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Jain M, Mohan S, van Dijk EHC. Central serous chorioretinopathy: Pathophysiology, systemic associations, and a novel etiological classification. Taiwan J Ophthalmol 2022; 12:381-393. [PMID: 36660127 PMCID: PMC9843580 DOI: 10.4103/2211-5056.362601] [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: 09/15/2022] [Accepted: 10/04/2022] [Indexed: 12/08/2022] Open
Abstract
Central serous chorioretinopathy (CSC) has remained an enigmatic disease since its initial description by Von Graefe. Over the years, multiple risk factors have been recognized: these include psychological stress, behavioral traits, and corticosteroids. The basic pathophysiology of CSC involves choroidal thickening, vascular congestion, altered choroidal blood flow (ChBF), and choroidal hyperpermeability, leading to retinal pigment epithelium decompensation and subsequent neurosensory detachment. Multiple organ systems, mainly the nervous, cardiovascular, endocrinal, and renal systems participate in the control of the vascular tone and the ChBF via hypothalamus-pituitary-adrenal axis and renin-angiotensin-aldosterone system, while others such as the hepatic system regulate the enzymatic degradation of corticosteroids. Many vasoactive and psychotropic drugs also modulate the ocular perfusion. In addition, there are anatomical and genetic predispositions that determine its progression to the chronic or recurrent form, through cellular response and angiogenesis. We herein review the basic pathophysiology and immunogenetics in CSC along with the role of multiple organ systems. With this background, we propose an etiological classification that should provide a framework for customized therapeutic interventions.
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Affiliation(s)
- Manish Jain
- Department of Ophthalmology, Al Dhannah Hospital, Abu Dhabi, United Arab Emirates,Address for correspondence: Dr. Manish Jain, Department of Ophthalmology, Al Dhannah Hospital, Abu Dhabi, United Arab Emirates. E-mail:
| | - Sashwanthi Mohan
- Department of Vitreous and Retina, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
| | - Elon H. C. van Dijk
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
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Jain M, Garg SJ, Khan M, Chaudhary V, Zeraatkar D, Kurian D, Lal S. The associations between central serous chorioretinopathy and muscle relaxants: A case-control study. Taiwan J Ophthalmol 2022; 12:415-422. [PMID: 36660119 PMCID: PMC9843563 DOI: 10.4103/2211-5056.361975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/09/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the role of muscle-relaxants as risk factors for the development of central serous chorioretinopathy (CSC) - the second most common retinopathy in our settings; despite multiple risk factors seen in our patients, 21% were initially labelled as idiopathic. MATERIALS AND METHODS Retrospective case-control study at a tertiary hospital in the United Arab Emirates, where we reviewed the medical records of 273 patients with CSC examined between 2010 and 2019 for use of muscle-relaxants including tolperisone/eperisone, carisoprodol and gabapentin/pregabalin within a year of onset/recurrence of the disease. Intake of drugs with known association with CSC (including corticosteroids/sympathomimetics) was also recorded. Two hundred eighty-six subjects with adverse events seen at the same institute during the same study period served as controls. Odds ratios, Chi-Square tests and multivariate logistic regression were carried out to determine any associations with the muscle-relaxants and other pharmacological confounders - corticosteroids/sympathomimetics. RESULTS Muscle relaxants may increase the risk of CSC as evident on multivariate regression analysis (OR: 2.55; confidence interval [CI]: 1.208-5.413); the significance was retained on removing the 6 subjects who had corticosteroids/sympathomimetics (OR: 2.30; CI: 1.073-4.939). Univariate analysis yielded an OR of 2.52 for muscle relaxants (CI: 1.2149-5.2276), 2.96 for eperisone/tolperisone (CI: 1.3531-6.5038), and 6.26 for eperisone as an individual agent (CI: 1.8146-21.6252). CONCLUSION We found muscle relaxants to be associated factors of CSC regardless of inclusion of corticosteroids/sympathomimetics (P < 0.05). Among individual classes of muscle relaxants in this study, only eperisone/tolperisone posed a significant risk (P < 0.05). The vascular smooth muscle relaxation could be the possible mechanism that affects the choroidal blood flow and indirectly predisposes to CSC.
