CORRELATION OF SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS AND VISUAL ACUITY IN CENTRAL SEROUS CHORIORETINOPATHY

Morphological and Functional Correlations in Acute Central Serous Chorioretinopathy

PURPOSE

We evaluate morphological and functional correlations in patients with acute central serous chorioretinopathy (CSC).

METHODS

A prospective study was conducted on 50 patients with an acute CSC episode lasting less than 3 months. At baseline, assessments included optical coherence tomography (OCT), best-corrected visual acuity (BCVA), contrast sensitivity (CS), microperimetry (MP), and multifocal electroretinography (mfERG). A correlation analysis between OCT morphological parameters (maximal subretinal fluid height (SRF), central retinal thickness (CRT), and macular volume (MV)) and functional parameters was conducted on the affected eye for each patient.

RESULTS

Among the morphological parameters, SRF showed the strongest correlations with functional parameters (r absolute value range = 0.10-0.70). Weak correlations were observed between BCVA and morphological parameters (r absolute value range = 0.14-0.26). Average retinal sensitivity (MP-A) was the functional parameter displaying the most robust negative correlation with morphological parameters (r absolute value range = 0.61-0.70). In contrast, average contrast sensitivity (CS-A) and mfERG average amplitude density in the first (mfERG-A1) and second (mfERG-A2) ring showed weak to moderate (r absolute value range = 0.35-0.56) yet statistically significantly nonzero correlations.

CONCLUSIONS

SRF and CRT could serve as the most representative morphological proxies for visual function deficit in acute CSC patients. Retinal sensitivity, as measured by MP, may be superior to BCVA in clinical research studies or when an in-depth visual function evaluation is needed.

Analysis of Cytokine Levels Based on Optical Coherence Tomography Findings in Acute and Chronic Central Serous Chorioretinopathy

Purpose: To investigate the characteristics of optical coherence tomography (OCT) and aqueous humor cytokine differences between acute and chronic central serous chorioretinopathy (CSC) and to evaluate the relevance of these findings.Methods: This was a cross-sectional, observational study. Patients with CSC were divided into acute and chronic groups based on the symptom duration and were compared with normal controls. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (CT), hyperreflective foci (HF), and cytokines including vascular endothelial growth factor (VEGF), interleukin (IL)-6, IL-8, IL-10, interferon-inducible protein-10 (IP-10), and monocyte chemoattractant protein-1 (MCP-1) were used as comparison metrics.Results: A total of 62 patients (62 eyes) with CSC (22 with acute CSC and 40 with chronic CSC) and 35 patients as controls were included in this study. The chronic CSC group had significantly older average ages and worse BCVA than the acute CSC group (both p < 0.05). Both CSC groups showed significant increases in CMT and CT (both p < 0.05). In chronic CSC, the CMT was thinner, with more HF in the neuroretina (p = 0.034). VEGF levels were significantly higher in patients with chronic CSC than in those with acute CSC and controls (p < 0.05). The levels of inflammatory cytokines showed no significant difference between the CSC and control groups. Spearman's correlation analysis showed that the number of HF was positively correlated with disease duration (r = 0.311, p = 0.014), logMAR BCVA (r = 0.487, P < 0.001) and MCP-1 levels (r = 0.256, p = 0.045).Conclusions: Chronicity of CSC could lead to upregulation of VEGF. HF was associated with a more severe visual impairment in CSC patients and had relations with the levels of MCP-1.

Association of Subretinal Fluid Duration and Baseline Chorioretinal Structure With Optical Coherence Tomography in Central Serous Chorioretinopathy

Purpose

This study investigated the association between subretinal fluid (SRF) duration and baseline chorioretinal structure in patients with naïve (first-episode and untreated) central serous chorioretinopathy (CSC).

Methods

We divided 59 patients into non-prolonged (<3 months) and prolonged (>3 months) groups based on SRF fluid persistence from the initial visit. The follow-up period varied as the shorter duration was chosen between SRF disappearance time and 3 months from the initial visit. We measured the central retinal thickness (CRT), central choroidal thickness (CCT), SRF height (SRFH), and outer nuclear layer thickness (ONL) using spectral-domain optical coherence tomography (SD-OCT) at the initial visit and recorded SRF duration. We compared these parameters between the groups, conducted multivariate analysis for SRF duration of more than 3 months, and investigated the correlation among CCT and CRT, SRFH, or ONL, and among SRF duration and CRT, CCT, SRFH, or ONL.

Results

CCT was significantly thicker in the prolonged than in the non-prolonged group at the initial visit (P = 0.044) and significantly correlated with CRT and SRFH (P = 0.007, r = 0.35 and P = 0.002, r = 0.39). SRF duration significantly correlated with CRT and SRFH (P = 0.009, r = 0.40 and P = 0.003, r = 0.41). The optimal model for SRF duration more than 3 months included age (P = 0.054) and CCT (P = 0.008).

Conclusions

Thicker baseline CCT can lead to a longer SRF duration in naïve CSC.

Translational Relevance

This association aids in early detection of cases at a higher risk of prolonged SRF.

Relationship between macular intervortex vein anastomosis and optical coherence tomography biomarkers in chronic central serous chorioretinopathy

BACKGROUNDS

To evaluate the optical coherence tomography (OCT) biomarkers of patients with central serous chorioretinopathy (CSC) according to the presence or absence of direct anatomical relation to intervortex vein anastomosis (IVA) on indocyanine green angiography.

METHODS

We reviewed the records of 39 patients with chronic CSC. Patients were categorized in 2 groups: presence of IVA(Group A) or absence of IVA(Group B) in the macular region. Localization of IVA was categorized in 3 areas according to ETDRS grid:inner 1 mm circle (area-1), 1-3 mm middle circle (area-2) and 3-6 mm outer circle (area-3).

RESULTS

There were 31 eyes in Group A,21 eyes in Group B. Mean age of the patients was 52.5 ± 11.3years in Group A,47.2 ± 11years in Group B(p<0.001).Mean initial visual acuity (VA) was 0.38±0.38LogMAR in Group A, 0.19±0.21LogMAR in Group B(p<0.001).Mean subfoveal choroidal thickness(SFCT) was 436.3 ± 134.3µ in Group A,480.2 ± 136.6µ in Group B(p<0.001).Localization of IVA in area-1 was correlated with inner choroidal attenuation (ICA) and leakage on IVA(p = 0.011,p = 0.02). Localization of IVA in area-3 was correlated with irregular lesions on RPE(p = 0.042).Smokestack configuration,intraretinal cysts and ICA were correlated with worse initial VA(p<0.001,p = 0.001 and p = 0.04).Shaggy subtype of photoreceptor disruption was associated with better initial VA(p = 0.003).

CONCLUSIONS

We detected older age, worse initial VA and thinner SFCT in patients with chronic CSC and macular region IVA(m-IVA). Long term follow-up of patients with and without m-IVA may exhibit the difference in treatment outcomes and development of neovasculopathy.

