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Feenstra HMA, van Dijk EHC, Cheung CMG, Ohno-Matsui K, Lai TYY, Koizumi H, Larsen M, Querques G, Downes SM, Yzer S, Breazzano MP, Subhi Y, Tadayoni R, Priglinger SG, Pauleikhoff LJB, Lange CAK, Loewenstein A, Diederen RMH, Schlingemann RO, Hoyng CB, Chhablani JK, Holz FG, Sivaprasad S, Lotery AJ, Yannuzzi LA, Freund KB, Boon CJF. Central serous chorioretinopathy: An evidence-based treatment guideline. Prog Retin Eye Res 2024; 101:101236. [PMID: 38301969 DOI: 10.1016/j.preteyeres.2024.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.
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Affiliation(s)
- Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Suzanne Yzer
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA; Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Siegfried G Priglinger
- Department of Ophthalmology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Laurenz J B Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Clemens A K Lange
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Ocular Angiogenesis Group, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jay K Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York, USA; Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
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Ramamurthy SR, Behera UC, Narula R, Sadda SR, Narayanan R. Intravitreal Brolucizumab for Chronic Central Serous Chorioretinopathy without Choroidal Neovascular Membrane - a Pilot Study. Semin Ophthalmol 2024:1-8. [PMID: 38270124 DOI: 10.1080/08820538.2024.2308808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE To study intravitreal brolucizumab in the management of persistent macular fluid in chronic central serous chorioretinopathy (CSCR) without choroidal neovascular membrane (CNVM). METHODS Retrospective case series which included eyes with chronic CSCR with persistent macular fluid for ≥ 3 months without CNVM. Intravitreal brolucizumab was administered in all eyes. Primary outcome measure was the resolution of intraretinal (IRF) and/or subretinal fluid (SRF) on OCT. RESULTS Five eyes (four patients) with chronic CSCR were included. All eyes showed complete resolution of SRF 1 month following injection. Minimal residual IRF was present in two eyes. Best corrected visual acuity (BCVA) was stable in three eyes, and two eyes showed improvement. Central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) showed reduction. CONCLUSION Intravitreal brolucizumab is effective in the rapid reduction of persistent macular fluid in chronic CSCR without CNVM. Long-term follow-up data are required to study recurrence and adverse effect profile.
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Affiliation(s)
- Srishti Raksheeth Ramamurthy
- Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
- Standard Chartered-LVPEI Academy for Eye Care Education, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Umesh Chandra Behera
- Anant Bajaj Retina Institute, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Ritesh Narula
- Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
- LILAC Image Reading Center, LV Prasad Eye Institute, Hyderabad, India
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Raja Narayanan
- Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Economics Research Center (IHOPE), LV Prasad Eye Institute, Hyderabad, India
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Yang JM, Kim SJ, Park S, Son W, Kim A, Lee J. Exosomal miR-184 in the aqueous humor of patients with central serous chorioretinopathy: a potential diagnostic and prognostic biomarker. J Nanobiotechnology 2023; 21:242. [PMID: 37507708 PMCID: PMC10375666 DOI: 10.1186/s12951-023-02019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/23/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Central serous chorioretinopathy (CSC) is the fourth most prevalent retinal disease leading to age-related macular degeneration (AMD) and retinal atrophy. However, CSC's pathogenesis and therapeutic target need to be better understood. RESULTS We investigated exosomal microRNA in the aqueous humor of CSC patients using next-generation sequencing (NGS) to identify potential biomarkers associated with CSC pathogenesis. Bioinformatic evaluations and NGS were performed on exosomal miRNAs obtained from AH samples of 62 eyes (42 CSC and 20 controls). For subgroup analysis, patients were divided into treatment responders (CSC-R, 17 eyes) and non-responders (CSC-NR, 25 eyes). To validate the functions of miRNA in CECs, primary cultured-human choroidal endothelial cells (hCEC) of the donor eyes were utilized for in vitro assays. NGS detected 376 miRNAs. Our results showed that patients with CSC had 12 significantly upregulated and 17 downregulated miRNAs compared to controls. miR-184 was significantly upregulated in CSC-R and CSC-NR patients compared to controls and higher in CSC-NR than CSC-R. In vitro assays using primary cultured-human choroidal endothelial cells (hCEC) demonstrated that miR-184 suppressed the proliferation and migration of hCECs. STC2 was identified as a strong candidate for the posttranscriptional down-regulated target gene of miR-184. CONCLUSION Our findings suggest that exosomal miR-184 may serve as a biomarker reflecting the angiostatic capacity of CEC in patients with CSC.
