disease family, pachychoroid macular disease.
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Affiliation(s)
- Alaa Din Abdin
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland.
| | - Shady Suffo
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - Fabian N Fries
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - Hakan Kaymak
- Internationale Innovative Ophthalmochirurgie (I. I. O.), 40549, Düsseldorf, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
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Fraenkel D, Suffo S, Langenbucher A, Seitz B, Abdin AD. Eplerenone for treatment of chronic central serous chorioretinopathy. Eur J Ophthalmol 2020; 31:1885-1891. [PMID: 32854564 DOI: 10.1177/1120672120952648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the morphological and functional outcome of oral eplerenone for treatment of patients with chronic central serous chorioretinopathy (CSC) in a real life experience. PATIENTS AND METHODS In this retrospective study, we reviewed the clinical files of 30 patients with chronic CSC. All patients were treated with eplerenone for a period of 6 weeks or 3 months depending on the clinical response. Main outcome measures included: best corrected visual acuity (BCVA), central macular thickness (CMT) and height of the subretinal fluid (SRF). Comparisons between responders and non-responders were performed to identify factors that were predictive of the treatment response. RESULTS All patients were treated with eplerenone 18 ± 20 weeks after onset of the first symptoms. BCVA (LogMAR) improved from 0.2 ± 0.2 to 0.13 ± 0.18 at 6 weeks (p = 0.01) and to 0.09 ± 0.15 at 3 months (p = 0.01). Mean CMT decreased from 409 ± 136 to 323 ± 87 µm at 6 weeks (p = 0.001) and to 298 ± 98 µm at 3 months (p = 0.01). Mean height of SRF decreased from 153 ± 126 to 73 ± 79 µm at 6 weeks (p = 0.001) and to 49 ± 88 µm at 3 months (p = 0.005). Complete resolution of SRF was achieved in 20 patients after 3 months (67%). Reported stress in the medical history was the only statistical significant predictive factor associated with a positive treatment response. CONCLUSION This study showed a statistically significant improvement of the best corrected visual acuity and a significant reduction of macular thickness and subretinal fluid in patients with chronic CSC treated with oral eplerenone, especially in patients under stress.
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Affiliation(s)
- Doris Fraenkel
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Germany
| | - Shady Suffo
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Germany
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Germany
| | - Alaa Din Abdin
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Germany
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Walkden A, Atkinson O, Linton E, Bull A, Abraham L, Chhabra R. Visual and anatomical outcomes of central serous chorioretinopathy patients presenting to a tertiary unit: a prospective analysis. Ther Adv Ophthalmol 2020; 12:2515841420923192. [PMID: 32529171 PMCID: PMC7263120 DOI: 10.1177/2515841420923192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/03/2020] [Indexed: 11/17/2022] Open
Abstract
Aim The aim of this study was to prospectively define the characteristics and outcomes of a cohort of central serous chorioretinopathy patients using optical coherence tomography imaging to determine anatomical disease resolution. Much of the literature available on the characteristics of central serous chorioretinopathy patients pre date the advent of OCT imaging, with conclusive epidemiological evidence being scarce. We describe a cohort of patients presenting to a large centre over the course of a year. Methods Prospective data collection was undertaken for all patients diagnosed with central serous chorioretinopathy at our unit over the course of 1 year. All patients underwent thorough history taking and optical coherence tomography imaging. Results In total, 59 eyes from 51 patients were diagnosed with central serous chorioretinopathy between April 2017 and April 2018; 23 (45.1%) patients had optical coherence tomography evidence of complete anatomical resolution within a year, with three (5.88%) patients suffering a worse visual acuity compared with that at presentation at 1-year end point; and three patients developed secondary choroidal neovascular membranes. Conclusion Our study reports much-needed prospective outcomes of patients with central serous chorioretinopathy, which helps to guide clinicians when deciding treatment strategies, as well as better informing patients of their prognosis for visual improvement.
