1
|
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
|
2
|
Mirshahi R, Naseripour M, Ghomashi A, Falavarjani KG. Clinical predictive factors and imaging biomarkers of treatment response to half dose PDT in patients with chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2024; 48:104224. [PMID: 38801855 DOI: 10.1016/j.pdpdt.2024.104224] [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: 01/12/2024] [Revised: 05/05/2024] [Accepted: 05/24/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To determine the clinical and imaging biomarkers of the response to half-dose photodynamic therapy (HD-PDT) in patients with central serous chorioretinopathy (CSC) METHODS: Clinical records and baseline ophthalmic images of 67 chronic CSC patients who underwent HD-PDT were assessed. In addition to demographic data, optical coherence tomography (OCT), fluorescein angiography (FA) and fundus autofluorescence (FAF) images were analyzed for specific biomarkers. The patients were categorized to early responder and late responder based on the time needed for complete resolution of subretinal fluid after PDT (less than 1 month vs. more than 1 month). The baseline clinical and imaging biomarkers were compared between the two groups. RESULTS Seventy-three eyes of 67 patients were included in the study. The mean response time to PDT was 1.63 ± 1.48 months with 82.2% (60/73) of eyes categorized as early responder. The mean response time to PDT in delayed-response group was 4.15±1.51 months. In multivariate analysis, delayed response to PDT was associated with lacking history of systemic corticosteroid consumption, lacking history of pretreatment with eplerenone or acetazolamide before PDT and presence of hyperreflective foci in baseline OCT images (all p values < 0.05). There was no association between final visual outcome and late response to PDT. CONCLUSION The presence of inflammatory biomarkers such as hyperreflective foci in baseline OCT images might be indicative of resistance to PDT. Moreover, the effect of pretreatment with mineralocorticoid antagonist on the response to PDT in chronic CSC should be explored in future prospective studies.
Collapse
Affiliation(s)
- Reza Mirshahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masood Naseripour
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Stem cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran; Finetech in Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Atefeh Ghomashi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Stem cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Shen X, Kong F, Wen J, Wang X, Huang C. The role of inflammation in central serous chorioretinopathy: From mechanisms to therapeutic prospects. Front Pharmacol 2024; 15:1200492. [PMID: 38835666 PMCID: PMC11148560 DOI: 10.3389/fphar.2024.1200492] [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: 04/05/2023] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
Central serous chorioretinopathy (CSC) is a leading cause of permanent vision loss, ranking fourth among macular diseases, trailing only age-related macular degeneration, diabetic retinopathy, and retinal vein obstruction. While mounting evidence implicates inflammation as a pivotal factor in the onset and advancement of CSC, the specific pathophysiological process and molecular mechanisms underlying inflammation remain incompletely understood. A complex network of cytokines, chemokines, and adhesion molecules interplay to trigger inflammatory and pathological cascades, highlighting the need for a comprehensive comprehension of the inflammation-related mechanisms behind CSC progression. In this piece, we examine the existing comprehension of CSC's pathology and pathogenesis. Additionally, we present an overview of the mechanisms underlying the onset and progression of CSC inflammation, followed by a thorough analysis and discussion of the potential of targeted inflammatory intervention for both preventing and treating CSC.
Collapse
Affiliation(s)
- Xiao Shen
- Department of Ophthalmology, Taizhou Central Hospital ( Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Fanhua Kong
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-Based Medical Materials, Wuhan, China
| | - Jing Wen
- Department of Ophthalmology, Taizhou Central Hospital ( Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Xiao Wang
- Department of Ophthalmology, Taizhou Central Hospital ( Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Chunlian Huang
- Department of Ophthalmology, Taizhou Central Hospital ( Taizhou University Hospital), Taizhou, Zhejiang, China
| |
Collapse
|
4
|
Suwal B, Khadka D, Shrestha A, Suwal R, Khatri B. Quantification of Metamorphopsia in Resolved Idiopathic Central Serous Chorioretinopathy: An Analysis Using M-CHARTS, Amsler Grid, and Optical Coherence Tomography. Clin Ophthalmol 2024; 18:937-942. [PMID: 38562644 PMCID: PMC10982064 DOI: 10.2147/opth.s456556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose To quantify metamorphopsia in patients with resolved idiopathic Central Serous Chorioretinopathy (CSCR) using M-CHARTS and compare the results with the traditional Amsler grid and optical coherence tomography (OCT). Patients and Methods For the purpose of this study, all consecutive cases of patients with resolved CSCR were evaluated for metamorphopsia (using the standard Amsler grid and M-CHARTS) and spectral domain OCT. The OCT images were analyzed for the following five parameters: central macular thickness, pigment epithelial detachment, retinal pigment epithelial bumps, discontinuation in the inner segment/outer segment junction or the external limiting membrane, fibrinous exudates in the subretinal space, and hyperreflective dots in the intraretinal and/or subretinal layer. Binary logistic regression was used to find the association between metamorphopsia and foveal morphology. Cohen's Kappa was used to determine the agreement between the M-CHARTS and Amsler grid for diagnosing metamorphopsia. The sensitivity, specificity, and accuracy in the diagnosis of metamorphopsia were calculated against the Amsler grid. Results Of 41 eyes, Amsler Grid detected metamorphopsia in 39.02%, and M-CHARTS detected metamorphopsia in 53.66%. The agreement rate of detection between the two tests was moderate (Kappa=0.52). M-CHARTS had a sensitivity of 87.50%, a specificity of 68.00%, a positive predictive value of 63.64%; and a negative predictive value of 89.47% for the diagnosis of metamorphopsia compared to the Amsler grid. The presence of PED in OCT was significantly associated with metamorphopsia. Conclusion M-CHARTS can be a useful ancillary test to detect and quantify metamorphopsia even after fluid resolution in CSCR. Structural changes in macular morphology as observed with OCT can predict the likelihood of metamorphopsia.
Collapse
Affiliation(s)
- Barsha Suwal
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Deepak Khadka
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Arjun Shrestha
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Rinkal Suwal
- Department of Optometry, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Bijay Khatri
- Academic and Research Department, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| |
Collapse
|
5
|
Zhou L, Huang C, Li Z, Lu T, Zhao H, Li C, Cong Q, Liang J, Zhong X, Jin L, Lu L, Jin C. A randomized non-inferiority trial of 577nm subthreshold micropulse laser versus half-dose photodynamic therapy for acute central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2024; 45:103908. [PMID: 38007036 DOI: 10.1016/j.pdpdt.2023.103908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE To compare the effectiveness of 577nm subthreshold micropulse laser (SML) with half-dose photodynamic therapy (Hd-PDT) for acute central serous chorioretinopathy (CSC). METHOD A non-inferiority clinical trial was performed with a non-inferiority margin of eight letters. Sixty-eight eyes of 68 patients with acute CSC were randomized to the Hd-PDT group or 577 nm SML group. Best-corrected visual acuity (BCVA ), the subretinal fluid (SRF), and the central foveal thickness (CFT) were evaluated at 6 months. RESULTS The visual acuity significantly improved from 70.38 ± 10.37 at baseline to 83.24 ± 3.03 at 6 months after treatment in the SML group (P < 0.001), from 71.09 ± 10.50 to 84.35 ± 2.09 in the PDT group (P < 0.001). SML was non-inferior to the PDT (mean difference: -0.41, 95% CI: -5.51 - 4.68, P = 0.0021). At the endpoint, CFT was significantly reduced in the two groups, but no statistical difference (P = 0.7694). The complete resolution of SRF reached 82.35% (28/34) in the SML group and 91.18% (31/34) in the PDT group, respectively,but no statistical difference (P = 0.3724). CONCLUSIONS SML was non-inferiority to half-dose PDT in improving the visual acuity for CSC, and it is a viable alternative, especially when the verteporfin in PDT is unavailable.
Collapse
Affiliation(s)
- Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Zijing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China; Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Tu Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Hongkun Zhao
- The Affiliated Hospital of Yunnan University, The Second People's Hospital of Yunnan Province, Kunming, Yunnan Province, China
| | - Cong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Qifeng Cong
- Department of Ophthalmology, Third People's Hospital of Dalian, Dalian Medical University, Dalian, China
| | - Jiandong Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Xiaojing Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China.
| |
Collapse
|
6
|
Bica M, David A, Balta F, Iacob A. Continuous Laser Versus Micropulse Laser in the Treatment of Central Serous Chorioretinopathy: A Retrospective Study. Cureus 2024; 16:e53799. [PMID: 38465179 PMCID: PMC10924632 DOI: 10.7759/cureus.53799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Central serous chorioretinopathy (CSCR) is a retinal disorder characterized by complex mechanisms leading to abnormal fluid accumulation under the retina. While management remains controversial, laser therapy has been successfully used. This study compares the efficacy of continuous laser (CL) and micropulse laser (ML) therapy in treating CSCR, focusing on reduction in macular thickness and improvement in visual acuity. METHODS A retrospective cohort study was conducted, including patients with CSCR treated with either CL or ML. The primary outcome measured was the reduction in average macular thickness (AMT), alongside secondary outcomes like changes in best corrected visual acuity (BCVA), subfoveal choroidal thickness (SFCT), and resolution of subretinal fluid (SRF). RESULTS The study evaluated 121 patients with CSCR, treated either with CL or ML. The primary outcome showed that the mean reduction in AMT was 51.14 µm (±20) in the CL group and 29.88 µm (±22) in the ML group, without a statistically significant difference (p=0.10). For the secondary outcomes, the improvement in BCVA was comparable in both groups, with CL at 0.15 (±0.1) and ML at 0.12 (±0.1) and no significant difference (p=0.41). However, in SFCT reduction, CL showed greater efficacy with a mean reduction of 32.19 µm (±15) compared to ML's 4.85 µm (±18), which was statistically significant (p=0.0004). The degree of SRF resolution showed no significant difference between the treatments (p=0.065). CONCLUSIONS Both CL and ML are effective in the management of CSCR, with CL being more effective in reducing SFCT. These findings suggest the need for personalized treatment strategies based on individual patient characteristics and underline the complexity of CSCR management.