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Affiliation(s)
- Jee Myung Yang
- Department of Ophthalmology, Asan Medical Center, College of Medicine, University of Ulsan, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Soo Jin Kim
- Department of Ophthalmology, Asan Medical Center, College of Medicine, University of Ulsan, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
- Department of Medical Science, Asan Medical Center, AMIST, University of Ulsan College of Medicine, Seoul, South Korea
- Translational Biomedical Research Group, Asan Institute for Life Science, Asan Medical Center, Seoul, South Korea
| | | | - Wonyung Son
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Anna Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Junyeop Lee
- Department of Ophthalmology, Asan Medical Center, College of Medicine, University of Ulsan, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea.
- Department of Medical Science, Asan Medical Center, AMIST, University of Ulsan College of Medicine, Seoul, South Korea.
- Translational Biomedical Research Group, Asan Institute for Life Science, Asan Medical Center, Seoul, South Korea.
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Palakkamanil M, Munro M, Sethi A, Adatia F. Intravitreal anti-vascular endothelial growth factor for the treatment of chronic central serous retinopathy: a meta-analysis of the literature. BMJ Open Ophthalmol 2023; 8:e001310. [PMID: 37493660 PMCID: PMC10335579 DOI: 10.1136/bmjophth-2023-001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the role of anti-vascular endothelial growth factor (anti-VEGF) treatment on the functional and structural parameters of chronic central serous retinopathy (CSR). METHODS PubMed was used to systematically review literature published from 1 January 2009 to 1 July 2022. Studies were included if patients in their cohort had symptoms for more than 3 months, anti-VEGF treatment was provided and the following outcomes were reported: best-corrected visual acuity (BCVA), central macular thickness (CMT) and proportion of subretinal fluid (SRF) resolution. RESULTS 339 eyes met inclusion criteria with a mean patient age of 45.8±4.9 years. The weighted mean baseline BCVA for the 20 studies was 0.39±0.23 logMAR, which improved to 0.28±0.24 after treatment with anti-VEGF injections (p=0.069). The weighted baseline CMT for the 20 studies decreased from 395.2±52.0 µm to 243.0±41.9 µm (p<0.001). The weighted overall percentage of SRF resolution was 68.4%. CONCLUSION Anti-VEGF treatment demonstrated significantly decreased macular thickness and resolution of SRF in the treatment of chronic CSR without any reported adverse effects. However, BCVA did not significantly improve with pharmacotherapy.
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Affiliation(s)
- Mathew Palakkamanil
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Monique Munro
- Divsion of Ophthalmology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Abhishek Sethi
- Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois, USA
| | - Feisal Adatia
- Divsion of Ophthalmology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Park JB, Kim K, Kang MS, Kim ES, Yu SY. Central serous chorioretinopathy: Treatment. Taiwan J Ophthalmol 2022; 12:394-408. [PMID: 36660123 PMCID: PMC9843567 DOI: 10.4103/2211-5056.362040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
Central serous chorioretinopathy (CSC) is a pachychoroid spectrum disease characterized by serous detachment of the neurosensory retina with subretinal fluid in young and middle-aged adults. The pathogenesis of CSC is not yet fully understood. However, it is considered a multifactorial disease that is strongly associated with choroidal dysfunction or vascular engorgement. Although there is no consensus on the treatment of CSC, photodynamic therapy has been effectively used to manage serous retinal detachment (SRD) in CSC. Moreover, micropulse diode laser photocoagulation and focal laser treatment have also been used. Recently, oral medications, including mineralocorticoid receptor antagonists, have been proposed for the management of CSC. Multimodal imaging plays a significant role in the diagnosis and treatment of CSC. Optical coherence tomography angiography (OCTA) has the advantage of detecting vascular flow in the retina and choroid layer, allowing for a better understanding of the pathology, severity, prognosis, and chronicity of CSC. In addition, early detection of choroidal neovascularization in CSC is possible using OCTA. This review article aims to provide a comprehensive and updated understanding of CSC, focusing on treatment.