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Affiliation(s)
- Manish Jain
- Department of Ophthalmology, Veer Chandra Singh Garhwali, Government Institute of Medical Sciences and Research, Srinagar, Uttarakhand, India,Department of Ophthalmology, NMC Hospital, Al Ain, United Arab Emirates,Address for correspondence: Dr. Manish Jain, Department of Ophthalmology, Veer Chandra Singh Garhwali, Government Institute of Medical Sciences and Research, Srinagar - 246 174, Uttarakhand, India. E-mail:
| | - Sunir J. Garg
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mohammad Khan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada
| | - Varun Chaudhary
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Dhanya Kurian
- Department of Ophthalmology, NMC Hospital, Al Ain, United Arab Emirates
| | - Sarath Lal
- Department of Ophthalmology, NMC Hospital, Al Ain, United Arab Emirates
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Pandolfo G, Genovese G, Bruno A, Palumbo D, Poli U, Gangemi S, Aragona P, Meduri A. Sharing the Same Perspective. Mental Disorders and Central Serous Chorioretinopathy: A Systematic Review of Evidence from 2010 to 2020. Biomedicines 2021; 9:biomedicines9081067. [PMID: 34440271 PMCID: PMC8394052 DOI: 10.3390/biomedicines9081067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/24/2022] Open
Abstract
Background: The relevance of the association between mental disorders and other conditions might have been underestimated due to its complexity. Central Serous Chorioretinopathy (CSC) is an ophthalmological disorder associated with many psychiatric factors. The aim of this systematic review is to evaluate the association between mental disorders and CSC. Methods: Articles about studies performed on humans on CSC published in peer-reviewed journals from 1 January 2010 to 31 December 2020 were included in the review. Results: We selected 21 research papers. Nine studies measured stress and anxious depressive symptoms, which are associated with CSC onset and recurrences, emerging as a state marker of the disease. Four out of the five studies focused on sleep disorders suggested a reliable association with CSC. Four studies evaluated other various psychiatric factors. The role of psychopharmacological medication has still not been elucidated (three studies). Conclusion: Multiple pieces of evidence highlights that CSC might arise in the context of systemic disease. This notion, together with the increasing evidence supporting a link between psychiatric disorders and choroidal thickness, suggests that CSC and mental disorders may share some etiopathogenetic pathways. Further research is needed to better investigate possible common etiopathogenetic pathways, especially vascular, immunological and endocrinological systems.
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Affiliation(s)
- Gianluca Pandolfo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (G.P.); (A.B.); (D.P.); (U.P.); (P.A.); (A.M.)
| | - Giovanni Genovese
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (G.P.); (A.B.); (D.P.); (U.P.); (P.A.); (A.M.)
- Correspondence:
| | - Antonio Bruno
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (G.P.); (A.B.); (D.P.); (U.P.); (P.A.); (A.M.)
| | - Diletta Palumbo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (G.P.); (A.B.); (D.P.); (U.P.); (P.A.); (A.M.)
| | - Umberto Poli
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (G.P.); (A.B.); (D.P.); (U.P.); (P.A.); (A.M.)
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Policlinico “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy;
| | - Pasquale Aragona
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (G.P.); (A.B.); (D.P.); (U.P.); (P.A.); (A.M.)
| | - Alessandro Meduri
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (G.P.); (A.B.); (D.P.); (U.P.); (P.A.); (A.M.)
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Plasma dopamine and catecholamine levels in patients with central serous chorioretinopathy. J Fr Ophtalmol 2021; 44:621-625. [PMID: 33865632 DOI: 10.1016/j.jfo.2020.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/27/2020] [Accepted: 08/24/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate plasma dopamine and catecholamine levels in patients with central serous chorioretinopathy (CSCR). MATERIALS AND METHODS In this prospective study, 32 patients with acute CSCR were included, along with 32 age- and gender-matched healthy controls without CSCR. Complete ophthalmologic examinations were performed. Plasma dopamine, epinephrine, norepinephrine levels were measured in the morning after 8-12hours of fasting. A P-value of less than 0.05 was considered statistically significant. RESULTS While the mean age of the CSCR group was 40.12±7.96 years, the mean age of the control group was 37.81±7.26 years. There was no statistically significant difference between the groups in terms of age or gender (P=0.229, P=0.740, respectively). The plasma dopamine level was 29.85±9.39pg/ml in the CSCR group and 23.93±7.33pg/ml in the control group (P=0.001). The plasma epinephrine level was 60.73±25.69pg/ml in the CSCR group and 45.77±18.55pg/ml in the control group (P=0.021). The plasma norepinephrine level was 206.68±71.51pg/ml in the CSCR group and 149.33±49.69pg/ml in the control group (P=0.001). Plasma dopamine, epinephrine, and norepinephrine levels were statistically significantly higher in the CSCR group. CONCLUSION We concluded that dopamine may be a possible factor in the etiology of CSCR, both through its receptors and by enhancing sympathetic activity.
