1
|
Kiilgaard HC, Nissen AHK, Balaratnasingam C, Borrelli E, Breazzano MP, van Dijk EHC, Sevik MO, Grauslund J, Subhi Y. Diagnostic accuracy of OCT angiography for macular neovascularization in central serous chorioretinopathy: A systematic review and meta-analysis. Acta Ophthalmol 2024. [PMID: 38988251 DOI: 10.1111/aos.16739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
Identifying macular neovascularization (MNV) in eyes with central serous chorioretinopathy (CSC) has important implications for its management. Optical coherence tomography angiography (OCTA) is increasingly used for this purpose. Here, we systematically reviewed the literature and conducted meta-analysis to determine the diagnostic accuracy of OCTA for detecting MNV in eyes with CSC. We systematically searched the literature in 12 databases for relevant studies from database inception until 18 November 2023. Eligible studies had eyes with CSC with MNV and CSC without MNV. Index test was OCTA. Reference test was retinal dye angiography. Study selection and data extraction were performed in duplicate, and study was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2. Our main outcome of interest was the sensitivity and specificity of OCTA for detecting MNV in CSC. Pooled diagnostic test accuracy estimates were computed using MetaDTA. Of 177 records screened, seven fulfilled the eligibility criteria for our study. These studies summarized data from a total of 1061 eyes. Summary estimate sensitivity and specificity to diagnose MNV in eyes with CSC using OCTA was 92.9% (95% CI: 81.7%-97.5%) and 99.4% (95% CI: 84.1%-100.0%), respectively. The main source of bias across studies was the reference standard, as four studies used multimodal imaging including OCTA for the reference standard. OCTA alone is excellent for detecting MNV in CSC compared to retinal dye angiography or multimodal imaging. Using OCTA first before considering retinal dye angiography could potentially save an important number of retinal dye angiographies.
Collapse
Affiliation(s)
| | | | - Chandrakumar Balaratnasingam
- Lions Eye Institute, Perth, Western Australia, Australia
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Enrico Borrelli
- Department of Ophthalmology, City of Health and Science Hospital, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York, Liverpool, New York, USA
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Elon H C van Dijk
- Lions Eye Institute, Perth, Western Australia, Australia
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mehmet Orkun Sevik
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Yousif Subhi
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| |
Collapse
|
2
|
Feenstra HMA, van Dijk EHC, Cheung CMG, Ohno-Matsui K, Lai TYY, Koizumi H, Larsen M, Querques G, Downes SM, Yzer S, Breazzano MP, Subhi Y, Tadayoni R, Priglinger SG, Pauleikhoff LJB, Lange CAK, Loewenstein A, Diederen RMH, Schlingemann RO, Hoyng CB, Chhablani JK, Holz FG, Sivaprasad S, Lotery AJ, Yannuzzi LA, Freund KB, Boon CJF. Central serous chorioretinopathy: An evidence-based treatment guideline. Prog Retin Eye Res 2024; 101:101236. [PMID: 38301969 DOI: 10.1016/j.preteyeres.2024.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.
Collapse
Affiliation(s)
- Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Suzanne Yzer
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA; Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Siegfried G Priglinger
- Department of Ophthalmology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Laurenz J B Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Clemens A K Lange
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Ocular Angiogenesis Group, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jay K Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York, USA; Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
| |
Collapse
|
3
|
Imanaga N, Terao N, Wakugawa S, Miyara Y, Sawaguchi S, Oshiro A, Yamauchi Y, Koizumi H. Scleral Thickness in Simple Versus Complex Central Serous Chorioretinopathy. Am J Ophthalmol 2024; 261:103-111. [PMID: 38281567 DOI: 10.1016/j.ajo.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE To evaluate the association between scleral thickness and a newly developed multimodal imaging-based classification of central serous chorioretinopathy (CSC). DESIGN Retrospective, cross-sectional study. METHODS This study included 217 eyes of 217 patients classified as simple or complex CSC based on the established protocols. Clinical and anatomical factors were compared between the 2 types. The scleral thickness was measured at 4 locations using anterior-segment optical coherence tomography. RESULTS Of the 217 eyes, 167 were classified as simple CSC and 50 as complex CSC. The complex CSC group showed older age (P = .011), higher male ratio (P = .001), more bilateral involvement (P < .001), poorer visual acuity (P < .001), greater subfoveal choroidal thickness (P = .025), and higher frequency of loculation of fluid (P < .001) and ciliochoroidal effusion (P < .001) than the simple CSC group. The complex CSC group had significantly greater scleral thicknesses in the superior, temporal, inferior, and nasal directions (all P < .001) than the simple CSC group. Multivariable analysis revealed that older age (odds ratio [OR] 1.054, 95% confidence interval [CI] 1.013-1.097, P < .001), male sex (OR 10.445, 95% CI 1.151-94.778, P < .001), bilateral involvement (OR 7.641, 95% CI 3.316-17.607, P < .001), and the mean value of scleral thicknesses in 4 directions (OR 1.022, 95% CI 1.012-1.032, P < .001) were significantly associated with the complex CSC. CONCLUSIONS Older age, male sex, bilateral involvement, and thick sclera were associated with the complex CSC. Scleral thickness seemed to determine the clinical manifestations of CSC.
