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Kalogeropoulos D, Shaw L, Skondra D, Ch'ng SW, Christodoulou A, Kalogeropoulos C. Central Serous Chorioretinopathy: An Update on the Current State of Management. Klin Monbl Augenheilkd 2024; 241:845-862. [PMID: 37336237 DOI: 10.1055/a-2062-3751] [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: 06/21/2023]
Abstract
Central serous chorioretinopathy (CSCR) is a relatively common retinal disorder that leads to central vision impairment, often with a high recurrence rate. The exact etiology and pathogenetic mechanisms have not been fully elucidated but are likely to be associated with hyperpermeability of the choroidal capillaries and failure of the retinal pigment epithelium (RPE), leading to serous detachment of the neurosensory retina. Multimodal imaging plays a critical role in the diagnostic approach and monitoring of CSCR. Fortunately, the natural course of the disease is usually self-limiting, with spontaneous resolution and total fluid reabsorption. However, some patients may exhibit recurrences or persistent subretinal fluid (chronic CSCR), leading to progressive and irreversible RPE atrophy or photoreceptor damage. Thus, to prevent permanent visual loss, individualized treatment should be considered. Recent developments in the diagnostic and therapeutic approach have contributed to better outcomes in patients with CSCR. More studies are required to improve our understanding of epidemiology, pathogenesis, diagnosis, and treatment, with a significant impact on the management of this challenging clinical entity. The purpose of this review is to summarize the current knowledge about the clinical features, diagnostic workup, and therapeutic approach of CSCR.
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Affiliation(s)
| | - Lincoln Shaw
- Ophthalmology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, United States
| | - Dimitra Skondra
- Ophthalmology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, United States
| | - Soon Wai Ch'ng
- Ophthalmology, Birmingham and Midland Eye Centre, Birmingham, United Kingdom of Great Britain and Northern Ireland
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Feenstra HMA, van Dijk EHC, Cheung CMG, Ohno-Matsui K, Lai TYY, Koizumi H, Larsen M, Querques G, Downes SM, Yzer S, Breazzano MP, Subhi Y, Tadayoni R, Priglinger SG, Pauleikhoff LJB, Lange CAK, Loewenstein A, Diederen RMH, Schlingemann RO, Hoyng CB, Chhablani JK, Holz FG, Sivaprasad S, Lotery AJ, Yannuzzi LA, Freund KB, Boon CJF. Central serous chorioretinopathy: An evidence-based treatment guideline. Prog Retin Eye Res 2024; 101:101236. [PMID: 38301969 DOI: 10.1016/j.preteyeres.2024.101236] [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: 09/12/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.
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Affiliation(s)
- Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Suzanne Yzer
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA; Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Siegfried G Priglinger
- Department of Ophthalmology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Laurenz J B Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Clemens A K Lange
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Ocular Angiogenesis Group, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jay K Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York, USA; Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
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Huang YT, Tien PT, Chen PY, Yang CL, Chen SN. Comparative efficacy of brolucizumab, half-dose photodynamic therapy, and aflibercept in managing chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2024; 262:1755-1763. [PMID: 38224344 DOI: 10.1007/s00417-024-06373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/03/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024] Open
Abstract
PURPOSE To compare the efficacy of brolucizumab, half-dose PDT, and aflibercept in treating chronic central serous chorioretinopathy (CSC). METHODS A retrospective cohort study with chronic CSC patients who underwent intravitreal injection of one shot of brolucizumab or aflibercept in the first 3 months, followed by pro re nata regimens or a single session of half-dose PDT, was retrospectively reviewed. The primary outcome measure was the proportion of eyes that achieved complete absorption of retinal fluid without requiring any rescue treatment. Secondary outcomes included changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), and central choroidal thickness (CCT). RESULTS A total of 54 consecutive patients were included in this study with 18 patients in each group. At months 1 and 2, the brolucizumab group exhibited the highest rate of complete retinal fluid resolution (61% and 77%), followed by the half-dose PDT group (56% and 72%), and lowest in the aflibercept group (28% and 33%), with statistically significant differences noted at month 2 (P = 0.012). The brolucizumab group also demonstrated the most significant reduction in CCT at months 1 and 2 among the three groups (P = 0.007 and 0.001). Recurrence of retinal fluid in the brolucizumab groups was predominantly observed at month 3. Conversely, the half-dose PDT group exhibited the most favorable anatomical results starting from month 3. Notably, mild vitritis was observed in one case from the brolucizumab group. CONCLUSIONS Single injection of brolucizumab demonstrates trends of faster regression of persistent residual retinal fluid, greater CCT and CRT decline, and matched BCVA compared to half-dose PDT in the short term.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Po-Yu Chen
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan
| | - Chi-Lan Yang
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan.
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
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Park J, Hwang SH, Nam DH, Lee DY. Changes in Aqueous Concentrations of Various Cytokines after Intravitreal Bevacizumab Injection for Chronic Central Serous Chorioretinopathy. KOREAN JOURNAL OF OPHTHALMOLOGY 2023; 37:453-461. [PMID: 37899289 PMCID: PMC10721406 DOI: 10.3341/kjo.2023.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 10/31/2023] Open
Abstract
PURPOSE This study aimed to investigate changes in cytokine levels after intravitreal bevacizumab injection in patients with chronic central serous chorioretinopathy (CSC). METHODS In a prospective interventional trial, 12 eyes from 12 patients with chronic CSC and six eyes from six patients who underwent cataract surgery were included as controls. Patients diagnosed as with CSC received a single intravitreal injection of bevacizumab (1.25 mg/0.05 mL). Aqueous humor samples were collected from the patients and controls. Best-corrected visual acuity and foveal thickness were evaluated, and aqueous samples were obtained before and 4 weeks after injection. The aqueous concentrations of interleukin (IL)-6, IL-8, interferon-induced protein (IP)-10, monocyte chemotactic protein (MCP)-1, platelet-derived growth factor (PDGF)-AA, and vascular endothelial growth factor (VEGF) were measured using a multiplex bead assay. RESULTS After injection, the foveal thickness decreased significantly from 328.08 μm (range, 210-477 μm) to 283.91 μm (range, 168-356 μm; p = 0.048), but the best-corrected visual acuity was not significantly different (p = 0.066). The aqueous levels of IL-8 increased significantly from 3.3 pg/mL (range, 1.5-8.3 pg/mL) to 4.7 pg/mL (range, 2.2-11.6 pg/mL) at 4 weeks after the injection (p = 0.046). The aqueous levels of VEGF decreased significantly from 31.4 pg/mL (range, 17.0-53.3 pg/mL) to 15.2 pg/mL (range, 7.7-21.5 pg/mL; p < 0.01). No significant changes in levels of IL-6 (p = 0.455), IP-10 (p = 0.055), MCP-1 (p = 0.076), and PDGF-AA (p = 0.339) were noted 4 weeks after injection. CONCLUSIONS In this study we found intravitreal bevacizumab injection decreased VEGF and increased IL-8 in the eyes of patients with chronic CSC. This study suggests the possibility that the pathogenesis of CSC may be related to abnormal circulation of the choroidal blood vessels through VEGF and IL-8 cytokine level changes.
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Affiliation(s)
- Jooye Park
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung Ha Hwang
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Heun Nam
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
| | - Dae Yeong Lee
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
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Palakkamanil M, Munro M, Sethi A, Adatia F. Intravitreal anti-vascular endothelial growth factor for the treatment of chronic central serous retinopathy: a meta-analysis of the literature. BMJ Open Ophthalmol 2023; 8:e001310. [PMID: 37493660 PMCID: PMC10335579 DOI: 10.1136/bmjophth-2023-001310] [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: 04/17/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the role of anti-vascular endothelial growth factor (anti-VEGF) treatment on the functional and structural parameters of chronic central serous retinopathy (CSR). METHODS PubMed was used to systematically review literature published from 1 January 2009 to 1 July 2022. Studies were included if patients in their cohort had symptoms for more than 3 months, anti-VEGF treatment was provided and the following outcomes were reported: best-corrected visual acuity (BCVA), central macular thickness (CMT) and proportion of subretinal fluid (SRF) resolution. RESULTS 339 eyes met inclusion criteria with a mean patient age of 45.8±4.9 years. The weighted mean baseline BCVA for the 20 studies was 0.39±0.23 logMAR, which improved to 0.28±0.24 after treatment with anti-VEGF injections (p=0.069). The weighted baseline CMT for the 20 studies decreased from 395.2±52.0 µm to 243.0±41.9 µm (p<0.001). The weighted overall percentage of SRF resolution was 68.4%. CONCLUSION Anti-VEGF treatment demonstrated significantly decreased macular thickness and resolution of SRF in the treatment of chronic CSR without any reported adverse effects. However, BCVA did not significantly improve with pharmacotherapy.