Collapse
Affiliation(s)
- Mihai Bica
- Ophthalmology, Spitalul Clinic de Urgente Oftalmologice Bucuresti, Bucharest, ROU
| | - Alexandru David
- Ophthalmology, Spitalul Clinic de Urgente Oftalmologice Bucuresti, Bucharest, ROU
| | - Florian Balta
- Ophthalmology, Spitalul Clinic de Urgente Oftalmologice Bucuresti, Bucharest, ROU
- Ophthalmology, Clinica Retina, Bucharest, ROU
| | | |
Collapse
|
7
|
Sodhi PK, Rao KC, R AT, Gautam A, D D, Rana AS, Kumar R, Santra S, Mohapatra A. Optical Coherence Tomography Angiography Parameters in Indian Patients With Central Serous Chorioretinopathy. Cureus 2023; 15:e46467. [PMID: 37927676 PMCID: PMC10624209 DOI: 10.7759/cureus.46467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Background In this study, we aimed to evaluate optical coherence tomography angiography (OCTA) parameters among Indian patients affected with central serous chorioretinopathy (CSCR). Methodology A cross-sectional study on Indian patients having unilateral or bilateral affection with CSCR was conducted at the Department of Ophthalmology, Guru Nanak Eye Centre, and Maulana Azad Medical College, New Delhi. A history of ocular symptoms such as a diminution of vision, metamorphopsia, decreased contrast sensitivity (CS), and defective color vision (CV) and their duration were obtained. A detailed ocular examination for best-corrected visual acuity (BCVA), intraocular pressure (IOP), CV, and CS was done. Following this, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed. OCT was done for central foveal thickness (CFT), subfoveal choroidal thickness (SFCT), neurosensory detachment (NSD), pigment epithelial detachment (PED), and choroidal neovascular membranes (CNVMs). The OCTA imaging was done to examine the foveal avascular zone (FAZ) size, perimeter and circularity, vessel density (VD), and features such as enlarged/distorted FAZ, dark areas, dark spots, abnormal vessels, and choriocapillaris island (CCI) in the retino-choroidal layers. We compared the OCTA features of affected eyes with those of fellow eyes. Results The study involved 52 eyes of 40 CSCR patients, including 32 (80%) males and eight (20%) females with a mean age of 39.3 ± 6.1 (24-49) years. Of the 40 patients, 12 (30%) had a bilateral involvement. The mean CFT was 300.3 ± 158.4 µ, and the SFCT was 258.5 ± 60.4 µ. The mean distance BCVA was the logarithm of the minimum angle of resolution (logMAR) 0.58 ± 0.32. The OCTA showed features such as enlarged/distorted FAZ (36.53% eyes), dark areas (NSD/PED) (84.61% eyes), dark spots (PED) (5.76% eyes), abnormal vessels (dilated vessels/CNVM) (96.15% eyes), and CCI (17.30% eyes). The mean FAZ area, perimeter, and circularity were 0.40 ± 0.71 mm2, 41.8 ± 280.0 mm, and 0.48 ± 0.12, respectively. The VD in the superficial capillary plexus (SCP) was 25.4 ± 14.1, deep capillary plexus (DCP) 15.0 ± 11.5, outer retina (OR) 5.9 ± 6.8, outer retinal choriocapillaris (ORCC) 33.7 ± 16.9, choriocapillaris 29.7 ± 17.5, and choroid 29.9 ± 17.5. The fellow eyes showed a mean FAZ area, perimeter, and circularity of 0.34 ± 0.23 mm2, 76.8 ± 391.2 mm, and 0.47 ± 0.11, respectively, while VD of SCP was 25.9 ± 13.6, DCP 16.5 ± 11.7, OR 14.3 ± 14.9, ORCC 38.0 ± 16.5, choriocapillaris 36.3 ± 17.7, and choroid 35.5 ± 19.2. Conclusions The CSCR eyes had a thicker fovea and sub-foveal choroid (SFC). The FAZ area of affected eyes was larger, while the perimeter was smaller than that in the fellow eye. In the affected eye, the VD in all the retino-choroidal layers was lower, although it was significantly reduced in OR whole (p = 0.006) and foveal choroid (p = 0.022).
Collapse
Affiliation(s)
- Punita K Sodhi
- Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, IND
| | - Kavya C Rao
- Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, IND
| | - Archana T R
- Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, IND
| | - Akanksha Gautam
- Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, IND
| | - Divya D
- Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, IND
| | - Aman S Rana
- Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, IND
| | - Rajesh Kumar
- Community Medicine, Maulana Azad Medical College, New Delhi, IND
| | - Sahadev Santra
- Community Medicine, Maulana Azad Medical College, New Delhi, IND
| | - Avilasha Mohapatra
- Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, IND
| |
Collapse
|
8
|
Kogo T, Muraoka Y, Ishikura M, Nishigori N, Ueda-Arakawa N, Miyata M, Tamura H, Hata M, Takahashi A, Miyake M, Tsujikawa A. Widefield choroidal vasculature associated with future condition of subretinal fluid in central serous chorioretinopathy. Heliyon 2023; 9:e18441. [PMID: 37576325 PMCID: PMC10412906 DOI: 10.1016/j.heliyon.2023.e18441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/27/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose To examine choroidal angiographic features in the posterior pole associated with resolution or persistency of subretinal fluid (SRF) in eyes with central serous chorioretinopathy (CSC). Design Observational case series. Methods Twenty-nine patients with treatment-naïve CSC were divided into two groups based on the presence or absence of SRF 3 months after the initial visit (month 3) without any treatment. Using enhanced depth imaging of widefield swept-source optical coherence tomography, the choroidal thickness (CT), vessel density (VD), and vessel diameter index (VDI) in the superotemporal and inferotemporal subfields on the temporal side of the 18-mm circle from the disc were measured at the initial visit. We calculated the vertical difference in CT and other choroidal angiographic parameters and evaluated their association with the SRF condition at 3 months. Results The SRF-resolved and SRF-persistent groups included 10 and 19 patients, respectively. At the initial visit, sex, age, axial length, symptom duration, the logarithm of the minimum angle of resolution visual acuity, and foveal thickness were not significantly different between the two groups. The SRF status at month 3 was not associated with the vertical difference in CT and choroidal VD (P = .614, .065, respectively). However, the vertical difference in choroidal VDI was positively associated with the future presence of SRF (P = .017). Conclusions Vertically asymmetric dilation of choroidal vessels in the posterior pole may be a vasculature feature associated with SRF from CSC and may be a good predictor of future SRF status.
Collapse
Affiliation(s)
- Takahiro Kogo
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaharu Ishikura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naomi Nishigori
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoko Ueda-Arakawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
9
|
Kalogeropoulos D, Shaw L, Skondra D, Christodoulou A, Kalogeropoulos C. Central Serous Chorioretinopathy: An Update on the Current State of Management. Klin Monbl Augenheilkd 2023. [PMID: 37336237 DOI: 10.1055/a-2062-3751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Central serous chorioretinopathy (CSCR) is a relatively common retinal disorder that leads to central vision impairment, often with a high recurrence rate. The exact etiology and pathogenetic mechanisms have not been fully elucidated but are likely to be associated with hyperpermeability of the choroidal capillaries and failure of the retinal pigment epithelium (RPE), leading to serous detachment of the neurosensory retina. Multimodal imaging plays a critical role in the diagnostic approach and monitoring of CSCR. Fortunately, the natural course of the disease is usually self-limiting, with spontaneous resolution and total fluid reabsorption. However, some patients may exhibit recurrences or persistent subretinal fluid (chronic CSCR), leading to progressive and irreversible RPE atrophy or photoreceptor damage. Thus, to prevent permanent visual loss, individualized treatment should be considered. Recent developments in the diagnostic and therapeutic approach have contributed to better outcomes in patients with CSCR. More studies are required to improve our understanding of epidemiology, pathogenesis, diagnosis, and treatment, with a significant impact on the management of this challenging clinical entity. The purpose of this review is to summarize the current knowledge about the clinical features, diagnostic workup, and therapeutic approach of CSCR.
Collapse
Affiliation(s)
| | - Lincoln Shaw
- Ophthalmology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, United States
| | - Dimitra Skondra
- Ophthalmology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, United States
| | | | | |
Collapse
|
10
|
Kiraly P, Habjan MŠ, Smrekar J, Mekjavić PJ. Functional Outcomes and Safety Profile of Trans-Foveal Subthreshold Micropulse Laser in Persistent Central Serous Chorioretinopathy. Life (Basel) 2023; 13:life13051194. [PMID: 37240839 DOI: 10.3390/life13051194] [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: 12/28/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Our study evaluated visual function changes after subthreshold micropulse laser (SML) treatment in persistent central serous chorioretinopathy (CSC) and SML safety profile. We conducted a prospective study including 31 fovea-involving CSC patients. The natural course was observed for the first 3 months, SML was performed at 3 months, and SML effectiveness was observed at 6 months. At all three clinical visits, optical coherence tomography (OCT), best corrected visual acuity (BCVA), contrast sensitivity (CS) in five spatial frequencies (1.5, 3.0, 6.0, 12.0, and 18.0 cycles per degree (cpd)), microperimetry (MP), and multifocal electroretinography (mfERG) were performed. The SML safety profile was evaluated with functional and morphological parameters. In the cohort of all CSC patients treated with SML, the statistically significant average improvement was observed in BCVA (p = 0.007), CS-1.5 (p = 0.020), CS-3.0 (p = 0.050), CS-12.0 (p < 0.001), CS-18.0 (p = 0.002), CS (CS-A) (p < 0.001), MP in the central ring (MP-C) (p = 0.020), peripheral ring (MP-P) (p = 0.042), and average retinal sensitivity (MP-A) (p = 0.010). After the SML treatment, mean changes in mfERG amplitudes and implicit times in our cohort were not statistically significant. No morphological or functional adverse effects of SML treatment were observed. SML treatment in persistent CSC episodes leads to significant functional improvement and has an excellent safety profile.