Biomarkers predicting central serous chorioretinopathy episode persistence

PURPOSE

The purpose of this study was to identify biomarkers at presentation that are associated with a persistent central serous chorioretinopathy (CSC) episode.

METHODS

The prospective study included 35 patients with an acute CSC episode. Potential clinical and imaging biomarkers were evaluated at baseline and 3 months from the episode onset. As biomarkers age, sex, steroid use, episode recurrence, central retinal thickness (CRT), macular volume (MV), choroidal thickness (CT), pigment epithelial detachment (PED) height, and width, number of retinal hyperreflective foci (HF), leakage pattern, and area of retinal pigment epithelial (RPE) alterations were investigated.

RESULTS

At 3 months from the CSC episode onset, spontaneous resolution occurred in 19 patients, while 16 patients had a persistent CSC episode. The group of patients with a persistent episode was statistically significantly associated with female sex (p = 0.032), older age (p = 0.015), wider PED (p = 0.005), and higher number of HF (p = 0.02). Moreover, this group of patients had a significant association with thinner choroid and diffuse RPE alterations as a pair (p = 0.008).

CONCLUSIONS

Older and female CSC patients with wider PED, increased number of HF, thinner choroid, and diffuse RPE alterations at presentation are inclined to episode persistence and could benefit from earlier treatment.

Morphological parameters predicting subthreshold micropulse laser effectiveness in central serous chorioretinopathy

PURPOSE

The purpose of this prospective study was to predict the effectiveness of subthreshold micropulse laser (SML) based on morphological parameters in patients with central serous chorioretinopathy (CSC).

METHODS

Thirty-one patients were examined at presentation, 3 months, and 6 months after the disease onset. In patients with persistent subretinal fluid (SRF) at 3 months, SML was performed. The following morphological parameters were observed just before treatment: central retinal thickness (CRT), maximal SRF, choroidal thickness (CT), pigment epithelial detachment (PED) height and width, number of hyperreflective foci (HF) at fovea and leakage site, secondary choroidal neovascularization (CNV), and severity of retinal pigment epithelium (RPE) alterations using multimodal imaging.

RESULTS

Good response was associated with lower SRF (p = 0.038), narrower PED (p = 0.078), and decreasing number of HF at fovea (difHFf) (p = 0 .016) just before the treatment. From a bivariate and multivariate point of view, the two groups differed significantly in the pair (SRF, PED width) (p = 0.048) and in the triple (SRF, PED width, difHFf) (p = 0.026).

CONCLUSION

Lower SRF, narrower PED, and decreasing HF could be associated with good response to SML in CSC patients.

Efficacy of Navigated Laser Photocoagulation for Chronic Central Serous Chorioretinopathy: A Retrospective Observational Study

Background. No consensus has been reached regarding the management of central serous chorioretinopathy (CSCR). We aimed to investigate the efficacy of navigated laser treatment for chronic CSCR and changes in the morphology of the retinal pigment epithelium (RPE). In this retrospective observational study, 19 patients with subjective symptoms admitted to the Nanjing Medical University Affiliated Eye Hospital were included between January 2021 and August 2021. All patients underwent visual acuity and optical coherence tomography (OCT) examination during follow-up. Fluorescein angiography (FA) was performed at baseline and at the final follow-up to confirm the dye leakage sites. The mean logMAR BCVA at baseline and at the end of follow-up was 0.49 ± 0.24 and 0.24 ± 0.15, respectively. The mean logMAR BCVA 3 months after treatment was significantly better than that before treatment (p = 0.002). Significant improvements were observed in central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) after navigated laser photocoagulation (p < 0.0001). Subretinal fluid was completely resolved in 13 (68%) of 19 eyes at 3 months. RPE lesions on OCT images showed RPE detachment in 17 eyes (61.5%), small protrusion of the RPE layer in 5 eyes (7.5%), and a rough RPE layer in 4 eyes (31%). After laser treatment, 9 points (35%) showed retinal detachment, and 10 (38.5%) regions showed an irregular RPE layer. An irregularly protruded RPE layer was also observed in different regions of the leakage spot in 5 (19%) eyes, and RPE defects were seen in 2 (7.5%) eyes. Navigated laser photocoagulation for chronic CSCR can achieve substantial anatomical and visual improvement. OCT outcomes may provide new information to facilitate understanding of the mechanism of chronic CSCR. Navigated laser photocoagulation should be chosen as an optimal treatment option in patients with chronic CSCR who cannot afford photodynamic therapy.

Visual acuity correlates with multimodal imaging-based categories of central serous chorioretinopathy

OBJECTIVE

To evaluate visual acuity (VA) and factors influencing VA using new multimodal imaging-based classification of central serous chorioretinopathy (CSCR).

METHODS

Retrospective, observational and cross-sectional study on 229 naïve eyes diagnosed as CSCR with available baseline data and multimodal imaging. Each case was classified into (i) simple/complex/atypical; (ii) primary/recurrent/resolved; (iii) persistent or not; (iv) outer retinal atrophy(ORA) present/absent; (v) foveal involvement present/absent; and (vi) macular neovascularization(MNV) present/absent. Best corrected visual acuity (BCVA) was correlated to the classification as well as every parameter of the classification.

RESULTS

Median BCVA was 0.18 logMAR [95% Confidence Interval (CI)0.16-0.18] with median duration of complaints of one month (95% CI,6.14-13.0 months). Age of the patient (r = -0.24, p = 0.002) and duration of the disease (r = -0.32, p < 0.001) correlated significantly with BCVA. Logistic regression model showed that older age [odds ratio (OR) = 0.96, p = 0.05], female gender (OR = 2.45, p = 0.046), presence of ORA(OR = 0.34, p = 0.012),and foveal involvement(OR = 0.18, p = 0.007) were statistically significantly associated with poorer BCVA. Eyes classified as complex, persistent CSCR, with ORA or foveal involvement demonstrated lower BCVA compared to those with simple, non-persistent CSCR, without ORA or without foveal involvement (p < 0.05). Eyes with complex CSCR (p < 0.001), atypical CSCR(p = 0.025), persistent subretinal fluid (SRF) (p = 0.001) and those with ORA (p < 0.001) demonstrated a trend towards severe visual loss. Prevalence of persistent SRF, recurrent episodes and ORA was significantly higher among eyes with complex CSCR (p < 0.001) while there was no difference in prevalence of resolved cases (p = 0.07), foveal involvement (p = 0.28) and MNV (p = 0.45) between simple and complex cases.

CONCLUSION

There is a strong correlation between VA and foveal involvement and ORA using the new classification. Thus, the objective parameters of the classification can be incorporated in establishing the treatment guidelines for CSCR.

Changes in the Foveal Outer Nuclear Layer of Central Serous Chorioretinopathy Patients Over the Disease Course and Their Response to Photodynamic Therapy

Objective:

To investigate the association between foveal outer nuclear layer (ONL) thickness and the natural course of central serous chorioretinopathy (CSC), as well as the thickness change after photodynamic therapy (PDT), exploring the PDT timing for CSC.