Collapse
Affiliation(s)
- Naoya Imanaga
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Nobuhiro Terao
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Sorako Wakugawa
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yasunori Miyara
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shota Sawaguchi
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Ayano Oshiro
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yukihide Yamauchi
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hideki Koizumi
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
| |
Collapse
|
4
|
Larsson JME, Boberg-Ans LC, Vangsted A, van Dijk EHC, Grauslund J, Hajari JN, Klefter ON, Schneider M, Subhi Y. Topical non-steroidal anti-inflammatory drugs for central serous chorioretinopathy: A systematic review and meta-analysis. Acta Ophthalmol 2024; 102:274-284. [PMID: 37551858 DOI: 10.1111/aos.15743] [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: 02/13/2023] [Revised: 07/07/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023]
Abstract
Central serous chorioretinopathy (CSC) is a prevalent exudative maculopathy and the ongoing verteporfin shortage restricts current treatment possibilities. Topical non-steroidal anti-inflammatory drugs (NSAID) have previously been proposed as a treatment for CSC, although its exact efficacy remains unclear. In this systematic review and meta-analysis, we outlined the efficacy of topical NSAIDs for the treatment of CSC. We searched 11 literature databases on 13 December 2022, for any study describing topical NSAID treatment for CSC. Thirteen eligible studies were included with a total of 1001 eyes of 994 patients with CSC. Six studies were case reports, two were cohort studies and five were non-randomized comparative studies. Where specified, topical NSAIDs used were bromfenac 0.09%, diclofenac 0.1%, ketorolac 0.4% and 0.5%, pranoprofen 0.1%, and nepafenac 0.1% and 0.3%. Studies were predominantly of cases with acute CSC and several case studies reported treatment outcomes simultaneously with discontinuation of corticosteroid use, which complicated treatment evaluation. Meta-analyses of comparative studies revealed a statistically significant but clinically irrelevant best-corrected visual acuity improvement of -0.04 logMAR (95% CI: -0.07 to -0.01 logMAR; p = 0.01) at 1-month follow-up, which became statistically insignificant at 3-month follow-up (-0.03 logMAR; 95% CI: -0.06 to 0.003 logMAR; p = 0.08). Further, we found no benefit in complete subretinal fluid resolution at 1-month follow-up (OR: 1.20; 95% CI: 0.81-1.76; p = 0.37) or 3-month follow-up (OR: 1.17; 95% CI: 0.86 to 1.59; p = 0.33). Taken together, available evidence does not support the use of topical NSAIDs for the treatment of CSC.
Collapse
Affiliation(s)
| | | | | | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jakob Grauslund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Javad N Hajari
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Oliver N Klefter
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Miklos Schneider
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
5
|
Pauleikhoff LJB, Diederen RMH, Chang-Wolf JM, Moll AC, Schlingemann RO, van Dijk EHC, Boon CJF. Choroidal hyperpermeability patterns correlate with disease severity in central serous chorioretinopathy: CERTAIN study report 2. Acta Ophthalmol 2024. [PMID: 38561630 DOI: 10.1111/aos.16679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/15/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Choroidal vascular hyperpermeability (CVH) on indocyanine green angiography (ICGA) is a hallmark feature of central serous chorioretinopathy (CSC). We identified three distinct CVH phenotypes in CSC: uni-focal indistinct signs of choroidal hyperpermeability (uni-FISH) with one focal area of CVH, multiple areas of focal CVH (multi-FISH), and diffuse hyperpermeability covering most of the posterior pole (DISH). This report investigates the distribution of these phenotypes and their association with signs of disease chronicity. METHODS The CERTAIN study is a monocentric, retrospective study on consecutive CSC patients referred to a large tertiary referral centre that underwent ultra-widefield (UWF) and 55° ICGA. Two independent graders assessed CVH patterns based on mid- to late-phase UWF and 55° ICGA with a third grader acting as referee. RESULTS Of the 167 eyes of 91 patients included in this study, 43 (26%) showed uni-FISH, 87 (52%) multi-FISH, and 34 (20%) showed DISH based on UWF ICGA. Median age (40 vs. 45 vs. 57; p < 0.001) and logMAR visual acuity (0 vs. 0 vs. 0.1, p < 0.001) differed significantly in-between groups, as did the occurrence of cystoid retinal degeneration (PCRD; 0% vs. 1% vs. 18%, p < 0.001) or diffuse atrophic RPE alterations (DARA; 0% vs. 17% vs. 29%, p < 0.001). The same was true when grading was based on 55° ICGA. CONCLUSIONS The CVH patterns of uni-FISH, multi-FISH, and DISH are typical of CSC. These patterns correlate with established signs of CSC chronicity. Their predictive role in treatment response and prognosis remains to be evaluated.
