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Kiilgaard HC, Nissen AHK, Balaratnasingam C, Borrelli E, Breazzano MP, van Dijk EHC, Sevik MO, Grauslund J, Subhi Y. Diagnostic accuracy of OCT angiography for macular neovascularization in central serous chorioretinopathy: A systematic review and meta-analysis. Acta Ophthalmol 2024. [PMID: 38988251 DOI: 10.1111/aos.16739] [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: 02/25/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
Identifying macular neovascularization (MNV) in eyes with central serous chorioretinopathy (CSC) has important implications for its management. Optical coherence tomography angiography (OCTA) is increasingly used for this purpose. Here, we systematically reviewed the literature and conducted meta-analysis to determine the diagnostic accuracy of OCTA for detecting MNV in eyes with CSC. We systematically searched the literature in 12 databases for relevant studies from database inception until 18 November 2023. Eligible studies had eyes with CSC with MNV and CSC without MNV. Index test was OCTA. Reference test was retinal dye angiography. Study selection and data extraction were performed in duplicate, and study was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2. Our main outcome of interest was the sensitivity and specificity of OCTA for detecting MNV in CSC. Pooled diagnostic test accuracy estimates were computed using MetaDTA. Of 177 records screened, seven fulfilled the eligibility criteria for our study. These studies summarized data from a total of 1061 eyes. Summary estimate sensitivity and specificity to diagnose MNV in eyes with CSC using OCTA was 92.9% (95% CI: 81.7%-97.5%) and 99.4% (95% CI: 84.1%-100.0%), respectively. The main source of bias across studies was the reference standard, as four studies used multimodal imaging including OCTA for the reference standard. OCTA alone is excellent for detecting MNV in CSC compared to retinal dye angiography or multimodal imaging. Using OCTA first before considering retinal dye angiography could potentially save an important number of retinal dye angiographies.
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Affiliation(s)
| | | | - Chandrakumar Balaratnasingam
- Lions Eye Institute, Perth, Western Australia, Australia
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Enrico Borrelli
- Department of Ophthalmology, City of Health and Science Hospital, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York, Liverpool, New York, USA
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Elon H C van Dijk
- Lions Eye Institute, Perth, Western Australia, Australia
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mehmet Orkun Sevik
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Yousif Subhi
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
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Son KY, Lim SG, Hwang S, Choi J, Kim SJ, Kang SW. Foveal atrophy in patients with active central serous chorioretinopathy at first presentation: characteristics and treatment outcomes. Br J Ophthalmol 2024:bjo-2023-324147. [PMID: 38789130 DOI: 10.1136/bjo-2023-324147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND/AIMS This study aimed to investigate the clinical characteristics and treatment outcomes of patients with active central serous chorioretinopathy (CSC) and foveal atrophy. METHODS Patients diagnosed with active idiopathic CSC using multimodal imaging and followed up for at least 6 months were included. They were divided into two groups (foveal atrophy group vs foveal non-atrophy group) according to a cut-off central foveal thickness of 120 µm on baseline optical coherence tomography (OCT). Baseline characteristics, angiographic and tomographic features and treatment outcomes were compared between the two groups. RESULTS Of the 463 patients, 92 eyes of 92 patients (19.9%) were in the foveal atrophy group and 371 eyes of 371 patients (80.1%) were in the foveal non-atrophy group. The baseline subretinal fluid (SRF) height was 111.3±76.8 µm in the foveal atrophy group and 205.0±104.4 µm in the foveal non-atrophy group on OCT images (p<0.001). Complete resolution of SRF after treatment was noted in 60.4% and 93.5% of patients in the foveal atrophy and foveal non-atrophy groups at the final visit, respectively (p<0.001). The foveal atrophy group showed worse visual acuity at baseline (logarithm of the minimum angle of resolution, 0.43±0.33 vs 0.13±0.18, p<0.001) and final visit (0.41±0.32 vs 0.05±0.15, p=0.035). CONCLUSIONS CSC with foveal atrophy was associated with a shallow SRF height, low treatment efficacy and poor vision before and after treatment. We suggest that early active treatment should be considered for eyes with CSC accompanied by a persistent shallow SRF and foveal atrophy.
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Affiliation(s)
- Ki Young Son
- Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong, Korea (the Republic of)
| | - Seul Gi Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Jaehwan Choi
- Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Korea (the Republic of)
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
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Liu P, Fang H, An G, Jin B, Lu C, Li S, Yang F, Du L, Jin X. Chronic Central Serous Chorioretinopathy in Elderly Subjects: Structure and Blood Flow Characteristics of Retina and Choroid. Ophthalmol Ther 2024; 13:321-335. [PMID: 37966697 PMCID: PMC10776535 DOI: 10.1007/s40123-023-00849-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION With advancements in imaging technology, researchers have been able to identify more distinctive imaging features of central serous chorioretinopathy (CSC). However, existing research primarily concentrates on young patients aged 50 years and below, leaving a dearth of studies on elderly CSC patients. Previous studies indicate that elderly CSC patients may exhibit unique imaging characteristics and have a clinical prognosis that significantly differs from younger patients. This study aimed to evaluate the characteristics of retina, choroid structure, and blood flow in elderly patients with chronic CSC (cCSC) examined multimode imaging and try to find new pathogenesis information of it. METHODS Using a cut-off age of 50 years, patients with chronic central serous chorioretinopathy were divided into two groups: older and younger. The control group consisted of 40 healthy individuals, with their right eyes assigned. Various clinical features were recorded, including the incidence of ellipsoid zone rupture (EZ-), fibrin in the subretinal fluid (SRF), pachydrusen, subretinal drusenoid deposits (SDD), pigment epithelial detachment (PED), double-layer sign (DLS), and choroidal lipid globule cavern. Measurements were taken for the thickness of the outer nuclear layer (ONL), the length of the extended outer photoreceptor segment (POS), the height and width of SRF, the vascular density of each layer of the retinal capillary plexus, the central macular thickness (CMT), and the subfoveal choroidal thickness (SFCT). RESULTS The proportion of females in the elderly group (43.75%) was significantly higher than that in the youth group (22.41%) (p = 0.034). The degree of hyperopia in the elderly group (1.03 ± 0.73) was higher than that in the youth group (0.26 ± 1.06), with a significant difference in BCVA (p = 0.05). The thickness of SFCT, CMT, ONL in the elderly group, and the length of photoreceptor outer segment in the elderly group were thinner than those in the youth group (p < 0.05). Choroidal capillary perfusion area (CCPA), macular area, and paramacular area were lower in the elderly group than those in the youth group in the full scan range (p < 0.05). The blood flow densities of deep capillary plexus (DCP), intermediate capillary plexus (ICP), and superficial capillary plexus (SCP) in the whole scan range, macular area, and paramacular area were lower in the elderly group than in the youth group, but the differences were not statistically significant. CONCLUSIONS In conclusion, our data suggest that elderly patients with cCSC may experience different disease outcomes. Elderly cCSC patients exhibit less gender bias, poorer vision, more severe structural damage and ischemia in the choroid and retina, and have a higher risk of developing choroidal neovascularization.