Methods:

This retrospective consecutive case series included 358 CSC patients between January 2014 and December 2019. All patients were divided into four groups depending on disease duration: Group A: ≤1 month; Group B: >1 and ≤3 months; Group C: >3 and≤6 months and Group D: >6 months. Foveal ONL thickness of the CSC eye and the clinically healthy fellow eye were measured and compared in all patients. Fifty-six patients were successfully treated with half-dose of PDT, showing complete subretinal fluid absorption, were followed up for more than 6 months and further investigated. The recovery of foveal ONL thickness was analyzed in the affected eyes of patients with different disease duration.

Results:

No significant reduction was found in CSC foveal ONL thickness (μm) compared to the fellow eye in patients with disease duration less than 1 week (112.3 ± 12.2 vs. 116.7 ± 15.3, P = 0.268). Patients with longer disease duration had varying degrees of ONL thinning compared to the contralateral eye (all P < 0.05) and this difference was more pronounced in patients with disease duration greater than 6 months (75.8 ± 12.9 vs. 113.0 ± 11.5, P < 0.001). At 6-month follow-up after PDT, foveal ONL thickness of patients with <1 month disease duration recovered significantly from onset (97.3 ± 18.2 to 113.6 ± 8.7, P < 0.001) and became similar to that of the healthy fellow eye. Foveal ONL thickness of patients with duration>1 and≤3 months recovered significantly (88.5 ± 11.5 to 95.8 ± 11.3, P = 0.012) but remained thinner than that of the healthy fellow eye. Foveal ONL thickness did not improve significantly in cases with disease duration longer than 3 months (P > 0.05).

Conclusion:

Foveal ONL thinning was positively associated with disease duration prior to treatment suggesting that longer disease duration limits scope for foveal ONL recovery. CSC patients should be treated with PDT as soon as possible to prevent disease development and reduced visual function.

Central Serous Chorioretinopathy - an Overview

Central serous chorioretinopathy (CSCR) is characterised by retinal serous detachment usually localised in the macular region. CSCR predominantly affects men between 30 and 50 years of age. Traditional classification differentiates between acute (duration shorter than 4 to 6 months) and chronic disease (duration longer than 4 to 6 months). The pathogenesis is multifactorial and current thinking assumes the presence of localised choroidal hyperpermeability with subsequent secondary changes in the retinal pigment epithelium (RPE). The symptoms of acute CSCR include central blurred vision, often with deterioration in visual acuity. Optical coherence tomography (OCT) reveals subretinal fluid (SRF) and/or single retinal pigment epithelial detachments. Fluorescein angiography (FA) usually shows a leaking point with absent or only minor RPE changes in the acute phase and indocyanine green angiography (ICG) highlights circumscribed areas of thickened and hyperpermeable choroid. Acute cases may show spontaneous resolution of SRF, but may also recur and/or become chronic. After the initial diagnosis, spontaneous remission is seen in about 70 to 80% of cases, with a recurrence rate of about 50%. Due to the favourable spontaneous course, it is recommended to wait for 4 to 6 months after the first symptoms manifest. Steroid therapy is considered as a major risk factor. Chronic cases are characterised by slow deterioration in visual acuity with reduced contrast and colour perception. There are extensive RPE changes, with secondary degenerative changes of the photoreceptors. The disease can by complicated by choroidal neovascularisation (CNV), especially in elderly patients. The literature lists a number of treatments: The leakage point (visible in the FA) can be treated by focal laser therapy, either micropulse laser or, if sufficiently distant from the fovea, by argon laser coagulation. Randomised trials in chronic CSCR demonstrated good outcomes with photodynamic therapy. With observation periods ranging from 3 to 6 months, several case series reports found improvement after systemic administration of mineralocorticoid receptor antagonists, carbonic anhydrase inhibitors or non-steroidal anti-inflammatory drugs. In the presence of secondary CNV, anti-VEGF treatment should be initiated. It is unclear whether the combination with PDT might be useful.

Applications of Multimodal Imaging in Central Serous Chorioretinopathy Evaluation

Central serous chorioretinopathy (CSCR) is a macular disease characterized by serous retinal detachment commonly involving the macular region. CSCR has a wide spectrum of clinical presentations. Although a significant proportion of CSCR cases are self-limiting, patients can suffer from persistent or recurrent disease, sometimes complicated with choroidal neovascularization, resulting in permanent visual loss. Multimodal imaging, including fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and optical coherence tomography, has advanced the diagnosis and classification of CSCR cases. Evolution of new imaging techniques including optical coherence tomography angiography, wide-field imaging, and en face reconstruction imaging has also contributed to better understandings of the pathophysiology of CSCR. This review article summarizes the features of multimodal imaging for CSCR and discusses the application of such features in evaluating the disease.

[Uniform classification of the pachychoroid spectrum disorders]

Pachychoroid spectrum disorders are characterized by a thickening of the choroid. The spectrum includes pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CCS), pachychoroid neovasculopathy (PNV), polypoidal choroidal vasculopathy (PCV)/aneurysmal type 1 choroidal neovascularization (ACNV-1), focal choroidal excavation (FCE) and peripapillary pachychoroid syndrome (PPS). If the choroid is thickened and there is a pathological alteration in the retinal pigment epithelium, the diagnosis is PPE; if the thickened choroid is accompanied by subretinal fluid, the diagnosis is CCS; if choroidal neovascularization is present, the diagnosis is PNV; if accompanied by aneurysms, the diagnosis is ACNV‑1. The PPE, CCS, PNV and ACNV‑1 were formerly regarded as independent disease entities but can be classified into four forms of a single disease family, pachychoroid macular disease.

OCT Risk Factors for 3-Year Development of Macular Complications in Eyes With "Resolved" Chronic Central Serous Chorioretinopathy

PURPOSE

To assess the relationship between demographics, clinical characteristics, and structural optical coherence tomography (OCT) findings and the development of sight-threatening macular complications (choroidal neovascularization [CNV], large areas of retinal pigment epithelium [RPE] atrophy, and cystoid macular degeneration [CMD]) in a cohort of eyes with "resolved" chronic central serous chorioretinopathy (CSC) at study baseline.

DESIGN

Retrospective cohort study.

METHODS

In this study, a total of 71 eyes with "resolved" (absence of subretinal fluid) chronic CSC at baseline and 36 months of regular follow-up examinations were retrospectively enrolled. Structural OCT scans were reviewed. Baseline OCT qualitative features reflecting distress of the neuroretina, RPE, or choroid were assessed and included ellipsoid zone discontinuity, outer nuclear layer (ONL) thinning; presence of hyper-reflective intraretinal foci; dome-shaped pigment epithelium detachment (PED); hyper-reflective flat, irregular PED; hyporeflective flat, irregular PED; and inner choroidal attenuation. OCT images obtained at follow-up visits were also reviewed for development of macular complications (CNV, large areas of RPE atrophy [at least 250 μm in diameter], and CMD). Main outcome measurements included incidence of macular complications and hazard ratio (HR) for demographics, clinical characteristics, and OCT risk factors.

