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Tillmann A, Ceklic L, Dysli C, Munk MR. Gender differences in retinal diseases: A review. Clin Exp Ophthalmol 2024; 52:317-333. [PMID: 38348562 DOI: 10.1111/ceo.14364] [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: 08/29/2023] [Revised: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 04/18/2024]
Abstract
Gender medicine is a medical specialty that addresses gender differences in health and disease. Traditionally, medical research and clinical practice have often been focused on male subjects and patients. As a result, gender differences in medicine have been overlooked. Gender medicine considers the biological, psychological, and social differences between the genders and how these differences affect the development, diagnosis, treatment, and prevention of disease. For ophthalmological diseases epidemiological differences are known. However, there are not yet any gender-based ophthalmic treatment approaches for women and men. This review provides an overview of gender differences in retinal diseases. It is intended to make ophthalmologists, especially retinologists, more sensitive to the topic of gender medicine. The goal is to enhance comprehension of these aspects by highlighting fundamental gender differences. Integrating gender medicine into ophthalmological practice helps promote personalized and gender-responsive health care and makes medical research more accurate and relevant to the entire population.
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Affiliation(s)
- Anne Tillmann
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
| | - Lala Ceklic
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Chantal Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Marion R Munk
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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2
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Sahoo NK, Ong J, Selvam A, Brown R, Avdalimov M, Kulkarni A, Hansraj S, Gujar R, Lupidi M, Zur D, Chhablani J. Gender differences in central serous chorioretinopathy based on the new multimodal imaging classification. Eye (Lond) 2024; 38:964-967. [PMID: 37925559 DOI: 10.1038/s41433-023-02812-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 10/11/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023] Open
Abstract
PURPOSE To analyse the gender-specific differences in central serous chorioretinopathy (CSCR) based on a new multimodal imaging classification system. METHOD This was a retrospective, multicentric, longitudinal, observational study in patients with a diagnosis of unilateral or bilateral CSCR. Visual acuity outcomes and differences based on 'Simple' and 'Complex' CSCR were analysed. The occurrence of choroidal neovascularization (CNVM) and number of recurrences were also compared. Regression analysis was used to evaluate baseline predictors of final visual acuity. RESULTS The study included 109 eyes of 58 patients (55 eyes of 28 female patients and 54 eyes of 30 male patients). Simple CSCR was seen in 8 (14.8%) eyes and 21 (38.2%) eyes in male and female groups respectively, while complex CSCR was seen in 46 (85.2%) eyes and 34 (61.8%) eyes in male and female groups respectively (p = 0.005). Recurrence was more commonly seen in males (34 eyes) than in females (23 eyes) (p = 0.03). Males (96.7%) were also significantly more likely to have a bilateral presentation (78.6% in females) (p = 0.03). Conversely, CNVM was more commonly seen in female eyes (8 eyes) than male eyes (4 eyes) (p = 0.23). On multivariable regression analysis, factors affecting reduced need for treatment were history of steroid use, good visual acuity at baseline, and simple CSCR. Factors affecting good final visual acuity were history of steroid use, good visual acuity at baseline, and younger age. CONCLUSION Males tended to have complex CSCR and recurrence compared to the female sub-group, while females exhibited CNVM more commonly than males.