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Affiliation(s)
- Mathew Palakkamanil
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Monique Munro
- Divsion of Ophthalmology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Abhishek Sethi
- Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois, USA
| | - Feisal Adatia
- Divsion of Ophthalmology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Park JB, Kim K, Kang MS, Kim ES, Yu SY. Central serous chorioretinopathy: Treatment. Taiwan J Ophthalmol 2022; 12:394-408. [PMID: 36660123 PMCID: PMC9843567 DOI: 10.4103/2211-5056.362040] [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: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
Central serous chorioretinopathy (CSC) is a pachychoroid spectrum disease characterized by serous detachment of the neurosensory retina with subretinal fluid in young and middle-aged adults. The pathogenesis of CSC is not yet fully understood. However, it is considered a multifactorial disease that is strongly associated with choroidal dysfunction or vascular engorgement. Although there is no consensus on the treatment of CSC, photodynamic therapy has been effectively used to manage serous retinal detachment (SRD) in CSC. Moreover, micropulse diode laser photocoagulation and focal laser treatment have also been used. Recently, oral medications, including mineralocorticoid receptor antagonists, have been proposed for the management of CSC. Multimodal imaging plays a significant role in the diagnosis and treatment of CSC. Optical coherence tomography angiography (OCTA) has the advantage of detecting vascular flow in the retina and choroid layer, allowing for a better understanding of the pathology, severity, prognosis, and chronicity of CSC. In addition, early detection of choroidal neovascularization in CSC is possible using OCTA. This review article aims to provide a comprehensive and updated understanding of CSC, focusing on treatment.
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Affiliation(s)
- Jong Beom Park
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Kiyoung Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Min Seok Kang
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Eung Suk Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea,Address for correspondence: Prof. Seung-Young Yu, Department of Ophthalmology, Kyung Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-Gu, Seoul 02447, Korea. E-mail:
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Xiang XL, Cao YH, Jiang TW, Huang ZR. Intravitreous injection of conbercept for bullous retinal detachment: A case report. World J Clin Cases 2022; 10:9510-9517. [PMID: 36159403 PMCID: PMC9477655 DOI: 10.12998/wjcc.v10.i26.9510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/25/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diffuse retinal pigment epitheliopathy (DRPE) associated with bullous retinal detachment is a severe variant of DRPE that is frequently misdiagnosed and often improperly treated.
CASE SUMMARY A 36-year-old female patient complained of "painless vision decline in the left eye with obscuration for 10 d". Slit-lamp microscopic fundus examination revealed white-yellow subretinal exudates in the posterior pole in both eyes, retinal detachment with shifting subretinal fluid in the left eye, and no retinal hiatus. Fundus fluorescein angiography revealed multiple subretinal leakage foci and localized hypofluorescent lesions with patched hyperfluorescence. There was fluorescence leakage in the retinal vessels in the retinal detachment area and occluded blood vessels in the lower and peripheral areas. Indocyanine green angiography revealed multifocal lamellar hyperfluorescence in the middle stage and low fluorescence in the retinal detachment area in the late stage. Retinal anatomical reduction significantly improved with intravitreal conbercept injections.
CONCLUSION Intravitreal injection of conbercept can anatomically reattach the retina in patients with bullous retinal detachment.
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Affiliation(s)
- Xiao-Li Xiang
- Department of Ophthalmology, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu 215500, Jiangsu Province, China
| | - Yi-Hong Cao
- Department of Ophthalmology, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu 215500, Jiangsu Province, China
| | - Ting-Wang Jiang
- Department of Key Laboratory, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu 215500, Jiangsu Province, China
| | - Zheng-Ru Huang
- Department of Ophthalmology, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu 215500, Jiangsu Province, China
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The Effect of Selective Retina Therapy with Automatic Real-Time Feedback-Controlled Dosimetry for Chronic Central Serous Chorioretinopathy: A Randomized, Open-Label, Controlled Clinical Trial. J Clin Med 2021; 10:jcm10194295. [PMID: 34640312 PMCID: PMC8509340 DOI: 10.3390/jcm10194295] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 01/15/2023] Open
Abstract
This prospective randomized controlled trial evaluated the safety and efficacy of real-time feedback-controlled dosimetry (RFD)-guided selective retina therapy (SRT) in chronic central serous chorioretinopathy (CSC). Forty-four participants with chronic CSC were included and randomly assigned to the control group or SRT group. The SRT laser system with RFD-guidance was applied to cover the entire leakage area. If SRF remained at the 6-week follow-up visit, re-treatment and rescue SRT was performed for the SRT group and crossover group, respectively. The rate of complete resolution of subretinal fluid (SRF), mean SRF height, and mean retinal sensitivity were compared between the two groups at 6-weeks post-treatment. The complete SRF resolution rate in all SRT-treated eyes was evaluated at 12-weeks post-treatment. The rate of complete SRF resolution was significantly higher in the SRT group (63.6%) than in the control group (23.8%) at 6-weeks post-treatment (p = 0.020). The mean SRF height at 6 weeks after SRT was significantly lower in the SRT group (p = 0.041). Overall, SRT-treated eyes showed complete SRF resolution in 70.3% of eyes at 12-weeks post-treatment. RFD-guided SRT was safe and effective to remove SRF in chronic CSC patients during the 3-month follow-up period.
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Park MS, Lee SJ. Comparison of Intravitreal Bevacizumab and Aflibercept Injections for Central Serous Chorioretinopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.7.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: We examined differences in the treatment effects of intravitreal bevacizumab injections and intravitreal aflibercept injections in patients with central serous chorioretinopathy. Methods: This retrospective analysis included 51 eyes of 49 patients who received intravitreal anti-vascular endothelial growth factor agent injections after initial diagnosis with central serous chorioretinopathy. The patients were divided into two groups: one received an intravitreal bevacizumab injection, and another one received an intravitreal aflibercept injection. Patients with no reaction to treatment or a worsened condition, received repeat treatment with the same therapy. After treatment, patients were monitored for >3 months. Data were collected regarding best- corrected visual acuity (BCVA), subfoveal choroidal thickness, injection number, and treatment duration. Results: Both intravitreal bevacizumab injections and intravitreal aflibercept injections led to significant differences in BCVA (p < 0.0001, p = 0.001) and subfoveal choroidal thickness (p < 0.0001, p = 0.011), compared between before and after treatment. However, no differences between groups were observed in mean change of BCVA or subfoveal choroidal thickness. In addition, there were no differences between groups in injection number and treatment duration. Conclusions: In patients with central serous chorioretinopathy, both intravitreal bevacizumab injections and intravitreal aflibercept injections are effective treatment methods. There were no differences between the two medicines in terms of functional and anatomical recovery, or the injection number and treatment duration.
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Mao JB, Zhang CY, Liu CY, Zhang Y, Lin JJ, Xu ZK, Chen YQ, Fan YY, Zhao SX, Shen LJ. Comprehensive evaluation of intravitreal conbercept versus half-dose photodynamic therapy for chronic central serous chorioretinopathy. Int J Ophthalmol 2021; 14:719-724. [PMID: 34012887 DOI: 10.18240/ijo.2021.05.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/23/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the safety and efficacy of conbercept intravitreal injection and half-dose photodynamic therapy (PDT) in treating chronic central serous chorioretinopathy (CSC). METHODS This study was retrospective. Thirty-seven patients (37 eyes) with chronic CSC received conbercept injections while 57 patients (57 eyes) were treated with half-dose PDT. All subjects were followed in 6mo. Outcome measures included change in best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and resolution of subretinal fluid (SRF). RESULTS There was no adverse event observed in either treatment group. At the 6-month follow-up, 26 eyes (70.3%) in the conbercept group and 54 eyes (94.7%) in the half-dose PDT group (P<0.05) reached full resolution of SRF. The mean logarithm of the minimum angle of resolution (logMAR) BCVA significantly improved (P<0.001) in both treatment groups with better outcome at early phase in the half-dose PDT group (2wk, 1, and 2mo, P<0.05). All subjects experienced significant CMT improvement (P<0.001) with no statistical difference between the two groups (P>0.05). The SFCT also improved in all subjects (P<0.001) with better outcome in the half-dose PDT group (P<0.05). CONCLUSION Both intravitreal conbercept and half-dose PDT are safe to use in treating chronic CSC. By 6mo, both treatment groups are efficacious in improving BCVA, reducing CMT and SFCT, and resolving SRF in eyes with chronic CSC. Half-dose PDT may show better outcome at initial phase of treatment in chronic CSC. Longer follow-up period is necessary to study for long-term effect and safety.