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Affiliation(s)
- Jong Beom Park
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Kiyoung Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Min Seok Kang
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Eung Suk Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea,Address for correspondence: Prof. Seung-Young Yu, Department of Ophthalmology, Kyung Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-Gu, Seoul 02447, Korea. E-mail:
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Han JY, Kim YJ, Choi EY, Lee J, Lee JH, Kim M, Byeon SH, Kim SS, Lee CS. Therapeutic Efficacy of Spironolactone for Central Serous Chorioretinopathy. Yonsei Med J 2022; 63:365-371. [PMID: 35352888 PMCID: PMC8965434 DOI: 10.3349/ymj.2022.63.4.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the therapeutic effects and safety of oral spironolactone (SPRL) in patients with central serous chorioretinopathy (CSC). MATERIALS AND METHODS The medical records and imaging data of patients diagnosed with CSC and treated with SPRL were retrospectively reviewed. Central macular thickness (CMT), subretinal fluid (SRF) height, subfoveal choroidal thickness (SFCT), and best-corrected visual acuity (BCVA) at baseline, at 1, 3, and 6 months, and at the last visit after the treatment were analyzed. RESULTS In total, 103 patients with 107 eyes were included. The mean age of the patients was 51.5±9.3 years, and 77 (72.0%) were male. The mean follow-up duration was 48.6±40.2 weeks. The mean duration of oral SPRL therapy was 15.5±13.4 weeks. CMT, SRF height, and SFCT improved significantly at 1, 3, and 6 months after SPRL therapy and at the last follow-up. BCVA, however, showed no significant change at any time point. The rate of complete resolution of SRF at 1 month was higher in those with chronic CSC than in those with acute CSC (21.1% vs. 6.0%, respectively). Recurrence occurred in 14 (13.1%) eyes after the complete resolution of SRF. Older age (p=0.001), a greater number of previous intravitreal bevacizumab injections (p=0.006), and poor initial visual acuity (p=0.048) were associated with recurrence. No permanent adverse effects were observed. CONCLUSION Oral SPRL showed therapeutic benefits in patients with CSC in terms of SRF resolution, but relatively frequent recurrence was observed, especially in older patients.
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Affiliation(s)
- Jae Yong Han
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Joon Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Young Choi
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Junwon Lee
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hwan Lee
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Short-term effect of anti-VEGF for chronic central serous chorioretinopathy according to the presence of choroidal neovascularization using optical coherence tomography angiography. PLoS One 2021; 16:e0245342. [PMID: 33428683 PMCID: PMC7799826 DOI: 10.1371/journal.pone.0245342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/28/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose To analyze the short-term therapeutic efficacy of intravitreal injection of bevacizumab (IVB) for chronic central serous chorioretinopathy (CSC) according to the presence of choroidal neovascularization (CNV) using optical coherence tomography angiography (OCTA). Methods A retrospective chart review was perfomed on cases of CSC with CNV (Group 1: n = 31) and an age-matched cases of CSC without CNV (Group 2: n = 30). The response to IVB was evaluated by changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), choroidal thickness (CT), and pachyvessel diameter. Univariate and multivariate linear regression analyses were performed to identify factors associated with the visual outcome of chronic CSC with CNV after IVB. Results At baseline, the CT values differed significantly between Groups 1 and 2 (371.55 ± 67.09 vs. 417.33 ± 71.32 μm, p = 0.01). In Group 1, BCVA improved significantly (p < 0.001), and CMT (p < 0.001), CT (p = 0.001) and pachyvessel diameter (p = 0.045) decreased significantly, after IVB. In Group 2, only pachyvessel diameter (p = 0.001) was significantly smaller after IVB. Univariate analysis showed that the initial CT (B = 0.002, p = 0.026) and pachyvessel diameter (B = 0.002, p = 0.001) significantly affected visual outcome. In multivariate analysis, the initial pachyvessel diameter exhibited significant results (B = 0.002, p = 0.001). Conclusions IVB showed less effective short-term outcomes in chronic CSC patients without CNV than in patients with CNV. In chronic CSC with CNV, the short-term visual outcome after IVB was better in patients with a thinner choroid and smaller pachyvessels.