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Affiliation(s)
- Niroj Kumar Sahoo
- Anant Bajaj retina Institute, Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, India
| | - Joshua Ong
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Amrish Selvam
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Richard Brown
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Milana Avdalimov
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ashwini Kulkarni
- Anant Bajaj retina Institute, Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, India
| | - Saarang Hansraj
- Anant Bajaj retina Institute, Kallam Anji Reddy campus, L V Prasad Eye Institute, Hyderabad, India
| | - Ramkailash Gujar
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, 06156, Perugia, Italy
| | - Marco Lupidi
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, 06156, Perugia, Italy
| | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jay Chhablani
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
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Gao S, Zhang Y, Zhang M. Efficacy and Predictive Factors of Oral Spironolactone Treatment in Chronic Central Serous Chorioretinopathy. J Ophthalmol 2024; 2024:7197249. [PMID: 38529362 PMCID: PMC10963119 DOI: 10.1155/2024/7197249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/09/2024] [Accepted: 03/05/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose To evaluate the efficacy of spironolactone in the treatment of chronic central serous chorioretinopathy (CSC) and identify imaging characteristics that can predict the benefit of spironolactone treatment. Methods Patients with chronic CSC were treated with spironolactone (20 mg/tid) and followed for 6 months. The primary outcome measure was complete resolution of the subretinal fluid (SRF), and the best-corrected visual acuity (BCVA), the SRF area, the central macular thickness (CMT), the subfoveal choroidal thickness (SFCT), and the density of the choriocapillaris vessel and adverse events were secondary outcome measures. Patients who presented complete resolution of SRF were included in the responder group and the other patients who had moderate or no resolution were included in the nonresponder group. Imaging characteristic comparisons between the responder and nonresponder groups were performed with regression analyses to identify factors that are predictive of a good response to treatment. Results Forty-two eyes of 42 patients with a mean age of 46.06 ± 6.66 years were included. A total of 57.1% of the patients achieved a complete resolution of SRF. The mean SRF area, CMT, and SFCT decreased significantly (all P < 0.05) throughout the follow-up period and BCVA improved slightly (P > 0.05). The vascular density of the choriocapillaris of the fellow eyes did not vary significantly during treatment. Logistic regression analysis revealed that SFCT (P=0.002) and the intact ellipsoid zone (P=0.001) were correlated with disease resolution. A relatively higher baseline SFCT was a predictive factor associated with a good response to treatment according to multivariate analysis. Conclusions This study suggested that oral spironolactone could be an effective and safe therapy for chronic CSC patients. Eyes with a higher baseline SFCT and intact ellipsoid zone could have a good response. These parameters are an important prognostic marker.
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Affiliation(s)
- Sheng Gao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
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Annam R, Padyala P, Annam P, Nandennagari S, Bethala K. Risks and Management of Central Serous Chorioretinopathy in a Middle-Aged Female. Cureus 2023; 15:e51325. [PMID: 38288177 PMCID: PMC10824147 DOI: 10.7759/cureus.51325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
Central serous chorioretinopathy (CSC) is the buildup of fluid in the posterior pole distorting the vision resulting from either neurosensory or retinal pigment epithelial detachment. This is a case report of a 33-year-old female complaining of cloudiness in the left eye who was subsequently diagnosed with CSC using optical coherence tomography (OCT). Remission was observed in four months, possibly from ocular drop treatment or spontaneous. Our case report is unique as the incidence of CSC is more common in males, almost six times higher than in females. Also, the etiology of CSC in this case report is questionable because all the risks are excluded from our patient history.
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Affiliation(s)
- Reshma Annam
- Medicine, Windsor University School of Medicine, Saint Kitts, KNA
| | | | - Preethi Annam
- Surgery, Avalon University School of Medicine, Curacao, CUW
| | | | - Krupavaram Bethala
- Pharmacology and Therapeutics, Centre of Excellence in Pharmaceutical Sciences, School of Pharmacy, KPJ Healthcare University College, Kuala Lumpur, MYS
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Wei J, Yu S, Du Y, Liu K, Xu Y, Xu X. Automatic Segmentation of Hyperreflective Foci in OCT Images Based on Lightweight DBR Network. J Digit Imaging 2023; 36:1148-1157. [PMID: 36749455 PMCID: PMC10287852 DOI: 10.1007/s10278-023-00786-0] [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: 10/25/2022] [Revised: 01/14/2023] [Accepted: 01/18/2023] [Indexed: 02/08/2023] Open
Abstract
Hyperreflective foci (HF) reflects inflammatory responses for fundus diseases such as diabetic macular edema (DME), retina vein occlusion (RVO), and central serous chorioretinopathy (CSC). Shown as high contrast and reflectivity in optical coherence tomography (OCT) images, automatic segmentation of HF in OCT images is helpful for the prognosis of fundus diseases. Previous traditional methods were time-consuming and required high computing power. Hence, we proposed a lightweight network to segment HF (with a speed of 57 ms per OCT image, at least 150 ms faster than other methods). Our framework consists of two stages: an NLM filter and patch-based split to preprocess images and a lightweight DBR neural network to segment HF automatically. Experimental results from 3000 OCT images of 300 patients (100 DME,100 RVO, and 100 CSC) revealed that our method achieved HF segmentation successfully. The DBR network had the area under curves dice similarity coefficient (DSC) of 83.65%, 76.43%, and 82.20% in segmenting HF in DME, RVO, and CSC on the test cohort respectively. Our DBR network achieves at least 5% higher DSC than previous methods. HF in DME was more easily segmented compared with the other two types. In addition, our DBR network is universally applicable to clinical practice with the ability to segment HF in a wide range of fundus diseases.
