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Leclercq B, Weiner A, Zola M, Mejlacowicz D, Lassiaz P, Jonet L, Gélizé E, Perrot J, Viengchareun S, Zhao M, Behar-Cohen F. The choroidal nervous system: a link between mineralocorticoid receptor and pachychoroid. Acta Neuropathol 2023; 146:747-766. [PMID: 37682293 PMCID: PMC10564818 DOI: 10.1007/s00401-023-02628-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
Central serous chorioretinopathy (CSCR) belongs to the pachychoroid spectrum, a pathological phenotype of the choroidal vasculature, in which blood flow is under the choroidal nervous system (ChNS) regulation. The pathogenesis of CSCR is multifactorial, with the most recognised risk factor being intake of glucocorticoids, which activate both the gluco- and the mineralocorticoid (MR) receptors. As MR over-activation is pathogenic in the retina and choroid, it could mediate the pathogenic effects of glucocorticoids in CSCR. But the role of MR signalling in pachychoroid is unknown and whether it affects the ChNS has not been explored. Using anatomo-neurochemical characterisation of the ChNS in rodents and humans, we discovered that beside innervation of arteries, choroidal veins and choriocapillaris are also innervated, suggesting that the entire choroidal vasculature is under neural control. The numerous synapses together with calcitonin gene-related peptide (CGRP) vesicles juxtaposed to choroidal macrophages indicate a neuro-immune crosstalk. Using ultrastructural approaches, we show that transgenic mice overexpressing human MR, display a pachychoroid-like phenotype, with signs of choroidal neuropathy including myelin abnormalities, accumulation and enlargement of mitochondria and nerves vacuolization. Transcriptomic analysis of the RPE/choroid complex in the transgenic mice reveals regulation of corticoids target genes, known to intervene in nerve pathophysiology, such as Lcn2, rdas1/dexras1, S100a8 and S100a9, rabphilin 3a (Rph3a), secretogranin (Scg2) and Kinesin Family Member 5A (Kif5a). Genes belonging to pathways related to vasculature development, hypoxia, epithelial cell apoptosis, epithelial mesenchymal transition, and inflammation, support the pachychoroid phenotype and highlight downstream molecular targets. Hypotheses on the imaging phenotype of pachychoroid in humans are put forward in the light of these new data. Our results provide evidence that MR overactivation causes a choroidal neuropathy that could explain the pachychoroid phenotype found in transgenic mice overexpressing human MR. In patients with pachychoroid and CSCR in which systemic dysautonomia has been demonstrated, MR-induced choroidal neuropathy could be the missing link between corticoids and pachychoroid.
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Affiliation(s)
- Bastien Leclercq
- Centre de Recherche des Cordeliers, Inserm, Université Paris Cité, Sorbonne Université, Physiopathology of Ocular Diseases: Therapeutic Innovations, 15 rue de l'Ecole de Médecine, 75006, Paris, France
| | - Allon Weiner
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses, Cimi-Paris, Paris, France
| | - Marta Zola
- Centre de Recherche des Cordeliers, Inserm, Université Paris Cité, Sorbonne Université, Physiopathology of Ocular Diseases: Therapeutic Innovations, 15 rue de l'Ecole de Médecine, 75006, Paris, France
- Ophthalmopole Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Hopital Foch, Suresnes, France
| | - Dan Mejlacowicz
- Centre de Recherche des Cordeliers, Inserm, Université Paris Cité, Sorbonne Université, Physiopathology of Ocular Diseases: Therapeutic Innovations, 15 rue de l'Ecole de Médecine, 75006, Paris, France
| | - Patricia Lassiaz
- Centre de Recherche des Cordeliers, Inserm, Université Paris Cité, Sorbonne Université, Physiopathology of Ocular Diseases: Therapeutic Innovations, 15 rue de l'Ecole de Médecine, 75006, Paris, France
| | - Laurent Jonet
- Centre de Recherche des Cordeliers, Inserm, Université Paris Cité, Sorbonne Université, Physiopathology of Ocular Diseases: Therapeutic Innovations, 15 rue de l'Ecole de Médecine, 75006, Paris, France
| | - Emmanuelle Gélizé
- Centre de Recherche des Cordeliers, Inserm, Université Paris Cité, Sorbonne Université, Physiopathology of Ocular Diseases: Therapeutic Innovations, 15 rue de l'Ecole de Médecine, 75006, Paris, France
| | - Julie Perrot
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, 94276, Le Kremlin-Bicêtre, France
| | - Say Viengchareun
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, 94276, Le Kremlin-Bicêtre, France
| | - Min Zhao
- Centre de Recherche des Cordeliers, Inserm, Université Paris Cité, Sorbonne Université, Physiopathology of Ocular Diseases: Therapeutic Innovations, 15 rue de l'Ecole de Médecine, 75006, Paris, France
| | - Francine Behar-Cohen
- Centre de Recherche des Cordeliers, Inserm, Université Paris Cité, Sorbonne Université, Physiopathology of Ocular Diseases: Therapeutic Innovations, 15 rue de l'Ecole de Médecine, 75006, Paris, France.