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Affiliation(s)
- Andrew Walkden
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Olivia Atkinson
- Manchester Royal Eye Hospital, Manchester University Foundation Trust, Manchester, UK
| | - Emma Linton
- Manchester Royal Eye Hospital, Manchester University Foundation Trust, Manchester, UK
| | - Adam Bull
- Manchester Royal Eye Hospital, Manchester University Foundation Trust, Manchester, UK
| | - Laina Abraham
- Manchester Royal Eye Hospital, Manchester University Foundation Trust, Manchester, UK
| | - Ramandeep Chhabra
- Manchester Royal Eye Hospital, Manchester University Foundation Trust, Manchester, UK
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Fusi-Rubiano W, Saedon H, Patel V, Yang YC. Oral medications for central serous chorioretinopathy: a literature review. Eye (Lond) 2020; 34:809-824. [PMID: 31527760 PMCID: PMC7182569 DOI: 10.1038/s41433-019-0568-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/04/2019] [Accepted: 07/27/2019] [Indexed: 02/08/2023] Open
Abstract
Central serous chorioretinopathy (CSCR) is characterised by acute or chronic neurosensory detachments of the retina, usually in the posterior pole, with or without associated detachments of retinal pigment epithelium. Although the condition often resolves spontaneously, chronic and recurrent cases can lead to significant visual loss in the working population and it is thus increasingly recognised as an important public health issue. The uncertainty regarding the underlying cause of CSCR has led to a wide range of therapies being tried for this condition including photodynamic therapy, laser photocoagulation, anti-VEGF injections and a multitude of oral agents. This article aims to review the current evidence for oral agents that have been used for treatment of CSCR. A systematic literature search was conducted for articles published between 1980 to July 2018. A total of 73 articles were included. These studied the following oral medications: eplerenone, spironolactone, beta blockers, H. pylori agents, omeprazole, rifampicin, methotrexate, aspirin, acetazolamide, mifepristone, melatonin, finasteride, ketoconazole, antioxidants and curcumin phospholipid. Although none of the studies showed robust evidence of efficacy, the mineralocorticoid receptor antagonists, particularly eplerenone, appear to demonstrate the highest quality evidence for use in this condition. The review aims to give the reader an overview of the current available evidence for oral medications used in the treatment of CSCR in order to provide an evidence-based discussion with the patient and guide through possible options for treatment.
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Affiliation(s)
- William Fusi-Rubiano
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK.
| | - Habiba Saedon
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK
| | - Vijay Patel
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK
| | - Yit C Yang
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK
- School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, UK
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Cakir B, Agostini H, Lange C. [Treatment of central serous chorioretinopathy with mineralocorticoid receptor antagonists]. Ophthalmologe 2019; 116:189-200. [PMID: 30255262 DOI: 10.1007/s00347-018-0785-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Over 3 years have passed since the last publication on the therapeutic principle "Mineralocorticoid receptor antagonists as treatment option for acute and chronic central serous chorioretinopathy" by Maier et al., and numerous new studies have been published on the topic. The aim of this work is to provide an update on the current literature and reevaluate the role of mineralocorticoid receptor antagonists in the treatment of central serous chorioretinopathy (CSC). METHODS AND RESULTS A computer-based literature search in PubMed yielded a total of 20 relevant articles published from 2013 to 2017, which were evaluated in terms of the effect of mineralocorticoid receptor antagonists in CSC treatment. Due to study protocol variability with different primary endpoints and follow-up periods, an in-depth comparison of the selected studies could not be performed. Moreover, the small study populations further limit their validity in this per se heterogeneous disease spectrum. Despite these limitations, current data indicate that aldosterone antagonists are effective in decreasing subretinal fluid and improving visual acuity in patients with CSC. The selective aldosterone antagonist eplerenone with a low side effect profile is a treatment option in patients with non-resolving CSC. CONCLUSION Prospective, randomized studies with uniform disease definition and study criteria are necessary to validate the therapeutic effect and to determine the ideal time of intervention and treatment duration.
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Affiliation(s)
- B Cakir
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - H Agostini
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - C Lange
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland.