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Affiliation(s)
- Jin Wei
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080, China
- Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Suqin Yu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080, China
| | - Yuchen Du
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080, China
- Department of Automation, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Kun Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080, China
| | - Yupeng Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080, China.
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080, China
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Wong A, Zhu D, Li AS, Lee JG, Ferrone PJ. Topical Dexamethasone as an Adjuvant to Mineralocorticoid Receptor Antagonists for the Treatment of Recalcitrant Central Serous Chorioretinopathy. Ophthalmic Surg Lasers Imaging Retina 2022; 53:659-665. [PMID: 36547963 DOI: 10.3928/23258160-20221115-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE A previous report demonstrated efficacy of mineralocorticoid antagonist with adjuvant topical dexamethasone (MRA+DEX) in resolving subretinal fluid (SRF) in a chronic central serous chorioretinopathy (CSCR) patient. This pilot study investigates the use of MRA+DEX to treat recalcitrant, chronic CSCR patients. STUDY DESIGN Retrospective review of chronic, recalcitrant CSCR patients unresponsive to MRA alone who were treated with MRA+DEX and followed for up to 3 months. Apical SRF thickness and visual acuity were measured. RESULTS Ten eyes of eight chronic, recalcitrant patients were included with an average follow-up of 109 days. Mean percent reduction in apical fluid thickness at one month and at last follow-up after adding dexamethasone (DEX) was 33% and 52%, respectively. Five eyes (50%) achieved complete resolution of SRF. Three eyes (30%) showed partial response and two (20%) eyes had no response. There was no significant change in visual acuity. CONCLUSIONS MRA+DEX decreased SRF in some recalcitrant, chronic CSCR patients. Large prospective studies are needed to evaluate the utility of MRA+DEX in these chronic CSCR patients. [Ophthalmic Surg Lasers Imaging Retina 2022;53:659-665.].
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Yoneyama S, Fukui A, Sakurada Y, Terao N, Shijo T, Kusada N, Sugiyama A, Matsubara M, Fukuda Y, Kikushima W, Parikh R, Mabuchi F, Sotozono C, Kashiwagi K. Distinct characteristics of central serous chorioretinopathy according to gender. Sci Rep 2022; 12:10565. [PMID: 35732691 PMCID: PMC9217960 DOI: 10.1038/s41598-022-14777-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
To investigate the differences in clinical and genetic characteristics between males and females with central serous chorioretinopathy (CSC). Consecutive 302 patients (mean age; 56.3 ± 11.7, male/female: 249/53) with CSC were evaluated on the initial presentation. All CSC patients underwent fluorescein angiography and indocyanine green angiography (FA/ICGA), swept-source or spectral-domain optical coherence tomography (OCT), and fundus autofluorescence (FAF) to confirm a diagnosis. All patients were genotyped for rs800292 and rs1329428 variants of CFH using TaqMan technology. On the initial presentation, female patients were significantly older (p = 2.1 × 10–4, female 61.6 ± 12.4 vs male 55.1 ± 11.3) and had thinner subfoveal choroidal thickness (p = 3.8 × 10–5) and higher central retinal thickness (p = 3.0 × 10–3) compared to males. A descending tract was more frequently seen in males than in females (p = 8.0 × 10–4, 18.1% vs 0%). Other clinical characteristics were comparable between the sexes. The risk allele frequency of both variants including CFH rs800292 and CFH rs1329428 was comparable between males and females (CFH rs800292 A allele male 51.2% vs female 47.2%, CFH rs1329428 T allele male 56.2% vs 52.8%). On the initial presentation, age, subfoveal choroidal thickness and central retinal thickness differ between males and females in eyes with CSC. A descending tract may be a strong male finding in CSC.