- Ophthalmopole Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
- Hopital Foch, Suresnes, France.
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Venkatesh R, Prabhu V, Joshi A, Mangla R, Singh R, Wu L, Lanzetta P, Kuppermann B, Bandello F, Cohen FB, Chhablani J. Real-world practice patterns of eplerenone use for central serous chorioretinopathy. Int J Retina Vitreous 2023; 9:61. [PMID: 37784202 PMCID: PMC10544617 DOI: 10.1186/s40942-023-00500-w] [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: 08/10/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE To report eplerenone use by retina specialists worldwide for central serous chorioretinopathy (CSCR). METHODS A self-reporting questionnaire was distributed to retina specialists worldwide to gather clinicians' perspectives on CSCR cases treated, eplerenone dosage and duration, reasons to use it, and side effects. RESULTS The survey included 241 retina specialists (122 Indian and 119 international) with an average experience of 15.69 ± 9.59 years. Oral eplerenone was used to treat CSCR by 149 (62%) participants. Only 6% (n = 9) had easy access to verteporfin dye and photodynamic therapy. 30 (20%) of the 149 respondents changed their treatment with eplerenone after VICI trial results. Eplerenone was prescribed mostly for chronic CSCR (n = 86, 58%), regardless of involvement laterality. 62% (n = 92) had fewer than 25% CSCR cases treated with eplerenone. 85 (57%) respondents used eplerenone only when other treatments failed, while 36 (24%) used it as first-line treatment. 73 (49%) respondents, prescribed eplerenone at a 50 mg daily dose and 137 (92%) retina specialists used eplerenone for 0-3 months. The drug's efficacy dissatisfied 21 (14%) study participants. 124 (83%) study participants did not encounter any ocular or systemic side effects with eplerenone use. Eplerenone related kidney and electrolyte issues were noted by 11 (7%) study participants. CONCLUSION The treatment of CSCR varies around the world and is primarily influenced by the photodynamic therapy availability and the findings of VICI trial. Despite the limited benefit of eplerenone reported by the VICI trial, it is still used as evidenced by real-world experience. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, Bangalore, 560022, India.
| | - Vishma Prabhu
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, Bangalore, 560022, India
| | - Aishwarya Joshi
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, Bangalore, 560022, India
| | - Rubble Mangla
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, Bangalore, 560022, India
| | - Rishi Singh
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
- Cleveland Clinic Martin Health, Stuart, FL, USA
| | - Lihteh Wu
- Macula, Vitreous and Retina Associates of Costa Rica, San José, Costa Rica
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| | - Baruch Kuppermann
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, 92697, USA
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francine Behar Cohen
- Centre de Recherche des Cordeliers, From Physiopathology of Retinal Diseases to Clinical Advances, Université de Paris Cité, Inserm, Paris, 75006, France
- Department of Ophthalmology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Ophtalmopôle, Paris, 75014, France
| | - Jay Chhablani
- Department of Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA
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You EL, Hébert M, Jin TS, Bourgault S, Caissie M, Tourville É, Chen J, Ordóñez-Mena J, Dirani A. Comparing interventions for chronic central serous chorioretinopathy: A network meta-analysis. Surv Ophthalmol 2023:S0039-6257(23)00045-0. [PMID: 36931437 DOI: 10.1016/j.survophthal.2023.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
We compare efficacy of treatments for chronic central serous chorioretinopathy (CSCR) > 3 months. Four treatment classes were considered: photodynamic therapy (PDT), subthreshold laser therapies (SLT), mineralocorticoid receptor antagonists (MRA) and anti-vascular endothelial growth factor (anti-VEGF) agents. Pairwise and network meta-analyses of the primary outcomes (complete resolution of subretinal fluid (SRF), mean change in best corrected visual acuity (BCVA) (logMAR) and mean change in SRF) and secondary outcomes (mean change in central retinal thickness, and central choroidal thickness (μm), recurrence of SRF, and adverse events) at 3, 6 and 12 months were compared. Confidence in Network Meta-Analysis (CINeMA) informed the certainty of NMA evidence. Eleven RCTs of 458 eyes (450 patients) were included. NMA at 3 months showed that both PDT and SLT were superior to control for resolution of SRF (OR 4.83; 95% CI 1.72 to 13.55 and 2.27; 1.14 to 4.49, respectively) and SLT was superior to control for improving BCVA (MD -0.10; -0.17 to -0.04). PDT was superior to SLT for improving CRT (MD-42.88; -75.27 to -10.50). On probability ranking, PDT and SLT were consistently the best-ranked treatments for each outcome at 3 months, but low confidence of evidence and paucity of studies preclude definitive conclusions.