Collapse
Affiliation(s)
- Laurenz J B Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jennifer M Chang-Wolf
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annette C Moll
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Ocular Angiogenesis Group, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
6
|
Mark J, Subhi Y. Blinded by Stress: A Patient and Physician Perspective on Central Serous Chorioretinopathy. Ophthalmol Ther 2024; 13:861-866. [PMID: 38386185 PMCID: PMC10912400 DOI: 10.1007/s40123-024-00907-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/05/2024] [Indexed: 02/23/2024] Open
Abstract
This commentary is co-authored by a patient with central serous chorioretinopathy (CSC), which is the fourth most common exudative maculopathy. The patient, a young and profiled member of the Danish Parliament, kindly shares his experience living with stress, onset of symptoms, and the experience of being diagnosed with CSC and receiving photodynamic treatment. The experiences of the patient are put into perspective by an ophthalmologist.
Collapse
Affiliation(s)
- Jacob Mark
- Patient Author, Christiansborg, Copenhagen, Denmark
| | - Yousif Subhi
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000, Odense C, Denmark.
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark.
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.
| |
Collapse
|
7
|
Pauleikhoff LJB, Diederen RMH, Chang-Wolf JM, Moll AC, Schlingemann RO, van Dijk EHC, Boon CJF. Choroidal Vascular Changes on Ultrawidefield Indocyanine Green Angiography in Central Serous Chorioretinopathy: CERTAIN Study Report 1. Ophthalmol Retina 2024; 8:254-263. [PMID: 37839547 DOI: 10.1016/j.oret.2023.10.007] [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: 07/10/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Choroidal venous overload was recently suggested to be a pathogenetic factor in central serous chorioretinopathy (CSC). Manifestations of venous overload on ultrawidefield indocyanine green angiography (UWF ICGA) include asymmetric arterial choroidal filling (AACF), enlarged choroidal vessels ("pachyvessels"), and asymmetric venous drainage (AVD) leading to choroidal intervortex venous anastomoses (CVAs) accompanied by choroidal vascular hyperpermeability (CVH). The purpose of the current study is to assess the presence of these signs of venous overload in a large cohort of CSC patients. DESIGN Monocentric retrospective cohort study. PARTICIPANTS Consecutive CSC patients seen at a large tertiary referral center. METHODS For the CERTAIN study, patients underwent a standardized imaging protocol including UWF ICGA. Features of choroidal venous overload were graded for each eye individually by 2 independent graders and, in case of disagreement, by a third grader. MAIN OUTCOME MEASURES Presence of AAFC, pachyvessels, AVD, CVA, and CVH. RESULTS In total, 178 eyes of 91 patients were included in this study. Mean patient age was 47.6 (± 12.0) years and 75 patients (82%) were male. The 116 eyes (65%) that showed subretinal fluid were considered affected (bilateral disease in 29 patients). In affected eyes, AACF was present in 62 eyes (85% of gradable eyes), pachyvessels in 102 eyes (88%), AVD in 81 eyes (74%), CVA in 107 eyes (94%), and CVH in 100% of affected eyes. For fellow eyes, prevalence of pachyvessels (94%), AVD (67%), and CVA (90%) was similar to affected eyes, whereas CVH was present in 85% of fellow eyes. Intergrader agreement was excellent for CVH (94%), and 74%-82% for all other criteria. Patients with pachyvessels and AVD in 1 eye were more likely to also show the same characteristic in the fellow eye (odds ratios 22.2 and 9.9, P < 0.01). CONCLUSIONS Signs of venous overload are seen in the vast majority of CSC patients, both in affected and unaffected eyes. Although pachyvessels, AVD, and CVA are observed frequently, CVH was observed in all affected eyes, showed excellent intergrader reliability, and is diagnostic for CSC. This supports the concept of choroidal venous overload as a major factor in CSC pathogenesis. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Laurenz J B Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jennifer M Chang-Wolf
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Annette C Moll
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Ocular Angiogenesis Group, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
8
|
Harbeck K, Ericksen C, Johnson W, Massop D, Bracha P. Pachychoroid Associated With Acute Retinal Necrosis Secondary to Varicella Zoster Virus. JOURNAL OF VITREORETINAL DISEASES 2024; 8:196-199. [PMID: 38465350 PMCID: PMC10924601 DOI: 10.1177/24741264241228652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Purpose: To report a case of pachychoroid associated with acute retinal necrosis secondary to the varicella zoster virus (VZV). Methods: A retrospective review of a single case was performed. Results: The VZV-related acute retinal necrosis with pachychoroid resolved with quiescence of the acute infectious process. Conclusions: Acute retinal necrosis can result in choroidal thickening adjacent to retinitis. Previous reports have described choroidal sparing in these cases.