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Affiliation(s)
- Pei Liu
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Haixin Fang
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Guangqi An
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Bo Jin
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
- Fundus Disease Institute of Zhengzhou University, Zhengzhou, 450000, China
| | - Chenyu Lu
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Shu Li
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Fan Yang
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Liping Du
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China.
- Henan Eye Hospital, Zhengzhou, 450000, China.
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China.
- Fundus Disease Institute of Zhengzhou University, Zhengzhou, 450000, China.
| | - Xuemin Jin
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China.
- Henan Eye Hospital, Zhengzhou, 450000, China.
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China.
- Fundus Disease Institute of Zhengzhou University, Zhengzhou, 450000, China.
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Funatsu R, Terasaki H, Sonoda S, Shiihara H, Mihara N, Sakamoto T. Characteristics Related to Visual Acuity Loss After Successful Photodynamic Therapy for Eyes With Central Serous Chorioretinopathy. Am J Ophthalmol 2023; 256:164-174. [PMID: 37331678 DOI: 10.1016/j.ajo.2023.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE This study aimed to examine baseline characteristics for identifying factors associated with vision loss (VL) in patients with central serous chorioretinopathy (CSC) who successfully responded to photodynamic therapy (PDT). DESIGN A retrospective, clinical case-control study. METHODS This study included 85 eyes with CSC, which underwent PDT, and resolved serous retinal detachment. These eyes were classified into 2 groups: the VL group (best-corrected visual acuity 6 months after PDT was worse than that at baseline) and the vision maintenance or improved group (the others). Baseline factors were analyzed to determine the characteristics of the VL group and assess the diagnostic potential of these factors. RESULT Seventeen eyes were included in the VL group. The mean values of the neurosensory retinal (NSR) thickness, the internal limiting membrane-external limiting membrane thickness (IET), and the external limiting membrane-photoreceptor outer segment thickness (EOT) in the VL group were significantly thinner than those in the vision maintenance or improved group (NSR thickness, 123.2 ± 39.7 µm vs 166.3 ± 49.6 µm, P < .001; IET, 63.1 ± 17.0 µm vs 88.0 ± 25.4 µm, P < .001; EOT, 60.1 ± 28.6 µm vs 78.3 ± 33.1, P = .041). The sensitivity, specificity, and positive and negative predictive values for predicting VL were 94.1%, 50.0%, 32.0%, and 97.1% for NSR thickness; 94.1%, 51.5%, 32.7%, and 97.2% for IET; and 94.1%, 30.9%, 25.4%, and 95.5% for EOT, respectively. CONCLUSIONS Pretreatment sensory retinal layer thickness could predict VL after PDT for CSC and may be a helpful reference for PDT.
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Affiliation(s)
- Ryoh Funatsu
- From the Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan (R.F., H.T., S.S., H.S., N.M., T.S.)
| | - Hiroto Terasaki
- From the Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan (R.F., H.T., S.S., H.S., N.M., T.S.)
| | - Shozo Sonoda
- From the Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan (R.F., H.T., S.S., H.S., N.M., T.S.)
| | - Hideki Shiihara
- From the Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan (R.F., H.T., S.S., H.S., N.M., T.S.)
| | - Naohisa Mihara
- From the Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan (R.F., H.T., S.S., H.S., N.M., T.S.)
| | - Taiji Sakamoto
- From the Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan (R.F., H.T., S.S., H.S., N.M., T.S.).
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Borrelli E, Berni A, Mastropasqua L, Querques G, Sadda SR, Sarraf D, Bandello F. Pushing Retinal Imaging Forward: Innovations and Their Clinical Meaning - The 2022 Ophthalmologica Lecture. Ophthalmologica 2023; 246:278-294. [PMID: 37703839 DOI: 10.1159/000533910] [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: 05/30/2023] [Accepted: 08/27/2023] [Indexed: 09/15/2023]
Abstract
Retinal imaging has greatly expanded our understanding of various pathological conditions. This article presents a summary of the key points covered during the 2022 Ophthalmologica Lecture held at the Euretina Congress in Hamburg. The first part of the article focuses on the use of optical coherence tomography angiography to examine and comprehend the choroid in age-related macular degeneration (AMD). Subsequently, we delve into the discussion of the "postreceptor neuronal loss" theory in AMD, which was studied using en face structural optical coherence tomography (OCT). Following that, we explore pertinent findings obtained through cross-sectional OCT in retinal and optic nerve diseases, such as AMD, diabetic macular edema, pathologic myopia, central serous chorioretinopathy, and Leber's hereditary optic neuropathy.