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Affiliation(s)
- Jian-Bo Mao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Cai-Yun Zhang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Chen-Yi Liu
- Chicago College of Optometry, Midwestern University, Downers Grove, IL 60515, USA
| | - Yun Zhang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Jing-Jing Lin
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Zhao-Kai Xu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Yi-Qi Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Yuan-Yuan Fan
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Shi-Xin Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Li-Jun Shen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
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Romano MR, Parolini B, Allegrini D, Michalewska Z, Adelman R, Bonovas S, Bopp S, Tekin K, Fiser I, Boon CJF, Dijk ECH, Donvito G, Güngel H, Özdoğan Erkul S, Ünsal E, Osmanbaşoğlu Ö, Dinçer N, Erçalık NY, Yenerel NM, Amar J, Ennemoser A, Besozzi G, Sallam AAB, Ellabban AA, Chang W, Eandi CM, Demir M, Lee J, Pak K, Arrevola L, Sloka A, Morawski K, Kulig ‐ Stochmal A, Romanowska ‐ Dixon B, Striebe N, Feltgen N, Hoerauf H, Inan UU, Tanev I, Dyrda A, Schüler A, Lucke K, Brix A, Pape S, Kusserow‐Napp C, Loo PA, Kanra AY, Ardagil Akçakaya A, Arı Yaylalı S, Bae SH, Kim HK, Kim SJ, Han JR, Nam WH, Odrobina D, Lavaque E, Bertelli E, Coser S, Ziemssen F, Forlini M, Benatti C, Cavallini GM, Stefanickova J, Berrod J, Saksonov S, Lytvinchuk L, Moussa M, Stefaniotou M, Christodoulou E, Zayed MA, Oz O, Tassinari P, Koch P, Declercq C, Johnston R, Rusnak S, Penas S, Ozdek S, Ucgul Y, Cisiecki S, Dziegielewski K, Klimczak D, Michalewska Z, Michalewski J, Nawrocka Z, Nawrocki J, Ornafel K, Pikulski Z, Maciej M, Acar N, Elshafei MM, Hamon F, Soyeur R, Badat I, Brousseau B, Hermouet E, Peiretti E, Lee J, Ferreira N, Yoon H, Alkhars WI, Dudani A, Minu R, Telang O, MorePatil VG, Furtado MJ, Jo Y, Piccolino FC, Finzi A. An international collaborative evaluation of central serous chorioretinopathy: different therapeutic approaches and review of literature. The European Vitreoretinal Society central serous chorioretinopathy study. Acta Ophthalmol 2020; 98:e549-e558. [PMID: 31808315 DOI: 10.1111/aos.14319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 11/02/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To study and compare the efficacy of different therapeutic options for the treatment of central serous chorioretinopathy (CSCR). METHODS This is a nonrandomized, international multicentre study on 1719 patients (1861 eyes) diagnosed with CSCR, from 63 centres (24 countries). Reported data included different methods of treatment and both results of diagnostic examinations [fluorescein angiography and/or optical coherent tomography (OCT)] and best-corrected visual acuity (BCVA) before and after therapy. The duration of observation had a mean of 11 months but was extended in a minority of cases up to 7 years. The aim of this study is to evaluate the efficacy of the different therapeutic options of CSCR in terms of both visual (BCVA) and anatomic (OCT) improvement. RESULTS One thousand seven hundred nineteen patients (1861 eyes) diagnosed with CSCR were included. Treatments performed were nonsteroidal anti-inflammatory eye drops, laser photocoagulation, micropulse diode laser photocoagulation, photodynamic therapy (PDT; Standard PDT, Reduced-dose PDT, Reduced-fluence PDT), intravitreal (IVT) antivascular endothelial growth factor injection (VEGF), observation and other treatments. The list of the OTHERS included both combinations of the main proposed treatments or a variety of other treatments such as eplerenone, spironolactone, acetazolamide, beta-blockers, anti-anxiety drugs, aspirin, folic acid, methotrexate, statins, vitis vinifera extract medication and pars plana vitrectomy. The majority of the patients were men with a prevalence of 77%. The odds ratio (OR) showed a partial or complete resolution of fluid on OCT with any treatment as compared with observation. In univariate analysis, the anatomical result (improvement in subretinal fluid using OCT at 1 month) was favoured by age <60 years (p < 0.005), no previous observation (p < 0.0002), duration less than 3 months (p < 0.0001), absence of CSCR in the fellow eye (p = 0.04), leakage outside of the arcade (p = 0.05) and fluid height >500 μm (p = 0.03). The OR for obtaining partial or complete resolution showed that anti-VEGF and eyedrops were not statistically significant; whereas PDT (8.5), thermal laser (11.3) and micropulse laser (8.9) lead to better anatomical results with less variability. In univariate analysis, the functional result at 1 month was favoured by first episode (p = 0.04), height of subretinal fluid >500 μm (p < 0.0001) and short duration of observation (p = 0.02). Finally, there was no statistically significant difference among the treatments at 12 months. CONCLUSION Spontaneous resolution has been described in a high percentage of patients. Laser (micropulse and thermal) and PDT seem to lead to significant early anatomical improvement; however, there is little change beyond the first month of treatment. The real visual benefit needs further clarification.
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Affiliation(s)
- Mario R Romano
- Department of Ophthalmology, Gavazzeni - Castelli Hospital, Humanitas University, Rozzano, Italy
| | - Barbara Parolini
- Department of Ophthalmology, Istituto Clinico S. Anna, Brescia, Italy
| | - Davide Allegrini
- Department of Ophthalmology, Gavazzeni - Castelli Hospital, Humanitas University, Rozzano, Italy
| | | | - Ron Adelman
- Department of Ophthalmology, Yale University, New Haven, Connecticut, USA
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Silvia Bopp
- Department of Ophthalmology & Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
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Dağ U, Çağlayan M, Öncül H, Alakuş MF. Central serous chorioretinopathy associated with high-dose follistatin-344: a retrospective case series. Int Ophthalmol 2020; 40:3155-3161. [PMID: 32671599 DOI: 10.1007/s10792-020-01501-6] [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: 01/24/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To present 11 bodybuilding athletes who developed central serous chorioretinopathy (CSCR) following high-dose subcutaneous follistatin-344, a peptide-based performance and image enhancing drug, injections to increase muscle mass. METHODS This is a retrospective case series from one institution. Demographic and clinical data of 11 patients who were admitted to our clinic with decreased visual acuity after high-dose follistatin-344 injections and optical coherence tomography (OCT) findings consistent with CSCR were analyzed. RESULTS All 11 patients were male, and the mean age was 36.8 ± 8.1 years. All patients had a history of injecting complete 1 mg vials of follistatin-344 subcutaneously in the abdomen. There was a history of a single previous high-dose follistatin-344 injection in eight patients and multiple previous injections in three patients. At the time of diagnosis, ten patients had unilateral CSCR findings and one had bilateral CSCR findings. In all eight patients with a history of only one injection, subretinal fluid completely disappeared after an average of 2.3 ± 0.7 months and symptoms regressed. Recurrent CSCR developed in three patients with a history of multiple follistatin-344 injections. CONCLUSION Follistatin-344 injection can be considered as a risk factor for CSCR. To take medical history from CSCR patients including follistatin-344 use may be important to reveal the CSCR etiology.
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Affiliation(s)
- Umut Dağ
- Department of Ophthalmology, University of Health Sciences, Diyarbakir Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| | - Mehtap Çağlayan
- Department of Ophthalmology, University of Health Sciences, Diyarbakir Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey.
| | - Hasan Öncül
- Department of Ophthalmology, University of Health Sciences, Diyarbakir Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| | - Mehmet Fuat Alakuş
- Department of Ophthalmology, University of Health Sciences, Diyarbakir Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
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Chung YR, Kim JW, Song JH, Park A, Kim MH. TWELVE-MONTH EFFICACY OF INTRAVITREAL BEVACIZUMAB INJECTION FOR CHRONIC, ATYPICAL, OR RECURRENT CENTRAL SEROUS CHORIORETINOPATHY. Retina 2020; 39:134-142. [PMID: 29077604 DOI: 10.1097/iae.0000000000001917] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate intravitreal bevacizumab (IVB) injection efficacy for the treatment of chronic, atypical, or recurrent central serous chorioretinopathy (CSC). METHODS Clinical data from 77 eyes of 71 patients with chronic, atypical, or recurrent CSC treated with IVB were retrospectively analyzed. After initial 6-weekly IVB administration until no subretinal fluid remained at the fovea, additional as-needed IVBs were administered, based on optical coherence tomography findings. Best-corrected visual acuity and central retinal thickness (CRT) were analyzed at baseline and 3, 6, 9, and 12 months after initial IVB. RESULTS The significant improvement of baseline logarithm of minimum angle of resolution best-corrected visual acuity and CRT at 3 months (both P < 0.001) was maintained throughout the 12-month follow-up period. Best-corrected visual acuity improved significantly in patients with chronic and recurrent CSC, at all time points (all P < 0.05), but not in patients with atypical CSC. The CRT reduction was significant in all subgroups during the follow-up period (all P < 0.05). Definite leakage on initial fluorescein angiography correlated with improved reduction in CRT (P = 0.039). CONCLUSION As-needed optical coherence tomography-based IVB was effective for reducing CRT in patients with chronic, atypical, or recurrent CSC, and for vision improvement in chronic and recurrent CSC over the 1-year follow-up period.
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Affiliation(s)
- Yoo-Ri Chung
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jong Wan Kim
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ji Hun Song
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Aram Park
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Min Ho Kim
- Department of Ophthalmology, Armed Forces Capital Hospital, Seongnam, Republic of Korea
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van Rijssen TJ, van Dijk EHC, Yzer S, Ohno-Matsui K, Keunen JEE, Schlingemann RO, Sivaprasad S, Querques G, Downes SM, Fauser S, Hoyng CB, Piccolino FC, Chhablani JK, Lai TYY, Lotery AJ, Larsen M, Holz FG, Freund KB, Yannuzzi LA, Boon CJF. Central serous chorioretinopathy: Towards an evidence-based treatment guideline. Prog Retin Eye Res 2019; 73:100770. [PMID: 31319157 DOI: 10.1016/j.preteyeres.2019.07.003] [Citation(s) in RCA: 272] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 12/17/2022]
Abstract
Central serous chorioretinopathy (CSC) is a common cause of central vision loss, primarily affecting men 20-60 years of age. To date, no consensus has been reached regarding the classification of CSC, and a wide variety of interventions have been proposed, reflecting the controversy associated with treating this disease. The recent publication of appropriately powered randomised controlled trials such as the PLACE trial, as well as large retrospective, non-randomised treatment studies regarding the treatment of CSC suggest the feasibility of a more evidence-based approach when considering treatment options. The aim of this review is to provide a comprehensive overview of the current rationale and evidence with respect to the variety of interventions available for treating CSC, including pharmacology, laser treatment, and photodynamic therapy. In addition, we describe the complexity of CSC, the challenges associated with treating CSC, and currently ongoing studies. Many treatment strategies such as photodynamic therapy using verteporfin, oral mineralocorticoid antagonists, and micropulse laser treatment have been reported as being effective. Currently, however, the available evidence suggests that half-dose (or half-fluence) photodynamic therapy should be the treatment of choice in chronic CSC, whereas observation may be the preferred approach in acute CSC. Nevertheless, exceptions can be considered based upon patient-specific characteristics.