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Affiliation(s)
- Seigo Yoneyama
- Department of Ophthalmology, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan
| | - Ayumi Fukui
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoichi Sakurada
- Department of Ophthalmology, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan.
| | - Nobuhiro Terao
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taiyo Shijo
- Department of Ophthalmology, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan
| | - Natsuki Kusada
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsushi Sugiyama
- Department of Ophthalmology, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan
| | - Mio Matsubara
- Department of Ophthalmology, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan
| | - Yoshiko Fukuda
- Department of Ophthalmology, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan
| | - Wataru Kikushima
- Department of Ophthalmology, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan
| | - Ravi Parikh
- New York University School of Medicine, New York, NY, USA.,Manhattan Retina and Eye Consultants, New York, NY, USA
| | - Fumihiko Mabuchi
- Department of Ophthalmology, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Kashiwagi
- Department of Ophthalmology, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan
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Bousquet E, Torres-Villaros H, Provost J, Elalouf M, Gigon A, Mantel I, Timsit A, Behar-Cohen F. Clinical Characteristics and Multimodal Imaging Findings of Central Serous Chorioretinopathy in Women versus Men. J Clin Med 2022; 11:jcm11061706. [PMID: 35330031 PMCID: PMC8954406 DOI: 10.3390/jcm11061706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023] Open
Abstract
(1) The aim of this study was to compare the clinical characteristics and multimodal imaging findings of central serous chorioretinopathy (CSCR) between women and men. (2) Women and men with CSCR were compared in terms of their age and risk factors, the clinical form of their disease, multimodal imaging findings and the presence of macular neovascularization (MNV) on optical coherence tomography (OCT)-angiography. (3) Results: The data of 75 women and 75 men were compared. The women were significantly older than the men (52.2 years versus 45.7 years; p < 0.001). Corticosteroid intake was more frequent in the women (56% versus 40%; p = 0.05). The women had a single foveal subretinal detachment more often than the men (73.3% versus 46.9%; p < 0.001) and they often had fewer gravitational tracks (16.3% versus 29.6%; p = 0.03). On mid-phase indocyanine green angiography, hyperfluorescent plaques were detected less often in the women than in the men (48% versus 72.2%, p = 0.001). MNV was detected on OCT-angiography in 35.9% of the women and in 13.3% of the men (p = 0.004). (4) In the women, CSCR occurs at an older age, is more often unifocal foveolar, and is associated with a higher rate of MNV. The reasons for these gender-related differences remain to be determined.
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Affiliation(s)
- Elodie Bousquet
- Department of Ophthalmology, Ophtalmopôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, 75014 Paris, France; (H.T.-V.); (J.P.); (A.T.); (F.B.-C.)