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van Dijk EHC, Boon CJF. Serous business: Delineating the broad spectrum of diseases with subretinal fluid in the macula. Prog Retin Eye Res 2021; 84:100955. [PMID: 33716160 DOI: 10.1016/j.preteyeres.2021.100955] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/14/2021] [Accepted: 02/19/2021] [Indexed: 02/08/2023]
Abstract
A wide range of ocular diseases can present with serous subretinal fluid in the macula and therefore clinically mimic central serous chorioretinopathy (CSC). In this manuscript, we categorise the diseases and conditions that are part of the differential diagnosis into 12 main pathogenic subgroups: neovascular diseases, vitelliform lesions, inflammatory diseases, ocular tumours, haematological malignancies, paraneoplastic syndromes, genetic diseases, ocular developmental anomalies, medication-related conditions and toxicity-related diseases, rhegmatogenous retinal detachment and tractional retinal detachment, retinal vascular diseases, and miscellaneous diseases. In addition, we describe 2 new clinical pictures associated with macular subretinal fluid accumulation, namely serous maculopathy with absence of retinal pigment epithelium (SMARPE) and serous maculopathy due to aspecific choroidopathy (SMACH). Differentiating between these various diseases and CSC can be challenging, and obtaining the correct diagnosis can have immediate therapeutic and prognostic consequences. Here, we describe the key differential diagnostic features of each disease within this clinical spectrum, including representative case examples. Moreover, we discuss the pathogenesis of each disease in order to facilitate the differentiation from typical CSC.
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Affiliation(s)
- Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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Jain M. Quetiapine associated Central Serous Chorioretinopathy: Implicit role of serotonin and dopamine pathways. Indian J Ophthalmol 2019; 67:292-294. [PMID: 30672500 PMCID: PMC6376803 DOI: 10.4103/ijo.ijo_929_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/16/2018] [Indexed: 12/03/2022] Open
Abstract
A 30-year-old insomniac, an off-label user of quetiapine, presented with blurring of central vision, eventually diagnosed as central serous chorioretinopathy. A potential association was suspected based on the drug's actions on the autonomic nervous system. He showed improvement on drug withdrawal; then he unwittingly resumed quetiapine and had a recurrence. Possible underlying mechanisms that include alteration in choroidal perfusion through serotonin and dopamine receptors are discussed. Although retinal vein occlusions and pigment epithelial detachment have been described with quetiapine, to the author's knowledge, this is the first case report of quetiapine-associated central serous chorioretinopathy.
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Affiliation(s)
- Manish Jain
- Department of Ophthalmology, NMC Specialty Hospital, Al Ain, Abu Dhabi, UAE
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The Impact of Financial Crisis on Central Serous Chorioretinopathy in Greece: Is There Any Correlation? Eur J Ophthalmol 2018; 24:559-65. [DOI: 10.5301/ejo.5000403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2013] [Indexed: 01/28/2023]
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Sakai T, Tsuneoka H. Reduced Blood Serotonin Levels in Chronic Central Serous Chorioretinopathy. Ophthalmol Retina 2016; 1:145-148. [PMID: 31047270 DOI: 10.1016/j.oret.2016.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/27/2016] [Accepted: 08/30/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate blood serotonin (5-hydroxytryptamine [5-HT]) levels in patients with chronic central serous chorioretinopathy (CSC). DESIGN A case-controlled retrospective study. PARTICIPANTS Forty-nine patients with CSC and 30 age-matched control subjects. METHODS Blood 5-HT levels were measured using high-performance liquid chromatography. MAIN OUTCOME MEASURES Blood 5-HT levels in patients with acute or chronic CSC were measured at the initial visit and compared with those in controls. RESULTS The blood 5-HT level (98.2±27.5 ng/ml) in patients with chronic CSC was significantly lower than those in patients with acute CSC (122.5±23.9 ng/ml, P = 0.0081) and controls (128.5±35.8 ng/ml, P = 0.0013). After adjusting for covariates, patients with decreased blood 5-HT levels were found to be more likely to develop chronic CSC (odds ratio, 0.97; 95% confidence interval, 0.95-0.99; P = 0.009). CONCLUSIONS These results suggest that serotonin may have a role in chronic CSC pathogenesis and is associated with disease progression.