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Schwartz R, Habot-Wilner Z, Martinez MR, Nutman A, Goldenberg D, Cohen S, Shulman S, Guzner-Gur H, Loewenstein A, Goldstein M. Eplerenone for chronic central serous chorioretinopathy-a randomized controlled prospective study. Acta Ophthalmol 2017; 95:e610-e618. [PMID: 28653813 DOI: 10.1111/aos.13491] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/30/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of eplerenone for chronic nonresolving central serous chorioretinopathy (CSC). METHODS Prospective, double-blind, randomized placebo-controlled study. Nineteen eyes of 17 patients with persistent subretinal fluid (SRF) due to CSC were enrolled and randomized to receive eplerenone 50 mg/day or placebo for 3 months, followed by a 3-month follow-up. The main outcome measure was change in SRF from baseline to 3 months of treatment. Secondary outcomes included change in SRF at any time-point, complete resolution of SRF, improvement in choroidal thickness and change in best-corrected visual acuity (BCVA). RESULTS Thirteen eyes were treated with eplerenone and six with placebo. Both groups showed reduction in SRF throughout the treatment period, with a significant reduction at months 1, 3 and 5 only in the treatment group. Twenty-three per cent in the treatment group and 30.8% per cent in the placebo group experienced complete resolution of SRF. A significant improvement in BCVA was noted in the placebo group at 4 months, as well as a significant difference in BCVA between groups at 3 months in favour of the placebo group (p = 0.005). There was no significant difference in choroidal thickness in either group throughout the study period. No adverse events related to eplerenone were noted in the treatment group. CONCLUSION In this study, eplerenone was not found to be superior to placebo in eyes with chronic CSC.
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Affiliation(s)
- Roy Schwartz
- Ophthalmology Division; Tel Aviv Medical Center; Tel Aviv Israel
- The Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Zohar Habot-Wilner
- Ophthalmology Division; Tel Aviv Medical Center; Tel Aviv Israel
- The Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Michael R. Martinez
- Ophthalmology Division; Tel Aviv Medical Center; Tel Aviv Israel
- The Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Amir Nutman
- The Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Internal Medicine Division; Tel Aviv Medical Center; Tel Aviv Israel
| | - Dafna Goldenberg
- Ophthalmology Division; Tel Aviv Medical Center; Tel Aviv Israel
- The Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Shai Cohen
- The Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Shiri Shulman
- Ophthalmology Division; Tel Aviv Medical Center; Tel Aviv Israel
- The Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Hanan Guzner-Gur
- The Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Internal Medicine Division; Tel Aviv Medical Center; Tel Aviv Israel
| | - Anat Loewenstein
- Ophthalmology Division; Tel Aviv Medical Center; Tel Aviv Israel
- The Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Sydney A. Fox chair of ophthalmology
| | - Michaella Goldstein
- Ophthalmology Division; Tel Aviv Medical Center; Tel Aviv Israel
- The Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Sun X, Shuai Y, Fang W, Li J, Ge W, Yuan S, Liu Q. Spironolactone versus observation in the treatment of acute central serous chorioretinopathy. Br J Ophthalmol 2017; 102:1060-1065. [DOI: 10.1136/bjophthalmol-2017-311096] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/13/2017] [Accepted: 09/30/2017] [Indexed: 11/03/2022]
Abstract
PurposeTo evaluate the efficacy of oral spironolactone in patients with acute central serous chorioretinopathy (CSC).MethodsThis is a prospective, randomised controlled clinical study. Thirty patients with acute CSC were the participants, including 18 patients who were treated with spironolactone (40 mg orally, twice daily) for 2 months in the experimental group and 12 patients who received observation in the control group. Main outcome measures included the proportion of eyes achieving complete resolution of subretinal fluid (SRF), changes in central macular thickness (CMT), the height of SRF (SRFH), best corrected visual acuity (BCVA) and subfoveal choroidal thickness (SFCT). The follow-up period was 2 months.ResultsComplete resolution of SRF was achieved in 55.6% (10/18) and 8.3% (1/12) of the eyes in the treatment group and the control group, respectively, at 2 months (p=0.018). The mean CMT and SRFH decreased significantly at each visit in both groups (p<0.05), and there was significant difference between the two groups at 2 months (p<0.05 and p<0.05, respectively). BCVA (in logarithm of the minimum angle of resolution; mean) improved in both groups at 2 months (p<0.05). In the treatment group, the mean baseline SFCT significantly decreased from 502.50±87.38 µm to 427.44±74.37 µm at 2 months (p<0.01), while the change from baseline (from 480.33±102.38 µm to 463.75±100.63 µm) was not significant in the control group (p=0.195). But the differences between the two groups in BCVA and SFCT were not significant.ConclusionsOral spironolactone is more effective with a faster absorption of SRF than observations. It is a promising treatment for acute CSC.Trial registration numberChiCTR-IPR-16008428, Results.
