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Cheung CMG, Dansingani KK, Koizumi H, Lai TYY, Sivaprasad S, Boon CJF, Van Dijk EHC, Chhablani J, Lee WK, Freund KB. Pachychoroid disease: review and update. Eye (Lond) 2024:10.1038/s41433-024-03253-4. [PMID: 39095470 DOI: 10.1038/s41433-024-03253-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 05/15/2024] [Accepted: 07/11/2024] [Indexed: 08/04/2024] Open
Abstract
The pachychoroid disease spectrum is a phenotype characterized by alterations in choroidal vasculature which result in outer retinal and choriocapillaris damage and visual loss. The presence of pachyvessels is one of the key features of the pachychoroid phenotype. Recent imaging studies suggest that pachyvessels may form because of choroidal venous congestion in one or more quadrants. The formation of intervortex anastomosis may function as a compensatory mechanism to dissipate the increased venous pressure, while outflow obstruction has been hypothesized to occur at the site of the vortex vein exiting the sclera. This review aims to summarize recent imaging findings and discuss evolution in the understanding of pathogenesis of the pachychoroid disease spectrum. We have summarized notable treatment trials in central serous chorioretinopathy and polypoidal choroidal vasculopathy and included an update of the current diagnostic and management strategies of the entities that are part of the pachychoroid disease spectrum.
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Affiliation(s)
- Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Sobha Sivaprasad
- Moorfields Clinical Research Facility, NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Camiel J F Boon
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C Van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
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Gawecki M, Pytrus W, Swiech A, Mackiewicz J, Lytvynchuk L. Laser Treatment of Central Serous Chorioretinopathy - An Update. Klin Monbl Augenheilkd 2024. [PMID: 39047764 DOI: 10.1055/a-2338-3235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Laser treatment has been a mainstay for management of central serous chorioretinopathy for a few decades. Different types of lasers have been used and non-damaging retinal laser is the most recent option. The aim of this review is to provide an update on this form of treatment, based on the research published during last 5 years, in comparison with earlier studies published. A MEDLINE database search was performed with a combination of the following terms: central serous chorioretinopathy and laser photocoagulation or subthreshold laser or subthreshold micropulse laser or nanosecond laser or microsecond laser or end-point management or photodynamic therapy. Results were analyzed separately for each modality of laser treatment. Reports published in recent years confirm findings of previous research and do not distinguish treatments of this clinical entity. Among all analyzed laser options, photodynamic therapy provides the fastest and most prominent morphological improvements, including subretinal fluid resorption and reduction of choroidal thickness. This modality is also associated with fewer recurrences than with other treatments. Subthreshold micropulse laser allows the physician to maintain and, in selected cases, improve the patient's vision. Conventional photocoagulation is still effective, especially with the introduction of navigated laser systems. Despite the availability of variable laser treatment options, long-term functional improvements in chronic cases are minor for each modality. Long-lasting central serous chorioretinopathy cases with significantly altered retinal morphology do not usually present with functional improvement, despite satisfactory morphological outcomes. Early initiation of treatment has the potential to prevent visual loss and to improve the patient's quality of life.