Collapse
Affiliation(s)
- Peter Kiraly
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Maja Šuštar Habjan
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Jaka Smrekar
- Faculty of Mathematics and Physics, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Polona Jaki Mekjavić
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Jožef Stefan Institute, 1000 Ljubljana, Slovenia
| |
Collapse
|
11
|
Lee PK, Ra H, Han SY, Baek J. QUANTITATIVE ANALYSIS OF CHOROIDAL MORPHOLOGY USING MULTIMODAL IMAGING IN ACUTE AND PERSISTENT CENTRAL SEROUS CHORIORETINOPATHY. Retina 2023; 43:832-840. [PMID: 36727765 DOI: 10.1097/iae.0000000000003715] [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 quantitative differences in choroidal morphology between acute and persistent central serous chorioretinopathy using multimodal images. METHODS Ultra-widefield indocyanine green angiography (UWICGA) and optical coherence tomography images of 72 eyes of 72 patients with acute (32 eyes) and persistent (40 eyes) central serous chorioretinopathy were collected. Choroidal thickness, area, vessel density, symmetry, and intervortex anastomosis were assessed. RESULTS The choroidal area on optical coherence tomography B-scan images was smaller and the choroidal vessel density on UWICGA images was lower in the persistent group ( P < 0.001 and P = 0.028, respectively). Choroidal vessel density on UWICGA showed positive correlation with that of vortex ampullae (all P ≤ 0.046). The constitution of the intervortex anastomosis and dominant vessels in the macular area showed differences between the groups ( P = 0.014 and P = 0.010, respectively), with greater inferonasal vessel participation in the anastomosis and combined superotemporal and inferotemporal vessels as dominant vessels in the persistent groups. CONCLUSION Acute and persistent central serous chorioretinopathy differed in subfoveal choroidal area, choroidal vessel density, and intervortex anastomosis constitution on UWICGA images. Choroidal vessel density on UWICGA images correlated with that of vortex ampullae. These findings enhance our understanding of the pathophysiology of central serous chorioretinopathy subtypes.
Collapse
Affiliation(s)
- Phil-Kyu Lee
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeonggi-do, Republic of Korea; and
| | - Ho Ra
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeonggi-do, Republic of Korea; and
| | - Su Yeon Han
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeonggi-do, Republic of Korea; and
| | - Jiwon Baek
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeonggi-do, Republic of Korea; and
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Bucheon, Seoul, Republic of Korea
| |
Collapse
|
12
|
Cong Q, Zhou L, Huang C, Li Z, Liang J, Lu T, Jin C. Changes of microstructure of central serous chorioretinopathy on OCT and its relationship with prognosis. Photodiagnosis Photodyn Ther 2023; 42:103499. [PMID: 36889423 DOI: 10.1016/j.pdpdt.2023.103499] [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: 12/27/2022] [Revised: 02/15/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE To quantitatively evaluate the relationship between retinal microstructure and prognosis in patients with central serous chorioretinopathy(CSC) using optical coherence tomography(OCT). METHODS 398 affected eyes of patients with central serous chorioretinopathy who visited Zhongshan Ophthalmic Centre(ZOC) from 2015 to 2018 were included in this retrospective study. The optical coherence tomography images of all patients in their first visit were analyzed, and logistic regression analysis were performed with 11 independent variables, and subretinal fluid absorption in 3 months after therapy as well as recur in 6 months after therapy as dependent variable respectively. The correlation between shortage of ellipsoid baseline and height of foveal subretinal fluid, width of foveal subretinal fluid were analyzed respectively. The difference of duration and baseline logMAR visual acuity in eyes with and without double layer sign or subretinal hyper-reflective materials were analyzed respectively. The difference of therapeutic outcome among different therapeutic methods was also analyzed in eyes with double-layer sign and subretinal hyper-reflective materials respectively. RESULTS In the regression analysis with subretinal fluid absorption in 3 months after therapy as dependent variable, shortage of ellipsoid zone was statistically significant(P<0.0001,B=1.288).In the regression analysis with recur in 6 months as dependent variable, no independent variable was statisically significant. There is no correlation between shortage of ellipsoid zone and width or height of subretinal fluid. Duration of disease in eyes with double layer sign or subretinal hyper-reflective materials was longer than those without these features. In the eyes with double-layer sign or subretinal hyper-reflective material, the difference of logMAR visual acuity 3 months after treatment between 2 therapeutic methods was not statistically significant. CONCLUSIONS When using optical coherence tomography to quantitatively evaluate change microstructure in eyes with central serous chorioretinopathy, we found that subretinal fluid was easier to absorb completely in eyes with less shortage of ellipsoid zone. Double layer sign and subretinal hyper-reflective materials are easier to exist in eyes with longer duration of disease.
Collapse
Affiliation(s)
- Qifeng Cong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Zijing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Jiandong Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Tu Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
13
|
Electrophysiological and anatomical outcomes of subthreshold micropulse laser therapy in chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2022; 41:103221. [PMID: 36464217 DOI: 10.1016/j.pdpdt.2022.103221] [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: 09/11/2022] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND To evaluate short-term efficacy of subthreshold micropulse laser therapy on chronic central serous chorioretinopathy (CSC) electrophysiologically and anatomically. METHODS This prospective study included 18 eyes with chronic CSC. Subthreshold micropulse laser therapy was applied to the eyes using Endpoint Management System (EpM). The efficacy of the treatment was evaluated with optical coherence tomography (OCT) and multifocal electroretinography (mfERG) measurements before and after one month of the treatment. RESULTS The mean patient age was 47.3 ± 5.7 years (ranged between 36 and 56). The mean symptomatic time of the disease was 12.7 ± 3.33 months. Central macular thickness, choroidal thickness, subretinal fluid height and width showed statistically significant decreases after EpM treatment (p < 0.05). P 1 amplitude of ring 1, 3, 4, and 5 in mfERG increased significantly (p < 0.05). CONCLUSIONS The study demonstrated that, in both OCT and electrophysiological evaluations, EpM subthreshold laser therapy resulted in anatomical and functional improvements in chronic CSC.
Collapse
|
14
|
Gonçalves AN, Scott IU, Jorge R. Alternative management of central serous chorioretinopathy using intravitreal metoprolol. Int J Retina Vitreous 2022; 8:50. [PMID: 35879809 PMCID: PMC9310426 DOI: 10.1186/s40942-022-00400-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Beta-blockers may counteract the effect of catecholamines on central serous chorioretinopathy (CSC) pathology and accelerate the improvement of neurosensory retinal detachment. Oral propranolol has been associated with decreased duration of CSC in some studies. We describe two patients with visually symptomatic chronic CSC (cCSC) treated successfully with intravitreal metoprolol. Case presentations After obtaining the patients’ informed consent, two eyes of two 43-year-old men diagnosed with cCSC treated unsuccessfully with oral spirolactone, micropulse laser and intravitreal anti‐vascular endothelial growth factor (anti-VEGF) agents were treated with one off-label intravitreal injection of metoprolol (50 µg/0.05 ml). Baseline (pre-injection) and follow-up examinations (at 1 month post-injection) included best-corrected visual acuity (BCVA), anterior and posterior segment biomicroscopy, fundus autofluorescence, spectral domain optical coherence tomography (Spectralis, Heidelberg), and electroretinogaphy (ERG) according to International Society for Clinical Electrophysiology of Vision (ISCEV) full-field scotopic and photopic standard protocols. ERG results at baseline (pre-injection) and at 1 month post-injection were compared using paired t-tests. Results There was no significant difference in any of the ISCEV recommended ERG parameters with respect to a- and b-wave amplitude and implicit time, and oscillatory potentials maximal amplitude. BCVA improved in both patients. Neither patient developed clinical evidence of intraocular inflammation. Subretinal and/or intraretinal fluid had improved in both patients at 1 month after the metoprolol injection. Conclusion These preliminary findings suggest that intravitreal metoprolol may be a safe alternative therapy for patients with cCSC.
Collapse
|
15
|
Kiraly P, Smrekar J, Jaki Mekjavić P. Biomarkers predicting central serous chorioretinopathy episode persistence. Eur J Ophthalmol 2022; 33:11206721221137153. [PMID: 36377260 DOI: 10.1177/11206721221137153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
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.