- Centre de Recherche des Cordeliers, Université de Paris, 75006 Paris, France
- Correspondence: ; Tel.: +33-1-5841-2215
| | - Héloïse Torres-Villaros
- Department of Ophthalmology, Ophtalmopôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, 75014 Paris, France; (H.T.-V.); (J.P.); (A.T.); (F.B.-C.)
| | - Julien Provost
- Department of Ophthalmology, Ophtalmopôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, 75014 Paris, France; (H.T.-V.); (J.P.); (A.T.); (F.B.-C.)
| | - Martine Elalouf
- Department of Ophthalmology, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, 1015 Lausanne, Switzerland; (M.E.); (A.G.); (I.M.)
| | - Anthony Gigon
- Department of Ophthalmology, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, 1015 Lausanne, Switzerland; (M.E.); (A.G.); (I.M.)
| | - Irmela Mantel
- Department of Ophthalmology, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, 1015 Lausanne, Switzerland; (M.E.); (A.G.); (I.M.)
| | - Aurélie Timsit
- Department of Ophthalmology, Ophtalmopôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, 75014 Paris, France; (H.T.-V.); (J.P.); (A.T.); (F.B.-C.)
| | - Francine Behar-Cohen
- Department of Ophthalmology, Ophtalmopôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, 75014 Paris, France; (H.T.-V.); (J.P.); (A.T.); (F.B.-C.)
- Centre de Recherche des Cordeliers, Université de Paris, 75006 Paris, France
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Arora S, Maltsev DS, Singh Randhir S, Sahoo NK, Jhingan M, Parmeshwarappa D, Arora T, Kulikov A, Iovino C, Zur D, Fainberg G, Ibrahim MN, Tatti F, Gujar R, Venkatesh R, Reddy N, Snehith R, Peiretti E, Lupidi M, Chhablani J. One year outcome and predictors of treatment outcome in central serous chorioretinopathy: Multimodal imaging based analysis. Eur J Ophthalmol 2021; 32:2319-2327. [PMID: 34747194 DOI: 10.1177/11206721211055018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate the follow up and treatment outcome of central serous chorioretinopathy (CSCR) based on the new multimodal imaging-based classification and identify the predictors for anatomic and visual outcome. METHODS Retrospective, multicentric study on 95 eyes diagnosed with CSCR and a follow up of at least 12 months were included. Eyes with macular neovascularization, atypical CSCR or any other disease were excluded. RESULTS At the baseline, observation was advised to 70% eyes with simple CSCR whereas photodynamic therapy (PDT) was performed in 49% eyes with complex CSCR. Over the follow up, decrease in CMT was significantly higher in simple CSCR as compared to complex CSCR (P = 0.008) and the recurrences were significantly more in eyes with lower CMT at baseline (P = 0.0002). Median time of resolution of SRF was 3 months and 6 months in simple and complex CSCR respectively (P = 0.09). For the 12 months follow up, the median fluid free period was greater (P = 0.03) while number of interventions performed was lesser in eyes with simple CSCR as compared to complex CSCR (P = 0.006). Multiple regression analysis showed baseline best corrected visual acuity (BCVA) and baseline persistent SRF to be significantly predictive of BCVA and persistent SRF at 12 months (P < 0.0001, 0.04) respectively. CONCLUSIONS Complex CSCR more often required PDT, was associated with shorter fluid free interval and longer time for SRF resolution. Baseline BCVA and persistent SRF were predictive of final visual and anatomical outcome. The new multimodal imaging based classification is helpful in establishing objective criteria for planning treatment approaches for CSCR.