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Affiliation(s)
- Maciej Gawecki
- Ophthalmology, Dobry Wzrok Ophthalmological Clinic, Gdansk, Poland
| | | | - Anna Swiech
- Chair of Ophthalmology, Department of Vitreoretinal Surgery, Medical University of Lublin, Poland
| | - Jerzy Mackiewicz
- Chair of Ophthalmology, Department of Vitreoretinal Surgery, Medical University of Lublin, Poland
| | - Lyubomyr Lytvynchuk
- Department of Ophthalmology, Eye Clinic, Justus Liebig University, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany
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Garg SJ, Hadziahmetovic M. Verteporfin Photodynamic Therapy for the Treatment of Chorioretinal Conditions: A Narrative Review. Clin Ophthalmol 2024; 18:1701-1716. [PMID: 38881707 PMCID: PMC11178081 DOI: 10.2147/opth.s464371] [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: 02/16/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Photodynamic therapy (PDT) with verteporfin involves intravenous administration of a photosensitizer followed by its laser light activation at the target site to inhibit aberrant choroidal vascularization. This narrative review provides an overview of the role verteporfin PDT plays in the management of chorioretinal conditions. A PubMed literature review of all English-language articles published through October 19, 2023, was conducted to identify relevant references. Verteporfin PDT has been shown to be safe and effective for the treatment of patients with choroidal neovascularization (CNV) due to neovascular age-related macular degeneration and is often used in combination with a vascular endothelial growth factor (VEGF) inhibitor. Additionally, patients with polypoidal choroidal vasculopathy, a subtype of neovascular age-related macular degeneration, also benefit from verteporfin PDT combined with a VEGF inhibitor for improving visual acuity. Verteporfin PDT has also been effective in treating patients with peripapillary CNV, as well as eyes with CNV due to ocular histoplasmosis and pathologic myopia. Reduced dose and/or fluence PDT protocols have been effective in patients with central serous chorioretinopathy while reducing adverse effects. In eyes with choroidal hemangioma, tumor regression and visual outcomes have been improved with verteporfin PDT treatment. Photodynamic therapy with verteporfin continues to play an important role in the management of chorioretinal conditions.
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Affiliation(s)
- Sunir J Garg
- Retina Service, Wills Eye Hospital, Philadelphia, PA, USA
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Kogo T, Muraoka Y, Ishikura M, Nishigori N, Akiyama Y, Ueda-Arakawa N, Miyata M, Ooto S, Hata M, Takahashi A, Miyake M, Tsujikawa A. Pigment Epithelial Detachment and Leak Point Locations in Central Serous Chorioretinopathy. Am J Ophthalmol 2024; 261:19-27. [PMID: 38244961 DOI: 10.1016/j.ajo.2024.01.012] [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: 10/27/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
PURPOSE To examine the associations between the vortex vein characteristics and locations of the pigment epithelial detachment (PED) and leak point in patients with central serous chorioretinopathy (CSC). DESIGN Observational case series. METHODS We evaluated 116 eyes of 104 patients with CSC. The PED and leak point locations were superimposed over the choroidal en face images using widefield swept-source optical coherence tomography and fluorescein angiography. We defined the draining areas of the superior and inferior vortex veins and analyzed their associations with the PED and leak point locations. RESULTS One of the 116 eyes with a unique irrigation pattern dominated by the nasal vortex vein was excluded from the analysis. Sixty-nine (60%) of the remaining 115 eyes exhibited asymmetry between the superior and inferior vortex veins. PEDs and leak points were in the vortex vein draining area with greater dilation in 66 (96%) of 69 eyes with asymmetry, and none (0%) were in the opposite areas. Both the PEDs and leak points showed significant differences in their distributions (P < .001, respectively). Additionally, 74% of PEDs and 84% of leak points were located upstream of the vortex vein draining areas, whose frequency was significantly higher compared to other areas (P < .001, respectively). CONCLUSION PED and leak point spatial distributions corresponded with the most terminal part of the dilated vortex veins, suggesting that blood flow disturbances, such as stasis within the affected vortex veins, may be essential in the pathogenesis of CSC.