Collapse
Affiliation(s)
- Peter Kiraly
- 574106Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Eye Hospital, 37664University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, 37667University of Ljubljana, Ljubljana, Slovenia
| | - Jaka Smrekar
- Faculty of Mathematics and Physics, 172465University of Ljubljana, Ljubljana, Slovenia
| | - Polona Jaki Mekjavić
- Eye Hospital, 37664University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, 37667University of Ljubljana, Ljubljana, Slovenia
- 61790Institute Jožef Stefan, Ljubljana, Slovenia
| |
Collapse
|
16
|
Giansanti F, Mercuri S, Serino F, Caporossi T, Savastano A, Rizzo C, Faraldi F, Rizzo S, Bacherini D. Scanning Laser Ophthalmoscopy Retromode Imaging Compared to Fundus Autofluorescence in Detecting Outer Retinal Features in Central Serous Chorioretinopathy. Diagnostics (Basel) 2022; 12:2638. [PMID: 36359481 PMCID: PMC9689095 DOI: 10.3390/diagnostics12112638] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 07/24/2023] Open
Abstract
Central serous chorioretinopathy (CSCR) is a retinal disease characterized by a heterogeneous clinical phenotype, depending on the influence of different factors in its pathogenesis, including the presence of subretinal fluid (SRF), trophism of the retinal pigmented epithelium (RPE) and choroidal hyper-permeability. Our study has the purpose of assessing the ability of scanning laser ophthalmoscopy (SLO) retromode imaging, compared to fundus autofluorescence (FAF), to identify outer retinal features in a cohort of patients with a diagnosis of CSCR. A total of 27 eyes of 21 patients were enrolled in our study. All patients underwent full ophthalmological examination, including fundus retinography, fundus fluorescein angiography, optical coherence tomography (OCT), FAF and SLO retromode imaging. For each patient, the following features were evaluated: SRF, the presence of pigmented epithelium detachment (PED), RPE dystrophy, and RPE atrophy. RPE dystrophy was further characterized according to the appearance in FAF of iso-, hyper- and hypo-autofluorescent dystrophy. The ability to identify each feature was evaluated for FAF and SLO retromode alone, compared to a multimodal imaging approach. FAF identified SRF in 11/14 eyes (78%), PED in 14/19 (74%), RPE dystrophy with iso-autofluorescence in 0/13 (0%), hyper-autofluorescence in 18/19 (95%), hypo-autofluorescence in 20/20 (100%), and RPE atrophy in 7/7 (100%). SLO retromode imaging identified SRF in 13/14 eyes (93%), PED in 15/19 (79%), RPE dystrophy with iso-autofluorescence in 13/13 (100%), hyper-autofluorescence in 13/19 (68%), hypo-autofluorescent in 18/20 (90%), and RPE atrophy in 4/7 (57%). SLO retromode imaging is able to detect retinal and RPE changes in CSCR patients with a higher sensitivity than FAF, while it is not able to identify the depth of lesions or supply qualitative information about RPE cells' health status, meaning that it is less specific. SLO retromode imaging may have a promising role in the assessment of patients with CSCR, but always combined with other imaging modalities such as OCT and FAF.
Collapse
Affiliation(s)
- Fabrizio Giansanti
- Department of Neurosciences, Psychology, Drug Research, and Child Health, Eye Clinic, University of Florence, AOU Careggi, 50139 Florence, Italy
| | - Stefano Mercuri
- Department of Neurosciences, Psychology, Drug Research, and Child Health, Eye Clinic, University of Florence, AOU Careggi, 50139 Florence, Italy
| | - Federica Serino
- Department of Neurosciences, Psychology, Drug Research, and Child Health, Eye Clinic, University of Florence, AOU Careggi, 50139 Florence, Italy
| | - Tomaso Caporossi
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
| | - Alfonso Savastano
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
| | - Clara Rizzo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy
| | | | - Stanislao Rizzo
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, 56124 Pisa, Italy
| | - Daniela Bacherini
- Department of Neurosciences, Psychology, Drug Research, and Child Health, Eye Clinic, University of Florence, AOU Careggi, 50139 Florence, Italy
| |
Collapse
|
17
|
Yu S, Cui K, Wu P, Wu B, Lu X, Huang R, Tang X, Lin J, Yang B, Zhao J, He Q, Liang X, Xu Y. Melatonin prevents experimental central serous chorioretinopathy in rats. J Pineal Res 2022; 73:e12802. [PMID: 35436360 DOI: 10.1111/jpi.12802] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
Central serous chorioretinopathy (CSC) is a vision-threatening disease with no validated treatment and unclear pathogenesis. It is characterized by dilation and leakage of choroidal vasculature, resulting in the accumulation of subretinal fluid, and serous detachment of the neurosensory retina. Numerous studies have demonstrated that melatonin had multiple protective effects against endothelial dysfunction, vascular inflammation, and blood-retinal barrier (BRB) breakdown. However, the effect of melatonin on CSC, and its exact pathogenesis, is not well understood thus far. In this study, an experimental model was established by intravitreal injection of aldosterone in rats, which mimicked the features of CSC. Our results found that melatonin administration in advance significantly inhibited aldosterone-induced choroidal thickening and vasodilation by reducing the expression of calcium-activated potassium channel KCa2.3, and attenuated tortuosity of choroid vessels. Moreover, melatonin protected the BRB integrity and prevented the decrease in tight junction protein (ZO-1, occludin, and claudin-1) levels in the rat model induced by aldosterone. Additionally, the data also showed that intraperitoneal injection of melatonin in advance inhibited aldosterone-induced macrophage/microglia infiltration, and remarkably diminished the levels of inflammatory cytokines (interleukin-6 [IL-6], IL-1β, and cyclooxygenase-2), chemokines (chemokine C-C motif ligand 3, and C-X-C motif ligand 1), and matrix metalloproteinases (MMP-2 and MMP-9). Luzindole, as the nonselective MT1 and MT2 antagonist, and 4-phenyl-2-propionamidotetraline, as the selective MT2 antagonist, neutralized the melatonin-induced inhibition of choroidal thickening and choroidal vasodilation, indicating that melatonin might exert the effects via binding to its receptors. Furthermore, the IL-17A/nuclear factor-κB signaling pathway was activated by intravitreal administration of aldosterone, while it was suppressed in melatonin-treated in advance rat eyes. This study indicates that melatonin could serve as a promising safe therapeutic strategy for CSC patients.
Collapse
Affiliation(s)
- Shanshan Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Kaixuan Cui
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Peiqi Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Benjuan Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xi Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Rong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xiaoyu Tang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Jianqiang Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Boyu Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Jinfeng Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Qingjing He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xiaoling Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yue Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| |
Collapse
|
18
|
Cerón Enríquez AM, Teherán Forero OL, Atencia Niño C, Almanza Benito Revollo R, Ramos Clason EC, Ochoa Díaz MM. Evaluation of clinical and functional sequels of central serous chorioretinopathy. A case series analysis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:S2173-5794(22)00109-8. [PMID: 35871997 DOI: 10.1016/j.oftale.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the clinical and functional sequelae of patients with a diagnosis of resolved CSC, through macular OCT, contrast sensitivity test, visual field 10-2 and Farnsworth D-15 color test. METHODS 27 eyes of 26 individuals with CSC resolved by macular OCT were included and evaluated; the patients underwent a contrast sensitivity test with the Optec 6500 equipment, a 10-2 visual field with an Octopus 900 Haag-Streit, and a Farnsworth D-15 color test. RESULTS Sequelae were observed in 20 eyes (74.1%) by macular OCT and in 21 (77.8%) in contrast sensitivity, predominantly type 2 defect. Also 27 (100%) had a visual field 10-2 altered corresponding to reduced foveal sensitivity, 11 eyes (40.7%) corresponded to central and paracentral scotomas. The color test showed alteration in 11 (40.7%) of the total eyes evaluated, finding tritanomaly in 9 of them (81.8%). No significant differences were observed in the studies between observation group vs the treatment group. CONCLUSIONS CSC can leave sequelae in the visual quality of patients despite treatment in the acute phase. Visual acuity before and after treatment in the intervention group had no significant difference.
Collapse
Affiliation(s)
- A M Cerón Enríquez
- Universidad del Sinú, Clínica Oftalmológica de Cartagena, Cartagena, Colombia.
| | - O L Teherán Forero
- Departamento de Glaucoma, Clínica Oftalmológica de Cartagena, Cartagena, Colombia
| | - C Atencia Niño
- Departamento de Retina y Vítreo, Clínica Ebenezer, Cartagena, Colombia
| | | | - E C Ramos Clason
- Grupo de investigación GIBACUS, Escuela de Medicina, Universidad del Sinú, Seccional Cartagena, Cartagena, Colombia
| | - M M Ochoa Díaz
- Grupo de investigación GIBACUS, Escuela de Medicina, Universidad del Sinú, Seccional Cartagena, Cartagena, Colombia
| |
Collapse
|
19
|
Chantarasorn Y, Rasmidatta K, Pokawattana I, Silpa-Archa S. Effects of Ketoconazole on the Clinical Recovery in Central Serous Chorioretinopathy. Clin Ophthalmol 2022; 16:1871-1882. [PMID: 35711967 PMCID: PMC9192783 DOI: 10.2147/opth.s368427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients with hypercortisolism have been associated with a higher prevalence of the pachychoroid spectrum including central serous chorioretinopathy (CSCR), which may explain the inconsistency of therapeutic responses of the mineralocorticoid receptor antagonist because hyperaldosteronism has rarely been detected in patients with CSCR. Therefore, this study aimed to evaluate the effects of ketoconazole, the first-line cortisol inhibitor, on the resolution of subretinal fluid (SRF) in CSCR and to analyze correlations between choroidal thickness and steroid hormones. Patients and Methods This retrospective cohort study included 41 naïve CSCR eyes of 41 patients categorized into control (20 eyes) and treatment (21 eyes) groups. Patients in the treatment group were administered oral ketoconazole at a daily dose of 400 or 600 mg for 3–6 weeks. At week 12, rescue laser therapy was applied to patients exhibiting persistent SRF. Thus, a survival analysis was performed to determine the time interval from presentation to clinical resolution of SRF. Secondary outcomes consisted of eyes with persistent SRF and factors affecting the therapeutic response. Results The mean 24-hour urinary free cortisol (UFC) levels were elevated at 181 ± 70 and 150 ± 68 µg/day (range: 20–150) in the treatment and control groups, respectively (p = 0.21). After controlling for age and gender, baseline UFC levels were significantly associated with choroidal thickness in both eyes (p < 0.05). Ketoconazole significantly increased the CSCR resolution with the median time to resolution of 7 vs 16 weeks (p < 0.01) and decreased the proportion of eyes receiving rescue therapy at 12 weeks (23.8% vs 50%; p = 0.01). Prolonged CSCR durations were likely found in elderly patients with thick choroids in fellow eyes. Conclusion Patients with CSCR showed elevated glucocorticoids, which further correlated with their choroidal thickness. Using cortisol blockers may shorten the duration of existing SRF.