RESULTS

At month 36, 20 eyes (28.2%) developed macular complications. Nine eyes (12.7%) displayed CNV, 9 eyes (12.7%) had large areas of RPE atrophy, and 2 eyes (2.8%) developed cystoid macular degeneration. The following factors were associated with an increased risk of development of CNV: intraretinal hyper-reflective foci had an HR of 11.58 (95% confidence interval [CI]: 1.10-37.24; P = .040); inner choroidal attenuation had an HR of 9.66 (95% CI: 1.07-22.34; P = .043); and the presence of macular complications in the fellow eye had an HR of 20.17 (95% CI: 1.34-39.41; P = .030). Factors associated with the development of RPE atrophy were also identified: ONL thinning had an HR of 13.47 (95% CI: 1.10-39.86; P = .042); dome-shaped PED had an HR of 21.40 (95% CI: 1.50-41.10; P = .031); and inner choroidal attenuation had an HR of 13.20 (95% CI: 1.07-39.32; P = .044).

CONCLUSIONS

OCT risk factors were identified for the development of macular complications in eyes with chronic CSC. Findings may help in the identification of high-risk patients.

Optical coherence tomography parameters as predictors of treatment response to a 577-nm subthreshold micropulse laser in chronic central serous chorioretinopathy

To determine the relation between retinal microstructural changes and the response to 577-nm subthreshold micropulse laser (SML) treatment in chronic central serous chorioretinopathy (cCSC). This retrospective study included 39 eyes of 39 patients with cCSC, treated with the 577-nm SML. The eyes were evaluated in three groups: complete remission, partial remission, and failure groups. The presence of some baseline retinal microstructural changes, thickness of the outer nuclear layer (ONL), status of the ellipsoid zone (EZ), and retinal pigment epithelium (RPE) were evaluated. The changes in central macular thickness (CMT), subretinal fluid (SRF) height, and best-corrected visual acuity (BCVA) were calculated. There were 14, 13, and 12 eyes in the complete remission, partial remission, and failure group, respectively. The baseline EZ and RPE were found intact in 71.4% and 64.3% of the eyes in the complete remission group, respectively; however, these rates were respectively 25% and 16.7% in the failure group (p < 0.05). Extrafoveal foci were present in 35.7% of the eyes in the complete remission group, but none was found in the failure group (p < 0.05). Although there was no statistically significant difference, the baseline ONL thickness was higher, and the hyperreflective dots, retinal bumps, subretinal fibrinous exudates, and PEDs were seen less in the complete remission group. The changes of the BCVA were not significant in any of the groups at the last visit (p > 0.05). The presence of baseline intact EZ and RPE, and extrafoveal foci can potentially be used as predictors of the SML treatment success in cCSC.

Central Serous Chorioretinopathy Classification

Central serous chorioretinopathy is characterized by an idiopathic neurosensory detachment of the retina. This narrative review aims to discuss the classification system used for central serous chorioretinopathy. Based on our current knowledge, there is no universally adopted classification system. This is the result of the unknown aspects related to pathogenesis and clinical spectrum and evolution. The best option could be to aggregate multimodal pieces of information alongside temporal and phenotypic characteristics.

Factors influencing the episode duration and the anatomical and functional outcome in cases of acute central serous chorioretinopathy

Objective

To investigate the factors affecting the duration of subretinal fluid (SRF) resolution and their correlation with the final anatomical and functional outcome in cases of treatment naïve acute central serous chorioretinopathy (CSCR).

Methods and analysis

We retrospectively studied 93 eyes of 93 patients diagnosed with treatment naïve acute CSCR presenting within 30 days of onset of symptoms. The eyes were divided into two groups (1 and 2) based on the duration of SRF resolution; which was ≤3 months in group 1 and >3 months in group 2. Demographic and medical history, and spectral domain optical coherence tomography features were noted and their association with duration for SRF resolution, final central macular thickness (CMT) and final best-corrected visual acuity (BCVA) were studied. All the patients were prescribed topical non-steroidal anti-inflammatory drug for 1 month at the diagnosis of CSCR.

Results

Longer duration of symptoms, female gender and baseline OCT factors like hyper-reflective dots and retinal pigment epithelial bumps were associated with longer duration for SRF resolution (p<0.001, p=0.04, p=0.001 and p=0.01, respectively). The SRF resolution time had strong correlations with the final CMT (r=-0.589, p<0.001) and final BCVA in logarithm of minimum angle of resolution (LogMAR) (r=+0.599, p<0.001). Group 2 eyes had worse final BCVA and thinner final CMT than Group 1 (both p<0.001). The final CMT of the patients of Group 1 was statistically thinner than the normal population (p<0.001).

Conclusion

Patient's baseline clinicodemographic and OCT features can be used to predict the course and visual outcome in cases of treatment naïve acute idiopathic CSCR.

Predictive factors of selective mineralocorticoid receptor antagonist treatment in chronic central serous chorioretinopathy

To compare the macular morphology of good and poor responders to eplerenone treatment in chronic central serous chorioretinopathy (CSCR) patients. Thirty eyes of 29 patients with chronic CSCR were treated with 50 mg/day oral eplerenone and followed up for 1 year. The integrity of outer retinal layers at baseline was assessed using optical coherence tomography. Patients who showed complete resolution of subretinal fluid at 1 year were assigned to the good responder group (Group 1), whilst those who showed moderate or no resolution were classified as poor responders (Group 2). Ellipsoid zone interruption, ELM interruption and hyperreflective foci in outer segment (OS) and outer nuclear layer (ON layer) was significantly more frequent in Group 2 than in Group 1 (p < 0.05 for all parameteres). Outer segment elongation was significantly more frequently seen in Group 1 than in Group 2 (p < 0.05) Multivariable regression analysis showed that intact ellipsoid zone at baseline is an independent predictor of good therapeutic response, with an odds ratio of 26.00 (95% CI 3.69–183.45; p = 0.001) after controlling for the effect of hyperreflective foci and ELM integrity. There is higher chance of the resolution of subretinal fluid after eplerenone treatment in CSCR patients with intact outer retinal layers at baseline. Baseline morphologic evaluation of the outer retinal layers on OCT scans can be useful in predicting the response to mineralocorticoid antagonist therapy in these patients.

Subretinal hyperreflective material in central serous chorioretinopathy

Purpose:

To describe the the appearance and behavior of subretinal hyperreflective material (SHRM) in eyes with central serous chorioretinopathy (CSCR).

Methods:

This retrospective study included 20 eyes of 20 patients with CSCR presenting with SHRM, defined as sub-retinal deposits that appear hyper-reflective on OCT The eyes underwent either laser (15 eyes) or observation (5 eyes). Optical coherence tomography and fundus fluorescein angiography (FFA) characteristics were analyzed at baseline and resolution of neurosensory detachment, which were then co-related with the visual acuity at resolution.