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Affiliation(s)
- Supriya Arora
- Bahamas Vision Center and Princess Margaret Hospital, Nassau, NP, Bahamas
| | - Dmitrii S Maltsev
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russian Federation
| | - Sumit Singh Randhir
- Jacobs Retina Center, Shiley Eye Center, University of California, San Diego, USA
| | - Niroj Kumar Sahoo
- Department of Retina and Vitreous, L V Prasad Eye Institute, Vijayawada, India
| | - Mahima Jhingan
- Jacobs Retina Center, Shiley Eye Center, University of California, San Diego, USA
| | - Deepika Parmeshwarappa
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Tarun Arora
- Bahamas Vision Center and Princess Margaret Hospital, Nassau, NP, Bahamas
| | - Alexei Kulikov
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russian Federation
| | - Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, 3111University of Cagliari, Cagliari, Italy
| | - Dinah Zur
- Division of Ophthalmology, 26738Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Fainberg
- Division of Ophthalmology, 26738Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Filippo Tatti
- Department of Surgical Sciences, Eye Clinic, 3111University of Cagliari, Cagliari, Italy
| | - Ramkailash Gujar
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, 60250University of Perugia, Italy
| | - Ramesh Venkatesh
- Department of Retina and Vitreous, 80219Narayana Nethralaya, Bengaluru, India
| | - Nikitha Reddy
- Department of Retina and Vitreous, 80219Narayana Nethralaya, Bengaluru, India
| | - Ram Snehith
- Department of Retina and Vitreous, 80219Narayana Nethralaya, Bengaluru, India
| | - Enrico Peiretti
- Department of Surgical Sciences, Eye Clinic, 3111University of Cagliari, Cagliari, Italy
| | - Marco Lupidi
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, 60250University of Perugia, Italy
| | - Jay Chhablani
- UPMC Eye Center, 6595University of Pittsburgh, Pittsburgh, USA
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Gamulescu MA. [Gender medicine in ophthalmology : The "small difference" between women and men]. Ophthalmologe 2020; 117:831-842. [PMID: 32699941 DOI: 10.1007/s00347-020-01174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Gender-specific or sex-specific medicine is part of "personalized" medicine. After differences in heart diseases between women and men were first identified and increasingly published in the field of cardiology since the 1980s, differences between the sexes have also become the focus of interest in other disciplines. Immunological and hormonal aspects indicate significant differences, e.g. in the severity of the disease or the response to treatment. Even in ophthalmology epidemiological differences in some diseases are known but so far these do not lead to a different approach in the practical treatment of patients. This CME article aims to raise awareness of gender medicine also in the field of ophthalmology and at the same time to promote understanding of these differences by presenting the fundamental differences between the sexes.
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Affiliation(s)
- M-A Gamulescu
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Deutschland.
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Wang J, Yu Y, Liang X, Wang Z, Qi B, Liu W. Pre- and post-operative differences between genders in idiopathic macular holes. BMC Ophthalmol 2020; 20:365. [PMID: 32912182 PMCID: PMC7488443 DOI: 10.1186/s12886-020-01633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare idiopathic macular holes (IMHs) between male and female before and after surgery. METHODS Patients with IMHs of stage 3 and stage 4 who underwent 23-gauge vitrectomy were retrospectively enrolled. Pre-operative clinical features like age of onset, and best-corrected visual acuity (BCVA) were reviewed. Optical coherence tomography parameters including minimum linear diameter (MLD), central macular thickness and some other indexes were measured and calculated. Main surgical outcomes included the primary closure rate, the highest BCVA during follow-up, and the recovery duration. All the metrics mentioned above were compared between genders with appropriate statistical methods. RESULTS A total of 298 eyes from 280 patients (male: 51; female: 229) were enrolled. Compared with men, women demonstrated a significantly higher ratio of stage3/stage4 (P = 0.045), larger horizontal MLD (P = 0.009), but similar surgical outcomes except for a relatively longer recovery duration (P = 0.024). For stage 3 IMHs, women exhibited significantly younger age of onset (P = 0.023), larger MLD (P = 0.003), and smaller height of the hole (P = 0.029). However, for stage 4 IMHs, all the pre- and post-operative metrics showed no differences between genders. CONCLUSIONS Female IMHs seem to demonstrate an earlier age of onset and larger size of hole, especially in IMHs of stage 3. However, these differences, which may owe to normal gender-related variations, have limited influence on the surgical outcomes.
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Affiliation(s)
- Jing Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, No 1, Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Yanping Yu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, No 1, Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Xida Liang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, No 1, Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Zengyi Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, No 1, Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Biying Qi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, No 1, Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Wu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, No 1, Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China.