Collapse
Affiliation(s)
- Yodpong Chantarasorn
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, 10300, Thailand
| | - Kochapong Rasmidatta
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, 10300, Thailand
| | - Itsara Pokawattana
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, 10300, Thailand.,Department of Ophthalmology, H.R.H Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, Nakhon Nayok, 26120, Thailand
| | - Sukhum Silpa-Archa
- Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, 10400, Thailand
| |
Collapse
|
20
|
Predicting persistent central serous chorioretinopathy using multiple optical coherence tomographic images by deep learning. Sci Rep 2022; 12:9335. [PMID: 35661150 PMCID: PMC9167285 DOI: 10.1038/s41598-022-13473-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
We sought to predict whether central serous chorioretinopathy (CSC) will persist after 6 months using multiple optical coherence tomography (OCT) images by deep convolutional neural network (CNN). This was a multicenter, retrospective, cohort study. Multiple OCT images, including B-scan and en face images of retinal thickness (RT), mid-retina, ellipsoid zone (EZ) layer, and choroidal layer, were collected from 832 eyes of 832 CSC patients (593 self-resolving and 239 persistent). Each image set and concatenated set were divided into training (70%), validation (15%), and test (15%) sets. Training and validation were performed using ResNet50 CNN architecture for predicting CSC requiring treatment. Model performance was analyzed using the test set. The accuracy of prediction was 0.8072, 0.9200, 0.6480, and 0.9200 for B-scan, RT, mid-retina, EZ, and choroid modalities, respectively. When image sets with high accuracy were concatenated, the accuracy was 0.9520, 0.8800, and 0.9280 for B-scan + RT, B-scan + EZ, and EZ + RT, respectively. OCT B-scan, RT, and EZ en face images demonstrated good performances for predicting the prognosis of CSC using CNN. The performance improved when these sets were concatenated. The results of this study can serve as a reference for choosing an optimal treatment for CSC patients.
Collapse
|
21
|
Kanda S, Zhou HP, Inoue T, Fujino R, Sugiura A, Aoyama Y, Kadonosono K, Maruyama-Inoue M, Obata R, Asaoka R. Predicting retinal sensitivity using optical coherence tomography parameters in central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:3499-3504. [PMID: 35665852 DOI: 10.1007/s00417-022-05717-3] [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: 03/03/2022] [Revised: 05/19/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To predict changes in retinal sensitivity using optical coherence tomography (OCT) in eyes with central serous chorioretinopathy (CSC). METHODS Twenty-three eyes in 23 patients with CSC were enrolled. Retinal sensitivity was measured twice using microperimetry in all the examined eyes. Spectral domain OCT measurements were simultaneously conducted. The relationship between retinal sensitivity and the thicknesses of (i) the retinal nerve fiber layer plus the ganglion cell layer (RNFL + GCL), (ii) the inner nuclear layer (INL), (iii) the outer nuclear layer (ONL), and (iv) the serous retinal detachment height (SRDH) were investigated in a point-wise manner. The associations between the change in retinal sensitivity and the OCT parameters at baseline were also investigated. RESULTS The mean age of the participants was 49.8 ± 10.7 years. The mean SRDH was significantly lower (p < 0.001), and the mean retinal sensitivity (p < 0.001) was significantly higher at the second examination, compared with the first; however, the logMAR visual acuity (VA) did not differ significantly between the two examinations (p = 0.063). The logMAR VA was associated with retinal sensitivity at both the first and second examinations (p < 0.001). The retinal sensitivity at the second examination was significantly correlated with the retinal sensitivity, RNFL + GCL, INL, ONL, and SRDH at the first examination and with the improvement in SRDH. CONCLUSIONS Retinal sensitivity was associated with the retinal structure in eyes with CSC; these parameters could be useful for predicting the change in visual function prior to treatment.
Collapse
Affiliation(s)
- Satoru Kanda
- Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama-shi, Saitama, Japan.,Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Han Peng Zhou
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology and Micro-Technology, Yokohama City University, 4-57 Urafune, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Ryosuke Fujino
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Aya Sugiura
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yurika Aoyama
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology and Micro-Technology, Yokohama City University, 4-57 Urafune, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Maiko Maruyama-Inoue
- Department of Ophthalmology and Micro-Technology, Yokohama City University, 4-57 Urafune, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Ryo Obata
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| |
Collapse
|
22
|
Kiraly P, Smrekar J, Mekjavić PJ. Visual function during and after an acute central serous chorioretinopathy episode. Doc Ophthalmol 2022; 145:27-35. [PMID: 35608741 DOI: 10.1007/s10633-022-09875-x] [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: 02/08/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate visual function parameters during and after an acute central serous chorioretinopathy (CSC) episode. METHODS A prospective study included 19 fovea involving acute CSC patients with episode resolution within 3 months from the episode onset. Optical coherence tomography, best corrected visual acuity (BCVA), contrast sensitivity (CS), microperimetry (MP), and multifocal electroretinography (mfERG) were performed at baseline, 3 and 6 months from the episode onset. In a sub analysis, patients were divided into groups with greater (gMV, N = 9) and lower (lMV, N = 10) macular volume at presentation, and functional outcomes were observed. RESULTS BCVA (p < 0.001), average CS (CS-A) (p < 0.001), average retinal sensitivity (MP-A) (p < 0.001), mfERG amplitude densities in the first and second ring (mfERG-A1, p < 0.001; mfERG-A2, p = 0.017), and implicit times in the first, second, and third ring (mfERG-IT1, p = 0.024; mfERG-IT2, p = 0.002; mfERG-IT3, p = 0.018) improved with episode resolution 3 months after the episode onset. From 3 to 6 months after the episode onset, only CS-A (p = 0.045) continued to improve. Patients in the gMV group had lower mfERG-A1 (p = 0.017) and central retinal sensitivity (MP-C, p = 0.05) 6 months from the episode onset. CONCLUSIONS Although all functional parameters mostly improve with CSC episode resolution, only CS continues to improve thereafter. Patients with greater MV at presentation have worse functional outcomes. Visual function impairment in acute CSC patients is confined to the topographical area of subretinal fluid detachment.
Collapse
Affiliation(s)
- Peter Kiraly
- Eye Hospital, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jaka Smrekar
- Faculty of Mathematics and Physics, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Polona Jaki Mekjavić
- Eye Hospital, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia. .,Faculty of Medicine, University of Ljubljana, 1000, Ljubljana, Slovenia. .,Institute Jožef Stefan, 1000, Ljubljana, Slovenia.
| |
Collapse
|
23
|
Vingopoulos F, Garg I, Kim EL, Thomas M, Silverman RF, Kasetty M, Hassan ZY, Yu G, Joltikov K, Choi EY, Laíns I, Kim LA, Zacks DN, Miller JB. Quantitative contrast sensitivity test to assess visual function in central serous chorioretinopathy. Br J Ophthalmol 2022:bjophthalmol-2021-320415. [PMID: 35292427 DOI: 10.1136/bjophthalmol-2021-320415] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/22/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND To characterise the contrast sensitivity function (CSF) in central serous chorioretinopathy (CSCR) compared with healthy controls using novel computerised contrast sensitivity (CS) testing with active learning algorithms. METHODS Prospective observational study measuring CSF in CSCR eyes and controls using the Manifold Platform (Adaptive Sensory Technology, San Diego, California). Mixed effects multivariate regression models were used. Outcomes included area under the log CSF (AULCSF), CS thresholds at 1, 1.5, 3, 12 and 18 cycles per degree (cpd) and best-corrected visual acuity (BCVA). Associations of contrast outcomes with structural findings on optical coherence tomography (OCT) and subjective symptomatology were investigated. RESULTS Forty CSCR eyes and 89 controls were included with median BCVA logarithm of median angle of resolution 0.10 (20/25) versus 0.00 (20/20), respectively (p=0.01). When accounting for age, CSCR was associated with significantly reduced median AULCSF (p=0.02, β=-0.14) and reduced CS thresholds at 6 cpd (p=0.009, β=-0.18), 12 cpd (p<0.001, β=-0.23) and 18 cpd (p=0.04, β=-0.09), versus controls. Within the CSCR group, subjectively perceived visual impairment (N=22) was associated with significantly decreased CS thresholds at all spatial frequencies and in AULCSF compared with asymptomatic CSCR eyes (N=18). Ellipsoid zone attenuation and subfoveal fluid on OCT were associated with decreased AULCSF and CS thresholds specifically at 3, 6 and 12 cpd, whereas presence of extrafoveal fluid at 1.5 and 3 cpd. CONCLUSION Contrast sensitivity is significantly reduced in CSCR, and strongly correlates with subjective visual impairment. Different structural biomarkers correlate with contrast thresholds reductions at different spatial frequencies.