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Khan P, Khan L, Anjum N, Saxena N. Central serous chorioretinopathy secondary to tuberculosis: cause or coincidence. BMJ Case Rep 2017; 2017:bcr-2016-216471. [PMID: 28500259 DOI: 10.1136/bcr-2016-216471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
32-year-old male with diagnosis of central serous chorioretinopathy (CSCR) in both eyes and negative history of administration of any medicine was treated with bilateral focal laser at leakage point, with visual recovery. Recurrence occurred after 2 years in right eye and was treated successfully with acetazolamide. Second recurrence occurred after 1 year. Acetazolamide was restarted, but no improvement was noted. Thorough re-evaluation of the patient revealed a family history of tuberculosis. Ancillary investigations rendered the presumptive diagnosis of tuberculosis, and antituberculosis treatment led to visual recovery with no recurrences. Present case poses two dilemmas: whether CSCR was secondary to tuberculosis or was it an incidental association in tuberculosis endemic population and second whether resolution occurred due to the treatment of tuberculosis or due to mineralo-corticoid antagonism action of rifampicin. Significance of patient's history, clinical observation and angiographic studies in the diagnosis of idiopathic and recurrent CSCR is reiterated.
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Affiliation(s)
- Perwez Khan
- Department of Ophthalmology, GSVM Medical College, Kanpur, India
| | - Lubna Khan
- Department of Pathology, GSVM Medical College, Kanpur, India
| | - Nikhat Anjum
- Department of Ophthalmology, GSVM Medical College, Kanpur, India
| | - Nutan Saxena
- Department of Ophthalmology, Rama Medical College and Research Centre, Kanpur, India
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Abstract
PURPOSE OF REVIEW Long-lasting devices releasing steroids have been approved recently for macular edema of various origins. Identification of the retina as a novel mineralo-sensitive tissue also raises new therapeutic options. RECENT FINDINGS Recently, the over activation of the mineralocorticoid receptor (MR) pathway has been shown to cause fluid accumulation in the retina, choroidal vasodilation, and to promote retinal neovascularization in hypoxic conditions. These findings indicate that MR antagonists could have beneficial effects in the treatment of retinal diseases. Central serous chorioretinopathy is a retinal disease associated with choroidal vasodilation and subretinal fluid that affects mostly men with type A personality and occurrence has been associated with steroid intake. In several independent studies, MR antagonists have shown beneficial effects, significantly reducing subretinal fluid in eyes of chronic central serous chorioretinopathy patients. SUMMARY The role of MR in retinal disorder is emerging and the potential association with psychological traits is considered. The place of MR antagonists for retinal diseases treatment is discussed.