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Yavuz S, Balsak S, Karahan M, Dursun B. Investigating the efficacy and safety of oral spironolactone in patients with central serous chorioretinopathy. J Fr Ophtalmol 2020; 44:13-23. [PMID: 33279285 DOI: 10.1016/j.jfo.2020.09.003] [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: 06/27/2020] [Revised: 09/07/2020] [Accepted: 09/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTıVE: The goal of this study was to investigate the efficacy and safety of oral spironolactone in patients with central serous chorioretinopathy (CSC). MATERıALS AND METHODS: In our study, acute CSC patients were divided into two groups: those who received spironolactone 25mg twice a day as the study group, and those who were not treated as the control group. Fundus fluorescein angiography was performed in all patients. Subretinal fluid (SRF) height and central macular thickness (CMT) spectral area were measured by optical coherence tomography as well as subfoveal choroid thickness (CT) in enhanced depth imaging (EDI) mode. The best-corrected visual acuity (BVCA) was measured with the Snellen chart. Side effects of spironolactone were evaluated. RESULTS: There were 31 eyes in the study group and 28 eyes in the control group. The mean follow-up was 2.4±0.5 months. The average SRF height of 240.26±92.89μm in the study group decreased to 26.77±39.52μm (P<0.05) at the last follow-up. SRF height was completely improved in 18 eyes (58.06%). On the first evaluation, the mean CMT of 453.26±147.73 was reduced to 276.19±109.29μm at the last follow-up. (P<0.05). While the initial mean subfoveal CT was 482.10±86.36μm, it decreased to 427.10±83.32μm at the last follow-up (P<0.01). The mean baseline BCVA of 0.5±0.23 was increased to 0.9±0.16 (P<0.01) at the last follow-up. At the last follow-up, BCVA was 10/10 (1.0) in 21 eyes (67.74%). In the control group, the mean SRF height of 277.71±108.83μm was 172.96±93.88μm (P<0.05) at the last follow-up. The mean CMT in the control group was 464.5±131.14μm at the first evaluation and 349.82±111.45μm (P<0.05) at the last follow-up. The initial mean subfoveal CT was 487.93±88.9μm; at the last follow-up, it was 447.71±71.32μm (P<0.01). While the mean BCVA of the control group was initially 0.53±0.19, it was found to be 0.64±0.19 (P<0.01) at the final control. The decrease in SRF height in the 3rd month was significantly greater in the study group compared to the control group (P<0.01). However, the decrease in CMT at 3 months and an increase in BCVA were also significant in the study group compared to the control group (P<0.01). CT decreased significantly in the third month in both groups compared to the first month, but there was no difference between the two groups. In a patient who developed palpitations and nausea, treatment was discontinued because he could not tolerate oral spironolactone. CONCLUSıON: In our series, effective visual improvement and subretinal fluid resorption were achieved in acute CSC patients who were given spironolactone. Side effects are rare.
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Affiliation(s)
- S Yavuz
- Diyarbakir Gazi Yasargil Egitim ve Arastirma Hastanesi, Turkey.