Collapse
Affiliation(s)
- Filippos Vingopoulos
- Harvard Retinal Imaging Lab, Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA.,Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Itika Garg
- Harvard Retinal Imaging Lab, Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA.,Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Esther Lee Kim
- Harvard Retinal Imaging Lab, Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA.,Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Merina Thomas
- Retina DIvision, Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Rebecca F Silverman
- Harvard Retinal Imaging Lab, Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Megan Kasetty
- Harvard Retinal Imaging Lab, Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Zakariyya Y Hassan
- Harvard Retinal Imaging Lab, Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Gina Yu
- Ophthalmology, Kellogg Eye Center, Univerisy of Michigan, Ann Arbor, MI, USA
| | - Katherine Joltikov
- Ophthalmology, Kellogg Eye Center, Univerisy of Michigan, Ann Arbor, MI, USA
| | - Eun Young Choi
- Harvard Retinal Imaging Lab, Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Inês Laíns
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Leo A Kim
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - David N Zacks
- Ophthalmology, Kellogg Eye Center, Univerisy of Michigan, Ann Arbor, MI, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA .,Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
24
|
Deng K, Gui Y, Cai Y, Liang Z, Shi X, Sun Y, Zhao M. Changes in the Foveal Outer Nuclear Layer of Central Serous Chorioretinopathy Patients Over the Disease Course and Their Response to Photodynamic Therapy. Front Med (Lausanne) 2022; 8:824239. [PMID: 35096914 PMCID: PMC8795370 DOI: 10.3389/fmed.2021.824239] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Kaixin Deng
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yufei Gui
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yi Cai
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Zhiqiao Liang
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Xuan Shi
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yaoyao Sun
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Mingwei Zhao
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| |
Collapse
|
25
|
Penas S, Beato J, Rosinha P, Araújo J, Costa A, Carneiro Â, Falcão-Reis F, Rocha-Sousa A. Longitudinal multimodal functional macular analysis after half-dose photodynamic therapy for central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2021; 37:102704. [PMID: 34954386 DOI: 10.1016/j.pdpdt.2021.102704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Half-dose photodynamic therapy (HD-PDT) has been widely used for central serous chorioretinopathy (CSC) with good anatomical results. However, long-term functional outcomes after this treatment remain uncertain. This study aimed a longitudinal multimodal macular assessment, correlating functional and anatomical outcomes. METHODS This is a retrospective study performed in a tertiary referral center including 111 eyes from 95 CSC patients. Data on best corrected visual acuity (BCVA), central macular thickness (CMT), central retinal sensitivity (CRS) using microperimetry (MP) and multifocal electroretinography (mfERG) at baseline and 3, 6, 12, 18, 24, 36, 48 and 60 months after treatment were registered. A correlation analysis was performed. RESULTS Mean follow-up was 34.5 ± 26.3 months. A significant improvement in BCVA and CMT was registered in all the visits. CRS significantly improved until 24 months (p<0.001 at 12 months, p<0.05 at 24 months), worsening afterwards. The mfERG amplitude of N1 and P1 waves significantly improved in the first 12 months, aggravating afterwards. The implicit time improved until 24 months, deteriorating after 48 months. This long-term decline was also described in some inactive untreated fellow eyes CONCLUSIONS: : A multimodal longitudinal analysis of CSC patients after HD-PDT shows that, after the first 12 to 24 months, the significant sustained improvement in BCVA and CMT is not paired by a sustained improvement in macular sensitivity or electrical response. This long-term functional deterioration might result from the disease itself and not directly from the treatment.
Collapse
Affiliation(s)
- Susana Penas
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto.
| | - João Beato
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Patrícia Rosinha
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Joana Araújo
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Ana Costa
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Ângela Carneiro
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Fernando Falcão-Reis
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Amândio Rocha-Sousa
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| |
Collapse
|
26
|
Enders C, Lang GE, Mayer B, Werner JU. Central Serous Chorioretinopathy: Morphological and Functional Outcome after Subthreshold Thermal Laser Coagulation with a Frequency-Doubled Nd:YAG Continuous-Wave Laser. Ophthalmologica 2021; 245:59-68. [PMID: 34517369 DOI: 10.1159/000519234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Central serous chorioretinopathy (CSCR) presents itself as a serous detachment of the central neurosensory retina (NR), which may be accompanied by focal detachment of the retinal pigment epithelium (RPE) and changes in the RPE itself. It is often self-limiting; however, if the macular region is affected, visual impairment can be serious. If spontaneous remission does not occur, data on the effectiveness of further treatment options are sparse. We therefore decided to examine the effectiveness of subthreshold laser photocoagulation (ST-LP) on best-corrected visual acuity (BCVA) and subretinal fluid (SRF) resorption. We conducted a retrospective analysis of all patients who underwent ST-LP based on the diagnosis of CSCR in a German university eye hospital from 2009 to 2014. METHODS The diagnosis of CSCR was based on the following criteria: detachment of the NR and possibly the RPE visible on ophthalmoscopy, evidence of SRF on optical coherence tomography (OCT), visualization of one or more source points typical for CSCR in fluorescein angiography, and exclusion of differential diagnoses. The time between the anamnestic onset of symptomatic complaints and ST-LP was determined as well as BCVA and OCT before ST-LP. ST-LP was performed as a subthreshold thermal laser coagulation with a frequency-doubled Nd:YAG continuous-wave laser. Follow-up examinations were scheduled at 4, 8, and 12 weeks after ST-LP. RESULTS Fifty-four eyes of 49 patients were included in the study. The median age of patients was 47 years. Eighty-nine percent of the included patients were male. Twenty percent of patients had a first manifestation of CSCR, 69% had a recurrence, and 11% had persistent SRF for >6 months. The median visual acuity rose from 0.30 at baseline (BL) to 0.10 at 4 weeks and 0.00 at 8 weeks, before dropping slightly to 0.05 at 12 weeks. Changes of visual acuity in comparison to BL were statistically significant (p < 0.05). The initial median retinal thickness of 397 μm at BL decreased to 264 μm at 4 weeks, to 236 μm at 8 weeks, and to 239 μm at 12 weeks (decreases to BL all statistically significant p < 0.05). CONCLUSION In our cohort, we were able to achieve substantial and significant clinical benefit through ST-LP measured by improvement in BCVA. Furthermore, we were also able to demonstrate measurable, significant morphological improvements as decreased retinal thickness and increased resorption of SRF as probable mechanisms explaining clinical improvement of CSCR with ST-LP. The advantage of ST-LP over other methods is the low risk of adverse events and its high availability. Controlled, randomized studies are necessary to confirm the data and demonstrate the effect over a longer period of time.
Collapse
Affiliation(s)
- Christian Enders
- Department of Ophthalmology, Ulm University, Ulm, Germany.,MVZ Prof. Neuhann GmbH, Munich, Germany
| | | | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | |
Collapse
|
27
|
Goel N, Mehta A, Gupta AK. Multifocal electroretinography-assisted anatomical and functional evaluation of subthreshold green laser in acute central serous chorioretinopathy. Indian J Ophthalmol 2021; 69:2341-2346. [PMID: 34427217 PMCID: PMC8544059 DOI: 10.4103/ijo.ijo_3401_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: To compare observation versus subthreshold green laser (STL) in acute central serous chorioretinopathy (CSC) in terms of anatomical and functional outcomes. Methods: Prospective randomized interventional study. 30 eyes with the first episode of acute CSC underwent complete ophthalmologic examination, measurement of best-corrected Snellen visual acuity (BCVA), contrast sensitivity (CS), fundus fluorescein angiography (FFA), spectral-domain optical coherence tomography (SD-OCT), and multifocal electroretinography (mfERG) at baseline. Patients were randomized equally to group A (observation) or group B (STL using 532 nm wavelength applied to the leakage point). Outcome measures included BCVA, CS, central foveal thickness (CFT), and mean macular thickness (MMT) on SD-OCT and P1 amplitude and implicit time (IT) on mfERG. Patients were followed up for 6 months. Results: Mean BCVA was comparable between the two groups on follow up; however, mean CS was significantly higher in group B at 6 months (P = 0.032). CFT was significantly lower in group B at 1 month (P = 0.001) and 3 months (P = 0.049); however, this difference was not maintained at 6 months (P = 0.265). P1 amplitude and IT in all 5 rings were comparable between the two groups at baseline. On follow up, P1 amplitude of ring 1 became significantly higher in group B at 3 months (P = 0.036) and 6 months (P = 0.022). Conclusion: Immediate treatment of acute CSC with STL, as compared to conservative management, leads to more rapid resolution on SD-OCT and superior functional outcomes as evidenced by CS and mfERG.
Collapse
Affiliation(s)
- Neha Goel
- Department of Ophthalmology, Max Multi Speciality Centre, New Delhi, India
| | - Aanchal Mehta
- Department of Vitreoretina, ICARE Eye Hospital and Postgraduate Institute, NOIDA, Uttar Pradesh, India
| | - A K Gupta
- Department of Vitreoretina, ICARE Eye Hospital and Postgraduate Institute, NOIDA, Uttar Pradesh, India
| |
Collapse
|
28
|
Tripathy K, Mishra C, Addya S. Commentary: Available evidence on early treatment of central serous chorioretinopathy. Indian J Ophthalmol 2021; 69:2348-2349. [PMID: 34427219 PMCID: PMC8544046 DOI: 10.4103/ijo.ijo_809_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Koushik Tripathy
- Department of Retina, Uvea, and Cataract, ASG Eye Hospital, Kolkata, West Bengal, India
| | - Chitaranjan Mishra
- Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Sujit Addya
- Department of Retina, ASG Eye Hospital, Guwahati, Assam, India
| |
Collapse
|
29
|
Zhou L, Lai K, Jin L, Huang C, Xu F, Gong Y, Li L, Zhu Z, Lu L, Jin C. Subthreshold Micropulse Laser vs. Conventional Laser for Central Serous Chorioretinopathy: A Randomized Controlled Clinical Trial. Front Med (Lausanne) 2021; 8:682264. [PMID: 34336888 PMCID: PMC8322653 DOI: 10.3389/fmed.2021.682264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate the effectiveness and safety of 577-nm subthreshold micropulse laser (SML) on acute central serous chorioretinopathy (CSC). Methods: One hundred and ten patients with acute CSC were randomized to receive SML or 577-nm conventional laser (CL) treatment. Optical coherence tomography and best-corrected visual acuity (BCVA) were performed before and after treatment. Results: At 3 months, the complete resolution of subretinal fluid (SRF) in 577-nm SML group (72.7%) was lower than that in CL group (89.1%) (Unadjusted RR, 0.82; P = 0.029), but it was 85.5 vs. 92.7% at 6 months (unadjusted RR, 0.92; P = 0.221). The mean LogMAR BCVA significantly improved, and the mean central foveal thickness (CFT) significantly decreased in the SML group and CL group (all P < 0.001) at 6 months. But there was no statistical difference between the two groups (all P > 0.05). In the SML group, obvious retinal pigment epithelium (RPE) damage was shown only in 3.64% at 1 month but 92.7% in the CL group (P < 0.001). Conclusions: Although 577-nm SML has a lower complete absorption of SRF compared with 577-nm CL for acute CSC at 3 months, it is similarly effective as 577-nm CL on improving retinal anatomy and function at 6 months. Importantly, 577-nm SML causes less damage to the retina.