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Affiliation(s)
- Thomas J van Rijssen
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Suzanne Yzer
- Department of Ophthalmology, Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Graduate School, Tokyo, Japan
| | - Jan E E Keunen
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre 162, London, United Kingdom
| | - Giuseppe Querques
- 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, West Wing, Oxford, United Kingdom
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Jay K Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, India
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong; 2010 Retina & Macula Centre, Tsim Sha Tsui, Kowloon, Hong Kong
| | - Andrew J Lotery
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands.
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Alishiri A, Jadidi K, Mosavi SA, Torabi H. Intravitreal bevacizumab administration for the treatment of chronic central serous chorioretinopathy. J Curr Ophthalmol 2019; 31:406-410. [PMID: 31844791 PMCID: PMC6896463 DOI: 10.1016/j.joco.2019.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 06/08/2019] [Accepted: 06/29/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose To evaluate the effects of intravitreal bevacizumab (IVB) injection on chronic central serous chorioretinopathy (CSC). Methods In this prospective interventional case series, a total of 22 eyes of 22 patients, diagnosed with unresolved CSC for three months or longer, received 1.25 mg IVB injection. Also, in case of failure to achieve success parameters, double dose IVB injections continued in order to reach the complete subretinal fluid (SRF) absorption. A complete ophthalmic assessment was carried out one day, one week, and one-month post-injection, and then a monthly visit was performed, and re-injection was done if needed. Visual acuity, subretinal space volume (SSV), central macular thickness (CMT), and contrast sensitivity were measured and compared among baseline values and final post-treatment values. Results The mean best corrected visual acuity increased significantly from 0.70 ± 0.22 to 0.17 ± 0.15 logMAR (P <0.001), and the CMT showed a significant reduction from 557.36 ± 129.12 to 259.50 ± 116.73 μm (P <0.001 ). In addition, SSV decreased significantly from 10.53 ± 2.03 to 6.63 ± 1.80 (P = 0.001), and contrast sensitivity improved significantly from 13.8182 ± 2.64820 dB to 17.6818 ± 1.80967 dB (P <0.001). Conclusion In this series, SRF absorption occurred and visual acuity improved after IVB injections, however, further comparative studies are needed to show the effect of IVB in chronic CSC.
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Affiliation(s)
- Aliagha Alishiri
- Department of Ophthalmology, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Khosrow Jadidi
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Vision Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Hamidreza Torabi
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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The Efficacy of Intravitreal Conbercept for Chronic Central Serous Chorioretinopathy. J Ophthalmol 2019; 2019:7409426. [PMID: 31205784 PMCID: PMC6530212 DOI: 10.1155/2019/7409426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/10/2019] [Accepted: 04/25/2019] [Indexed: 02/02/2023] Open
Abstract
Purpose To evaluate the efficacy and safety of conbercept for patients with chronic central serous chorioretinopathy (CSC). Methods A retrospective clinical study. Thirty-one patients (35 eyes) with chronic CSC were given intravitreal injections of conbercept and followed up for at least 6 months. Observed indicators included best-corrected visual acuity (BCVA), central macular thickness (CMT), and resolution of subretinal fluid (SRF). Serial changes in BCVA and CMT were analyzed by using repeated measures analysis of variance. Results During the 6-month follow-up, the mean number of injections required and performed was 1.77 ± 0.60. The logMAR BCVA was 0.48 ± 0.26 at the baseline, 0.34 ± 0.26, 0.30 ± 0.26, 0.27 ± 0.26, 0.24 ± 0.26, and 0.23 ± 0.26 at 2-week and 1-, 2-, 3-, and 6-month follow-ups, respectively (F = 27.173, P < 0.05). CMT was 313.74 ± 144.51 μm at the baseline and decreased to 263.49 ± 120.44 μm, 225.91 ± 91.98 μm, 195.77 ± 66.69 μm, 189.74 ± 65.41 μm, and 199.49 ± 81.50 μm at 2-week and 1-, 2-, 3-, and 6-month follow-ups, respectively (F = 18.093, P < 0.05). Full resolution of SRF was achieved in 8 (22.9%) eyes at 1 month, 16 (45.7%) eyes at 2 months, 22 (62.9%) eyes at 3 months, and 27 (77.1%) eyes at 6 months after the initial treatment of anti-VEGF injection. No severe adverse event was noted relevant to the therapy. Conclusions Intravitreal injection of conbercept may effectively reduce the CMT and improve the BCVA in chronic CSC in a short term of 6 months.
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Kim YJ, Lee YG, Lee DW, Kim JH. Selective Retina Therapy with Real-Time Feedback-Controlled Dosimetry for Treating Acute Idiopathic Central Serous Chorioretinopathy in Korean Patients. J Ophthalmol 2018; 2018:6027871. [PMID: 29545953 PMCID: PMC5818953 DOI: 10.1155/2018/6027871] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/24/2017] [Accepted: 01/16/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate short-term treatment outcomes following selective retina therapy (SRT) with real-time feedback-controlled dosimetry in Korean patients with acute idiopathic central serous chorioretinopathy (CSC). METHODS Sixteen eyes (16 patients) with acute idiopathic CSC (symptom duration < 3 months) were included in this retrospective study. All patients underwent a single session of SRT with real-time feedback-controlled dosimetry. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) before and 3 months after treatment were examined and compared. RESULTS The logarithm of minimal angle of resolution BCVA was significantly better 3 months after treatment (0.16 ± 0.18) than at the time of diagnosis (0.27 ± 0.18, P = 0.002). Additionally, subretinal fluid had resolved in all 16 eyes 3 months after treatment and CFT was significantly lower 3 months after treatment (215.6 ± 17.9 μm) than at baseline (441.4 ± 124.8 μm, P < 0.001). No notable SRT-related complications were observed during the study period. CONCLUSION The results of the present study suggest that SRT is a useful therapeutic option for patients with acute idiopathic CSC. Further studies are required to better understand the long-term efficacy of this treatment. This trial is registered with clinical trial registration number NCT03339856.
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Affiliation(s)
- Ye Ji Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Republic of Korea
| | - Youn Gon Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Republic of Korea
| | - Dong Won Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Republic of Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Republic of Korea
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Akhlaghi MR, Nasrollahi C, Namgar SM, Kianersi F, Dehghani AR, Arefpour R. Effect of Intravitreal Injection of Bevacizumab on Acute Central Serous Chorioretinopathy Patients Who Visited Feiz Hospital during 2014-2015 Period. Adv Biomed Res 2017; 6:125. [PMID: 29142888 PMCID: PMC5672646 DOI: 10.4103/abr.abr_193_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Aim of this clinical trial is the evaluation of the effect of intravitreal injection of bevacizumab on acute central serous chorioretinopathy (CSC). Materials and Methods: In a nonrandomized clinical trial, 36 CSC eyes (with <1-month disease history) were examined. Initially, all the patients underwent posterior and anterior segment examinations as well as complete eye examination to evaluate the best spectacle-corrected visual acuity (BSCVA). Then, optical coherence tomography was performed to confirm the diagnosis. The patients were divided to the two groups each of 18 subjects, which 18 patients received intravitreal injection of bevacizumab (1.25 mg) and the rest of them did not receive any treatment (control group). The patients were health checked by the end of the 1st and 3rd months. Significance level was considered as P < 0.05. Results: In the BSCVA, no significant difference in visual improvement was observed in baseline vision compared to each other (P = 0.481). There was also no significant difference in the vision of intervention and control groups 1 and 3 months after injection (P = 0.379 and P = 0.557). A significant decrement existed in the intervention group compared with the control group in the maximum central macular thickness at 1 month after injection (P = 0.001); however, the difference was not significant when comparing the two groups at baseline and 3 months after injection (P = 0.925 and P = 0.338). Conclusion: In general, according to the results of this study, intravitreal injection of bevacizumab was not effective in improvement of patients with acute CSC, although it had no side effects.
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Affiliation(s)
| | - Cobra Nasrollahi
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Mohamad Namgar
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzan Kianersi
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Reza Dehghani
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Arefpour
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Exudative retinal detachment. Surv Ophthalmol 2017; 62:723-769. [DOI: 10.1016/j.survophthal.2017.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 12/11/2022]
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Tekin K, Sekeroglu MA, Cankaya AB, Teke MY, Doguizi S, Yilmazbas P. Intravitreal Bevacizumab and Ranibizumab in the Treatment of Acute Central Serous Chorioretihopathy: A Single Center Retrospective Study. Semin Ophthalmol 2016; 33:265-270. [PMID: 27841949 DOI: 10.1080/08820538.2016.1228985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate and compare the anatomical and functional outcomes of patients with acute central serous chorioretinopathy (CSC) who did not receive any intervention or treatment with intravitreal bevacizumab or ranibizumab. METHODS A single-center retrospective comparative study. Seventy eyes of 70 patients were recruited for the study; 27 patients were only observed without any medication or intervention (observation group), 23 were treated with intravitreal bevacizumab (IVB group), and the remaining 20 were treated with intavitreal ranibizumab (IVR group). The best-corrected visual acuity (BCVA) and central macular thickness (CMT) obtained by spectral-domain optical coherence tomography were compared between the groups. RESULTS There were no significant differences between the groups with regard to age, sex, and follow-up periods (p>0.05). The mean time from baseline to initial complete resolution of subretinal fluid was 3.52±1.64 months in the observation group, 1.19±0.60 months in the IVB group, and 1.11±0.47 months in the IVR group; the resolution time was significantly longer in the observation group (p<0.001). While the CMT was significantly thicker in the observation group when compared to the IVB and IVR groups in the first month (p=0.001), it was similar between the groups in the third, sixth, and twelfth months (p>0.05). Additionally, pairwise comparisons of the IVB and IVR groups revealed that there were no significant differences between these groups regarding CMT at any follow-up time (p>0.05). CONCLUSIONS Compared with observation alone, neither IVB nor IVR had a positive effect in terms of anatomical and functional outcomes for acute CSC. Although the resolution time of SRF is shorter by using ranibizumab, both the ranibizumab and bevacizumab could be effective in achieving rapid resolution of serous detachment in patients with acute CSC.