| | - S Balsak
- Diyarbakir Gazi Yasargil Egitim ve Arastirma Hastanesi, Turkey
| | - M Karahan
- Diyarbakir Gazi Yasargil Egitim ve Arastirma Hastanesi, Turkey
| | - B Dursun
- Diyarbakir Gazi Yasargil Egitim ve Arastirma Hastanesi, Turkey
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Han JY, Choi EY, Lee CS. Therapeutic Effects and Safety of Spironolactone for Central Serous Chorioretinopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.11.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kang HM, Choi JH, Koh HJ, Lee SC. Long-term treatment response after intravitreal bevacizumab injections for patients with central serous chorioretinopathy. PLoS One 2020; 15:e0238725. [PMID: 32898167 PMCID: PMC7478837 DOI: 10.1371/journal.pone.0238725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate long-term treatment response after intravitreal bevacizumab injections (IVBIs) for central serous chorioretinopathy (CSC). Methods This retrospective, interventional study investigated the medical records of 45 eyes of 44 patients with CSC who underwent IBVIs and completed at least 2-year follow-up period. Complete resolution (CR) was defined as complete resolution of subretinal fluid at least 3 months after the last IVBI. Thick-choroid CSC was defined as mean subfoveal choroidal thickness more than 300.0 μm. The main outcome measure was long-term treatment outcome after IVBIs in patients with CSC. Results Thirty-five patients (79.5%) were male, and their mean age was 45.5 ± 9.6 years. The mean follow-up period was 35.1 ± 11.5 months. Twenty-two eyes (48.9%) had acute CSC, and 40 eyes (88.9%) achieved CR. Twenty eyes (50.0%) developed recurrence, the mean number of IVBIs to achieve the first CR was not significantly different between eyes with and without recurrences (2.6 ± 1.6 vs. 2.9 ± 1.9; P = 0.658). Thick-choroid CSC was significantly difference between the eyes with and without recurrence (17 eyes, 85.0% vs. eyes, 50.0%; P = 0.020). Among the baseline characteristics, serous pigment epithelial detachment (B = - 2.580, P = 0.032) and thick-choroid (B = 1.980, P = 0.019) were significantly associated with recurrence. Conclusion Eyes with CSC treated with IVBI and achieving complete resolution of subretinal fluid have 50% chance of recurrence in the long term. Thinner choroid and serous pigment epithelial detachment appear protective for recurrences.
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Affiliation(s)
- Hae Min Kang
- Department of Ophthalmology, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
- * E-mail:
| | | | - Hyoung Jun Koh
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
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Moreno-Morillo FJ, Fernández-Vigo JI, Güemes-Villahoz N, Burgos-Blasco B, López-Guajardo L, Donate-López J. Update on the management of chronic central serous chorioretinopathy. ACTA ACUST UNITED AC 2020; 96:251-264. [PMID: 32891458 DOI: 10.1016/j.oftal.2020.07.023] [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: 05/07/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
Central serous chorioretinopathy (CSC) is one of the main causes of impaired visual acuity in patients younger than 60 years. Its pathophysiology remains partially unknown, although it has been postulated that choroidal hyper-permeability may be involved. This typically produces a neurosensory retinal detachment and/or a detachment of the retinal pigment epithelium in the posterior pole. Although acute CSC generally does not require treatment, when chronic it must be treated to avoid visual impairment. With the development of new imaging techniques, there has been an improvement in diagnosis, and different therapeutic strategies have been proposed. Various treatments for the management of chronic CSC have currently been shown to be useful to improve or stabilise visual acuity, the resolution of subretinal fluid, and to prevent recurrences. The most commonly used treatments today are photodynamic therapy, micropulse subthreshold laser, mineralocorticoid antagonists, or anti-vascular endothelial growth factor drugs. There are also other proposals and new treatments being developed, with promising results. This review aims to provide the reader with an overview of the current scientific evidence of the different treatment options available for CSC in order to help decision-making in clinical practice.
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Affiliation(s)
- F J Moreno-Morillo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - J I Fernández-Vigo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España; Centro Internacional de Oftalmología Avanzada, Madrid, España.