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Affiliation(s)
- Enrico Borrelli
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Berni
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Mastropasqua
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Giuseppe Querques
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Srinivas R Sadda
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
| | - David Sarraf
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Stein Eye Institute, Los Angeles, California, USA
| | - Francesco Bandello
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
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Funatsu R, Terasaki H, Sonoda S, Shiihara H, Mihara N, Sakamoto T. A Photodynamic Therapy Index for Central Serous Chorioretinopathy to Predict Visual Prognosis Using Pretreatment Factors. Am J Ophthalmol 2023; 253:86-95. [PMID: 37182730 DOI: 10.1016/j.ajo.2023.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE This study aimed to establish a treatment index based on functional outcomes of photodynamic therapy (PDT) for central serous chorioretinopathy (CSC). DESIGN A retrospective clinical case-control study. METHODS This was a single-institute study. Eighty (80) eyes with CSC, who were treated by PDT and whose subretinal fluid resolves within 6 months were divided into two groups: those with poor visual outcome (PVO) (best-corrected visual acuity [BCVA] ≤ 0.5 6 months post-PDT), and the remaining eyes (better visual outcome [BVO]). The areas under the curve (AUC) and cutoff values from receiver operating characteristic curves were examined. These was used to predict the groups using pretreatment BCVA and the thickness of each retinochoroidal layer. RESULT Twenty-one (21) eyes were in the PVO group and 59 eyes in the BVO group were included. The AUCs were 0.959 for BCVA, 0.959 for the thickness from the internal limiting membrane to the external limiting membrane (IET), 0.820 for the thickness from the external limiting membrane to the photoreceptor outer segment layer, 0.715 for the subfoveal retinal thickness, and 0.515 for the subfoveal choroidal thickness. The BCVA and IET cut-off values were 0.267 logMAR and 71.5 µm, respectively. Using the combination of the cutoff values of BCVA and IET, the highest values for the sensitivity, specificity, positive predictive value, and negative predictive value were 95.2%, 94.9%, 85.0%, and 98.0%, respectively. CONCLUSION The combination of pre-PDT BCVA and IET in CSC can accurately predict the post-treatment visual prognosis. These values could be used as a treatment index of PDT for CSC.
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Affiliation(s)
- Ryoh Funatsu
- From Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroto Terasaki
- From Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shozo Sonoda
- From Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hideki Shiihara
- From Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Naohisa Mihara
- From Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Taiji Sakamoto
- From Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
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Borrelli E, Barresi C, Battista M, Berni A, Ricardi F, Cascavilla ML, Reibaldi M, Bandello F. PREVALENCE AND MORPHOLOGIC BIOMARKERS OF METAMORPHOPSIA IN EYES WITH "RESOLVED" CHRONIC CENTRAL SEROUS CHORIORETINOPATHY. Retina 2023; 43:1563-1572. [PMID: 37229754 DOI: 10.1097/iae.0000000000003845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To assess relationships between demographics, clinical characteristics, and optical coherence tomography characteristics with persistence of metamorphopsia after resolution of subretinal fluid in eyes with chronic central serous chorioretinopathy. METHODS One-hundred participants with "resolved" (absence of subretinal fluid) chronic central serous chorioretinopathy were retrospectively analyzed. Patients underwent a complete ophthalmologic evaluation, including assessment of the presence of metamorphopsia. At the study visit, optical coherence tomography scans were reviewed for qualitative and quantitative features. RESULTS Sixty-six of 100 patients (66.0%) complained of metamorphopsia. Both the foveal and parafoveal ganglion cell complex thicknesses were thinner in central serous chorioretinopathy eyes with metamorphopsia (35.1 ± 10.6 µ m and 82.0 ± 18.1 µ m vs. 40.7 ± 11.8 µ m and 93.1 ± 13.5 µ m, P = 0.030 and P < 0.0001). In the foveal region, the outer plexiform layer and outer nuclear layer thicknesses were thinner in patients with metamorphopsia (24.6 ± 8.5 µ m and 63.1 ± 20.9 µ m vs. 29.1 ± 8.7 and 76.2 ± 18.2 µ m, P = 0.016 and P = 0.005). The ellipsoid zone band was more frequently discontinued in eyes with metamorphopsia (56.1% vs. 35.3%, P = 0.039). Multivariate stepwise linear regression analysis demonstrated that the strongest associations with the presence of metamorphopsia were with parafoveal ganglion cell complex thickness ( P = 0.004), foveal outer nuclear layer thickness ( P = 0.010), and number of previous recurrences of subretinal fluid accumulation ( P = 0.017). The time interval from the last subretinal fluid resolution was not associated with the presence of metamorphopsia. CONCLUSION In "resolved" central serous chorioretinopathy, clinical aspects (i.e., number of previous recurrences) and structural changes (i.e., ganglion cell complex and outer nuclear layer thinning) are associated with metamorphopsia after subretinal fluid resolution.