Results:

Improvement in vision was seen in 16 eyes. Ellipsoid zone damage (P = 0.03) and external limiting membrane (ELM) damage (P = 0.000) at resolution; diffuse retinal pigment epithelium (RPE) abnormalities on FFA (P = 0.04), and the presence of scar (P = 0.000), were associated with poor visual outcome in univariate analysis. ELM damage at resolution was statistically significant (P = 0.001) in multivariate analysis.

Conclusion:

CSCR with SHRM have a good visual prognosis. ELM damage at resolution corelates with a poor visual acuity at resolution.

Relationship between photoreceptor layer changes before half-dose photodynamic therapy and functional and anatomic outcomes in central serous chorioretinopathy

OBJECTIVES

To investigate the relationship between photoreceptor layer (PRL) changes before half-dose photodynamic therapy (PDT) and functional and anatomic outcomes in central serous chorioretinopathy (CSC).

METHODS

Baseline PRL changes were classified based on optical coherence tomography: (1) smooth PRL outer border without a foveal PRL defect; (2) smooth PRL outer border with a foveal PRL defect; (3) granulated PRL outer border and (4) scattered dots of PRL. The best-corrected visual acuity (BCVA), difference in the foveal outer nuclear layer (ONL) thickness between the CSC and normal contralateral eyes and ellipsoid zone (EZ) integrity 12 months after half-dose PDT were compared.

RESULTS

In total, 132 patients were included. Group 4 eyes had rather poor BCVA (20/2000-20/400) with little improvement (P = 0.088) at 1 year following half-dose PDT. In the other groups, the mean BCVA improved significantly to 20/25 or better (all P < 0.001). Group 1 eyes had the smallest foveal ONL thickness reduction (-5.12 ± 6.89 μm) and intact EZs (33/33), whereas Group 4 eyes had the largest foveal ONL thickness reduction (-70.00 ± 7.87 μm) and disrupted EZs (4/4). Group 2 and Group 3 eyes behaved similarly: they both had notable foveal ONL thickness reductions (-19.21 ± 18.53 and -20.75 ± 17.62 μm, respectively), but usually continuous EZs (18/19 and 69/76, respectively).

CONCLUSIONS

The PRL change category before half-dose PDT was closely related to functional and anatomic outcomes. This information could aid clinicians to better determine the timing of treatment with half-dose PDT in CSC.

Quantitative Assessment of Retinal Capillary Vessel Density and Foveal Avascular Zone Area in Central Serous Chorioretinopathy Using OCTA

PURPOSE

To quantitatively assess the retinal capillary vessel density (VD) and foveal avascular zone (FAZ) area in acute and chronic central serous chorioretinopathy (CSC) patients compared to healthy subjects using optical coherence tomography angiography (OCTA) and determine their correlation with visual acuity (VA).

METHODS

This was a cross-sectional, case-control study. All subjects were divided into three groups: acute CSC, chronic CSC, and healthy controls. The best-corrected VA test, optical coherence tomography, and OCTA were performed on the same day. In this study, we recorded and compared the main data of FAZ and VD in 3 × 3 mm OCTA images among three groups, also calculated the correlation between OCTA variables and VA in CSC patients.

RESULTS

A total of 148 subjects (148 eyes) were included in this study, with 50 eyes in acute CSC, 48 eyes in chronic CSC, and 50 eyes in control groups. The mean age was 50.11 ± 8.14 years. Chronic CSC had the significantly lowest VD both on the superficial and deep retina and the largest FAZ (0.39 ± 0.13 mm2) compared to acute CSC and controls (all p < 0.05). There was no statistical difference between acute CSC and controls on VD or FAZ (both p > 0.05). In chronic CSC, both the decreased VD on deep retina and expanded FAZ were correlated with a worse VA (both p < 0.05).

CONCLUSIONS

OCTA could serve as a reliable tool to evaluate different courses of CSC quantitively. In 3 × 3 mm OCTA images, both decreased VD and expanded FAZ were observed in chronic CSC patients.

Pattern electroretinography in patients with unilateral acute central serous chorioretinopathy

BACKGROUND

To evaluate the pattern electroretinography (PERG) in patients with acute central serous chorioretinopathy (CSCR) at baseline and after spontaneous resolution.

METHODS

A total of 32 patients (mean ± SD age: 38.8 ± 8.2 years, 71.9 per cent female) with unilateral acute CSCR and spontaneous resolution during follow-up period were included. The unaffected eyes of the study patients comprised the control group. The best-corrected visual acuity, PERG and optical coherence tomography findings were recorded both at baseline and following spontaneous resolution at two to four months.

RESULTS

The P50 and N95 amplitudes of the affected eyes were significantly lower than the control group both at baseline and after CSCR resolution (p < 0.001 for each). A significant increase was noted in both P50 and N95 amplitudes of the affected eyes from baseline to post-resolution (p < 0.001 for each). Subfoveal choroidal thickness was significantly higher in the affected eyes as compared with control eyes both at the baseline and after CSCR resolution along with a significant decrease in the affected eyes from baseline to post-resolution (p < 0.001 for each). The central retinal thickness was higher in the affected eyes as compared with the control eyes at baseline (p = 0.009), along with a significant decrease in the affected eyes from baseline to post-resolution (p < 0.001). Between the baseline P50 amplitude and the visual acuities of the affected eyes, a strong correlation was noted at baseline (r = -0.691, p < 0.001) and a moderate correlation was noted after CSCR resolution (r = -0.422, p = 0.031).

CONCLUSIONS

In conclusion, our findings revealed an association of CSCR with impaired P50 and N95 amplitudes and a significant improvement but not a complete recovery in both parameters after CSCR resolution. Our findings emphasise potential utility of PERG in the electrophysiological evaluation of functional impairment in CSCR patients and the likelihood of P50 amplitude to have a prognostic value in CSCR.

Baseline Predictive Factors of Visual Outcome and Persistence of Subretinal Fluid Based on Morphologic Changes in Spectral Domain Optical Coherence Tomography in Patients with Idiopathic Central Serous Chorioretinopathy

Background

To determine the influence of spectral domain optical coherence tomography (OCT) changes on visual outcome and persistence of subretinal fluid (SRF) in patients with idiopathic central serous chorioretinopathy (CSCR).

Materials and methods

In a retrospective study done in 48 eyes of 45 patients diagnosed as CSCR, all eyes were subjected to fundus photography, spectral domain OCT, and fluorescein angiography (FA) in selected cases.

Results

Retinal pigment epithelium detachment was present in 22.91% of the cases at presentation. The logMar best corrected visual acuity improved from 0.46±0.29 at presentation to 0.18±0.22 at 3 months (P-value<0.01). The mean foveal thickness was 486.81±146.06 µm at presentation and 259±94.5 µm at 3 months (P-value<0.01) (paired T-test). OCT factors that were associated with poor visual outcome (BCVA>0.3 logMar) were disruption in the inner segment (IS)/outer segment (OS) junction or external limiting membrane (ELM) line and hyper-reflective dots in the intra/subretinal layer (P-value<0.05) (Fischer’s Exact test). Out of the total 48 eyes, 26 had persistent SRF at 3 months. The presence of discontinuation in IS/OS junction and hyper-reflective dots in the intra/subretinal layer were the only two OCT factors that were associated with the persistence of SRF (P-value<0.01) (Pearson’s Chi-square test).