Collapse
Affiliation(s)
- Katherine Harbeck
- Des Moines University College of Osteopathic Medicine, Des Moines, IA, USA
| | | | | | | | | |
Collapse
|
9
|
Liu P, Fang H, An G, Jin B, Lu C, Li S, Yang F, Du L, Jin X. Chronic Central Serous Chorioretinopathy in Elderly Subjects: Structure and Blood Flow Characteristics of Retina and Choroid. Ophthalmol Ther 2024; 13:321-335. [PMID: 37966697 PMCID: PMC10776535 DOI: 10.1007/s40123-023-00849-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION With advancements in imaging technology, researchers have been able to identify more distinctive imaging features of central serous chorioretinopathy (CSC). However, existing research primarily concentrates on young patients aged 50 years and below, leaving a dearth of studies on elderly CSC patients. Previous studies indicate that elderly CSC patients may exhibit unique imaging characteristics and have a clinical prognosis that significantly differs from younger patients. This study aimed to evaluate the characteristics of retina, choroid structure, and blood flow in elderly patients with chronic CSC (cCSC) examined multimode imaging and try to find new pathogenesis information of it. METHODS Using a cut-off age of 50 years, patients with chronic central serous chorioretinopathy were divided into two groups: older and younger. The control group consisted of 40 healthy individuals, with their right eyes assigned. Various clinical features were recorded, including the incidence of ellipsoid zone rupture (EZ-), fibrin in the subretinal fluid (SRF), pachydrusen, subretinal drusenoid deposits (SDD), pigment epithelial detachment (PED), double-layer sign (DLS), and choroidal lipid globule cavern. Measurements were taken for the thickness of the outer nuclear layer (ONL), the length of the extended outer photoreceptor segment (POS), the height and width of SRF, the vascular density of each layer of the retinal capillary plexus, the central macular thickness (CMT), and the subfoveal choroidal thickness (SFCT). RESULTS The proportion of females in the elderly group (43.75%) was significantly higher than that in the youth group (22.41%) (p = 0.034). The degree of hyperopia in the elderly group (1.03 ± 0.73) was higher than that in the youth group (0.26 ± 1.06), with a significant difference in BCVA (p = 0.05). The thickness of SFCT, CMT, ONL in the elderly group, and the length of photoreceptor outer segment in the elderly group were thinner than those in the youth group (p < 0.05). Choroidal capillary perfusion area (CCPA), macular area, and paramacular area were lower in the elderly group than those in the youth group in the full scan range (p < 0.05). The blood flow densities of deep capillary plexus (DCP), intermediate capillary plexus (ICP), and superficial capillary plexus (SCP) in the whole scan range, macular area, and paramacular area were lower in the elderly group than in the youth group, but the differences were not statistically significant. CONCLUSIONS In conclusion, our data suggest that elderly patients with cCSC may experience different disease outcomes. Elderly cCSC patients exhibit less gender bias, poorer vision, more severe structural damage and ischemia in the choroid and retina, and have a higher risk of developing choroidal neovascularization.
Collapse
Affiliation(s)
- Pei Liu
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Haixin Fang
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Guangqi An
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Bo Jin
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
- Fundus Disease Institute of Zhengzhou University, Zhengzhou, 450000, China
| | - Chenyu Lu
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Shu Li
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Fan Yang
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Liping Du
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China.
- Henan Eye Hospital, Zhengzhou, 450000, China.
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China.
- Fundus Disease Institute of Zhengzhou University, Zhengzhou, 450000, China.
| | - Xuemin Jin
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China.
- Henan Eye Hospital, Zhengzhou, 450000, China.
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China.
- Fundus Disease Institute of Zhengzhou University, Zhengzhou, 450000, China.
| |
Collapse
|
10
|
van Dijk EHC, Ossewaarde-van Norel J, Vingerling JR, Cohen SY, Boon CJF. Serous Maculopathy Due to Aspecific Choroidopathy (SMACH). Asia Pac J Ophthalmol (Phila) 2023; 12:496-498. [PMID: 36454234 DOI: 10.1097/apo.0000000000000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Johannes R Vingerling
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Salomon Y Cohen
- Ophthalmic Center for Imaging and Laser, Paris, France
- Department of Ophthalmology, Intercity Hospital and University of Paris Est, Creteil, France
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Pauleikhoff LJ, Diederen RM, Feenstra HM, Schlingemann RO, van Dijk EH, Boon CJ. SINGLE-SESSION BILATERAL REDUCED-SETTINGS PHOTODYNAMIC THERAPY FOR BILATERAL CHRONIC CENTRAL SEROUS CHORIORETINOPATHY. Retina 2023; 43:1356-1363. [PMID: 37307569 PMCID: PMC10627544 DOI: 10.1097/iae.0000000000003807] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/30/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE We performed a multicenter, retrospective study on patients with bilateral chronic central serous chorioretinopathy (cCSC) who received single-session bilateral reduced-settings photodynamic therapy (ssbPDT) and assessed anatomical (resolution of subretinal fluid [SRF]) and functional (best-corrected visual acuity [BCVA]) outcomes and safety. METHODS Patients who underwent ssbPDT between 01/01/2011 and 30/09/2022 were included. The resolution of SRF at first, second, and final follow-up was assessed on optical coherence tomography (OCT), and BCVA measurements were collected at these visits. When fovea-involving ssbPDT was performed, ellipsoid zone (EZ) and external limiting membrane (ELM) integrity was graded before and after treatment. RESULTS Fifty-five patients were included in this study. Sixty-two of hundred and eight eyes (56%) showed a complete resolution of SRF at the first follow-up, which increased to 73/110 (66%) at the final follow-up. The mean logMAR BCVA improved by -0.047 ( P = 0.02) over follow-up. EZ integrity increased from 14/21 (67%) to 24/30 (80%) while ELM integrity increased from 22/30 (73%) to 29/30 (97%). CONCLUSION Patients with cCSC with bilateral SRF at baseline showed significant anatomical and functional improvements after ssbPDT, both at short-term and long-term follow-up. No relevant adverse events were noted.