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Affiliation(s)
- Enrico Borrelli
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - Costanza Barresi
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - Marco Battista
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - Alessandro Berni
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - Federico Ricardi
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - Maria Lucia Cascavilla
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | | | - Francesco Bandello
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy; and
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Kaplan FB, Açıkalın B, Ergin A, Kocapınar Y. PROGNOSIS EVALUATION WITH OPTICAL COHERENCE TOMOGRAPHY IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY. Photodiagnosis Photodyn Ther 2023; 42:103552. [PMID: 37023997 DOI: 10.1016/j.pdpdt.2023.103552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Central serous chorioretinopathy (CSCR) is the fourth most common retinopathy that causes severe vision loss and is frequently seen in young and active patients. Our aim in this study is to evaluate whether a foresight about the prognosis of patients with CSCR can be obtained by optical coherence tomography (OCT) findings. MATERIALS AND METHODS Patients diagnosed with chronic CSCR at Fatih Sultan Mehmet Research and Training Hospital, Ophthalmology Department, were screened between January 2017 and September 2019, and 30 patients were included in the study. The anatomical and functional changes of the patients during the 6-month follow-up and the relationship between the OCT findings at baseline and the best corrected visual acuity (BCVA) in the sixth month were evaluated. RESULTS All of the participants were treated with subthreshold micropulse laser therapy. BCVA increased significantly at first month and sixth month examinations compared to baseline, while the central macular thicknesses decreased significantly (p=0.01, p=0.00). Among the parameters examined in the baseline OCT, a positive correlation was found between the thickness of the outer nuclear layer (r=-0.520, p=0.003) and BCVA at sixth month. In addition, subretinal fluid density and the number of intra-subretinal hyperreflective dots negatively affected BCVA (r=0.371, p=0.044 and r=0.509, p=0.004). CONCLUSION Outer nuclear layer thickness, subretinal fluid density and intra-subretinal hyperreflective dots were the OCT biomarkers related to sixth month BCVA. The clinical use of these biomarkers will help evaluate the prognosis of the CSCR.
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Affiliation(s)
- Fatih Bilgehan Kaplan
- University of Health Sciences, Department of Ophthalmology Ataşehir, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy mahallesi Hastane sokak No: 1/8, Istanbul 34752, Türkiye.
| | - Banu Açıkalın
- University of Health Sciences, Department of Ophthalmology Ataşehir, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy mahallesi Hastane sokak No: 1/8, Istanbul 34752, Türkiye
| | - Ayşe Ergin
- University of Health Sciences, Department of Ophthalmology Ataşehir, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy mahallesi Hastane sokak No: 1/8, Istanbul 34752, Türkiye
| | - Yıldırım Kocapınar
- Department of Ophthalmology, Siirt Training and Research Hospital, Siirt, Türkiye
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Caplash S, Surakiatchanukul T, Arora S, Maltsev DS, Singh SR, Sahoo NK, Parameshwarappa D, Kulikov AN, Iovino C, Tatti F, Gujar R, Venkatesh R, Reddy NG, Snehith R, Peiretti E, Lupidi M, Chhablani J. Multimodal Imaging Based Predictors for the Development of Choroidal Neovascularization in Patients with Central Serous Chorioretinopathy. J Clin Med 2023; 12:jcm12052069. [PMID: 36902857 PMCID: PMC10004102 DOI: 10.3390/jcm12052069] [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: 01/05/2023] [Revised: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
This study evaluated predictors for choroidal neovascularization (CNV) associated with central serous chorioretinopathy (CSCR) based on multimodal imaging. A retrospective multicenter chart review was conducted on 134 eyes of 132 consecutive patients with CSCR. Eyes were classified as per the multimodal imaging-based classification of CSCR at baseline into simple/complex CSCR and primary episode/recurrent/resolved CSCR. Baseline characteristics of CNV and predictors were evaluated with ANOVA. In 134 eyes with CSCR, 32.8% had CNV (n = 44) with 72.7% having complex CSCR (n = 32), 22.7% having simple (n = 10) and 4.5% having atypical (n = 2). Primary CSCR with CNV were older (58 vs. 47, p = 0.00003), with worse visual acuity (0.56 vs. 0.75, p = 0.01) and of longer duration (median 7 vs. 1, p = 0.0002) than those without CNV. Similarly, recurrent CSCR with CNV were older (61 vs. 52, p = 0.004) than those without CNV. Patients with complex CSCR were 2.72 times more likely to have CNV than patients with simple CSCR. In conclusion, CNV associated with CSCR was more likely in complex CSCR and older age of presentation. Both primary and recurrent CSCR are implicated in CNV development. Patients with complex CSCR were 2.72 times more likely to have CNV than patients with simple CSCR. Multimodal imaging-based classification of CSCR supports detailed analysis of associated CNV.
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Affiliation(s)
- Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA 15213, USA
- Correspondence:
| | - Thamolwan Surakiatchanukul
- Department of Ophthalmology, Jamaica Hospital Medical Center, 8900 Van Wyck Expy, New York Medical College, New York, NY 11418, USA
| | - Supriya Arora
- Princess Margaret Hospital, 3MF7+P9G, Shirley St, Nassau P.O. Box N-3730, Bahamas
| | - Dmitrii S. Maltsev
- Department of Ophthalmology, Military Medical Academy, 194044 St. Petersburg, Russia
| | | | - Niroj Kumar Sahoo
- LV Prasad Eye Institute, Kode Venkatadri Chowdary Campus, Penamaluru Rd, Tadigadapa, Vijayawada 521134, India
| | - Deepika Parameshwarappa
- LV Prasad Eye Institute, Kode Venkatadri Chowdary Campus, Penamaluru Rd, Tadigadapa, Vijayawada 521134, India
| | - Alexei N. Kulikov
- Department of Ophthalmology, Military Medical Academy, 194044 St. Petersburg, Russia
| | - Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Università, 40, 09124 Cagliari, Italy
| | - Filippo Tatti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Università, 40, 09124 Cagliari, Italy
| | - Ramkailash Gujar
- Department of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Piazza Università, 1, 06156 Perugia, Italy
| | - Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya Foundation, 1st Main, Binnamangala, Defence Colony, 100 Feet Road, Bengaluru 560099, India
| | - Nikitha Gurram Reddy
- Department of Retina and Vitreous, Narayana Nethralaya Foundation, 1st Main, Binnamangala, Defence Colony, 100 Feet Road, Bengaluru 560099, India
| | - Ram Snehith
- Department of Retina and Vitreous, Narayana Nethralaya Foundation, 1st Main, Binnamangala, Defence Colony, 100 Feet Road, Bengaluru 560099, India
| | - Enrico Peiretti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Università, 40, 09124 Cagliari, Italy
| | - Marco Lupidi