Conclusion

Visual outcome and persistence of subretinal fluid at 3 months can be predicted on the basis of early morphologic changes in OCT. This will aid in counseling patients regarding its course and may guide us in its management.

Outer Nuclear Layer as the Main Predictor to Anatomic Response to Half Dose Photodynamic Therapy in Chronic Central Serous Retinopathy

PURPOSE

To evaluate the predictors for subretinal fluid resorption in patients with chronic central serous retinopathy (cCSR) submitted to half-dose photodynamic therapy (HD-PDT).

METHODS

Observational, longitudinal, and retrospective study of patients with cCSR submitted to HD-PDT in a tertiary ophthalmology department in Portugal between January 2015 and February 2018. Best-corrected visual acuity (BCVA) and SD-OCT at baseline and 12 ± 3 months after treatment were performed. The central macular thickness (CMT), outer nuclear layer (ONL) thickness, integrity of the external limiting membrane (ELM), ellipsoid (EZ) and interdigitation zone (IZ), subretinal fluid (SFR) height, and choroidal thickness (CT) were evaluated. Patients were classified into responders and nonresponders based on SRF resorption.

RESULTS

Sixty-one eyes of 42 patients were included; 75.4% were classified as responders. Final BCVA was significantly better in responders (p=0.002). The baseline ONL was thicker (p < 0.01) and intact ELM (67.2% vs. 16.4%), EZ (49.2% vs. 8.2%), and IZ (31.2% vs. 1.6%) were more prevalent in responders than in nonresponders. Anatomic response was correlated with a thicker ONL (rs (59) = 0.416, p=0.001 ∗ ), intact ELM (rs (59) = 0.261, p=0.04 ∗ ), EZ (rs (59) = 0.278, p=0.03 ∗ ), and IZ (rs (59) = 0.318, p=0.01 ∗ ). Binary logistic regression showed that a thicker ONL thickness increased the chance of an anatomic response to HD-PDT. The other evaluated retinal layers did not have statistical significance in the binary regression model.

CONCLUSIONS

cCSR responders to HD-PDT have a better final BCVA, a thicker baseline ONL, and an intact baseline ELM, EZ, and IZ. However, ONL was the only predictor in a logistic regression model for SRF resorption.

Correlation between morphological characteristics in spectral-domain-optical coherence tomography, different functional tests and a patient's subjective handicap in acute central serous chorioretinopathy

PURPOSE

The purpose of this study was to identify quantitatively measurable morphologic optical coherence tomography (OCT) characteristics in patients with an acute episode of central serous chorioretinopathy (CSC) and evaluate their correlation to functional and psychological variables for their use in daily clinical practice.

METHODS

Retinal thickness (RT), the height, area and volume of subretinal fluid (SRF)/pigment epithelium detachments were evaluated using the standardized procedures of the Vienna Reading Center. These morphologic characteristics were compared with functional variables [best-corrected visual acuity (BCVA), contrast sensitivity (CS), retinal sensitivity/microperimetry, fixation stability], and patients' subjective handicap from CSC using the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25).

RESULTS

Data from 39 CSC patients were included in this analysis. Three different SRF height measures showed a high negative correlation (r = -0.7) to retinal sensitivity within the central 9°, which was also negatively correlated with SRF area and volume (r = -0.6). The CS score and fixation stability (fixation points within 2°) showed a moderate negative correlation (r = -0.4) with SRF height variables. Comparison of the subjective handicap with morphological characteristics in spectral-domain (SD)-OCT showed SRF height had the highest correlation (r = -0.4) with the subjective problems reported and overall NEI VFQ-25 score.

CONCLUSION

In conclusion, SRF height measured in SD-OCT showed the best correlation with functional variables and patients' subjective handicap caused by the disease and therefore seems to be the best variable to look at in daily clinical routine. Even though area and volume also show a correlation, these cannot be so easily measured as height and are therefore not suggested for daily clinical routine.

Correlation between redefined optical coherence tomography parameters and best-corrected visual acuity in non-resolving central serous chorioretinopathy treated with half-dose photodynamic therapy

Purpose

To assess parameters on optical coherence tomography (OCT), and their correlation with best-corrected visual acuity (BCVA) in patients with non-resolving central serous chorioretinopathy (CSC).

Methods

For 25 non-resolving CSC patients treated with photodynamic therapy (PDT), the thickness of retinal layers was assessed on the foveal spectral-domain (SD) OCT scan. Evaluated OCT parameters included the central retinal thickness (CRT), defined as the internal limiting membrane (ILM) to ellipsoid zone (EZ) distance, and the second band thickness (SBT), defined as the EZ to hyperreflective subretinal accumulation distance. Integrity of the external limiting membrane (ELM) and the EZ bands was also determined. These parameters, along with BCVA and CRT measured automatically by SD-OCT device software were obtained before PDT, after PDT, and at final visit. After Bonferroni correction, a p-value <0.007 was considered statistically significant.

Results

Twenty-five patients could be included at last visit before PDT and first visit after PDT. At final visit, 24 patients could be included, since 1 patients was lost to follow-up. Mean CRT was 112 μm at last visit before PDT, 118 μm at first visit after PDT (p = 0.030), and 127 μm at final visit (p<0.001compared to baseline). Mean SBT was 74 μm, 26 μm (p<0.001 compared to baseline), and 21 μm (p<0.001 compared to baseline), respectively. Mean BCVA in Early Treatment of Diabetic Retinopathy Study letters was 79 at baseline, 85 at first visit after PDT (p = 0.005 compared to baseline), and 87 at final visit (p = 0.001 compared to baseline). BCVA had an estimated correlation of β = 0.103 (p = 0.114) with CRT, β = -0.051 (p = 0.014) with SBT, β = 0.615 (p = 0.600) with the integrity of the ELM, and β = 4.917 with the integrity of the EZ (p = 0.001).

Conclusions

In non-resolving CSC patients treated with half-dose PDT, the CRT increased at final visit in comparison to the last visit before PDT. The continuity of the EZ on SD-OCT was positively correlated with BCVA. We propose that the distance between ILM and EZ should be used as a reliable CRT measurement in non-resolving CSC patients treated with half-dose PDT.

Retinal and choroidal changes in steroid-associated central serous chorioretinopathy

Background

To evaluate the retinal and choroidal alterations in steroid-associated central serous chorioretinopathy (CSC) in comparison to idiopathic CSC.

Methods

In this retrospective cohort study, swept source optical coherence tomography scans of eyes with steroid-associated CSC (group A) were compared with the same in idiopathic CSC (group B). The key features included central subfield retinal thickness, subfoveal choroidal thickness, subfoveal large choroidal vessel diameter, subretinal deposits, retinal pigment epithelial irregularities, double layer sign, hyperreflective dots, intraretinal fluid, and choroidal vascularity index (ratio of choroidal luminal area and total choroidal area, measured on a high definition horizontal 9 mm OCT B-scan.