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Affiliation(s)
- Eunice Linh You
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Canada
| | - Mélanie Hébert
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Canada
| | | | - Serge Bourgault
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Canada
| | - Mathieu Caissie
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Canada
| | - Éric Tourville
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Canada
| | - John Chen
- Department of Ophthalmology, McGill University, Montreal, Canada
| | - José Ordóñez-Mena
- Nuffield Department of Primary Care Health, Oxford University, Oxford, England
| | - Ali Dirani
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Canada.
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Felipe CQ, Biancardi AL, Civile VT, Carvas Junior N, Serracarbassa PD, Koike MK. Mineralocorticoid receptor antagonists for chronic central serous chorioretinopathy: systematic review and meta-analyses. Int J Retina Vitreous 2022; 8:34. [PMID: 35672807 PMCID: PMC9172176 DOI: 10.1186/s40942-022-00385-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mineralocorticoid receptor antagonists (MRAs) are widely used for chronic central serous chorioretinopathy (cCSCR), but their effectiveness remains unclear. This research was conducted to evaluate the efficacy of this drugs for cCSCR. METHODS This is a review of randomized clinical trials (RCT) comparing MRAs to placebo in adults with cCSCR, using the effects of MRAs on best-corrected visual acuity (BCVA) and adverse events as primary outcomes and the effects of MRAs on anatomical parameters as secondary outcomes: central subfield thickness (CST), subretinal fluid height (SFH) and central choroidal thickness (CCT). Our all-language online search included Medline (via PubMed), Central, Embase, Lilacs, Ibecs, and RCT registers platforms, as late as May 2021. We used the Cochrane risk-of-bias tool (version 2) to assess the methodological quality of each study and synthesized the results in meta-analyses using a random-effects model. RESULTS The search identified 302 records, five of which were eligible, totaling 225 cCSCR patients (aged 45-62 years; M/F ratio 3.1:1) treated for 1 to 12 months with spironolactone (50 mg/day) or eplerenone (50 mg/day) vs. placebo. Moderate-certainty evidence suggests MRAs result in little to no improvement in BCVA compared to placebo (SMD 0.22; 95% CI - 0.04 to 0.48; studies = 5; comparisons = 6; participants = 218; I2 = 0%). Very low-certainty evidence suggests that, when compared to placebo, MRAs have a very uncertain impact on adverse effects (no meta-analysis was performed), and CST (MD 18.1; 95% CI - 113.04 to 76.84; participants = 145; studies = 2; I2 = 68%). MRAs also result in little to no difference in SFH (SMD - 0.35; 95% CI - 0.95 to 0.26; studies = 5; comparisons = 6; participants = 221; I2 = 76%; moderate certainty) and CCT (MD - 21.23; 95% CI - 64.69 to 22.24; participants = 206; studies = 4; comparisons = 5; I2 = 85%; low certainty). CONCLUSION MRAs have little to no effect on BCVA. Evidence for adverse events and CST is very uncertain. MRAs also have little to no effect on SFH and CCT. These findings should be considered when prescribing MRAs for cCSCR. This research was previous registration in the PROSPERO platform (CRD42020182601).