| | - N Güemes-Villahoz
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - B Burgos-Blasco
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - L López-Guajardo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - J Donate-López
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
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van Rijssen TJ, van Dijk EHC, Yzer S, Ohno-Matsui K, Keunen JEE, Schlingemann RO, Sivaprasad S, Querques G, Downes SM, Fauser S, Hoyng CB, Piccolino FC, Chhablani JK, Lai TYY, Lotery AJ, Larsen M, Holz FG, Freund KB, Yannuzzi LA, Boon CJF. Central serous chorioretinopathy: Towards an evidence-based treatment guideline. Prog Retin Eye Res 2019; 73:100770. [PMID: 31319157 DOI: 10.1016/j.preteyeres.2019.07.003] [Citation(s) in RCA: 274] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 12/17/2022]
Abstract
Central serous chorioretinopathy (CSC) is a common cause of central vision loss, primarily affecting men 20-60 years of age. To date, no consensus has been reached regarding the classification of CSC, and a wide variety of interventions have been proposed, reflecting the controversy associated with treating this disease. The recent publication of appropriately powered randomised controlled trials such as the PLACE trial, as well as large retrospective, non-randomised treatment studies regarding the treatment of CSC suggest the feasibility of a more evidence-based approach when considering treatment options. The aim of this review is to provide a comprehensive overview of the current rationale and evidence with respect to the variety of interventions available for treating CSC, including pharmacology, laser treatment, and photodynamic therapy. In addition, we describe the complexity of CSC, the challenges associated with treating CSC, and currently ongoing studies. Many treatment strategies such as photodynamic therapy using verteporfin, oral mineralocorticoid antagonists, and micropulse laser treatment have been reported as being effective. Currently, however, the available evidence suggests that half-dose (or half-fluence) photodynamic therapy should be the treatment of choice in chronic CSC, whereas observation may be the preferred approach in acute CSC. Nevertheless, exceptions can be considered based upon patient-specific characteristics.
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Affiliation(s)
- Thomas J van Rijssen
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Suzanne Yzer
- Department of Ophthalmology, Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Graduate School, Tokyo, Japan
| | - Jan E E Keunen
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre 162, London, United Kingdom
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, West Wing, Oxford, United Kingdom
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Jay K Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, India
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong; 2010 Retina & Macula Centre, Tsim Sha Tsui, Kowloon, Hong Kong
| | - Andrew J Lotery
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands.
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The Efficacy of Intravitreal Conbercept for Chronic Central Serous Chorioretinopathy. J Ophthalmol 2019; 2019:7409426. [PMID: 31205784 PMCID: PMC6530212 DOI: 10.1155/2019/7409426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/10/2019] [Accepted: 04/25/2019] [Indexed: 02/02/2023] Open
Abstract
Purpose To evaluate the efficacy and safety of conbercept for patients with chronic central serous chorioretinopathy (CSC). Methods A retrospective clinical study. Thirty-one patients (35 eyes) with chronic CSC were given intravitreal injections of conbercept and followed up for at least 6 months. Observed indicators included best-corrected visual acuity (BCVA), central macular thickness (CMT), and resolution of subretinal fluid (SRF). Serial changes in BCVA and CMT were analyzed by using repeated measures analysis of variance. Results During the 6-month follow-up, the mean number of injections required and performed was 1.77 ± 0.60. The logMAR BCVA was 0.48 ± 0.26 at the baseline, 0.34 ± 0.26, 0.30 ± 0.26, 0.27 ± 0.26, 0.24 ± 0.26, and 0.23 ± 0.26 at 2-week and 1-, 2-, 3-, and 6-month follow-ups, respectively (F = 27.173, P < 0.05). CMT was 313.74 ± 144.51 μm at the baseline and decreased to 263.49 ± 120.44 μm, 225.91 ± 91.98 μm, 195.77 ± 66.69 μm, 189.74 ± 65.41 μm, and 199.49 ± 81.50 μm at 2-week and 1-, 2-, 3-, and 6-month follow-ups, respectively (F = 18.093, P < 0.05). Full resolution of SRF was achieved in 8 (22.9%) eyes at 1 month, 16 (45.7%) eyes at 2 months, 22 (62.9%) eyes at 3 months, and 27 (77.1%) eyes at 6 months after the initial treatment of anti-VEGF injection. No severe adverse event was noted relevant to the therapy. Conclusions Intravitreal injection of conbercept may effectively reduce the CMT and improve the BCVA in chronic CSC in a short term of 6 months.