Results

There were 20 eyes in group A and 30 in group B. Group A had a higher female proportion (60 vs. 16.67%; P < 0.01) and higher bilaterality (30 vs. 6.67%; P = 0.03). The height of neurosensory detachment was lower in group A (153.1 ± 175.70 µm vs. 312.9 ± 223.06 µm; P < 0.01). There was no significant difference in the prevalence of subretinal deposits, retinal pigment epithelial irregularities, pigment epithelial detachments, double layer sign, outer retinal layer disruption, and intraretinal fluid. Hyperreflective dots (HRDs) were less common in group A (15 vs. 46.67%; P = 0.03). The subfoveal choroidal thickness (P = 0.65) and subfoveal large choroidal vessel diameter (P = 0.78) were comparable. There was a trend towards a higher choroidal vascularity index (CVI) in group A (A: mean, 82%, 95% CI, 66–99%; B: mean, 58%, 95% CI, 57–59%; P = 0.10).

Conclusion

Steroid-associated CSC has a marginally higher CVI and less common association with HRDs as compared to idiopathic CSC.

Correlation between baseline retinal microstructures in spectral-domain optic coherence tomography and need for early intervention in central serous chorioretinopathy

Purpose

To investigate the association between baseline retinal microstructures observed with spectral-domain optical coherence tomography (OCT) and the need for early intervention in central serous chorioretinopathy (CSC).

Methods

Cases of acute CSC from July 2011 to December 2014 were retrospectively reviewed. OCT images were further classified using six parameters: foveal serous retinal detachment; pigment epithelial detachment; fibrinous exudates in the subretinal space; retinal pigment epithelium bumps; thickened outer retinal layer and hyper-reflective dots in the intraretinal and/or subretinal layer. Correlation among these parameters and the need for intervention was analysed. Receiver operating characteristic (ROC) curves were performed to identify the optimal number of parameters for prediction.

Results

A total of 47 eyes from 47 patients were included. Among these, 25 eyes required treatment. The presence of subretinal hyper-reflective dots was the only OCT factor having significant association with the need for intervention. An ROC curve analysis revealed that the optimal cut-off value (Youden index) was achieved when combining subretinal hyper-reflective dots with aged ≥50 years and female sex for analysis (area under the curve, 0.735; Youden index: 0.425).

Conclusion

The presence of subretinal/intraretinal hyper-reflective dots observed with OCT, female and aged ≥50 years might help predict the need for early intervention in acute CSC.

Multimodal retinal imaging in central serous chorioretinopathy treated with oral eplerenone or photodynamic therapy

PurposeTo correlate function and structural optical coherence tomography (OCT) to optical coherence tomography angiography (OCT-A) measures in patients affected by central serous chorioretinopathy (CSC) and to describe their changes after treatments (ie oral eplerenone, half-fluence photodynamic therapy (PDT)).Patients and methodsTwenty eyes of 16 consecutive patients with treatment-naïve CSC undergoing either eplerenone or PDT were enrolled in this prospective, observational study. All patients underwent structural OCT and OCT-A at baseline and after therapy at months 1 and 3.ResultsEleven eyes of nine patients and nine eyes of seven patients underwent eplerenone or PDT treatment, respectively. Central macular thickness (CMT) and subretinal fluid (SRF) correlated to fovea avascular zone (FAZ) area (r=0.74 and r=0.71, P=0.01) and vessel density (r=0.77 and r=0.68, P=0.01) at deep capillary plexus (DCP). CMT (P=0.0011), SRF (P=0.0005), SFCT (P=0.0016), FAZ area at DCP (P=0.0334) improved at 3-month visit. A significant reduction of deep FAZ area was appreciated in eplerenone (P=0.0204) but not in PDT (P=0.5) group. SFCT reduction was significantly higher in PDT than eplerenone group (P=0.0347).ConclusionStructural and vascular parameters are correlated in CSC and they improve after different treatments. Both half-fluence PDT and oral eplerenone do not permanently damage choriocapillaris or other choroidal layers as evaluated by OCT-A.

Pattern of Contrast Sensitivity Changes in Acute Central Serous Chorioretinopathy

Purpose

To evaluate contrast sensitivity (CS) changes in acute central serous chorioretinopathy (CSC).

Methods

Visual acuity (VA), CS, and subretinal fluid (SRF) were evaluated monthly for 6 months. Treatment was considered at 3 months in case of persistent SRF.

Results

Twelve of 20 eyes (60%) had spontaneous SRF resolution within 4 months. Five of 8 patients with delayed SRF resolution received either focal laser or photodynamic therapy. The CS was impaired in all spatial frequencies at baseline. There was a negative correlation between the baseline SRF thickness and CS at 3 and 6 cycles per degree (cpd). The CS improved significantly at the time of fluid resolution (p = 0.001) and continued to improve in 3 and 6 cpd. The CS at 6 cpd did not recover if compared to a normal fellow eye at 6 months (p = 0.018). The CS of 12 cpd at 6 months was superior in the spontaneous resolution group.

Conclusion

The impaired CS gradually improved as the SRF reduced at all spatial frequencies. CS at 3 and 12 cpd continued to improve after complete fluid resolution. Despite an excellent final VA, the CS at 6 months did not regain its normal value.

Choroidal thickness evaluation of healthy eyes, central serous chorioretinopathy, and fellow eyes using spectral domain optical coherence tomography in Indian population

Aim:

The purpose of this study is to establish a normative database of subfoveal choroidal thickness (CT) in healthy young Indians using spectral domain optical coherence tomography (SD OCT). Evaluation and comparison of CT of central serous chorioretinopathy (CSC) and fellow eyes were also performed.

Materials and Methods:

This was a prospective, cross-sectional, and observational study. It included 112 normal eyes of 112 healthy volunteers who had no evidence of ocular or systemic disease, 84 CSC eyes with acute, treatment-naïve CSC, and 69 fellow eyes with no evidence of neurosensory detachment or pigment epithelium detachment on SD OCT. Complete history, examination, and SD OCT were performed in all eyes.

Results:

The mean age of 81 patients (84 eyes) with CSC was 35.04 ± 8.86 years, 69 fellow eyes was 34.61 ± 8.71 years, and 112 healthy volunteers (112 eyes) was 33.16 ± 9.4 years (P < 0.05). The mean subfoveal CT of CSC eyes was 429 ± 74.18 μ, fellow eyes was 360 ± 57.99 μ, and normal eyes was 301.80 ± 46.59 μ (P < 0.001).

Conclusion:

CT varies not only with age, axial length, and refractive error but also with races. Therefore, it is important to establish a normative database in a particular population before carrying out further research in diseased states. CT in CSC eyes is significantly thicker than fellow eyes, and CT of fellow eyes is significantly thicker than normal eyes. This reinforces the fact that choroidal permeability is increased in both eyes of patients with CSC.