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Romdhane K, Zola M, Matet A, Daruich A, Elalouf M, Behar-Cohen F, Mantel I. Predictors of treatment response to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for choroidal neovascularisation secondary to chronic central serous chorioretinopathy. Br J Ophthalmol 2019; 104:910-916. [PMID: 31615761 DOI: 10.1136/bjophthalmol-2019-314625] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/02/2019] [Accepted: 10/02/2019] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of anti-vascular endothelial growth factor (VEGF) therapy on choroidal neovascularisation (CNV) complicating central serous chorioretinopathy (CSC) using multimodal imaging, and to identify possible predictive factors of the treatment response. DESIGN Retrospective study. METHODS Data of 27 eyes with CNV complicating CSC treated with anti-VEGF therapy (either ranibizumab or aflibercept) were reviewed. Response to anti-VEGF treatment was evaluated by change in visual acuity, intra/subretinal fluid modifications and CNV changes on optical coherence tomography angiography (OCTA). Univariate and multivariate analyses were performed to identify predictive factors for central retinal thickness (CRT) change and for the relative degree of treatment response (complete, incomplete or absent fluid reduction). RESULTS CRT was significantly reduced at 32±15 days after 2.8±1.3 injections (p=0.0004) as was the subretinal fluid (p=0002). Complete fluid resorption was observed in 45% of cases. Best corrected visual acuity did not significantly improve (p=0.18). CNV area (p=0.09) and CNV flow area (p=0.07) did not significantly decrease. No changes in CNV pattern were noted. Univariate analysis identified greater CRT at baseline (p<0.0001), greater amount of subretinal fluid (p<0.0001), a shorter period of retinal fluid (p=0.04) and female gender (p=0.04) as predictors for CRT reduction. After multivariate analysis the factor of greater CRT at baseline (p<0.0001) proved independent. The degree of treatment response was dependent on the size of CNV surface (p=0.05) and flow area (p=0.05) on OCTA in the univariate analysis, and the latter independent after multivariate analysis. In addition, a shorter time period of retinal fluid appeared to play a role (p=0.01 multivariate, p=0.19 univariate). CONCLUSION The anti-VEGF response was highly variable and often incomplete, suggesting that CNV was not solely responsible for the fluid accumulation. Predictive factors may guide indication for anti-VEGF in CNV associated with CSC.
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Affiliation(s)
- Khaled Romdhane
- Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Marta Zola
- Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Alexandre Matet
- Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Alejandra Daruich
- Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Martine Elalouf
- Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | | | - Irmela Mantel
- Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
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Risk Factors for Persistent or Recurrent Central Serous Chorioretinopathy. J Ophthalmol 2019; 2019:5970659. [PMID: 31485346 PMCID: PMC6710733 DOI: 10.1155/2019/5970659] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 05/23/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose To investigate the risk factors for persistent or recurrent central serous chorioretinopathy (CSC). Materials and Methods Consecutive treatment-naïve CSC patients were included from January 2017 to October 2018. All patients were asked to complete questionnaires, addressing previously described risk factors for the development of CSC. Patients were divided into two groups: those with acute CSC, who were in the first episode, with spontaneous resolution of subretinal fluid within 3 months, and with no recurrence within 1 year; and those with persistent or recurrent CSC, the remaining patients. Results In total, 138 patients were enrolled: 20 (14.5%) with acute CSC and 118 (85.5%) with persistent or recurrent CSC. Using multivariate analysis, male sex (odds ratio (OR), 95% confidence interval: 5.63 [1.02–31.02]; p=0.047), older age (OR: 1.14 [1.03–1.25]; p=0.008), and higher Insomnia Severity Index score (OR: 1.30 [1.05–1.60]; p=0.015) were found to be independently associated with persistent or recurrent CSC. Conclusions Male sex, age, and sleep disorders are risk factors for persistent or recurrent CSC in the natural history. These patients may require early photodynamic therapy. Treatment for sleep disorders is strongly recommended. All CSC patients may require careful and periodic follow-up.
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