Collapse
Affiliation(s)
- Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Kunbei Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yajun Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Longhui Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhe Zhu
- Department of Medicine, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, United States
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
30
|
Li C, Xu F, Zhou L, Zhao H, Yu M, Zhou S, Jin C. Quantitative evaluation of photoreceptor density in chronic central serous chorioretinopathy using the Spectralis High Magnification Module. Photodiagnosis Photodyn Ther 2021; 35:102410. [PMID: 34147696 DOI: 10.1016/j.pdpdt.2021.102410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To quantitatively evaluate the photoreceptor density in patients with chronic central serous chorioretinopathy (cCSC) using the Spectralis High Magnification Module (HMM). METHODS Twenty-four eyes of 24 patients with resolved cCSC, 24 fellow eyes from 24 other patients with unilateral cCSC, and 24 normal eyes of 24 healthy clients were enrolled in this observational case study. Photoreceptor densities of the retina in the nasal, temporal, superior, and inferior areas 500 μm from the central fovea were counted manually through the High Magnification Module (HMM) images using ImageJ software, and the average values were taken for further analysis. RESULTS The mean photoreceptor density 500 μm from the central fovea in the normal eyes (17,217 ± 1144 cells/mm2) was significantly higher than that of both affected eyes (9721 ± 1699 cells/mm2) and fellow eyes (15,667 ± 1909 cells/mm2) (P < 0.001; P = 0.002, respectively). The mean photoreceptor density was significantly correlated with logMAR visual acuity (r = -0.432, P = 0.035), duration of symptoms (r = -0.537, P = 0.007), retinal sensitivity and fixation stability P2 in eyes with resolved cCSC (r = 0.430, P = 0.036; r = 0.420, P = 0.041, respectively). CONCLUSIONS The HMM images revealed significant photoreceptor loss in patients with cCSC. The findings suggest that early intervention of the affected eyes, with short duration and good visual function, might be beneficial in preserving photoreceptor cells. As a novel imaging modality producing fast, high-resolution images, HMM shows great potential to detect microstructural impairments in retinal diseases.
Collapse
Affiliation(s)
- Cong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, China
| | - Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, China
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, China
| | - Hongkun Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, China
| | - Minzhong Yu
- Department of Ophthalmology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Shaobo Zhou
- Department of Ophthalmology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, China.
| |
Collapse
|
31
|
Chubachi A, Miki A, Hayashida M, Sakamoto M, Imai H, Kusuhara S, Nakamura M. Clinical Factors Associated with Low-Contrast Visual Acuity after Reduced-Fluence Photodynamic Therapy in Patients with Resolved Central Serous Chorioretinopathy and Good Baseline Visual Acuity. Pharmaceuticals (Basel) 2021; 14:ph14040303. [PMID: 33800693 PMCID: PMC8066140 DOI: 10.3390/ph14040303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
This retrospective study was conducted to investigate the clinical factors associated with low-contrast visual acuity after reduced-fluence photodynamic therapy (RFPDT) in patients with resolved central serous chorioretinopathy (CSC) and good baseline visual acuity. A total of 45 eyes of 45 patients with resolved CSC at post-RFPDT and best-corrected visual acuity of >1.0 (logarithm of the minimal angle of resolution [logMAR], 0) at baseline were examined. Visual acuities of both eyes were measured at four contrast levels (100%, 25%, 12%, and 6%) at post-RFPDT. The low-contrast visual acuity (6%, 12%, and 25%) was significantly lower than the 100% contrast visual acuity in the affected eyes. Visual acuities of affected eyes were significantly worse than those of fellow eyes at any contrast levels. The degree of changes in 6% and 100% contrast visual acuities was significantly greater in affected eyes than that in fellow eyes (p < 0.05). The 6% contrast visual acuities in affected eyes at post-RFPDT were significantly associated with the symptom duration (p < 0.05). Patients with a long duration of symptoms might have disturbed low-contrast visual acuities at post-RFPDT even if their baseline visual acuities were good.
Collapse
|
32
|
Altinel MG, Kanra AY, Totuk OMG, Ardagil A, Turkmen OF. Comparison of the efficacy and safety between subthreshold micropulse laser, standard-fluence and low-fluence photodynamic therapy for chronic central serous chorioretinopathy. J Fr Ophtalmol 2021; 44:499-508. [PMID: 33642060 DOI: 10.1016/j.jfo.2020.08.027] [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: 07/15/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the efficacy and safety of subthreshold micropulse laser treatment (SML), standard-fluence photodynamic therapy (PDT) and low-fluence PDT in patients with chronic central serous chorioretinopathy (cCSC). METHODS This retrospective study included 52 eyes of 46 patients with chronic CSC who were treated with 577nm SML (n=23), standard-fluence PDT (verteporfin 6mg/m2 and light energy 50J/cm2) (n=13), or low-fluence PDT (verteporfin 6mg/m2 and light energy 25J/cm2) (n=16). The mean changes in best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) parameters, including central retinal thickness (CRT), subretinal fluid (SRF) height, and ellipsoid zone (EZ) disruption, over the follow-up period were evaluated. RESULTS The mean follow-up period was 8.42±3.34 months. In the SML group, the SRF resolution time was longer than the other groups. At 1 month, the SML group's mean CRT was higher than the other groups. The BCVA improvement was statistically significant in all groups (P<0.05), but in the SML group, it was slower than the other groups. Three eyes in the low-fluence and one eye in the standard-fluence PDT group received a second PDT treatment. The mean number of SML treatments was 2.48±1.08. If the EZ was intact, the rate of complete resolution of SRF was higher than if the EZ was disrupted or lost. CONCLUSION SML, standard-fluence PDT, and low-fluence PDT can all improve visual acuity in cCSC. Standard-fluence and low-fluence PDT induced a more rapid reabsorption of the fluid, improvement of BCVA, and equal safety compared with SML. More treatment sessions of SML were required than with the other treatment modalities.
Collapse
Affiliation(s)
- M G Altinel
- Department of Ophthalmology, Saglik Bilimleri University Fatih Sultan Mehmet Training and Research Hospital, 34752 Atasehir, Istanbul, Turkey.
| | - A Y Kanra
- Department of Ophthalmology, Medicana Health Group Camlica, 34692 Uskudar, Istanbul, Turkey
| | - O M G Totuk
- Department of Ophthalmology, Faculty of Medicine, Bahcesehir University, 34734 Kadikoy, Istanbul, Turkey
| | - A Ardagil
- Department of Ophthalmology, Atakoy Dunyagoz Hospital, 34158 Bakirkoy, Istanbul, Turkey
| | - O F Turkmen
- Faculty of Medicine, Bahcesehir University, 34734 Kadikoy, Istanbul, Turkey
| |
Collapse
|
33
|
Fukuyama H, Komuku Y, Gomi F. Characteristics and treatment responses of cystoid retina associated with central serous chorioretinopathy. Jpn J Ophthalmol 2021; 65:372-379. [PMID: 33532933 DOI: 10.1007/s10384-021-00815-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 12/03/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To detect the characteristics of cystoid retina associated with central serous chorioretinopathy (CSC) using multimodal imaging and to evaluate anatomical and functional responses for treatment. STUDY DESIGN A retrospective case series METHOD: This retrospective study included 21 eyes of 17 patients with the treatment for combined cystoid retinal changes and submacular fluid associated with CSC. Multimodal imaging analysis including cross-sectional OCT, en face OCT, fluorescein and indocyanine green angiography, and fundus autofluorescence were performed to assess the characteristics of cystoid changes. In 21 eyes of 17 patients, clinical courses after treatment were reviewed. RESULTS Fourteen of 17 patients were men (82.4%), and the mean age was 63.2. Fluorescein angiography revealed one or more focal leakages in all eyes, and intense leakage, due to peripapillary atrophy and from areas showing retinal pigment epithelial atrophy, was observed in 11 eyes and 12 eyes respectively. En face OCT visualized cystoid retinal changes as honey-comb like areas, and this was observed in the papillomacular region in 16 eyes (76.2%). After reduced-fluence photodynamic therapy (PDT), combination of anti-VEGF and PDT, or photocoagulation, subretinal fluid resolved in 20 eyes (95.2%), and complete resolution of cystoid retinal changes was obtained in 13 eyes (61.9%). CONCLUSION Cystoid retinal changes can be associated with patchy retinal pigment epithelial atrophy and with peripapillary atrophy in CSC eyes. Laser treatment is beneficial for resolving cystoid retina as well as subretinal fluid.