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Seo EJ, Um T, Yoon YH. Abnormal choroidal flow on optical coherence tomography angiography in central serous chorioretinopathy. Clin Exp Ophthalmol 2019; 47:505-512. [PMID: 30515936 DOI: 10.1111/ceo.13454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/23/2018] [Accepted: 11/09/2018] [Indexed: 11/28/2022]
Abstract
IMPORTANCE Analysing choroidal flow in central serous chorioretinopathy (CSC) with novel device. BACKGROUND To examine the abnormal morphology of choriocapillary flow with optical coherence tomography angiography (OCTA) according to the presence of subretinal fluid (SRF) in CSC. DESIGN A hospital-based retrospective study. PARTICIPANTS We analysed OCTA results of 68 eyes (68 patients) diagnosed as CSC with or without SRF (active and resolved CSC, respectively) at the Asan Medical Center. METHODS We classified OCTA choriocapillary images into three pattern groups: mixed perfusion, hyper-perfusion and normal perfusion. Data analysis included age, follow-up duration, treatment modalities, number of treatments, subfoveal choroidal thickness and SRF height. MAIN OUTCOME MEASURES The relationship between CSC activity and choriocapillary pattern. RESULTS Abnormal choroidal flow (mixed and hyper-perfusion) was more frequently found in eyes with active CSC (100%) than resolved CSC (47.5%, P < 0.001). In active CSC eyes, mixed perfusion was predominant (71.4%), while hyper-perfusion was predominant in those with resolved CSC (73.7%). Eyes with recently resolved CSC (SRF absorption present for <2 months) had abnormal choriocapillary flow more often than the remaining eyes with resolved CSC (83.3% vs 32.1%, P = 0.005). Resolved CSC eyes with abnormal choriocapillary flow demonstrated more recurrence than eyes with normal choriocapillary flow (42.1% vs 9.5%, P = 0.017). CONCLUSIONS AND RELEVANCE The pattern of choriocapillary flow abnormalities on OCTA can indicate CSC disease activity. Because eyes with resolved CSC showing abnormal choroidal flow have a high recurrence rate, they should be carefully followed-up.
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Affiliation(s)
- Eoi Jong Seo
- Department of Ophthalmology, Yonsei Plus Eye Center, Sungnam, South Korea
| | - Taewoong Um
- Department of Ophthalmology, Pureun Eye Center, Jeonju, South Korea
| | - Young Hee Yoon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
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Doepfner JM, Michels S, Graf N, Becker MD, Freiberg FJ. Photodynamic therapy in combination with intravitreal ziv-aflibercept and aflibercept injection in patients with chronic or repeatedly recurrent acute central serous chorioretinopathy: a single-center retrospective study. Clin Ophthalmol 2018; 12:1301-1309. [PMID: 30050283 PMCID: PMC6056159 DOI: 10.2147/opth.s165199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose The objective of the study was to assess the effect of off-label photodynamic therapy (PDT) in combination with intravitreal off-label ziv-aflibercept or off-label aflibercept injection in patients with chronic or repeatedly recurrent acute central serous chorioretinopathy (CSC). Patients and methods Changes in best corrected visual acuity (BCVA) and subfoveal subretinal fluid (sSRF) and maximum subretinal fluid (mSRF) were retrospectively analyzed in a single-center cohort study of 17 patients (18 eyes) with persistent subretinal fluid for more than 3 months of duration of CSC. Treatment efficacy was measured between injection and PDT at 30±15 days, 90±15 days and 180±30 days after PDT. Results Significant reduction of sSRF and mSRF was shown after therapy with ziv-aflibercept and aflibercept combined with PDT (p<0.001). Course of BCVA showed non-significant improvement within 6 months (p=0.065). One case of allergic reaction after fluorescein angiography and one case of ophthalmic migraine after ziv-aflibercept injection were documented. One case of reversible vision loss occurred during 6 months after combination therapy. No other adverse events or side effects were reported. Conclusion Combination therapy of ziv-aflibercept and aflibercept with PDT seems to be beneficial, even in cases of chronic or repeatedly recurrent acute CSC. This includes cases of CSC resistant to or recurrent after medical treatment, PDT alone or therapy with anti-vascular endothelial growth factor alone.