Factors affecting the visual outcome in acute central serous chorioretinopathy

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.

Spectral domain optical coherence tomography findings of patients under treatment for pediatric acute lymphoblastic leukemia

PURPOSE

To investigate the use of spectral domain optical coherence tomography (SD-OCT) findings in pediatric acute lymphoblastic leukemia (ALL) patients.

METHODS

Children that were diagnosed with precursor B-cell ALL and classified as belonging to the medium-risk group for relapse were selected for this study. Individuals who were in continuous remission and on maintenance therapy were included in the study group. Cases that had central nervous system involvement were excluded. Age-matched, otherwise healthy children were selected for the control group. Each study participant underwent a comprehensive eye examination and SD-OCT evaluation. Thickness measurements were made within the retinal nerve fiber layer (RNFL), central macula, posterior polar, and peripapillary choroid.

RESULTS

A total of 112 eyes of 56 children were included: 54 eyes in the study group and 58 in the control group. Compared to the control group, subfoveal and temporal choroidal thicknesses of the posterior pole were significantly thinner in the study group (P < 0.005). Similarly, peripapillary choroidal thicknesses were significantly thinner in most sectors of the study group (P < 0.005). There were no major differences between groups in terms of central macular thicknesses and overall RNFL thicknesses.

CONCLUSIONS

Evidence of choroidal attenuation was found in this subgroup of pediatric ALL patients. Further studies are warranted to clarify the utility of SD-OCT in detecting subclinical ocular involvement and monitoring treatment response and risk of relapse in patients with pediatric leukemia.

Modified Photodynamic Therapy Treatment of Central Serous Chorioretinopathy

PURPOSE

Central serous chorioretinopathy (CSC) is a condition characterized by serous detachment of the neurosensory retina at the level of the retinal pigmented epithelium (RPE) as a result of leakage from the choriocapillaris. The pathophysiology of CSC is not completely understood rendering treatment and management decisions more complex. When an observational approach and topical medical therapy are unsuccessful, a surgical intervention may be necessary. Here, we examine the role of modified photodynamic therapy (PDT) in recurrent CSC with multiple points of RPE leakage.

CASE REPORT

A 37-year-old male patient presented a case of recurrent CSC in the left eye. After an initial presentation of a large area of submacular fluid, near complete resolution was seen in 8 weeks using a topical NSAID protocol and close monitoring. Two weeks later, a second serous neurosensory detachment larger than the first occurred. The recurrent CSC was successfully treated with focal grid laser photocoagulation and modified PDT resulting in complete resolution and return of visual function 4 months after the initial presentation.

CONCLUSIONS

CSC is a multifactorial condition with the potential to severely impair daily visual function. Spectral domain optical coherence tomography retinal imaging has provided a remarkable tool in the diagnosis and monitoring of CSC. The addition of FA and ICG can create a highly precise picture of the subretinal fluid. Although most patients will spontaneously resolve, a subset of patients may benefit from medical therapy including topical nepafenac 0.1%. A smaller subset will require surgical intervention. Modified PDT with ICG-guided laser photocoagulation has a growing body of evidence as an effective treatment for recurrent CSC. Modified PDT may be the best course of action for chronic, non-resolving RPE leakage for both paramacular and foveal leaks leading to minimization of adverse visual effects.

Central Serous Chorioretinopathy Misdiagnosed as Posterior Uveitis and the Vicious Circle of Corticosteroid Therapy

Purpose:

To determine the proportion of patients with central serous chorioretinopathy (CSCR) mistaken for posterior uveitis and to identify the deleterious consequences.

Methods:

Charts of 1,657 patients admitted in the section of inflammatory eye diseases at the Center for Ophthalmic Specialized Care (COS) in Lausanne, Switzerland from 1995 to 2013 were reviewed. CSCR cases misdiagnosed as posterior uveitis or those with superimposed disease due to steroid therapy for uveitis were studied. Delay in diagnosis, specific erroneous uveitis diagnosis and evolution of the disease were also evaluated. Retrospectively, the most useful means for a correct diagnosis of CSCR were the original fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) when available.

Results:

Out of a total of 1,657 patients, 15 (0.9%) cases with CSCR were identified. These included 12 subjects misdiagnosed as posterior uveitis and 3 uveitis subjects with superimposed CSCR following corticosteroid therapy for uveitis. The presentation of the disease was largely influenced by improper and continued use of corticosteroids.

Conclusion:

CSCR is a rare but not negligible misdiagnosis in posterior uveitis representing approximately 1% of subjects from a collective series of uveitis cases at a referral center. Investigative measures such as FA, ICGA and OCT are crucial for reaching a correct diagnosis and avoiding disease aggravation due to corticosteroid therapy.

Predictive factors for postoperative visual acuity in idiopathic epiretinal membrane: a systematic review

The aim of this study was to review the literature on predictive factors for postoperative visual acuity (VA) in surgery for idiopathic epiretinal membrane (ERM). A systematic review of the literature in the databases of PubMed and Embase was performed. The risk of bias was assessed based on predefined criteria and the results were summarized. In total, 1927 studies were retrieved of which 35 were potentially eligible. Nineteen studies were of adequate quality in terms of bias. Preoperative VA, central foveal thickness (CFT) and inner segment/outer segment (IS/OS) integrity on optical coherence tomography (OCT) were most extensively studied. Other preoperative factors studied were severity of metamorphopsia, several OCT parameters, fundus autofluorescence and multifocal electroretinogram. In the current literature, preoperative VA is the only variable consistently associated with postoperative VA. IS/OS integrity on OCT is probably associated, and the severity of metamorphopsia, cone outer segment tips integrity and fundus autofluorescence are possibly associated with postoperative VA. CFT is not associated with postoperative VA. Further studies with adequate methodological quality are needed to confirm these findings. Therefore, an overall prediction model, including different parameters, is still awaited.

[Imaging of corneal dystrophies: Correlations between en face anterior segment OCT and in vivo confocal microscopy]

PURPOSE

To evaluate the usefulness of en face Optical Coherence Tomography (OCT) for evaluation of corneal dystrophies and to describe correlations with in vivo confocal microscopy (IVCM).

PATIENTS AND METHODS

Thirty-two eyes of 16 patients with 4 types of corneal dystrophies (epithelial basement membrane dystrophy, Fuchs dystrophy, Reis-Bücklers corneal dystrophy and Crocodile Shagreen dystrophy) were enrolled in this study. Axial and reconstructed en face scans were acquired using OCT. Images were then correlated to IVCM findings.

RESULTS

En face OCT provided new insights into the structure, size and depth of corneal tissue alterations in various corneal dystrophies. OCT en face images were well correlated with IVCM features. Despite lower resolution than IVCM, en face OCT offers the advantages of being non-invasive and allowing the analysis of larger corneal areas.

CONCLUSION

En face OCT provides useful new information in corneal dystrophies. This imaging technique will probably increase in popularity in the near future for the assessment of various anterior segment diseases.