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Affiliation(s)
- Takahiro Kogo
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Masaharu Ishikura
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naomi Nishigori
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Akiyama
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoko Ueda-Arakawa
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sotaro Ooto
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Hata
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Takahashi
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- From the Department of Ophthalmology and Visual Sciences (T.K., Y.M., M.I., N.N., Y.A., N.U.A., M.M., S.O., M.H., A.T., M.M., A.T.), Kyoto University Graduate School of Medicine, Kyoto, Japan
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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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Kogo T, Muraoka Y, Ishikura M, Nishigori N, Ueda-Arakawa N, Miyata M, Tamura H, Hata M, Takahashi A, Miyake M, Tsujikawa A. Widefield choroidal vasculature associated with future condition of subretinal fluid in central serous chorioretinopathy. Heliyon 2023; 9:e18441. [PMID: 37576325 PMCID: PMC10412906 DOI: 10.1016/j.heliyon.2023.e18441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/27/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose To examine choroidal angiographic features in the posterior pole associated with resolution or persistency of subretinal fluid (SRF) in eyes with central serous chorioretinopathy (CSC). Design Observational case series. Methods Twenty-nine patients with treatment-naïve CSC were divided into two groups based on the presence or absence of SRF 3 months after the initial visit (month 3) without any treatment. Using enhanced depth imaging of widefield swept-source optical coherence tomography, the choroidal thickness (CT), vessel density (VD), and vessel diameter index (VDI) in the superotemporal and inferotemporal subfields on the temporal side of the 18-mm circle from the disc were measured at the initial visit. We calculated the vertical difference in CT and other choroidal angiographic parameters and evaluated their association with the SRF condition at 3 months. Results The SRF-resolved and SRF-persistent groups included 10 and 19 patients, respectively. At the initial visit, sex, age, axial length, symptom duration, the logarithm of the minimum angle of resolution visual acuity, and foveal thickness were not significantly different between the two groups. The SRF status at month 3 was not associated with the vertical difference in CT and choroidal VD (P = .614, .065, respectively). However, the vertical difference in choroidal VDI was positively associated with the future presence of SRF (P = .017). Conclusions Vertically asymmetric dilation of choroidal vessels in the posterior pole may be a vasculature feature associated with SRF from CSC and may be a good predictor of future SRF status.
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Affiliation(s)
- Takahiro Kogo
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaharu Ishikura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naomi Nishigori
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoko Ueda-Arakawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Nishigori N, Muraoka Y, Ishikura M, Kogo T, Ueda-Arakawa N, Miyata M, Tamura H, Hata M, Takahashi A, Miyake M, Tsujikawa A. Extensive reduction in choroidal thickness after photodynamic therapy in eyes with central serous chorioretinopathy. Sci Rep 2023; 13:10890. [PMID: 37407690 DOI: 10.1038/s41598-023-37802-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023] Open
Abstract
We examined the effect of reduced fluence (rf)-photodynamic therapy (PDT) of the macular area on the wide-field choroidal thickness in 20 eyes with central serous chorioretinopathy (CSC) and 20 age- and sex-matched control eyes. The choroidal thickness at the posterior pole was measured before and after rf-PDT, using a grid with inner and outer rings, each divided into superotemporal, inferotemporal, superonasal, and inferonasal quadrants, respectively, making up a total of nine subfields including the central 3 mm ring. Before treatment, all eyes showed wide-field choroidal thickening from the dilated vortex vein ampulla to the fovea, along the course of the vein. After rf-PDT of the macular area, the choroidal thickness significantly decreased, not only in the irradiated macular area but also outside the arcade vessels in all quadrants (p < 0.001 for all inner subfields; p = 0.035 and p = 0.024 for the outer superonasal and inferonasal subfields, respectively; p < 0.001 and p = 0.004 for the outer superotemporal and inferotemporal subfields, respectively). For control eyes, the choroidal thickness did not differ between the initial visit and follow-up 1.2 ± 0.7 months after the initial visit (p > 0.05 for all subfields). These findings provide new insights into the pathogenesis of CSC and explain the reasons for the effectiveness of rf-PDT for this condition.