- Department of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Piazza Università, 1, 06156 Perugia, Italy
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA 15213, USA
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Zhang L, Van Dijk EHC, Borrelli E, Fragiotta S, Breazzano MP. OCT and OCT Angiography Update: Clinical Application to Age-Related Macular Degeneration, Central Serous Chorioretinopathy, Macular Telangiectasia, and Diabetic Retinopathy. Diagnostics (Basel) 2023; 13:diagnostics13020232. [PMID: 36673042 PMCID: PMC9858550 DOI: 10.3390/diagnostics13020232] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Similar to ultrasound adapting soundwaves to depict the inner structures and tissues, optical coherence tomography (OCT) utilizes low coherence light waves to assess characteristics in the eye. Compared to the previous gold standard diagnostic imaging fluorescein angiography, OCT is a noninvasive imaging modality that generates images of ocular tissues at a rapid speed. Two commonly used iterations of OCT include spectral-domain (SD) and swept-source (SS). Each comes with different wavelengths and tissue penetration capacities. OCT angiography (OCTA) is a functional extension of the OCT. It generates a large number of pixels to capture the tissue and underlying blood flow. This allows OCTA to measure ischemia and demarcation of the vasculature in a wide range of conditions. This review focused on the study of four commonly encountered diseases involving the retina including age-related macular degeneration (AMD), diabetic retinopathy (DR), central serous chorioretinopathy (CSC), and macular telangiectasia (MacTel). Modern imaging techniques including SD-OCT, TD-OCT, SS-OCT, and OCTA assist with understanding the disease pathogenesis and natural history of disease progression, in addition to routine diagnosis and management in the clinical setting. Finally, this review compares each imaging technique's limitations and potential refinements.
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Affiliation(s)
- Lyvia Zhang
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
| | | | - Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, 20132 Milan, Italy
| | - Serena Fragiotta
- Ophthalmology Unit, Department NESMOS, S. Andrea Hospital, University of Rome “La Sapienza”, 00189 Rome, Italy
| | - Mark P. Breazzano
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY 13088, USA
- Correspondence: ; Tel.: +1-(315)-445-8166
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Borrelli E, Viganò C, Battista M, Sacconi R, Senni C, Querques L, Grosso D, Bandello F, Querques G. Individual vs. combined imaging modalities for diagnosing neovascular central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2022; 261:1267-1273. [PMID: 36441229 DOI: 10.1007/s00417-022-05924-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To assess the diagnostic accuracy of individual and combined imaging modalities compared with multimodal imaging for the detection of choroidal neovascularization (CNV) in central serous chorioretinopathy (CSC). METHODS We analyzed patients with CSC with and without CNV who had indocyanine green angiography (ICGA), structural optical coherence tomography (OCT), and OCT angiography (OCTA) obtained on the same day. The presence of CNV was determined using multimodal imaging by a senior retina specialist (i.e., diagnostic reference). Individual and combined (i.e., ICGA + structural OCT) imaging modalities were then graded by two expert readers for the presence of CNV. Sensitivity, specificity, positive (PPV), and negative (NPV) predictive values were computed for individual and combined imaging modalities relative to the diagnostic reference. RESULTS CNV was detected in 17 eyes in 17 out of 33 CSC patients according to the reference standard. Using ICGA, the identification of CNV had a sensitivity of 66.7%, specificity of 66.7%, PPV of 70.6%, and NPV of 62.5%. Structural OCT had the following diagnostic accuracy values: 83.3% of sensitivity, 53.3% of specificity, 68.1% of PPV, and 72.7% of NPV. Using OCTA, CNV was graded to be present with a sensitivity of 77.8%, specificity of 86.7%, PPV of 87.5%, and NPV of 76.5%. The combination of ICGA and structural OCT granted the identification of CNV with a sensitivity of 83.3%, specificity of 86.7%, PPV of 88.2%, and NPV of 81.3%. CONCLUSIONS OCTA has an elevated diagnostic accuracy in identifying CSC-associated CNV, though a combination of ICGA and structural OCT has a comparable diagnostic efficiency.
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Affiliation(s)
- Enrico Borrelli
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Viganò
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Battista
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Sacconi
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlotta Senni
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lea Querques
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Domenico Grosso
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Querques
- Vita-Salute San Raffaele University, Milan, Italy.
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Zheng F, He J, Su Z, Liu Y, Xu Y, Liu L, Ye P. OCT biomarkers related to subthreshold micropulse laser treatment effect in central serous chorioretinopathy. BMC Ophthalmol 2022; 22:252. [PMID: 35668416 PMCID: PMC9172075 DOI: 10.1186/s12886-022-02472-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background To identify the OCT biomarkers related to the anatomical outcomes in eyes with central serous chorioretinopathy (CSCR) after subthreshold micropulse laser (SML) treatment. Methods Patients with CSCR underwent SML were enrolled in this retrospective study. Only patients who underwent enhanced depth imaging optical coherence tomography (EDI-OCT) examination before and after SML were selected. Patients were divided into two groups based on whether subretinal fluid (SRF) absorbed or not after SML. Group 1 was the SRF resolved group, and Group 2 was the SRF non-resolved group. Factors including age and gender, duration of symptoms, CSCR history, the height of SRF at baseline, retinal pigment epithelium (RPE) /inner choroid alterations, as well as subfoveal choroidal thickness (SFCT) of the affected eye and the fellow eye before and after SML were recorded and compared between two groups. Longitudinal change of SFCT of a subgroup of patients were analyzed. Results A total of 58 eyes of 58 patients were involved in this study. SRF of 31 eyes got completely absorbed, and SRF of 27 eyes was retained after SML. Logistic regression analysis revealed baseline SFCT of the affected eye (OR = 1.007, 95% CI: 1.001–1.012, P = 0.019) and RPE/inner choroid alterations (OR = 25.229, 95% CI: 2.890–220.281, P = 0.004) were correlated with SML efficacy. Thirty-three eyes of 33 patients were enrolled in the subgroup analysis. A significant difference of SFCT changes between two groups were demonstrated (P = 0.001). The difference of SFCT between baseline and three months after SML was also related to SRF resolution (OR = 0.952, 95% CI: 0.915–0.990, P = 0.014). Conclusion Baseline SFCT, change of SFCT at 3-month after treatment, and RPE/inner choroid alterations were the OCT biomarkers related to SRF resolution after SML treatment.