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Affiliation(s)
- Kemal Tekin
- a Ankara Ulucanlar Eye Training and Research Hospital , Ankara , Turkey
| | | | | | - Mehmet Yasin Teke
- a Ankara Ulucanlar Eye Training and Research Hospital , Ankara , Turkey
| | - Sibel Doguizi
- a Ankara Ulucanlar Eye Training and Research Hospital , Ankara , Turkey
| | - Pelin Yilmazbas
- a Ankara Ulucanlar Eye Training and Research Hospital , Ankara , Turkey
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Shin KH, Kim JH, Cho SW, Lee TG, Kim CG, Kim JW. Efficacy of Intravitreal Bevacizumab for Recurrent Central Serous Chorioretinopathy in Patients Who Had Previously Responded Well to the Same Therapy. J Ocul Pharmacol Ther 2016; 32:425-30. [PMID: 27404289 DOI: 10.1089/jop.2015.0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To investigate the efficacy of intravitreal bevacizumab therapy in the treatment of recurrent central serous chorioretinopathy (CSC) that had previously resolved after intravitreal bevacizumab administration. METHODS This retrospective, observational study included 24 eyes from 24 patients with recurrent CSC who had previously responded to intravitreal bevacizumab. Patients were classified into the responder group when resolution of serous retinal detachment was noted within 3 months after intravitreal bevacizumab (1.25 mg/0.05 mL) administration; the remaining patients were classified into the non-responder group. Patient characteristics were compared between the 2 groups. RESULTS Ten eyes (42%) were included in the responder group, and 14 eyes (58%) were included in the non-responder group. Patients in the responder group were significantly older (mean age, 47.0 ± 4.5 years) than those in the non-responder group (mean age, 40.9 ± 5.5 years; P = 0.023). The visual acuity of the patients in the responder group was significantly worse than that of the patients in the non-responder group at the time of the first (mean 0.25 ± 0.15 vs. 0.13 ± 0.15) and second episodes (0.24 ± 0.14 vs. 0.14 ± 0.18; P = 0.040 and P = 0.021 for the first and second episodes, respectively). CONCLUSIONS Repeated intravitreal bevacizumab can be considered a useful treatment option for relatively older patients with CSC who previously responded well to the same therapy. The results of the present study also suggest that a vascular endothelial growth factor-dependent pathologic process may be involved in CSC in older subjects.
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Affiliation(s)
- Kyung-Hoon Shin
- Department of Ophthalmology, Konyang University College of Medicine, Kim's Eye Hospital , Seoul, South Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Konyang University College of Medicine, Kim's Eye Hospital , Seoul, South Korea
| | - Sung Won Cho
- Department of Ophthalmology, Konyang University College of Medicine, Kim's Eye Hospital , Seoul, South Korea
| | - Tae Gon Lee
- Department of Ophthalmology, Konyang University College of Medicine, Kim's Eye Hospital , Seoul, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Konyang University College of Medicine, Kim's Eye Hospital , Seoul, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Konyang University College of Medicine, Kim's Eye Hospital , Seoul, South Korea
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Kang S, Park YG, Kim JR, Seifert E, Theisen-Kunde D, Brinkmann R, Roh YJ. Selective Retina Therapy in Patients With Chronic Central Serous Chorioretinopathy: A Pilot Study. Medicine (Baltimore) 2016; 95:e2524. [PMID: 26817895 PMCID: PMC4998269 DOI: 10.1097/md.0000000000002524] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We evaluated visual outcomes, changes of maximum macular thickness (MMT) and subretinal fluid (SRF), and safety in patients with chronic central serous chorioretinopathy (CSC) after treatment with selective retina therapy (SRT). Retrospective cohort study of patients with chronic CSC presenting to a university-based hospital from January 2014 through January 2015 was conducted. A total of 12 eyes of 12 patients with chronic CSC lasting for at least 3 months was recruited. The follow-up period ranged from 3 to 12 months. Following evaluation of test spots at temporal arcades, SRT (Q-switched neodymium-doped yttrium lithium fluoride [Nd:YLF] laser; wavelength, 527 nm, pulse duration, 1.7 microsececond) was applied to the surrounding areas of leakage observed on fluorescein angiogram and/or pigment epithelial detachment (PED). Changes in best-correct visual acuity (BCVA), MMT, and SRF and macular sensitivity (MS) by microperimetry (MP) were evaluated. Eyes received treatment in a mean of 3.83 spots at the pulse energy of 65 to 90 μJ. Mean BCVA (logMAR) improved from 0.23 ± 0.12 at baseline to 0.14 ± 0.13 at 3 months. MMT decreased from 341.4 ± 85.5 μm at baseline to 236.0 ± 57.9 μm at 3 months. SRF completely resolved in 75% (9 eyes) at 3 months. Large PEDs (2 eyes) were flattened at 3 months. Retreatment was performed in 4 eyes. MP showed no evidence of scotoma around SRT-treated lesions. SRT treatment targeting the surrounding area of leakage point showed favorable visual and structural outcomes in chronic CSC patients without the risk of scotoma.
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Affiliation(s)
- Seungbum Kang
- From the Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (SK, YGP, JRK, YJR); Clinical Research Institute, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea (SK); and Medical Laser Center Lübeck GmbH, Lübeck, Germany (ES, DT-K, RB)
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Photodynamic therapy and anti-vascular endothelial growth factor for acute central serous chorioretinopathy: a systematic review and meta-analysis. Eye (Lond) 2015; 30:15-22. [PMID: 26514243 DOI: 10.1038/eye.2015.208] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/03/2015] [Indexed: 11/08/2022] Open
Abstract
This systematic review aims to update current evidence on the efficacy and safety of photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF) injections for acute central serous chorioretinopathy (CSC). A comprehensive literature search was conducted in PubMed, EMBASE, and Cochrane Library. Studies comparing (1) PDT versus placebo, (2) anti-VEGF versus placebo, and (3) PDT versus anti-VEGF were included and meta-analyzes were performed when appropriate. Ocular and systemic adverse effects were also summarized. Literature search yielded six comparative studies, among which five were included for this review. Meta-analysis with three studies indicated that eyes treated with PDT achieved better best-corrected visual acuity (BCVA) and central macular thickness (CMT) than the placebo group throughout a follow-up of 12 months. Meta-analysis with another two studies comparing anti-VEGF injections and placebo showed that BCVA at first month was better in anti-VEGF group than in placebo group, though the differences of BCVA and CMT no longer existed at 3 and 6 months after injection. There was no report directly comparing PDT and anti-VEGF for acute CSC. No severe complications was reported in included studies. In this review, current evidence suggested that early treatment of acute CSC by PDT is valuable in improving visual acuity, reducing subretinal fluid, and maintaining long term effectiveness. Anti-VEGF injection could shorten the duration of symptoms and accelerate visual improvement at early stage of disease. Direct comparison between these two treatment will be needed in the future.
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Abrishami M, Mousavi M, Hosseini SM, Norouzpour A. Treatment of Chronic Central Serous Chorioretinopathy with Oral Methotrexate. J Ocul Pharmacol Ther 2015; 31:468-75. [DOI: 10.1089/jop.2014.0173] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Majid Abrishami
- Retina Research Center, Khatam-Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - MirNaghi Mousavi
- Retina Research Center, Khatam-Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh-Maryam Hosseini
- Retina Research Center, Khatam-Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Norouzpour
- Retina Research Center, Khatam-Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Clinical characteristics of responders to intravitreal bevacizumab in central serous chorioretinopathy patients. Eye (Lond) 2015; 29:732-40; quiz 741. [PMID: 25952951 DOI: 10.1038/eye.2015.58] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 02/12/2015] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To investigate factors associated with good response to intravitreal bevacizumab (IVB) in central serous chorioretinopathy (CSC) patients. METHODS We retrospectively reviewed 42 eyes of CSC patients of symptom duration more than 3 months who received a single or multiple successive IVBs on an as-needed basis (0.05 ml, 1.25 mg). High responders (HRs) were defined as complete resolution of subretinal fluid (SRF) on spectral domain optical coherence tomography (SD-OCT). Moderate responders (MRs) were defined as SRF resolution of 50-99% of pretreatment volume and poor responders (PRs) as SRF resolution <50%. Clinical, SD-OCT, fluorescein, and indocyanine green angiography findings were analyzed to find factors associated with HR. Descriptive statistics for all demographic and clinical variables were calculated, and comparisons were made using Wilcoxon's matched-pairs signed-rank test, the Mann-Whitney U-test for means with continuous data, Pearson's χ(2) test, and Fisher's exact test for categorical data. RESULTS The mean number of IVB was 1.9. At postoperative 1 month, there were 10 (24%) HRs, 18 (43%) MRs, and 14 (33%) PRs. At the last follow-up (the mean 8.6 months), there were 25 HRs (60%), 9 MRs (21%), and 8 PRs (19%). Thicker subfoveal choroid (P=0.036), smaller lesion diameter (P=0.019), and better baseline best-corrected visual acuity (P=0.002) predicted HRs at postoperative 1 month. HR at the last follow-up was associated with classic pattern fluorescein angiography finding. CONCLUSIONS Suboptimal effects of IVB on persistent CSC suggest primary IVB on selective cases with better vision, smaller lesion, and thicker choroid at baseline.