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Affiliation(s)
- Tsutomu Sakai
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan.
| | - Hiroshi Tsuneoka
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan
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Lahousen T, Painold A, Luxenberger W, Schienle A, Kapfhammer HP, Ille R. Psychological factors associated with acute and chronic central serous chorioretinopathy. Nord J Psychiatry 2016; 70:24-30. [PMID: 25947110 DOI: 10.3109/08039488.2015.1041156] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Central serous chorioretinopathy (CSC) has been associated with several psychological factors. But previous psychological data are limited and mainly restricted to male patients and small sample size. In this study we investigated psychosomatic complaints, personality factors, life events, and stress coping in acute and chronic recurrent CSC patients. METHODS Ninety-five patients (71 men, 24 women) with either acute or chronic CSC were evaluated regarding critical life events before diagnosis, psychosomatic complaints, personality traits and coping style. The characteristics of CSC patients were compared with a control group comprising 75 patients (46 men, 29 women) suffering from acute or chronic ophthalmic disorders other than CSC. RESULTS Compared with patients of the control group, CSC patients reported more psychosomatic problems, unfavourable stress coping strategies and critical life events as well as elevated tension, aggression, strain, emotional instability and achievement orientation. Except for aggression the observed characteristics were more pronounced in acute than in chronic CSC patients. CONCLUSIONS The appearance of CSC may be associated with an accumulation of stressful life events with an unfavourable coping style and distinctive personality factors. Acute CSC is related to more unfavourable stress coping and more physical complaints compared to its chronic course. Elevated aggression may imply one potential risk factor for CSC manifestation and also may have an adverse effect with its chronification.
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Affiliation(s)
- Theresa Lahousen
- a Theresa Lahousen, Department of Psychiatry, Medical University of Graz , Austria
| | - Annamaria Painold
- b Annamaria Painold, Department of Psychiatry, Medical University of Graz , Austria
| | - Wolfgang Luxenberger
- c Wolfgang Luxenberger, Department of Psychiatry, Medical University of Graz , Austria
| | - Anne Schienle
- d Anne Schienle, Department of Psychology, Karl-Franzens-University of Graz , Austria
| | - Hans-Peter Kapfhammer
- e Hans-Peter Kapfhammer, Department of Psychiatry, Medical University of Graz , Austria
| | - Rottraut Ille
- f Rottraut Ille, Department of Psychology, Karl-Franzens-University of Graz , Austria
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Kooijman E, Nijboer CH, van Velthoven CTJ, Kavelaars A, Kesecioglu J, Heijnen CJ. The rodent endovascular puncture model of subarachnoid hemorrhage: mechanisms of brain damage and therapeutic strategies. J Neuroinflammation 2014; 11:2. [PMID: 24386932 PMCID: PMC3892045 DOI: 10.1186/1742-2094-11-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/17/2013] [Indexed: 01/05/2023] Open
Abstract
Subarachnoid hemorrhage (SAH) represents a considerable health problem. To date, limited therapeutic options are available. In order to develop effective therapeutic strategies for SAH, the mechanisms involved in SAH brain damage should be fully explored. Here we review the mechanisms of SAH brain damage induced by the experimental endovascular puncture model. We have included a description of similarities and distinctions between experimental SAH in animals and human SAH pathology. Moreover, several novel treatment options to diminish SAH brain damage are discussed.SAH is accompanied by cerebral inflammation as demonstrated by an influx of inflammatory cells into the cerebral parenchyma, upregulation of inflammatory transcriptional pathways and increased expression of cytokines and chemokines. Additionally, various cell death pathways including cerebral apoptosis, necrosis, necroptosis and autophagy are involved in neuronal damage caused by SAH.Treatment strategies aiming at inhibition of inflammatory or cell death pathways demonstrate the importance of these mechanisms for survival after experimental SAH. Moreover, neuroregenerative therapies using stem cells are discussed as a possible strategy to repair the brain after SAH since this therapy may extend the window of treatment considerably. We propose the endovascular puncture model as a suitable animal model which resembles the human pathology of SAH and which could be applied to investigate novel therapeutic therapies to combat this debilitating insult.
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Affiliation(s)
- Elke Kooijman
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cora H Nijboer
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cindy TJ van Velthoven
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annemieke Kavelaars
- Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cobi J Heijnen
- Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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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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