Collapse
Affiliation(s)
- Laurenz J.B. Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Eye Center, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roselie M.H. Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Helena M.A. Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; and
| | - Reinier O. Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Foundation Asile des Aveugles, Lausanne, Switzerland
| | - Elon H.C. van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; and
| | - Camiel J.F. Boon
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; and
| |
Collapse
|
12
|
Latalska M, Bartosińska J, Dresler S, Toro MD, Krasowska D, Rejdak R. Comparison of Nailfold Videocapillaroscopy with Retinal and Choroidal Vascular Parameters in Patients with Central Serous Chorioretinopathy. J Clin Med 2023; 12:4817. [PMID: 37510932 PMCID: PMC10381500 DOI: 10.3390/jcm12144817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/21/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
AIM This study seeks to evaluate the results of nailfold videocapillaroscopies (NVCs) among patients with central serous chorioretinopathy (CSC) and their correlation with the choroid and retinal parameters. MATERIAL AND METHODS The examined group included 152 patients with acute, recurrent, chronic and neovascular CSC (34 F, 118 M, mean age 45.9 ± 8.9) and 41 healthy controls (12 F, 29 M, mean age 47 ± 11.5). The NVC examination, ophthalmoscopy, angio-OCT and OCT were performed. In addition, the medical history regarding chronic general disorders and known risk factors were recorded. RESULTS Abnormal NVC patterns and the dilated apical part of capillaries were found only in CSC patients (p = 0.000). Neoangiogenesis was observed in 25 acute (58.14%), 22 recurrent (42.31%), 16 chronic (36.36%) and 5 neovascular patients (45.45%) and 2 control subjects (4.88%) (p = 0.000). Glomerular capillaries were found in 8 acute (18.6%), 17 recurrent (31.48%), 25 chronic (56.82%) and 8 neovascular patients (72.73%) (p = 0.000). Meandering capillaries were more common in acute and recurrent CSC and glomerular capillaries were more common in chronic and aneurysmal dilations in neovascular CSC. CONCLUSIONS The observed digital microcirculation abnormalities in patients with CSC, such as dilation, meandering, tortuosity and glomerular, may confirm systemic micro-vasculopathy. The potential role of the NVC examination in assessing the CSC prognosis requires further evaluation.
Collapse
Affiliation(s)
- Małgorzata Latalska
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland
| | - Joanna Bartosińska
- Department of Cosmetology and Aesthetic Medicine, Medical University of Lublin, 20-093 Lublin, Poland
| | - Sławomir Dresler
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland
- Department of Plant Physiology and Biophysics, Institute of Biological Sciences, Maria Curie-Skłodowska University, Akademicka 19, 20-033 Lublin, Poland
| | - Mario Damiano Toro
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland
- Eye Clinic, Public Health Department, University of Naples Federico II, Via S. Pansini 5, 80133 Naples, Italy
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Robert Rejdak
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland
| |
Collapse
|
13
|
Boberg-Ans LC, Klefter ON, Rasmussen MLR, van Dijk EHC, Subhi Y. Scientific Literature Database Coverage of Randomized Clinical Trials for Central Serous Chorioretinopathy. J Pers Med 2023; 13:983. [PMID: 37373972 DOI: 10.3390/jpm13060983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Systematic literature searches are the cornerstone of systematic reviews. In this study, we evaluated database coverage of randomized clinical trials for central serous chorioretinopathy (CSC). METHODS We searched 12 databases (BIOSIS Previews, CINAHL, the Cochrane Central, Current Contents Connect, Data Citation Index, Derwent Innovations Index, EMBASE, KCI-Korean Journal Database, MEDLINE, PubMed, SciELO Citation Index, and Web of Science Core Collection) on 10 April 2023 for randomized clinical trials for CSC. After identifying all eligible studies across all databases, we investigated the coverage of these studies within each database, including the coverage of any combination of two databases. RESULTS The 12 databases yielded 848 records for screening, of which 76 were randomized clinical trials for CSC. No single database provided full coverage. The most comprehensive coverage was provided by EMBASE (88%), the Cochrane Central (87%), and PubMed (75%). A combined search in the Cochrane Central and PubMed led to complete coverage (100%) while reducing the number of records for screening from 848 to 279. CONCLUSIONS Systematic review search design should include multiple databases. For randomized clinical trials for CSC, the combination of the Cochrane Central and PubMed provides an excellent balance between coverage and workload.