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Long-term results and recurrence rates after spironolactone treatment in non-resolving central serous chorio-retinopathy (CSCR). Graefes Arch Clin Exp Ophthalmol 2016; 255:221-229. [DOI: 10.1007/s00417-016-3436-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/14/2016] [Accepted: 07/07/2016] [Indexed: 11/25/2022] Open
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Wong KH, Lau KP, Chhablani J, Tao Y, Li Q, Wong IY. Central serous chorioretinopathy: what we have learnt so far. Acta Ophthalmol 2016; 94:321-5. [PMID: 26132864 DOI: 10.1111/aos.12779] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 05/11/2015] [Indexed: 11/26/2022]
Abstract
Central serous chorioretinopathy (CSCR) is a common retinal cause of visual loss. The mainstays of management are observation, photodynamic therapy (PDT) and laser procedures. Over the past decade, there has been rapid development in the existing and novel imaging techniques, functional testing and management of CSCR. However, there is no convincing treatment designed for CSCR yet. In recent years, the advances in PDT, with various adjustments in fluence and verteporfin dosage, and the comparisons between different types of PDT for acute and chronic CSCR in recent studies have provided greater insights into the role of PDT in treating CSCR. Novel laser procedures, such as the diode micropulse laser, have shown comparable efficacy to conventional lasers without laser-induced damage. Antivascular endothelial growth factor, which was originally developed for treating cancers, has emerged to be a potentially effective treatment for CSCR. The potential role of mineralocorticoid receptor antagonists in treating CSCR has provided greater understanding of the pathogenesis. Based on the relevant studies, mainly from the past decade, we discuss updates to the management of CSCR according to the risk factor modifications, pharmacological interventions, PDT and laser procedures and concluded that PDT is the current best option for CSCR.
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Affiliation(s)
- Kah Hie Wong
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Hong Kong
| | - Kin Pong Lau
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Hong Kong
| | - Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre; L. V. Prasad Eye Institute; Hyderabad India
| | - Yong Tao
- Department of Ophthalmology; People's Hospital; Peking University and Key Laboratory of Vision Loss and Restoration; Ministry of Education; Beijing China
| | - Qing Li
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Hong Kong
| | - Ian Y. Wong
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Hong Kong
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Feucht N, Maier M, Lohmann CP, Reznicek L. OCT Angiography Findings in Acute Central Serous Chorioretinopathy. Ophthalmic Surg Lasers Imaging Retina 2016; 47:322-7. [DOI: 10.3928/23258160-20160324-03] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/22/2016] [Indexed: 11/20/2022]
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Framme C, Walter A, Berger L, Prahs P, Alt C, Theisen-Kunde D, Kowal J, Brinkmann R. Selective Retina Therapy in Acute and Chronic-Recurrent Central Serous Chorioretinopathy. Ophthalmologica 2015; 234:177-88. [PMID: 26368551 DOI: 10.1159/000439188] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/30/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Selective retina therapy (SRT), the confined laser heating and destruction of retinal pigment epithelial cells, has been shown to treat acute types of central serous chorioretinopathy (CSC) successfully without damaging the photoreceptors and thus avoiding laser-induced scotoma. However, a benefit of laser treatment for chronic forms of CSC is questionable. In this study, the efficacy of SRT by means of the previously used 1.7-µs and shorter 300-ns pulse duration was evaluated for both types of CSC, also considering re-treatment for nonresponders. MATERIAL AND METHODS In a two-center trial, 26 patients were treated with SRT for acute (n = 10) and chronic-recurrent CSC (n = 16). All patients presented with subretinal fluid (SRF) in OCT and leakage in fluorescein angiography (FA). SRT was performed using a prototype SRT laser system (frequency-doubled Q-switched Nd:YLF-laser, wavelength 527 nm) with adjustable pulse duration. The following irradiation settings were used: a train of 30 laser pulses with a repetition rate of 100 Hz and pulse durations of 300 ns and 1.7 µs, pulse energy 120-200 µJ, retinal spot size 200 µm. Because SRT lesions are invisible, FA was always performed 1 h after treatment to demonstrate laser outcome (5-8 single spots in the area of leakage). In cases where energy was too low, as indicated by missing FA leakage, energy was adjusted and the patient re-treated immediately. Observation intervals were after 4 weeks and 3 months. In case of nonimprovement of the disease after 3 months, re-treatment was considered. RESULTS Of 10 patients with active CSC that presents focal leakage in FA, 5 had completely resolved fluid after 4 weeks and all 10 after 3 months. Mean visual acuity increased from 76.6 ETDRS letters to 85.0 ETDRS letters 3 months after SRT. Chronic-recurrent CSC was characterized by less severe SRF at baseline in OCT and weaker leakage in FA than in acute types. Visual acuity changed from baseline 71.6 to 72.8 ETDRS letters after 3 months. At this time, SRF was absent in 3 out of 16 patients (19%), FA leakage had come to a complete stop in 6 out of 16 patients (38%). In 6 of the remaining chronic CSC patients, repeated SRT with higher pulse energy was considered because of persistent leakage activity. After the re-treatment, SRF resolved completely in 5 patients (83.3%) after only 25 days. CONCLUSION SRT showed promising results in treating acute CSC, but was less effective in chronic cases. Interestingly, re-treatment resulted in enhanced fluid resolution and dry conditions after a considerably shorter time in most patients. Therefore, SRT including re-treatment if necessary might be a valuable CSC treatment alternative even in chronic-recurrent cases.