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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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Kim JA, Shin JY, Bae SH, Ahn JY, Chung H, Heo JW. Comparison of Choroidal Hyperpermeability Change after Photodynamic Therapy and Ranibizumab for Chronic Central Serous Chorioretinopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.2.205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jeong Ah Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Young Shin
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - So Hyun Bae
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jee Yun Ahn
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hum Chung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jang Won Heo
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Okamoto M, Matsuura T, Ogata N. Choroidal Thickness and Choroidal Blood Flow After Intravitreal Bevacizumab Injection in Eyes With Central Serous Chorioretinopathy. Ophthalmic Surg Lasers Imaging Retina 2015; 46:25-32. [DOI: 10.3928/23258160-20150101-04] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/19/2014] [Indexed: 11/20/2022]
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Pneumatic displacement with perfluoropropane gas and intravitreal tissue plasminogen activator for subretinal subfoveal hemorrhage after focal laser photocoagulation in central serous chorioretinopathy. Case Rep Ophthalmol Med 2014; 2014:592746. [PMID: 25485161 PMCID: PMC4251634 DOI: 10.1155/2014/592746] [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: 07/26/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022] Open
Abstract
Objective. To report the visual and anatomic outcomes of pneumatic displacement with perfluoropropane (C3F8) gas and intravitreal tissue plasminogen activator (IVTPA) for subretinal subfoveal hemorrhage after focal laser photocoagulation in central serous chorioretinopathy (CSCR). Method. Interventional, retrospective case report of one eye (one patient). Outcome measures included visual acuity (VA), central macular thickness (CMT), and size of the lesion at two weeks of followup. Fluorescein angiography (FA) and optical coherent tomography (OCT) were used to measure anatomic outcomes. Results. A 35-year-old man with history of chronic CSCR received focal laser photocoagulation in the right eye two days before presentation. At initial examination, VA was 20/200 (ETDRS chart), CMT was 398 μ, and a subretinal subfoveal hemorrhage was seen. Tissue plasminogen activator (tPA) at a dose of 25 µg/0.1 mL was injected intravitreally before intravitreal C3F8 injection, and prone positioning was indicated postoperatively. At 24 hours, the hemorrhage had been displaced inferiorly and VA improved to 20/100. Two weeks later, VA improved to 20/80, CMT decreased to 225 μ, and the hemorrhage decreased without foveal involvement. Conclusions. The technique seems safe and effective in treating visually significant subretinal subfoveal hemorrhage.
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Schaap-Fogler M, Ehrlich R. What is new in central serous chorioretinopathy? World J Ophthalmol 2014; 4:113-123. [DOI: 10.5318/wjo.v4.i4.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/05/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Central serous chorioretinopathy (CSCR) is considered a benign, self-limiting disease. However, as many as third of the patients have recurrent episodes or chronic disease that may cause significant functional impairment. New diagnostic tools and new treatment modalities are emerging in order to improve the functional outcomes of these patients. Spectral domain optical coherence tomography (SD-OCT) has the ability to image individual layers of the retina and choroid. SD-OCT images in CSCR patients have demonstrated increased subfoveal thickness measurements, high reflective deposits in areas of subretinal precipitates and changes in the Retinal pigment epithelium layers of the asymptomatic eyes of patients with supposedly unilateral CSCR. A positive correlation was found between the level of distribution to the layer of inner segment/outer segment junction of the photoreceptors and the visual impairment. Fundus autoflouresence images show a wide variety during different stages of the disease in CSCR patients. Minimal abnormalities during the early stages are followed by hyperautofluoresence in the detached area in later stages, often in a manner of inferior gravitation and at the borders of the detachments. The chronic phase is characterized by varying degrees of atrophy and areas of decreased autofluorescence surrounding areas of chronic leaks. These changes help differentiate an active disease from an inactive state. Multifocal electroretinography (mfERG) has the ability to demonstrate a persistent depression despite the resolution of subretinal detachments. It is therefore being investigated as a follow up tool for patients with chronic CSCR. An excellent correlation was found between changes in mfERG and visual function. Macular microperimetry, measuring retinal sensitivity within the central visual field, is intended to compensate for the underestimation of visual impairment in patients with macular diseases. Reduced retinal sensitivity was found in areas of previous subretinal fluids in CSCR patients. The device can also serve as a follow up tool in these patients. Regarding treatment in CSCR patients, focal argon laser photocoagulation treatment may be applied to small extrafoveal leaks. However, the main purpose of this treatment is to shorten disease duration, with no advantage over observation regarding final visual outcome, rate of progression to chronic CSCR or number of recurrences. Photodynamic therapy (PDT) with verteporfin has been shown to completely resolve serous detachment in 60%-80% of patients and to have a partial affect in the remaining patients. Reduced-fluence treatment is replacing full-fluence therapy in order to minimize side effects with no accompanying reduced effectiveness. Visual acuity is also improved following reduced-fluence PDT compared to placebo. It has also been found that patients with intense hyperfluorescence are more likely to show resolution of accumulating fluid compared to patients with mild or no leakage observed on indocyanine-green angiography prior to treatment. Regarding newer treatment modalities, intravitreal injections of anti-vascular endothelial growth factor agents have a limited effect in patients with CSCR. Recent reports have not demonstrated an advantage for this treatment in regards to anatomic and functional outcome. Micropulse diode laser was not proven to be safer or more effective than argon laser or PDT. Corticosteroid antagonists, not tested in controlled trials, may have a beneficial effect in patients with CSCR. Aspirin may also play a role in treating these patients, with rapid recovery of visual acuity and reduced number of recurrences observed. In conclusion, imaging is evolving rapidly while the clinical implications of these new imaging modalities are less clear. Large randomized trials investigating different treatment modalities are still lacking.
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Altun A, Kurna SA, Olcaysu OO, Sengor T, Aki SF, Atakan TG. Success of ranibizumab in central serous chorioretinopathy resistant to bevacizumab. J Ocul Pharmacol Ther 2014; 30:842-6. [PMID: 25216333 DOI: 10.1089/jop.2014.0043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To present effectiveness of intravitreal ranibizumab (IVR) injection for central serous chorioretinopathy (CSC), resistant to intravitreal bevacizumab (IVB) injection. METHODS Files of the patients who had the diagnosis of CSC between 2005 and 2013 were reviewed retrospectively. Eighty-five eyes of 81 patients' files have been investigated. Ten eyes of 10 patients that were resistant to IVB, with no history of photodynamic therapy, were included in to this study. Demographic details, best-corrected visual acuity (BCVA), and central macular thickness (CMT) were studied to analyze the effectiveness of IVR. RESULTS The mean age of the patients was 38.8 years (SD=4.7 years). The mean follow-up time after first IVR injection was 7.9 months (SD=1.5 months). The mean number of IVB and IVR injections was 2.0 (SD=0.7) and 1.3 (SD=0.4), respectively. The mean CMT before IVR injection was 392.4 μm (SD=66.3) and decreased to 194.1 μm (SD=9.3, P<0.001) at the last visit. The mean BCVA before IVR injection was 0.50 logMAR (SD=0.23) and improved to 0.05 logMAR (SD=0.06, P<0.001) at the last visit. In all cases after IVR injection, the subretinal fluid almost resolved completely, and leakage disappeared in fundus fluorescein angiography. CONCLUSION Ranibizumab might be a promising option for the patients with CSC, resistant to bevacizumab in acute or early chronic stage.
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Affiliation(s)
- Ahmet Altun
- 1 Fatih Sultan Mehmet Education and Research Hospital , Clinic of Ophthalmology, Istanbul, Turkey
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Park SU, Lee SJ, Kim M. Intravitreal anti-vascular endothelial growth factor versus observation in acute central serous chorioretinopathy: one-year results. KOREAN JOURNAL OF OPHTHALMOLOGY 2014; 28:306-13. [PMID: 25120339 PMCID: PMC4120351 DOI: 10.3341/kjo.2014.28.4.306] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 11/29/2013] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy of anti-vascular endothelial growth factor (VEGF) compared with observation for treating acute central serous chorioretinopathy (CSC). Methods A retrospective study of 36 patients with acute CSC, including 21 patients treated with anti-VEGF (anti-VEGF group) and 15 patients with observation (observation group). Patients in the anti-VEGF group received a single dose of bevacizumab or ranibizumab at baseline. Best-corrected visual acuity (BCVA), central foveal thickness (CFT) and resolution of subretinal fluid (SRF) on optical coherence tomography (OCT) were assessed. The integrity of the foveal inner segment/outer segment (IS/OS) line at 12 months was also analyzed. Results Resolution of SRF was achieved in 20 of 21 eyes in the anti-VEGF group and in 12 of 15 eyes in the observation group (p = 0.151). Mean BCVA and CFT were not different between the two groups at 12 months (p > 0.05). The amount of change in BCVA, however, differed significantly between the groups (p = 0.044). Final OCT more frequently detected the foveal IS/OS line in the anti-VEGF group than in the observation group (p = 0.012). Conclusions In terms of BCVA, anti-VEGF and observation only had similar therapeutic effects in acute CSC patients. In some patients, however, the rapid resolution of SRF by anti-VEGF might reduce the risk of photoreceptor degeneration and improve long-term visual acuity.