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Affiliation(s)
- Fang Zheng
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, No.88, Jiefang Road, Hangzhou, 310009, China
| | - Jingliang He
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, No.88, Jiefang Road, Hangzhou, 310009, China
| | - Zhitao Su
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, No.88, Jiefang Road, Hangzhou, 310009, China
| | - Ye Liu
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, No.88, Jiefang Road, Hangzhou, 310009, China
| | - Yufeng Xu
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, No.88, Jiefang Road, Hangzhou, 310009, China
| | - Lei Liu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Panpan Ye
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, No.88, Jiefang Road, Hangzhou, 310009, China.
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Zhou X, Komuku Y, Araki T, Terasaki H, Miki A, Kuwayama S, Nishi T, Kinoshita T, Gomi F. Risk factors and characteristics of central serous chorioretinopathy with later development of macular neovascularisation detected on OCT angiography: a retrospective multicentre observational study. BMJ Open Ophthalmol 2022; 7:bmjophth-2022-000976. [PMID: 35537029 PMCID: PMC9016399 DOI: 10.1136/bmjophth-2022-000976] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/23/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To identify the risk factors and characteristics of central serous chorioretinopathy (CSC) with subsequent macular neovascularisation (MNV) detected on optical coherence tomography angiography (OCTA). Methods and analysis We included patients from six institutions who were initially diagnosed with CSC and subsequently did or did not develop MNV detected by OCTA. Potential influencing factors were identified by evaluating the patients’ baseline demographics, multimodal fundus imaging, treatment options, recurrence and outcomes in both groups. Results We enrolled 176 eyes in 152 patients (112 men, 40 women; mean age: 52.1±10.4 years) with a mean follow-up of 30.4±16.3 months. Secondary MNV was present in 23 eyes (13.1%), and non-MNV was observed in 153 eyes (86.9%) by OCTA. Multivariate analysis revealed that older age (OR 1.06; 95% CI 1.01 to 1.11; p=0.014), chronic CSC (OR 3.05; 95% CI 1.12 to 8.30; p=0.029), leakage sites within the fovea on fluorescein angiography (OR 7.60; 95% CI, 1.89 to 30.48; p=0.004) and recurrent fluid within the first year (OR 5.12; 95% CI 1.66 to 15.77; p=0.012) were risk factors for subsequent MNV. Moreover, eyes with CSC complicated with MNV were characterised by poor visual acuity and low complete fluid resolution rates. Conclusion The factors associated with MNV secondary to CSC were older age, higher rates of chronic CSC and recurrence, and foveal leakage points on fluorescein angiography.
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Affiliation(s)
- Xiaoyin Zhou
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
| | - Yuki Komuku
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
| | - Takashi Araki
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
| | - Hiroto Terasaki
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
- Department of Ophthalmology, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Akiko Miki
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
- Department of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Soichiro Kuwayama
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomo Nishi
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
- Department of Ophthalmology, Nara Medical University, Kashihara, Nara, Japan
| | - Takamasa Kinoshita
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- Japan Clinical Retina Study (JCREST) group, Kagoshima, Kagoshima, Japan
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Hagag AM, Rasheed R, Chandra S, Jeffery G, Sivaprasad S. The Diagnostic Accuracy of Double-Layer Sign in Detection of Macular Neovascularization Secondary to Central Serous Chorioretinopathy. Am J Ophthalmol 2022; 236:271-280. [PMID: 34699741 DOI: 10.1016/j.ajo.2021.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the diagnostic value of elevated retinal pigment epithelium (RPE) and double-layer sign (DLS) in identifying macular neovascularization (MNV) secondary to central serous chorioretinopathy (CSCR). DESIGN Retrospective, cross-sectional study. METHODS Patients with CSCR underwent optical coherence tomography (OCT) and OCT angiography (OCT-A) scanning at Moorfields Eye Hospital. OCT scans were reviewed to identify the presence/absence of an RPE elevation. The maximum length and maximum height of the elevated RPE were measured. A minimum length of 1000 µm and a maximum height of 150 µm were used to define the "double-layer sign." Other qualitative anatomical features were also graded from OCT scans. OCT-A was examined to confirm the presence/absence of MNV. Binary logistic regression analyses were used to assess the association between OCT features and the detection of MNV on OCT-A. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the diagnostic accuracy. RESULTS One hundred sixty-three eyes from 132 patients were included. Elevated RPE was detected in 148 eyes (91%). OCT-A-confirmed MNV was detected in 54 eyes (33%). The sensitivity and specificity of RPE elevation were 100% and 13.8%, respectively. DLS was identified in 95 eyes (58%). The sensitivity and specificity of DLS for detecting MNV were 87% and 56%, respectively. Hyperreflectivity and nonhomogeneity of the sub-RPE space were independently associated with MNV within the DLS (odds ratio, 17.7 and 14.8, P < .001 and P = .02, respectively). None of the other demographic or anatomical features were associated with MNV. The presence of nonhomogeneous hyperreflective RPE elevation had a sensitivity and specificity of 98% and 67%, with PPV and NPV of 60% and 99%, respectively. CONCLUSIONS Nonhomogeneous and hyperreflective space under an elevated RPE of any length or height indicates an eye with higher risk of MNV than DLS. OCT-A should at least be performed for these eyes to confirm the presence of MNV and treat accordingly.