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Affiliation(s)
| | - Stephan Michels
- Department of Ophthalmology, Triemli City Hospital, Zurich, Switzerland, .,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Islam QU, Farooq MA, Mehboob MA. Factors affecting the visual outcome in acute central serous chorioretinopathy. Pak J Med Sci 2017; 33:3-7. [PMID: 28367162 PMCID: PMC5368324 DOI: 10.12669/pjms.331.11664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: To determine the visual outcome in patients with acute Central serous chorioretinopathy (CSCR) and to analyze the association of clinical, angiographic and tomographic factors with final visual outcome in Pakistani population. Methods: This study was conducted at AFIO Rawalpindi and PNS Shifa Naval hospital Karachi from November 2011 to August 2016. Fifty five eyes of 53 patients with acute CSCR were included. All patients underwent a detailed ophthalmic examination including SD OCT imaging at baseline, One month and three month and FFA was performed at baseline. Primary outcome measures were measurement of initial and final BCVA and CFT. SPSS 13.0 was used for the analysis of data. Results: Mean age of study population was 36.66 ± 6.24 years. On OCT mean CFT at baseline was 467.49 ± 144.80 µm in affected eye, whereas mean CFT measurements at final follow up was 244.67 ± 32.99 µm (p <0.01). Presenting mean log MAR BCVA was 0.47 ± 0.25 and final mean log MAR BCVA was 0.18 ± 0.14 (p <0.01). Baseline BCVA showed statistically significant association with final BCVA (p=0.03). Conclusion: Presenting VA of 6/12 or better is associated with favorable visual outcome in patients with acute CSCR.
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Affiliation(s)
- Qamar Ul Islam
- Dr. Qamar Ul Islam, FCPS (Ophthalmology), FCPS (VRO). Department of Ophthalmology, PNS Shifa Hospital, Karachi
| | | | - Mohammad Asim Mehboob
- Dr. Mohammad Asim Mehboob, MBBS. Department of Ophthalmology, PNS Shifa Hospital, Karachi
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Falavarjani KG, Amirsardari A, Habibi A, Eshaghi A, Bakhti S, Aghdam KA. Visual and Anatomical Outcomes of Spironolactone Therapy in Patients with Chronic Central Serous Chorioretinopathy. J Ophthalmic Vis Res 2017; 12:281-289. [PMID: 28791061 PMCID: PMC5525497 DOI: 10.4103/jovr.jovr_139_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To evaluate the effect of spironolactone on chronic central serous chorioretinopathy (CSC). METHODS In this prospective interventional case series, patients with chronic CSC were treated with spironolactone (25 mg daily) for at least 6 weeks. If the subretinal fluid (SRF) had not completely resolved by this time, treatment was continued, and the dosage was increased to 25 mg twice daily. Primary outcome measure was the change in maximum SRF height at the final follow-up visit, as detected by optical coherence tomography. Secondary outcome measures were changes in best corrected visual acuity (BCVA) and central macular thickness (CMT). RESULTS Sixteen eyes of 14 patients with chronic CSC were enrolled. Mean follow-up time was 6.4 ± 4.3 months. Baseline BCVA was 0.54 ± 0.44 logarithm of the minimum angle of resolution (log MAR), which improved to 0.42 ± 0.43 log MAR at the final visit (P = 0.04). Mean CMT decreased from 282.69 ± 103.23 μm at baseline to 236.75 ± 90.10 μm at final visit (P = 0.11), and the mean of maximum SRF height decreased from 155.63 ± 95.27 μm at baseline to 77.19 ± 95.68 μm at the final visit (P = 0.04). SRF resolved completely in seven eyes (43.75%). CONCLUSION In eyes with persistent SRF due to CSC, spironolactone therapy was associated with a statistically significant decrease in maximum SRF height, as well as an improvement in BCVA.
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Affiliation(s)
| | - Anahita Amirsardari
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Habibi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Acieh Eshaghi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shohreh Bakhti
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Kaveh Abri Aghdam
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Stur M, Ansari-Shahrezaei S, Haas A, Tittl M. Leitlinien für die Betreuung und Behandlung von Patienten mit Chorioretinopathia centralis serosa. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-015-0276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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