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Affiliation(s)
- Naomi Nishigori
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Masaharu Ishikura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takahiro Kogo
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Naoko Ueda-Arakawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
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Miyake M, Nakao SY, Morino K, Yasukura S, Mori Y, Ishihara K, Muraoka Y, Miyata M, Tamura H, Sakamoto T, Tsujikawa A. Effect of Duration of Macular Detachment on Visual Prognosis after Surgery for Macula-Off Retinal Detachment: Japan-Retinal Detachment Registry. Ophthalmol Retina 2023; 7:375-382. [PMID: 36707048 DOI: 10.1016/j.oret.2023.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the association between the duration of macular detachment (DMD) and visual prognosis in patients with macula-off rhegmatogenous retinal detachment (RD). DESIGN Prospective observational cohort study. PARTICIPANTS This study analyzed 719 eyes with macula-off rhegmatogenous RD registered with the Japan-Retinal Detachment Registry created by the Japan Retina and Vitreous Society. METHODS We included patients with macular detachment without a history of prior surgery, except cataract surgery and vitrectomy. Reoperation cases, hereditary RD, and macular hole RD were excluded. We compared the visual prognosis between patients with DMD of N days or less and those with DMD of N + 1 days or more (N = 2-5). For these 4 comparisons, the inverse probability of treatment weighting (IPTW) methodology was employed, to balance 20 baseline characteristics between the shorter and longer DMD groups. The baseline characteristics included age, sex, axial length, baseline visual acuity, operative procedures, and detailed characteristics of RD. P-values < 0.01 were considered statistically significant. MAIN OUTCOME MEASURES The best-corrected visual acuity (BCVA) 6 months after surgery. RESULTS The final analysis included 719 eyes. For all comparisons, the patients' backgrounds were well balanced after IPTW with standardized differences < 0.10. The IPTW regression analysis revealed that the BCVA after 6 months was significantly better after surgeries for DMD of ≤ 2 days than that for DMD of ≥ 3 days. Similarly, the 6-month BCVA for surgeries for DMD of ≤ 3 days was significantly better than that for surgeries for DMD of ≥ 4 days (differences in logarithm of the minimum angle of resolution: -0.113, P = 9.1 × 10-7; -0.076, P = 1.6 × 10-3, respectively). On the other hand, there were no statistically significant differences for the other comparisons. CONCLUSIONS Earlier surgical treatment within 3 days from the onset of macular detachment should be considered, after accounting for social circumstances, such as weekends. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Shin-Ya Nakao
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuya Morino
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shota Yasukura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Mori
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Ishihara
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Japan Retina and Vitreous Society
| | | | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan; Japan Retina and Vitreous Society
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Yagi M, Miyake M, Mori Y, Hosoda Y, Takahashi A, Muraoka Y, Ueda-Arakawa N, Miyata M, Yamashiro K, Tamura H, Ooto S, Tsujikawa A. Natural Course of Pachychoroid Pigment Epitheliopathy. OPHTHALMOLOGY SCIENCE 2022; 2:100201. [PMID: 36531587 PMCID: PMC9754975 DOI: 10.1016/j.xops.2022.100201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/24/2022] [Accepted: 07/07/2022] [Indexed: 05/28/2023]
Abstract
PURPOSE To investigate the natural course of pachychoroid pigment epitheliopathy (PPE). DESIGN A retrospective cohort study. SUBJECTS From the Kyoto central serous chorioretinopathy (CSC) cohort consisting of 548 patients with CSC as of September 2020, we included consecutive unilateral patients with acute or chronic CSC between January 2013 and December 2016. METHODS All patients underwent complete ophthalmic examination, including multimodal imaging such as fundus autofluorescence, spectral-domain optical coherence tomography, and fluorescein angiography/indocyanine green angiography and/or optimal coherence tomography angiography. The fellow eyes of eyes diagnosed with CSC were screened for PPE, and their natural course was evaluated. We also evaluated the association of ARMS2 rs10490924, CFH rs800292, TNFRSF10A rs13278062, and GATA5 rs6061548 genotypes with the natural course. MAIN OUTCOME MEASURES Incidence of CSC, pachychoroid neovasculopathy, and pachychoroid geographic atrophy (GA). RESULTS In total, 165 patients with unilateral CSC (mean age, 55.7 ± 12.6 years; female, 22.4%) were included from the Kyoto CSC cohort. Among them, 148 (89.7%) were diagnosed as having PPE in their non-CSC eye. Survival analysis revealed that 16.8% of PPE eyes developed CSC during the 6-year follow up, whereas non-PPE eyes did not. Although genetic factors did not have significant association with CSC development (P > 0.05, log-rank test), choroidal vascular hyperpermeability (CVH) and subfoveal choroidal thickness (SFCT) were significantly associated with CSC incidence (P = 0.001, log-rank test). Survival analysis showed that eyes without CVH and eyes with SFCT < 300 μm did not develop CSC during the 6-year follow-up. Pachychoroid neovasculopathy developed in only 1 eye with PPE during a follow-up of 46.4 months. Pachychoroid GA did not develop in any of the studied eyes. CONCLUSIONS This study revealed a natural history of PPE in a relatively large Japanese cohort. Choroidal vascular hyperpermeability and SFCT were significant risk factors for the development of CSC in PPE eyes. Although the current results cannot be generalized for all eyes with PPE, these findings present an important clinical implication.