Collapse
Affiliation(s)
- Lars C Boberg-Ans
- Department of Ophthalmology, Rigshospitalet, DK-2600 Copenhagen, Denmark
| | - Oliver N Klefter
- Department of Ophthalmology, Rigshospitalet, DK-2600 Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Marie L R Rasmussen
- Department of Ophthalmology, Rigshospitalet, DK-2600 Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Ophthalmology, Alrijne Hospital, 2353 GA Leiderdorp, The Netherlands
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, DK-2600 Copenhagen, Denmark
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| |
Collapse
|
14
|
Lu H, Xie S, Xiong J, Chen C, Wang Y, Moriyama M, Kamoi K, Uramoto K, Ohno-Matsui K. COMPLEX HEMODYNAMICS OF INTERVORTEX VEIN ANASTOMOSES IN HIGHLY MYOPIC EYES. Retina 2023; 43:723-732. [PMID: 36728124 DOI: 10.1097/iae.0000000000003738] [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: 02/03/2023]
Abstract
PURPOSE To analyze the complex pattern of filling of the intervortex vein (IVV) anastomoses through large trunks in highly myopic eyes based on indocyanine green angiographic (ICGA) videos. METHODS The medical records of 1,060 consecutive highly myopic eyes that had undergone ICGA were studied. IVV anastomoses were identified in the ICGA images, and the ICGA images and videos were analyzed comprehensively to characterize their hemodynamic features. RESULTS Seven eyes with IVV anastomoses through large trunks were analyzed. In the ICGA videos of six eyes, laminar flow was observed in the IVV anastomotic vessels. The laminar flow started in the arterial phase in two eyes, with pulsatile fashion in 1 of them. The flow began in the early arteriovenous transition phase in four eyes. The laminar flow continued for a mean of 12.17 ± 3.06 seconds, and the remaining section was gradually filled slower than the surrounding veins. The anastomotic trunk for the remaining one eye was too narrow to be analyzed. Four eyes had longitudinal ICGA records, and two had significant attenuation and narrowing of the anastomotic vessels. CONCLUSION The very early filling of part of the IVV anastomoses suggests that arteriovenous anastomoses are involved in the IVV of highly myopic eyes. However, this suggestion needs further study. There may be similar pathogenesis for IVV anastomoses either in thick or thin sclera.
Collapse
Affiliation(s)
- Hongshuang Lu
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Subhi Y, Windfeld-Mathiasen J, Horwitz A, Horwitz H. Risk of Central Serous Chorioretinopathy in Male Androgen Abusers. Ophthalmol Ther 2023; 12:1073-1080. [PMID: 36692812 PMCID: PMC10011293 DOI: 10.1007/s40123-023-00658-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/13/2023] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Male gender is an important risk factor of central serous chorioretinopathy (CSC), and studies have explored the pathophysiological role of androgens in CSC with conflicting results. In this study, we shed light on this hot topic by exploring the risk of CSC in a large cohort of male androgen abusers. METHODS This study included male androgen abusers identified through a nationwide anti-doping test program across Danish fitness centers from January 3 2006 to March 1 2018. For each case, we randomly sampled ten male controls using Danish nationwide registries. These controls were matched in age and date. Cases and controls were followed until May 16 2018. Data on diagnoses were extracted using the Danish National Registry of Patients using ICD-10 codes to identify cases with CSC. RESULTS We included 1189 cases and 11,890 controls. Mean age at the time of doping sentence was 27.4 ± 6.9 years, and mean length of follow-up was 15.8 ± 3.6 years. We identified no cases of CSC in androgen abusers, and five cases of CSC in the control cohort. The difference between groups was not statistically significant (P = 1.0). CONCLUSIONS Male androgen abusers were not at increased risk of CSC. Considering the lack of any signal in this large study, we speculate that if male androgen plays any direct role in the pathophysiology of CSC, its role may be subtle at best.
Collapse
Affiliation(s)
- Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Valdemar Hansens Vej 3, 2600, Glostrup, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | | | - Anna Horwitz
- Department of Ophthalmology, Rigshospitalet, Valdemar Hansens Vej 3, 2600, Glostrup, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Horwitz
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
16
|
B. Brown R, Mohan S, Chhablani J. Pachychoroid Spectrum Disorders: An Updated Review. J Ophthalmic Vis Res 2023; 18:212-229. [PMID: 37181617 PMCID: PMC10172805 DOI: 10.18502/jovr.v18i2.13188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/12/2023] [Indexed: 05/16/2023] Open
Abstract
Pachychoroid disease spectrum is a recent term that has been associated with an increasing number of phenotypes. This review discusses updated findings for each of the typical pachychoroid entities (central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, peripapillary pachychoroid syndrome, and focal choroidal excavation), as well as two relatively new additions (peripapillary pachychoroid neovasculopathy and peripheral exudative hemorrhagic chorioretinopathy). Here, we discuss the potential pathogenic mechanisms for these diseases and relevant imaging updates. Finally, we argue for a consistent classification scheme for these entities.