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Affiliation(s)
- Sang-Uk Park
- Department of Ophthalmology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seung-Jun Lee
- Department of Ophthalmology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Moosang Kim
- Department of Ophthalmology, Kangwon National University School of Medicine, Chuncheon, Korea
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Jung SH, Kim KA, Sohn SW, Yang SJ. Cytokine levels of the aqueous humour in central serous chorioretinopathy. Clin Exp Optom 2014; 97:264-9. [PMID: 24417755 DOI: 10.1111/cxo.12125] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/10/2013] [Accepted: 09/23/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study aimed to investigate the levels of aqueous humour cytokines in the eyes of patients with central serous chorioretinopathy (CSC), who received an intravitreal injection of bevacizumab, and to evaluate the differences in cytokine levels between bevacizumab responders and non-responders. METHODS Aqueous humour samples were collected from 39 eyes of 39 patients with CSC and 25 eyes of 25 control patients undergoing cataract surgery and were analysed using Multiplex bead assays. We compared the cytokine levels in patients with CSC (responders and non-responders) and control subjects. After intravitreal injections of bevacizumab in patients with CSC, we evaluated the changes in visual acuity and optical coherence tomographic parameters. RESULTS Significantly increased levels of interferon gamma-induced protein (IP-10) were detected in the aqueous humour of eyes from patients with CSC compared to controls (p = 0.036). Vascular endothelial growth factor (VEGF) levels were significantly higher in bevacizumab responders than in non-responders (p = 0.021). The concentrations of the other cytokines investigated did not differ significantly between patients with CSC and control subjects or between responders and non-responders. CONCLUSION The results of the present study suggest that IP-10 and VEGF may contribute to the pathogenesis of CSC. It is clear that intravitreal bevacizumab was helpful in some of the patients with CSC, who showed higher levels of VEGF in the aqueous humour. However, the true effect and the rationale of anti-VEGF injection treatment in patients with CSC remain to be elucidated. Our results suggest that patients with CSC may be more susceptible to VEGF and/or other cytokines than the normal population.
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Affiliation(s)
- Sang Hoon Jung
- Functional Food Center, Korea Institute of Science and Technology (KIST) Gangneung Institute, Gangneung, Korea
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Kweon EY. Factors Influencing the Effect of the Intravitreal Bevacizumab Injection in Patients with Central Serous Chorioretinopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.3.391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Eui Yong Kweon
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
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Chung YR, Seo EJ, Lew HM, Lee KH. Lack of positive effect of intravitreal bevacizumab in central serous chorioretinopathy: meta-analysis and review. Eye (Lond) 2013; 27:1339-46. [PMID: 24202051 DOI: 10.1038/eye.2013.236] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 09/22/2013] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To review and evaluate the effects of intravitreal bevacizumab injection (IVB) in centralserous chorioretinopathy (CSC) by meta-analysis. PATIENTS AND METHODS Clinical controlled studies that evaluated the effect of IVB in CSC were identified through systematic searches of Embase, PubMed, and the Cochrane Central Register of Controlled Trials. Data on the best-corrected visual acuity (BCVA) in logMAR and central macular thickness (CMT) in μm at baseline and 6 months after IVB were extracted and compared with those treated by simple observation. RESULTS Four clinical controlled studies were included in the meta-analysis. The IVB injection group achieved better BCVA at a follow-up of 6 months. However, the analysis showed that there were no significant differences of BCVA at 6 months after injection between IVB group and the observation group (-0.02 logMAR, 95% CI -0.14 to 0.11, P=0.80). The analysis of the reduction in CMT revealed that the difference between groups was not statistically significant (-8.37 μm, 95% CI -97.26 to 80.52, P=0.85). No report assessed severe complications or side effects of IVB in patients with CSC. CONCLUSIONS Meta-analysis failed to verify the positive effect of IVB in CSC based on the epidemiological literature published to date.
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Affiliation(s)
- Y-R Chung
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, South Korea
| | - E J Seo
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, South Korea
| | - H M Lew
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, South Korea
| | - K H Lee
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, South Korea
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Bujarborua D, Borooah S, Dhillon B. The stress response as a target for treatment of central serous chorioretinopathy. EXPERT REVIEW OF OPHTHALMOLOGY 2013. [DOI: 10.1586/17469899.2013.837298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Karim SP, Adelman RA. Profile of verteporfin and its potential for the treatment of central serous chorioretinopathy. Clin Ophthalmol 2013; 7:1867-75. [PMID: 24092965 PMCID: PMC3788817 DOI: 10.2147/opth.s32177] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterized by serous retinal detachments associated with focal leakage on fluorescein angiography and pigment epithelial detachments. While the majority of cases improve spontaneously over several months, a significant subset of patients advance to a chronic recurrent form of the disease with diffuse pigment epitheliopathy, foveal atrophy, scarring, and permanent visual loss. Photodynamic therapy (PDT) with verteporfn has been extensively studied as a potential therapeutic option for chronic cases. Multiple prospective interventional studies have demonstrated the efficacy of PDT for CSCR with significant functional and anatomic improvements achieved. Refinement of the PDT protocol has subsequently been performed in an effort to minimize adverse effects. Anti-vascular endothelial growth factor (anti-VEGF) agents, such as bevacizumab, have been utilized in the treatment of CSCR. Recent advances in imaging and functional testing have shed further light on possible pathophysiologic mechanisms of disease and post treatment changes induced by PDT. While the body of evidence supports PDT as an efficacious and relatively safe treatment for CSCR, further evaluation of the long-term efficacy and safety of PDT, as well as protocol improvements are required.
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Affiliation(s)
- Shaheen P Karim
- Department of Ophthalmology and Visual Science, Yale University, New Haven, CT, USA
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Nicholson B, Noble J, Forooghian F, Meyerle C. Central serous chorioretinopathy: update on pathophysiology and treatment. Surv Ophthalmol 2013; 58:103-26. [PMID: 23410821 DOI: 10.1016/j.survophthal.2012.07.004] [Citation(s) in RCA: 412] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 07/27/2012] [Accepted: 07/31/2012] [Indexed: 01/30/2023]
Abstract
Recent technological advances--new pathophysiological insights, new imaging techniques for diagnosis and management, and new treatments--have led to an improved understanding of central serous chorioretinopathy (CSC). The primary role of the choroid has become more widely accepted with widespread use of indocyanine green angiography. Optical coherence tomography (OCT), and particularly enhanced depth imaging OCT, demonstrate a thickened and engorged choroid. Adaptive optics, fundus autofluorescence, multifocal electroretinography, microperimetry, and contrast sensitivity testing reveal that patients with even a mild course suffer previously undetected anatomic and functional loss. Although focal laser and photodynamic therapy are the current standard of care for persistent subretinal fluid in CSC, they are not appropriate in all cases, and the optimal timing of intervention remains unclear.
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Affiliation(s)
- Benjamin Nicholson
- National Eye Institute, National Institutes of Health, Bethesda, MD 20814, USA
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Teng YT, Chen CH, Lee JJ, Kuo HK, Wu PC. Intravitreous injection of bevacizumab for chronic central serous chorioretinopathy. Taiwan J Ophthalmol 2013. [DOI: 10.1016/j.tjo.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Prakash G, Chauhan N, Jain S, Satsangi SK. Central Serous Chorioretinopathy: A Review of the Literature. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2013; 2:104-10. [PMID: 26108047 DOI: 10.1097/apo.0b013e31829069ee] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Central serous chorioretinopathy (CSCR) is an incompletely understood multifactorial disease of those who are middle aged characterized by the collection of fluid between the retinal pigment epithelium and the neurosensory retina. The exact etiology of CSCR and the reason of its predominance in middle-aged males are still unknown. Many pharmacologic modalities are suggested for CSCR with no proven efficacy. So this article was written to give a review of the relevant and recent literature on CSCR and to summarize the etiology, clinical features, and diagnostic modalities for CSCR with special emphasis on the treatment options available and those that are still under trial and can be of help in the future to fasten the recovery and reduce the recurrences.