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Affiliation(s)
- Carsten Framme
- University Eye Hospital, Medical School Hannover, Hannover, Germany
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15
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Abouammoh MA. Advances in the treatment of central serous chorioretinopathy. Saudi J Ophthalmol 2015; 29:278-86. [PMID: 26586979 PMCID: PMC4625218 DOI: 10.1016/j.sjopt.2015.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/18/2015] [Accepted: 01/19/2015] [Indexed: 02/06/2023] Open
Abstract
Central serous chorioretinopathy is a disease that is partly understood. Novel advancements have led to further understanding of the disease, and have identified choroidal dysfunction as the principal element in CSCR development. New imaging tools have aided in better monitoring disease response to various treatment models. Enhanced depth imaging optical coherence tomography, in particular, has helped in observing choroidal thickness changes after various treatment models. To date, photodynamic therapy and focal laser remain the main stay of treatment. More understanding of disease pathophysiology in the future will help in determining the drug of choice and the best management option for such cases.
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16
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Pitcher JD, Witkin AJ, DeCroos FC, Ho AC. A prospective pilot study of intravitreal aflibercept for the treatment of chronic central serous chorioretinopathy: the CONTAIN study. Br J Ophthalmol 2015; 99:848-52. [DOI: 10.1136/bjophthalmol-2014-306018] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/08/2014] [Indexed: 02/02/2023]
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17
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Kirschfeld K. [Treatment of serous macular retinal detachment with antihistamines]. Ophthalmologe 2014; 112:57-60. [PMID: 25278347 DOI: 10.1007/s00347-014-3096-y] [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: 11/26/2022]
Abstract
The etiology of retinal detachment in central serous retinopathy (CSR) is unknown; however, three facts are generally accepted: (1) the serous exudate which raises the layers of the receptors/pigment epithelium is formed due to hyperpermeability in the choriocapillaries, (2) patients frequently suffer from headaches and (3) stress promotes the incidence of CSR. A high blood plasma histamine concentration can cause the abovementioned symptoms which suggests that histamine might provoke CSR. Within 1 week after administration of the antihistamine loratadin a considerable reduction in the retinal exudate and restoration of vision were observed. This supports the hypothesis that histamine could be involved in the process of retinal detachment. Further investigations and large scale clinical trials should clarify if this hypothesis can be proved or disproved and whether antihistamines can be used for age-related macular degeneration (AMD).
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Affiliation(s)
- K Kirschfeld
- Max-Planck-Institut für biologische Kybernetik, Spemannstr. 41, 72076, Tübingen, Deutschland,
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18
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Maier M, Stumpfe S, Feucht N, Strobl P, Rath V, Lohmann C. Mineralokortikoidrezeptorantagonisten als Therapieoption bei akuter und chronischer Chorioretinopathia centralis serosa. Ophthalmologe 2014; 111:173-80. [DOI: 10.1007/s00347-013-3001-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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