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Key Words
- BCVA, best-corrected visual acuity
- CI, confidence interval
- CSC, central serous chorioretinopathy
- CVH, choroidal vascular hyperpermeability
- FA, fluorescein angiography
- GA, geographic atrophy
- ICGA, indocyanine green angiography
- MNV, macular neovascularization
- PNV, pachychoroid neovasculopathy
- PPE, pachychoroid pigment epitheliopathy
- SD, standard deviation
- SFCT, Subfoveal choroidal thickness
- SNPs, single nucleotide polymorphisms
- central serous chorioretinopathy
- pachychoroid
- pachychoroid pigment epitheliopathy
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Affiliation(s)
- Mariko Yagi
- Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Ophthalmology, Kansai Electric Power Hospital, Osaka, Japan
| | - Masahiro Miyake
- Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Mori
- Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Ayako Takahashi
- Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoko Ueda-Arakawa
- Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology, Kochi University Graduate School of Medicine, Kochi, Japan
| | - Hiroshi Tamura
- Center for Innovative Research and Education in Data Science, Institute for Liberal Arts and Sciences, Kyoto University, Kyoto, Japan
| | - Sotaro Ooto
- Department of Ophthalmology, Otsu Red-Cross Hospital, Otsu, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Morino K, Miyake M, Kamei T, Kawaguchi T, Mori Y, Hosoda Y, Uji A, Yamashiro K, Matsuda F, Tsujikawa A. Association between central serous chorioretinopathy susceptibility genes and choroidal parameters. Jpn J Ophthalmol 2022; 66:504-510. [PMID: 36181643 DOI: 10.1007/s10384-022-00945-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/06/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the association between central serous chorioretinopathy (CSC) susceptibility genes and choroidal parameters in a large Japanese cohort. STUDY DESIGN Retrospective cohort study. METHODS Of the 9850 individuals in the Nagahama study whose second visit was between 2013 and 2016, those with optical coherence tomography (OCT) images with enhanced depth imaging (EDI), axial length, and genome-wide single nucleotide polymorphism (SNP) genotyping data were included. We calculated subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), normalized choroidal intensity (NCI), and vertical asymmetry of choroidal thickness. Genome-wide quantitative trait locus (QTL) analyses were performed for each parameter. We screened for four CSC susceptibility SNPs: CFH rs800292, TNFRSF10A rs13278062, GATA5 rs6061548, and VIPR2 rs3793217. Whenever an SNP was not included in the genotyping data after quality control, its proxy SNP was selected. RESULTS In total, 4586 participants were evaluated. CFH rs800292 was significantly associated with SFCT (P < 0.001) and CVI (P < 0.001). VIPR2 rs3793217 was significantly associated with SFCT (P < 0.001) but not with CVI. Whereas, TNFRSF10A rs13254617 and GATA5 rs6061548 were not significantly associated with SFCT or CVI. None of these SNPs was associated with NCIEDI and asymmetry of choroidal thickness. CONCLUSION CFH, VIPR2, TNFRSF10A, and GATA5 showed different association patterns with choroidal parameters. Although the mechanism of CSC pathogenesis by choroidal changes is not fully understood, this finding suggests that each gene may be involved in different mechanisms of CSC development. Our genetic study provides a basis for understanding the role of CSC susceptibility genes.
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Affiliation(s)
- Kazuya Morino
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara, Shogoin, Sakyo, Kyoto, 606-8507, Japan.,Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara, Shogoin, Sakyo, Kyoto, 606-8507, Japan. .,Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takuro Kamei
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara, Shogoin, Sakyo, Kyoto, 606-8507, Japan.,Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Mori
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara, Shogoin, Sakyo, Kyoto, 606-8507, Japan.,Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara, Shogoin, Sakyo, Kyoto, 606-8507, Japan
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