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Affiliation(s)
- Gunjan Prakash
- From the Upgraded Department of Ophthalmology, Sarojini Naidu Medical College, Agra, India
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Kim M, Lee SC, Lee SJ. Intravitreal Ranibizumab for Acute Central Serous Chorioretinopathy. Ophthalmologica 2013; 229:152-7. [DOI: 10.1159/000345495] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/29/2012] [Indexed: 11/19/2022]
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Kim YS, Lee YH, Kim HS, Jin SY, Lee TG. Comparison of Therapeutic Effect Between Half-Energy Photodynamic Therapy and Intravitreal Bevacizumab Injection in Chronic Central Serous Chorioretinopathy for 12 Months. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.10.1526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Young Seung Kim
- Department of Ophthalmology, Konyang University College of Medicine, Daejon, Korea
| | - Young Hoon Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejon, Korea
| | - Hyoung Seok Kim
- Department of Ophthalmology, Konyang University College of Medicine, Daejon, Korea
| | - Sun Young Jin
- Department of Ophthalmology, Konyang University College of Medicine, Daejon, Korea
| | - Tae Gon Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Myung-Gok Eye Research Institute, Seoul, Korea
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Quin G, Liew G, Ho IV, Gillies M, Fraser-Bell S. Diagnosis and interventions for central serous chorioretinopathy: review and update. Clin Exp Ophthalmol 2012; 41:187-200. [DOI: 10.1111/j.1442-9071.2012.02847.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Kim YC, Kim SD, Kim KS. A case of idiopathic central serous chorioretinopathy in a 12-year-old male treated with bevacizumab. KOREAN JOURNAL OF OPHTHALMOLOGY 2012; 26:391-3. [PMID: 23060728 PMCID: PMC3464325 DOI: 10.3341/kjo.2012.26.5.391] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 12/21/2010] [Indexed: 11/25/2022] Open
Abstract
A 12-year-old male presented with a chief complaint of a 1-month-history of decreased visual acuity in his right eye. The patient had no past history of steroid use or other systemic diseases. On fundus examination, which included fluorescent angiography (FAG) and optical coherence tomography (OCT), the patient was diagnosed with idiopathic central chorioretinopathy, whose clinical course was monitored without any specific treatments. At the time of admission, the best-corrected visual acuity was 0.5 in the right eye and 1.0 in the left eye. On fundoscopy, a serous detachment of 1 disc diameter in size was observed in the posterior pole. According to the FAG and the OCT, serous neurosensory detachment was present. After two months of monitoring the clinical course, the best corrected visual acuity in the right eye was 0.8, and there was improvement of neurosensory retinal detachment. However, OCT detected recurrence after five months, and the corrected visual acuity was decreased to 0.6. Bevacizumab was then injected into the vitreous cavity. Complete resolution of the subretinal fluid resulted eight months later, and the corrected visual acuity improved to 1.0.
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Affiliation(s)
- Yu Cheol Kim
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Intravitreal bevacizumab versus low-fluence photodynamic therapy for treatment of chronic central serous chorioretinopathy. Jpn J Ophthalmol 2012; 56:608-12. [PMID: 22915299 DOI: 10.1007/s10384-012-0162-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 04/26/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE To report the effectiveness and safety of intravitreal bevacizumab injection (IVB) compared with low-fluence photodynamic therapy (L-PDT) in eyes with chronic central serous chorioretinopathy (CSC). METHODS This was a prospective comparative interventional study of 22 patients affected by chronic CSC. Patients were randomly assigned to group 1 (12 patients treated with 1.25 mg IVB) and group 2 (10 patients treated with L-PDT). In group 2, PDT with verteporfin was delivered at low fluence (300 mW/cm(2) for 83 s, 25 J/cm(2)). Follow-up visits were scheduled at 1, 3, 6, and 9 months. RESULTS The improvement in visual acuity was greater in group 1 than in group 2, although the difference was not statistically significant (P = 0.59). The mean change in central point thickness over 9 months from baseline was 127 μm (SD 36) in group 1 and 114 μm (SD 42) in group 2. After the first injection, retreatments were given if recurrence was noted, with an average of 3.0 ± 1 injections in group 1 and 1.6 ± 0.6 treatments with L-PDT in group 2. The difference between retreatment in the 2 groups was not statistically significant (P = 0.45). CONCLUSIONS Based on the results obtained after 9 months of follow-up, our study provides evidence that IVB may be a treatment option for chronic CSC.
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Cuevas P, Outeiriño LA, Azanza C, Angulo J, Giménez-Gallego G. Short-term efficacy of intravitreal dobesilate in central serous chorioretinopathy. Eur J Med Res 2012; 17:22. [PMID: 22788836 PMCID: PMC3478972 DOI: 10.1186/2047-783x-17-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 07/02/2012] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To report the anatomic and functional outcome of intravitreal dobesilate to treat recurrent central serous chorioretinopathy (CSC). METHODS This is an interventional case report in which dobesilate was intravitreally injected in a case of recurrent CSC. Main measures included fundoscopy, Snellen visual acuity (VA) testing, fluorescein angiography and optical coherence tomography (OCT). RESULTS We present anatomical and functional evidences, obtained as early as eleven days after the treatment, of the efficacy of intravitreal dobesilate, in the treatment of chronic CSC condition. The effect after intravitreal dobesilate injection for CSC might be related to the normalization of retinal architecture. CONCLUSIONS Intravitreal dobesilate may be an effective treatment option for recurrent CSC.
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Affiliation(s)
- Pedro Cuevas
- Departamento de Investigación, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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Entezari M, Ramezani A, Yaseri M. Intravitreal bevacizumab for treatment of refractory central serous choroidoretinopathy. KOREAN JOURNAL OF OPHTHALMOLOGY 2012; 26:139-42. [PMID: 22511842 PMCID: PMC3325620 DOI: 10.3341/kjo.2012.26.2.139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 08/01/2010] [Indexed: 11/23/2022] Open
Abstract
In a clinical case series, 5 patients with not-resolved central serous choroidoretinopathy (CSC) lasting more than 1 year received one intravitreal bevacizumab injection (IVB, 1.25 mg) injection. All patients underwent a through ophthalmic examination 1 day, 1 week, and 1, 2, and 6 months after the injection. Best corrected visual acuity (BCVA) and central macular thickness were compared before and after treatment by optical coherence tomography. Mean BCVA was improved significantly (p = 0.020) from 0.60 ± 0.25 to 0.50 ± 0.18 and 0.29 ± 0.19 logarithm of minimum angle of resolution at 6 and 18 weeks, respectively. Central macular thickness was also decreased significantly (p = 0.010) from 370 ± 65 to 208 ± 23 µm at 4 months. No recurrence was occurred during follow-up. IVB injection may have beneficial effect in the treatment of refractory CSC.
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Affiliation(s)
- Morteza Entezari
- Ophthalmic Research Center, Department of Ophthalmology, Imam Hossein Medical Center, Shahid Beheshti University, Tehran, Iran.
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Concentration of cytokines in the aqueous humor of patients with central serous chorioretinopathy. Retina 2012; 31:1937-43. [PMID: 21478806 DOI: 10.1097/iae.0b013e31820a6a17] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the levels of aqueous humor cytokines in the eyes of patients with central serous chorioretinopathy (CSC) before an intravitreal injection of bevacizumab. METHODS In a prospective interventional trial, 20 eyes of 20 patients with symptomatic CSC of at least 3 months duration and 20 eyes of 20 patients with cataract as control were included. Eyes with CSC received a single intravitreal injection of bevacizumab (1.25 mg/0.05 mL). Aqueous humor samples were collected from patients and controls. Multiplex bead assays were used for measurement of cytokines, including vascular endothelial growth factor and platelet-derived growth factor. RESULTS Similar vascular endothelial growth factor levels and significantly decreased platelet-derived growth factor levels were measured in the aqueous humor of eyes from patients with CSC compared with controls (P = 0.172 and P = 0.004, respectively). There was a significant inverse correlation between the vascular endothelial growth factor and platelet-derived growth factor in patients (r = -0.555; P = 0.026). Interleukin 6, interleukin 8, and monocyte chemoattractant protein-1 were detectable, but not significantly different between the patients and controls. CONCLUSION The results of the current study suggest that platelet-derived growth factor contributes to the pathogenesis of CSC; however, the roles of vascular endothelial growth factor in CSC are unclear and warrant further investigation.
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Koh KM, Kim JY, Kim JW, Choi MJ. The Efficacy of Intravitreal Bevacizumab Injection in Patients with Acute Central Serous Chorioretinopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.6.781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kyung Min Koh
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Konyang University Kim's Eye Hospital, Seoul, Korea
| | - Joo Yeon Kim
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Konyang University Kim's Eye Hospital, Seoul, Korea
| | - Jong Woo Kim
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Konyang University Kim's Eye Hospital, Seoul, Korea
| | - Moon Jung Choi
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Konyang University Kim's Eye Hospital, Seoul, Korea
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Gregori-Gisbert I, Aguirre-Balsalobre F, García-Sánchez J, León-Salvatierra G, Mengual-Verdú E, Hueso-Abancéns JR. [Recurrent and chronic central serous chorioretinopathy. Retina thickness evaluation one month after intravitreal bevacizumab injection]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2011; 86:407-411. [PMID: 22117740 DOI: 10.1016/j.oftal.2011.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 04/17/2011] [Accepted: 05/03/2011] [Indexed: 05/31/2023]
Abstract
PURPOSE To evaluate the efficacy of intavitreal injection of bevacizumab in patients with chronic central serous chorioretinopathy. METHODS A study of 8 patients with central serous chorioretinopathy who were treated with intravitreal injection of bevacizumab. We studied the visual acuity with Snelleńs method and the foveal thickness, before and after the injection. RESULTS The mean age of the patients was 50.25 years. After one month of follow-up, visual acuity before the injection was 0.431 ± 0.249 vision lines and after was 0.631 ± 0.310 vision lines (P=.017).The foveal thickness was 351.25 ± 78.492 μm and after treatment was 183.50 ± 22.640 μm (P=.012). CONCLUSIONS Intravitreal bevacizumab can be an alternative treatment in patients with serous central chorioretinopathy as it leads to a better objective visual acuity and foveal thickness with optical coherence tomography.
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Affiliation(s)
- I Gregori-Gisbert
- Servicio de Oftalmología, Hospital Clínico Universitario San Juan de Alicante, España.
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