Collapse
Affiliation(s)
- Richard B. Brown
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
17
|
Feenstra HMA, Diederen RMH, Lamme MJCM, Tsonaka R, Fauser S, Yzer S, van Rijssen T, Gkika T, Downes SM, Schlingemann RO, Hoyng CB, van Dijk EHC, Boon CJF. INCREASING EVIDENCE FOR THE SAFETY OF FOVEA-INVOLVING HALF-DOSE PHOTODYNAMIC THERAPY FOR CHRONIC CENTRAL SEROUS CHORIORETINOPATHY. Retina 2023; 43:379-388. [PMID: 36727801 PMCID: PMC9935620 DOI: 10.1097/iae.0000000000003686] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE A retrospective study was performed with data from the prospective randomized controlled trials, PLACE and SPECTRA, assessing the risk of foveal atrophy and the likelihood of structural and functional improvement on optical coherence tomography, after foveal half-dose photodynamic therapy in chronic central serous chorioretinopathy. METHODS A total of 57 chronic central serous chorioretinopathy patients received a single half-dose photodynamic therapy with a treatment spot that included the fovea. Optical coherence tomography scans and fundus autofluorescence images were analyzed for structural improvement and possible atrophy development, at baseline and at several visits after treatment. Main outcome measures were integrity of the external limiting membrane and ellipsoid zone on optical coherence tomography and hypoautofluorescence on fundus autofluorescence. RESULTS The subfoveal external limiting membrane was graded as continuous in 21 of 57 of patients (36.8%) at baseline, and the subfoveal ellipsoid zone was graded as continuous in 5 of 57 patients (8.8%) at first visit, which improved to 50 of 51 (98.0%) and 32 out of 51 (62.7%) at the final visit at 2 years, respectively (both P < 0.001). Hypoautofluorescent changes on fundus autofluorescence were present in 25 of 55 patients (45.5%) at baseline and in 23 of 51 patients (45.1%) at the final visit ( P = 0.480). CONCLUSION In patients with chronic central serous chorioretinopathy who received a single, foveal, half-dose photodynamic therapy, a significant improvement in structure and function was seen at the final follow-up. None of the patients developed foveal atrophy.
Collapse
Affiliation(s)
- Helena M. A. Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Roselie M. H. Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Roula Tsonaka
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
- F. Hoffmann-La Roche, Basel, Switzerland
| | - Suzanne Yzer
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas van Rijssen
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Theodora Gkika
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Susan M. Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom; and
| | - Reinier O. Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Carel B. Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elon H. C. van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Camiel J. F. Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| |
Collapse
|
18
|
van Dijk EHC, Feenstra HMA, Bjerager J, Grauslund J, Boon CJF, Subhi Y. Comparative efficacy of treatments for chronic central serous chorioretinopathy: A systematic review with network meta-analyses. Acta Ophthalmol 2023; 101:140-159. [PMID: 36178171 DOI: 10.1111/aos.15263] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/27/2022]
Abstract
Treatment of chronic central serous chorioretinopathy (cCSC) remains a topic of controversy. As cCSC is a disease that can wax and wane, treatment efficacy is difficult to assess especially when trials compare active treatments without any placebo/control group. In this study, we systematically reviewed short-term efficacies of any cCSC treatment tested in randomized controlled trials (RCT) and employed network meta-analyses to compare to non-treatment controls. We searched 11 literature databases on 20 March 2022 for RCTs of treatment of cCSC. We identified 17 RCTs including a total of 1172 eyes. Treatments included conventional laser (44 eyes), half-dose or half-fluence photodynamic therapy (PDT) (298 eyes), ranibizumab (16 eyes), antioxidants (50 eyes), mineralocorticoid receptor antagonists (187 eyes), rifampicin (91 eyes), selective retina therapy (SRT) (67 eyes) and subthreshold micropulse laser (192 eyes). Compared with controls, significant benefit on complete subretinal fluid resolution was only obtained from half-dose or half-fluence PDT (OR: 20.6; 95% CI: 6.3-66.7; p < 0.0001) and conventional laser (OR: 36.4; 95% CI: 2.0-655.7; p = 0.015), and at an order of magnitude lower degree from SRT (OR: 3.4; 95% CI: 1.7-6.8; p = 0.00075). Compared with controls and after sensitivity analyses, significant benefit in the change in best-corrected visual acuity was only obtained by half-dose/-fluence PDT (-0.13 logMAR; 95% CI: -0.20 to -0.06 logMAR; p = 0.00021). In conclusion, three treatment options provide significant improvement over no treatment: half-dose/-fluence PDT, conventional laser and to a much lesser degree SRT. Considering that conventional laser can only be applied for extrafoveal leaks, and the long-term data available for PDT-based treatments finding persisting treatment results, half-dose or half-fluence PDT is the only viable treatment option for patients with cCSC. Shortage issues with verteporfin should not lead to employment of ineffective treatment modalities, as they put patients at unnecessary risk of adverse events.