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Affiliation(s)
- Ahmed M Hagag
- From the Moorfields Eye Hospital NHS Foundation Trust (A.M.H., R.R., S.C., S.S.); and the UCL Institute of Ophthalmology (A.M.H., R.R., S.C., G.J., S.S.), London, United Kingdom
| | - Rajna Rasheed
- From the Moorfields Eye Hospital NHS Foundation Trust (A.M.H., R.R., S.C., S.S.); and the UCL Institute of Ophthalmology (A.M.H., R.R., S.C., G.J., S.S.), London, United Kingdom
| | - Shruti Chandra
- From the Moorfields Eye Hospital NHS Foundation Trust (A.M.H., R.R., S.C., S.S.); and the UCL Institute of Ophthalmology (A.M.H., R.R., S.C., G.J., S.S.), London, United Kingdom
| | - Glen Jeffery
- From the Moorfields Eye Hospital NHS Foundation Trust (A.M.H., R.R., S.C., S.S.); and the UCL Institute of Ophthalmology (A.M.H., R.R., S.C., G.J., S.S.), London, United Kingdom
| | - Sobha Sivaprasad
- From the Moorfields Eye Hospital NHS Foundation Trust (A.M.H., R.R., S.C., S.S.); and the UCL Institute of Ophthalmology (A.M.H., R.R., S.C., G.J., S.S.), London, United Kingdom..
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Visual acuity correlates with multimodal imaging-based categories of central serous chorioretinopathy. Eye (Lond) 2022; 36:517-523. [PMID: 34645969 PMCID: PMC8873496 DOI: 10.1038/s41433-021-01788-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/14/2021] [Accepted: 09/17/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To evaluate visual acuity (VA) and factors influencing VA using new multimodal imaging-based classification of central serous chorioretinopathy (CSCR). METHODS Retrospective, observational and cross-sectional study on 229 naïve eyes diagnosed as CSCR with available baseline data and multimodal imaging. Each case was classified into (i) simple/complex/atypical; (ii) primary/recurrent/resolved; (iii) persistent or not; (iv) outer retinal atrophy(ORA) present/absent; (v) foveal involvement present/absent; and (vi) macular neovascularization(MNV) present/absent. Best corrected visual acuity (BCVA) was correlated to the classification as well as every parameter of the classification. RESULTS Median BCVA was 0.18 logMAR [95% Confidence Interval (CI)0.16-0.18] with median duration of complaints of one month (95% CI,6.14-13.0 months). Age of the patient (r = -0.24, p = 0.002) and duration of the disease (r = -0.32, p < 0.001) correlated significantly with BCVA. Logistic regression model showed that older age [odds ratio (OR) = 0.96, p = 0.05], female gender (OR = 2.45, p = 0.046), presence of ORA(OR = 0.34, p = 0.012),and foveal involvement(OR = 0.18, p = 0.007) were statistically significantly associated with poorer BCVA. Eyes classified as complex, persistent CSCR, with ORA or foveal involvement demonstrated lower BCVA compared to those with simple, non-persistent CSCR, without ORA or without foveal involvement (p < 0.05). Eyes with complex CSCR (p < 0.001), atypical CSCR(p = 0.025), persistent subretinal fluid (SRF) (p = 0.001) and those with ORA (p < 0.001) demonstrated a trend towards severe visual loss. Prevalence of persistent SRF, recurrent episodes and ORA was significantly higher among eyes with complex CSCR (p < 0.001) while there was no difference in prevalence of resolved cases (p = 0.07), foveal involvement (p = 0.28) and MNV (p = 0.45) between simple and complex cases. CONCLUSION There is a strong correlation between VA and foveal involvement and ORA using the new classification. Thus, the objective parameters of the classification can be incorporated in establishing the treatment guidelines for CSCR.
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Borrelli E, Sacconi R, Battista M, Bandello F, Querques G. Reply to Comment on OCT Risk Factors for 3-Year Development of Macular Complications in eyes with "Resolved" Chronic Central Serous Chorioretinopathy. Am J Ophthalmol 2021; 229:314-317. [PMID: 33857505 DOI: 10.1016/j.ajo.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
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AGGARWAL DAVID, TAKKAR BRIJESH. Comment on OCT Risk Factors for 3-Year Development of Macular Complications in Eyes With "Resolved" Chronic Central Serous Chorioretinopathy. Am J Ophthalmol 2021; 229:314-317. [PMID: 33857503 DOI: 10.1016/j.ajo.2021.03.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
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Esen E, Sizmaz S, Demircan N. Microstructural changes after half-dose photodynamic therapy in patients with chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2021; 35:102347. [PMID: 34033938 DOI: 10.1016/j.pdpdt.2021.102347] [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: 04/08/2021] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To evaluate the retinal and choroidal microstructural changes at fovea after half-dose photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (CSC), using optical coherence tomography (OCT). METHODS The study included 35 eyes with unilateral chronic CSC treated with half-dose PDT. The foveal outer nuclear layer (ONL) and subfoveal choroidal thickness (SFCT) in the affected eyes were compared with baseline measurements at month 1, 3, and 6 after half-dose PDT, and those of the healthy contralateral eyes. RESULTS The mean baseline ONL thickness of the affected eyes was thinner compared to unaffected fellow eyes (66.9 ± 16.5 μm vs 111.5 ± 11.6 μm, p<0.001), and increased significantly to 68.6 ± 17.0 μm at month 3 and 68.9 ± 17.3 μm at month 6 after treatment (p = 0.025 and p = 0.014 respectively). The mean baseline SFCT of the affected eyes was thicker compared to unaffected fellow eyes (399.9 ± 87.0 μm vs 338.2 ± 75.4 μm, p<0.001), and decreased significantly after treatment at month 1, 3, and 6 (374.0 ± 84.8 μm, 369.7 ± 81.8 μm, 367.3 ± 80.8 μm respectively, p<0.001 for all). The responder group (n = 26), in which subretinal fluid was completely resorbed, showed a significant increase in ONL thickness and decrease in SFCT after treatment, whereas in the non-responder group (n = 9) ONL thickness and SFCT did not differ after treatment. CONCLUSIONS In CSC patients, significant changes are observed in foveal ONL thickness and SFCT after half-dose PDT. ONL thickness and SFCT are suggested to be considered in the OCT examinations of CSC patients.