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Affiliation(s)
- Camila Q. Felipe
- Postgraduate Program in Health Sciences, Institute of Medical Care for Civil Servants in the State of São Paulo (IAMSPE), São Paulo, Brazil
| | - Ana Luiza Biancardi
- Laboratory of Infectious Diseases in Ophthalmology, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Vinicius T. Civile
- Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Nelson Carvas Junior
- Cochrane Brazil and Department of Physiotherapy, Paulista University, São Paulo, Brazil
| | | | - Marcia K. Koike
- Postgraduate Program in Health Sciences, IAMSPE and Laboratory of Medical Investigation 51 (LIM-51), University of São Paulo, São Paulo, Brazil
- Postgraduate Program in Health Sciences of the Institute of Medical Care for Civil Servants in the State of São Paulo (IAMSPE), Avenida Ibirapuera 981, 2 andar, Vila Clementino, São Paulo, SP CEP 04029-000 Brazil
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Duan J, Zhang Y, Zhang M. Efficacy and safety of the mineralocorticoid receptor antagonist treatment for central serous chorioretinopathy: a systematic review and meta-analysis. Eye (Lond) 2021; 35:1102-1110. [PMID: 33414535 DOI: 10.1038/s41433-020-01338-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/22/2020] [Accepted: 11/24/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES We performed a systematic review and meta-analysis to assess the efficacy and safety of the mineralocorticoid receptor antagonist (MRA) treatment for central serous chorioretinopathy (CSC). METHODS We searched the PubMed, Embase, and the Cochrane Library to identify relevant clinical studies published prior to March 2020. The primary outcome was change in best-corrected visual acuity (BCVA), and the secondary outcomes included the subretinal fluid (SRF), subfoveal choroidal thickness (SFCT), and central macular thickness (CMT). RESULTS Five randomized controlled trials (RCT) and four cohort studies met the inclusion criteria with a total of 352 eyes. The MRA treatment was not superior to placebo in BCVA at 1 month (WMD = -0.06, 95% CI -0.15-0.02, P = 0.15, I2 = 86%), 3 months (WMD = -0.04, 95% CI -0.14-0.06, P = 0.44, I2 = 77%) and 6 months (WMD = -0, 95% CI -0.05-0.05, P = 0.92, I2 = 0%). The MRA treatment resulted in significant reduction than the placebo in the SRF (WMD = -60.64, 95% CI -97.91 to -23.37, P = 0.001, I2 = 49%), SFCT (WMD = -39.15, 95% CI -52.58 to -25.72, P < 0.001, I2 = 0%), and CMT (WMD = -60.75, 95% CI -97.85 to -23.65, P = 0.01, I2 = 53%). CONCLUSIONS Our meta-analysis shows that the MRA treatment can improve anatomical structure in CSC patients, but it is not effective for achieving BCVA gain. The applicant of the MRA is safe and have no severe effect.
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Affiliation(s)
- Jianan Duan
- Macular Disease Research Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yun Zhang
- Macular Disease Research Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Meixia Zhang
- Macular Disease Research Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Huang C, Zhou L, Tian Z, Lai K, Zhong X, Xu F, Gong Y, Li L, Jin C. Dynamic changes and correlation analysis of outer retinal microstructure in macular area of central serous chorioretinopathy patients during restoration period. Int Ophthalmol 2021; 41:1191-1201. [PMID: 33420567 DOI: 10.1007/s10792-020-01672-2] [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: 07/08/2019] [Accepted: 11/30/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the dynamic changes and possible affecting variables of outer retinal microstructure in macular area of central serous chorioretinopathy (CSC) patients. METHODS This was a retrospective study. The data of optical coherence tomography (OCT) and autofluoroscopy (AF) of 36 CSC patients admitted to our hospital from February 2012 to February 2013 were included. Dynamic variations and possible correlated variables of central retinal thickness (CRT), subretinal fluid diameter (SRFD), ellipsoid zone (EZ), interdigitation zone (IZ) and/or hyperautofluorescent spot (HAS) were analyzed. RESULTS The outer retinal microstructure was gradually restored along with the subretinal fluid absorption during the follow-up. EZ in 94.4% (34/36) and the IZ in 100% (36/36) eyes were completely disappeared at baseline and restored (completed or incomplete) in 88.9% (8/9) and 44.4% (4/9) eyes, respectively, after 6-month follow-up. HAS was evident in 25% eyes (8/32 eyes) at baseline, and the density was initially increased and then declined during follow-up. Correlation analysis demonstrated that the restoration of EZ and IZ was correlated with the restoration period and subretinal fluid absorption. CONCLUSION The outer retinal microstructure was restored during the subretinal fluid absorption in CSC patients, with EZ restored earlier than IZ. The restoration period and the absorption of subretinal fluid were two closely correlated variables of macular microstructure restoration.
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Affiliation(s)
- Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Zhen Tian
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Kunbei Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Xiaojing Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Yajun Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Longhui Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China.
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