Collapse
Affiliation(s)
- Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Ophthalmology, Haga Hospital, The Hague, The Netherlands
| | - Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jakob Bjerager
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Jakob Grauslund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
19
|
Fernández-Vigo JI. The apogee of the choroid. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:245-246. [PMID: 36738921 DOI: 10.1016/j.oftale.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 02/05/2023]
|
20
|
Faatz H, Lommatzsch A. [Pachychoroid Disease]. Klin Monbl Augenheilkd 2023; 240:218-232. [PMID: 36395810 DOI: 10.1055/a-1967-2522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pachychoroid spectrum disorders include uncomplicated pachychoroid, pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularisation, focal choroidal excavation and peripapillary pachychoroid syndrome. They are characterized by a thickened and hyperpermeable choroid and thinning of the choriocapillaris. The disorders are being diagnosed with increasing frequency and differentiation due to the advancement of multimodality imaging. Current understanding of the development, course, possible complications and treatment of these diseases is growing rapidly, but not all mechanisms have yet been elucidated. A correct diagnosis is important, especially the differentiation between the presence of active neovascularisation or a purely exudative stage, in order to initiate a therapy. It is also not yet clear why patients have a thickened choroid and why some of these patients develop pathological changes such as subretinal fluid, RPE changes or neovascularisation.
Collapse
|
21
|
Zarnegar A, Ong J, Matsyaraja T, Arora S, Chhablani J. Pathomechanisms in central serous chorioretinopathy: A recent update. Int J Retina Vitreous 2023; 9:3. [PMID: 36670451 PMCID: PMC9854068 DOI: 10.1186/s40942-023-00443-2] [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] [Received: 12/22/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Central serous chorioretinopathy (CSCR) is a potentially blinding choroidal disease. Despite decades of research, the pathological mechanisms of CSCR are still poorly understood. In recent years, there has been a strong emphasis on choroidal dysfunction as a primary cause of CSCR. MAIN BODY The concept of the pachychoroid disease spectrum and pachychoroid-driven processes are central to current theories regarding the pathophysiological underpinnings of CSCR. Choroidal hyperpermeability and subsequent leakage of fluid seen in CSCR may be due to several causes. Among them are venous congestion, inflammation, mineralocorticoid receptor activation, systemic factors including hemodynamic changes, obstructive sleep apnea, phosphodiesterase inhibitor use, pregnancy, and genetic predispositions. Congestion of vortex veins that drain blood from the choroid may contribute to the dilation of Haller vessels and cause fluid leakage. Vortex veins exit the eye through the sclera; thus, increased scleral thickness has been proposed to be a factor in venous congestion. Asymmetric vortex vein drainage may similarly result in congestion of the local venous system. Vortex vein anastomoses may overload the venous system and form secondary to venous congestion. Recent studies suggest inflammation and mineralocorticoid activation may factor into the development of CSCR, though more research in these areas is called for. Systemic conditions and genetics may predispose individuals to develop CSCR. CONCLUSIONS By striving to understand the molecular and physiological mechanisms of this disease, we can better diagnose and treat CSCR to improve outcomes for patients.
Collapse
Affiliation(s)
- Arman Zarnegar
- grid.21925.3d0000 0004 1936 9000Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Joshua Ong
- grid.21925.3d0000 0004 1936 9000Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | | | - Supriya Arora
- Bahamas Vision Centre and Princess Margaret Hospital, Nassau, NP Bahamas
| | - Jay Chhablani
- grid.21925.3d0000 0004 1936 9000Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| |
Collapse
|
22
|
Faatz H, Lommatzsch A. Pachychoroidale Erkrankungen. AUGENHEILKUNDE UP2DATE 2022. [DOI: 10.1055/a-1676-0740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
ZusammenfassungPachychoroidale Erkrankungen umfassen eine Gruppe von Erkrankungen, die charakteristische choroidale Merkmale zeigen. Diese können heutzutage durch multimodale Bildgebung immer
differenzierter beschrieben werden und umfassen fokale oder diffuse Aderhautverdickungen mit erweiterten und hyperpermeablen choroidalen Gefäßen. Die richtige Diagnose und Abgrenzung von
anderen exsudativen Erkrankungen ist für eine mögliche Therapie von großer Bedeutung.
Collapse
|
23
|
Pachychoroid Spectrum Diseases in Patients with Cushing’s Syndrome: A Systematic Review with Meta-Analyses. J Clin Med 2022; 11:jcm11154437. [PMID: 35956052 PMCID: PMC9369356 DOI: 10.3390/jcm11154437] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/11/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Cushing’s syndrome is a rare disease with an endogenous cause of excess cortisol secretion. More evidence substantially links cortisol levels to the pachychoroid spectrum diseases. In this systematic review and meta-analysis, we summarize available evidence on pachychoroid spectrum diseases in patients with Cushing’s syndrome. We performed a systematic literature search in 11 databases on 21 May 2022. Studies were considered eligible if they performed retinal examination of a consecutive group of patients with Cushing’s syndrome using optical coherence tomography (OCT) scans. We extracted data on subfoveal choroidal thickness in patients with Cushing’s syndrome compared to matched controls. We also extracted data on the prevalence of pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CSC), and polypoidal choroidal vasculopathy (PCV). We identified six eligible studies with a total of 159 patients with Cushing’s syndrome. On average, patients with Cushing’s syndrome have 49.5 µm thicker subfoveal choroidal thickness compared to matched healthy individuals. Pachychoroid spectrum diseases were relatively common in these patients: PPE in 20.8%, CSC in 7.7%, and PCV in 2.8%. We conclude that there should be low threshold to recommend ophthalmic examination to patients with Cushing’s syndrome, and that a macular OCT is recommended during this examination.
Collapse
|