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Affiliation(s)
- Ebru Esen
- Department of Ophthalmology, School of Medicine, Cukurova University, Adana, Turkey.
| | - Selcuk Sizmaz
- Department of Ophthalmology, School of Medicine, Cukurova University, Adana, Turkey.
| | - Nihal Demircan
- Department of Ophthalmology, School of Medicine, Cukurova University, Adana, Turkey.
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The COVID-19 Pandemic Has Had Negative Effects on Baseline Clinical Presentation and Outcomes of Patients with Newly Diagnosed Treatment-Naïve Exudative AMD. J Clin Med 2021; 10:jcm10061265. [PMID: 33803808 PMCID: PMC8003286 DOI: 10.3390/jcm10061265] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate whether the coronavirus disease 2019 (COVID-19) pandemic-associated postponement in care had effects on the baseline clinical presentation of patients with newly diagnosed treatment-naïve exudative neovascular age-related macular degeneration (AMD). METHODS We included the first 50 consecutive patients referred within the COVID-19 pandemic with a diagnosis of treatment-naïve exudative neovascular AMD. Two groups of fifty consecutive patients with newly diagnosed neovascular exudative AMD presenting in 2018 and 2019 (control periods) were also included for comparisons. RESULTS Baseline visual acuity was statistically worse in patients referred during the COVID-19 pandemic period (0.87 ± 0.51 logarithm of the minimum angle of resolution (LogMAR)) as compared with both the "2019" (0.67 ± 0.48 LogMAR, p = 0.001) and "2018" (0.69 ± 0.54 LogMAR, p = 0.012) control periods. Data on the visual function after a loading dose of anti-vascular endothelial growth factor (VEGF) was available in a subset of patients (43 subjects in 2020, 45 in 2019 and 46 in 2018, respectively). Mean ± SD best corrected visual acuity (BCVA) at the 1-month follow-up visit after the third anti-VEGF injection was still worse in patients referred during the COVID-19 pandemic (0.82 ± 0.66 LogMAR) as compared with both the "2019" (0.60 ± 0.45 LogMAR, p = 0.021) and "2018" (0.55 ± 0.53 LogMAR, p = 0.001) control periods. On structural optical coherence tomography (OCT), the maximum subretinal hyperreflective material (SHRM) height and width were significantly greater in the COVID-19 pandemic patients. CONCLUSIONS We demonstrated that patients with newly diagnosed treatment-naïve exudative neovascular AMD referred during the COVID-19 pandemic had worse clinical characteristics at presentation and short-term visual outcomes.
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Borrelli E, Battista M, Vella G, Sacconi R, Querques L, Grosso D, Bandello F, Querques G. Three-year OCT predictive factors of disease recurrence in eyes with successfully treated myopic choroidal neovascularisation. Br J Ophthalmol 2021; 106:1132-1138. [PMID: 33692035 DOI: 10.1136/bjophthalmol-2020-318440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/16/2020] [Accepted: 02/21/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To assess the relationship of demographics, clinical characteristics and structural optical coherence tomography (OCT) findings to disease recurrence in a cohort of patients with newly diagnosed myopic choroidal neovascularisation (CNV) METHODS: In this retrospective, longitudinal study, a total of 64 participants (64 eyes) with successfully treated myopic CNV had obtained resolution of exudation after treatment (study baseline) and with 3 years of regular follow-ups. Several baseline OCT qualitative features and quantitative measurements were assessed at baseline and included in the analysis. Main outcome measures included incidence of disease recurrence and HR for demographics, clinical characteristics and OCT risk factors. RESULTS At month 36, 40 eyes (62.5%) developed disease recurrence (active CNV). Multivariate linear regression analysis revealed that final visual acuity (dependent variable) was associated with visual acuity at the first visit after complete resolution of exudation (p<0.0001), baseline size of patchy atrophy (p=0.010), baseline subfoveal choroidal thickness (p=0.008), baseline maximum CNV height and width (p=0.011 and p=0.003) and recurrence of CNV exudation (p=0.007). The following factors were associated with an increased risk of disease recurrence: size of patchy atrophy had an HR of 1.14 (95% CI 1.01 to 1.29; p=0.036); maximum CNV width had an HR of 1.02 (95% CI 1.01 to 1.04; p<0.0001). CONCLUSION We identified OCT risk factors for the disease recurrence in eyes with successfully treated myopic CNV. Assuming that disease recurrence is a sight-threatening event, our findings may help in the identification of high-risk patients and eventually ameliorate their outcome.
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Affiliation(s)
- Enrico Borrelli
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Ophthalmology, University Vita-Salute San Raffaele, Milan, Italy
| | - Marco Battista
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Ophthalmology, University Vita-Salute San Raffaele, Milan, Italy
| | - Giovanna Vella
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Ophthalmology, University Vita-Salute San Raffaele, Milan, Italy
| | - Lea Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Domenico Grosso
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Ophthalmology, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Ophthalmology, University Vita-Salute San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Milan, Italy .,Department of Ophthalmology, University Vita-Salute San Raffaele, Milan, Italy
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