RISK OF RHEGMATOGENOUS RETINAL DETACHMENT WITH CENTRAL SEROUS CHORIORETINOPATHY

Review: The Development of Risk Factors and Cytokines in Retinal Vein Occlusion

Retinal vein occlusion (RVO) is the second most prevalent retinal disease. Despite this, the pathogenic mechanisms and risk factors are not entirely clear. In this article, we review recent publications on the classification, pathogenesis, risk factors, ischemic changes, cytokines, and vital complications of RVO. Risk factors and cytokines are important for exploring the mechanisms and new treatment targets. Furthermore, risk factors are interrelated, making RVO mechanisms more complex. Cytokines act as powerful mediators of pathological conditions, such as inflammation, neovascularization, and macular edema. This review aims to summarize the updated knowledge on risk factors, cytokines of RVO and signaling in order to provide valuable insight on managing the disease.

Peripheral retinal findings in populations with macular disease are similar to healthy eyes

PURPOSE

Recent evidence suggests several macular diseases are associated with peripheral retinal changes. This study investigated the number, type and management consequences of peripheral retinal findings detected in patients attending a referral only, eye-care clinic, the Centre for Eye Health(CFEH) with macular disease.

METHODS

Records of 537 patients attending CFEH for a macular assessment were included in the study. Subjects were classified as having age-related macular degeneration (AMD), epiretinal membrane (ERM), central serous chorioretinopathy (CSCR), inherited macular dystrophy or no macular disease. Data extracted included reason for referral, macular findings, peripheral findings (based on examination by ultra-widefield scanning laser ophthalmoscopy), diagnosis and management.

RESULTS

After age-matching, the number of peripheral findings in subjects with AMD, ERM or CSCR was not significant different to normal subjects. The most common finding for all cohorts were non-specific, degenerative changes such as drusen or pigmentation (61-72%) except inherited macular dystrophy subjects who had mostly vascular findings (30%; p < 0.05). Subjects with AMD and ERM with peripheral findings were significantly more likely to be reviewed or referred to an ophthalmologist than discharged back to their community eye care provider compared to subjects without findings. However only 8% of subjects had altered management based specifically on peripheral findings suggesting the macular findings in most subjects dictated their management. For those with a change, it was significant (upgrade to referral to an ophthalmologist). Peripheral findings also flagged 5% of subjects with vascular findings for referral to their general practitioner (GP).

CONCLUSIONS

Overall, the percentage and distribution of peripheral retinal findings in some macular diseases was similar to normal subjects. However, subjects with peripheral findings appeared to have significant differences in management. Considering some common findings, such as peripheral drusen may be relevant to AMD pathogenesis and therefore affect management of this disease, assessment of the peripheral retina should not be overlooked when the clinical focus is on the posterior pole.

THE IMPORTANCE OF THE PERIPHERAL RETINA IN PATIENTS WITH CENTRAL SEROUS CHORIORETINOPATHY

PURPOSE

This research investigated the peripheral retinas of patients with central serous chorioretinopathy (CSCR).

METHODS

Sixty patients with CSCR and 60 age- and gender-matched controls were included in this prospective cross-sectional study. All 120 participants underwent ocular examinations and peripheral retinal evaluations using a Goldmann three-mirror lens.

RESULTS

The examinations demonstrated peripheral retinal degeneration, atrophic or hyperplastic retinal pigment epithelial changes, and retinal breaks. The peripheral retinal degeneration rate was 39% in the CSCR group and 15% in the control group, and the CSCR group reported significantly more lattice degeneration than the control group (22 vs. 3%) (P = 0.004, odds ratio = 1.97, confidence interval = 0.68-5.65 and P = 0.002, odds ratio = 4.55, confidence interval = 0.77-26.83, respectively). Symptomatic U-shaped retinal breaks were found in three eyes (5%) in the CSCR group, and the rate of peripheral retinal degeneration was higher in the patients with chronic CSCR (vs. acute CSCR). However, this difference was not significant (P = 0.244).

CONCLUSION

This study showed that peripheral retinal abnormalities, particularly lattice degeneration, are more common in patients with CSCR. Therefore, the authors recommend regular retinal examinations, with the inclusion of peripheral retinal assessments, for patients with CSCR.

Chronic Central Serous Chorioretinopathy in a Patient with Pigment Dispersion Syndrome: A Possible Correlation

Chronic central serous chorioretinopathy (CSCR) is a progressive chorioretinopathy with widespread atrophic RPE abnormalities and serous retinal detachments (SRDs) present for 6 months or longer. We report a case of CSCR in a 38-year-old patient with Pigment Dispersion Syndrome (PDS). In the presented case of CSCR, the chronic course of the disease may in part be associated with an underlying generalized degenerative dysfunction of the pigmented cells of the eye on grounds of PDS. We suggest that a chronic course of disease may be suspected in the setting of CSCR with concurrent RPE pathology, such as what is found in PDS.