Collapse
Affiliation(s)
- Hisashi Fukuyama
- Department of Ophthalmology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yuki Komuku
- Department of Ophthalmology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| |
Collapse
|
34
|
Vilela M, Mengue C. Central Serous Chorioretinopathy Classification. Pharmaceuticals (Basel) 2020; 14:26. [PMID: 33396886 PMCID: PMC7823356 DOI: 10.3390/ph14010026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Manuel Vilela
- Medical School, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90560-002, Brazil
- Institute of Cardiology, University Foundation of Cardiology, Porto Alegre 90040-371, Brazil;
| | - Carolina Mengue
- Institute of Cardiology, University Foundation of Cardiology, Porto Alegre 90040-371, Brazil;
| |
Collapse
|
35
|
Parajuli A, Joshi P. Factors influencing the episode duration and the anatomical and functional outcome in cases of acute central serous chorioretinopathy. BMJ Open Ophthalmol 2020; 5:e000540. [PMID: 33305002 PMCID: PMC7709512 DOI: 10.1136/bmjophth-2020-000540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/21/2020] [Accepted: 11/08/2020] [Indexed: 11/04/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Purushottam Joshi
- Retina, Pediatric Ophthalmolgy and Strabismus, Cataract, Mechi Eye Hospital, Birtamode, Nepal
| |
Collapse
|
36
|
Short Term Presence of Subretinal Fluid in Central Serous Chorioretinopathy Affects Retinal Thickness and Function. J Clin Med 2020; 9:jcm9113429. [PMID: 33114519 PMCID: PMC7692782 DOI: 10.3390/jcm9113429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Acute central serous chorioretinopathy (CSCR), with subretinal fluid (SRF) resolving spontaneously within a few months from disease onset, has been considered as a benign and self-limiting disease for many years. This study sought to discover if a short presence of SRF can result in morphological and functional damage to the retina. Materials and methods: The study included patients treated by subthreshold diode micropulse laser (SDM) application for acute CSCR at the Dobry Wzrok Ophthalmological Clinic between January 2018 and November 2019. Inclusion criteria were: first episode of CSCR; duration of symptoms of two months or less; complete resolution of subretinal fluid (SRF) after a single session of SDM; and a lack of any retinal pathology, previous CSCR episode, significant anisometropia or amblyopia in the collateral eye. Fifteen patients fulfilled the inclusion criteria, including 13 males and two females aged 42.3 ± 9.5 years. The mean duration of symptoms before treatment was 4.7 ± 1.3 weeks on average. Baseline and follow-up examinations were performed in both the affected and collateral eyes and included best-corrected visual acuity (BCVA); spectral-domain optical coherent tomography measurements such as central retinal thickness (CRT) and minimal foveal thickness (MFT) (at the follow-up visit only); fluorescein angiography (at presentation only) and fundus autofluorescence. The first follow-up visit, when the total resolution of SRF was noted, was conducted between 8 and 12 weeks after SDM. Results: Resolved CSCR eyes had significantly poorer BCVA, CRT, and MFT findings in comparison with healthy collateral eyes (respectively, 0.11 +/− 0.1 vs. 0.01 +/− 0.04 logMAR; 238.80 +/− 23.39 vs. 264.87 +/− 21.22 µm and 178.93 +/− 16.88 vs. 199.47 +/− 17.87 µm) despite the short period of CSCR duration (maximum of 14 ± 2.15 weeks on average). Conclusion: Short presence of SRF typical for acute CSCR can affect retinal function and morphology resulting in poorer visual outcome.
Collapse
|
37
|
Chen LC, Ma JW, Shieh PC, Horng CT. Oral Treatment of Central Serous Chorioretinopathy Patients Using Propranolol Tablets. Pharmaceuticals (Basel) 2020; 13:ph13110336. [PMID: 33114121 PMCID: PMC7690838 DOI: 10.3390/ph13110336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose: To evaluate the pharmacological effects of propranolol treatment of patients with central serous chorioretinopathy (CSCR) over 4 months. Results: Among the 89 male and 31 female patients, the mean BCVA decreased to 0.42 ± 0.08 logMAR during CSCR attacks. Oral propranolol showed good effectiveness in reducing CSCR signs after at least 4 months of treatment. The final BCVA of the patients in groups 1 and 2 was 0.09 ± 0.01 and 0.19 ± 0.03 logMAR, respectively (p < 0.05). Moreover, the mean complete remission time in groups 1 and 2 was 1.9 and 3.5 months, respectively (p < 0.05), while the “success” rate in groups 1 and 2 was 95.0% (57/60) and 78.3% (47/60), respectively (p < 0.05). The recurrence rate in groups 1 and 2 was 5.3% (3/57) and 25.5% (12/47) after a further 5 months of follow-up, respectively (p < 0.05). Materials and Methods: One hundred and twenty patients were enrolled and randomly divided into two groups that both underwent a visual acuity test and optical coherence tomography (OCT) scanning, between April and December 2017. The 60 patients in group 1 were requested to take propranolol for 4 months, while the other 60 subjects (group 2) received placebo therapy during the same period. The best-corrected visual acuity (BCVA) of every volunteer and an OCT image of each patient were checked and recorded at the beginning of the study and each week thereafter. If the signs of CSCR disappeared completely from the OCT scans, the case was considered a “success” and treatment stopped at once. However, the “success” subjects were further evaluated in follow-ups throughout the next 5 months to determine the rate of recurrence in groups 1 and 2. The time of total complete remission of CSCR from the OCT scans was also measured in groups 1 and 2. Conclusion: CSCR patients revealed an excellent prognosis and success rate of 95.0% after taking propranolol. The treatment was able to enhance subretinal fluid (SRF) absorption, shorten the time to total complete remission, and significantly decrease CSCR recurrence. As such, we suggest that taking propranolol may be an alternative and viable choice for CSCR patients, given that the new method was shown to be safe, cheap, effective, well tolerated and convenient.
Collapse
Affiliation(s)
- Li-Chai Chen
- Department of Pharmacy, Tajen University, Pingtung 907, Taiwan; (L.-C.C.); (J.-W.M.); (P.-C.S.)
| | - Jui-Wen Ma
- Department of Pharmacy, Tajen University, Pingtung 907, Taiwan; (L.-C.C.); (J.-W.M.); (P.-C.S.)
| | - Po-Chuen Shieh
- Department of Pharmacy, Tajen University, Pingtung 907, Taiwan; (L.-C.C.); (J.-W.M.); (P.-C.S.)
| | - Chi-Ting Horng
- Department of Pharmacy, Tajen University, Pingtung 907, Taiwan; (L.-C.C.); (J.-W.M.); (P.-C.S.)
- Koahsiung Armed Forces General Hospital, Koahsiung 802, Taiwan
- Correspondence:
| |
Collapse
|
38
|
Current Choroidal Imaging Findings in Central Serous Chorioretinopathy. Vision (Basel) 2020; 4:vision4040044. [PMID: 33081096 PMCID: PMC7712239 DOI: 10.3390/vision4040044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Central serous chorioretinopathy (CSCR) is a chorioretinal disease affecting mostly middle age males. It is marked by the serous detachment of the neurosensory layer at the macula. This review of the literature provides a framework of the current characteristic/relevant imaging findings of CSCR. Although the pathogenesis of CSCR is unclear, the choroid plays a major role and its changes are fundamental to the diagnosis and treatment of CSCR. Methods: A systematic literature search focusing on current multimodal imaging for CSCR was performed. Only articles reporting on original clinical data were selected, studies in a language other than English were included only if an English abstract was provided. Additional sources included articles cited in the references list of the first selected articles. We deduced imaging findings based on current and relevant literature on the topic. Results: We found that sub foveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) were greater in eyes with acute CSCR than in eyes with chronic CSCR or normal eyes. There was increased choroidal thickness (CT) in the macula compared to peripapillary region. In healthy eyes, the highest CVI was found in the nasal region followed by the inferior, temporal, and superior quadrant. The area with the least CVI was the macula. In eyes with CSCR, 100% had asymmetric dominant vortex veins compared to 38% in normal eyes. Conclusion: Choroidal imaging has advanced the diagnosis of CSCR. This has led to numerous imaging biomarkers like CVI, CT, and hyper-reflective dots for early detection and possible prognostication of CSCR. More techniques like wide field scans and en face imaging are being employed to characterize the choroid in CSCR.
Collapse
|
39
|
Nkrumah G, Paez-Escamilla M, Singh SR, Rasheed MA, Maltsev D, Guduru A, Chhablani J. Biomarkers for central serous chorioretinopathy. Ther Adv Ophthalmol 2020; 12:2515841420950846. [PMID: 32923941 PMCID: PMC7448152 DOI: 10.1177/2515841420950846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/27/2020] [Indexed: 01/25/2023] Open
Abstract
Central serous chorioretinopathy (CSCR) is a common chorioretinal disease characterized by serous retinal detachment that most commonly involves the macular region. Although the natural history of the acute form shows a self-limiting course, a significant number of patients suffer from recurrent episodes leading to chronic disease, often leaving patients with residual visual impairment. Visual morbidity is often worsened by a delay in the diagnosis due to the incorrect understanding of the particular biomarkers of the disease. The aim of this review is to provide clinical understanding of the biomarkers of CSCR with an emphasis on the most recent findings in patient demographics, risk factors, clinical imaging findings, and management options. Patients with these biomarkers, age 30–44 years, male gender, increased stress levels, hypercortisolism (endogenous and exogenous exposures), sleep disturbance, pregnancy, and genetic predisposition have increased susceptibility to CSCR. Also, biomarkers on optical coherence tomography (OCT) such as choroidal thickness (CT) and choroidal vascularity index (CVI) showed good diagnostic and prognostic significance in the management of CSCR. There are nonspecific features of CSCR on OCT and OCT angiography such as choroidal neovascularization, photoreceptor alteration/cone density loss, and flat irregular pigment epithelium detachment. We described rare complications of CSCR such as cystoid macular edema (CME) and cystoid macular degeneration (CMD). Patients with CME recovered some vision when treated with anti-vascular endothelial growth factors (anti-VEGFs). Patients with CMD had irreversible macular damage even after treatment with anti-VEGFs.
Collapse
Affiliation(s)
- Gideon Nkrumah
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sumit Randhir Singh
- Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, CA, USA
| | | | - Dmitri Maltsev
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Abhilash Guduru
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
| | - Jay Chhablani
- Faculty-Clinician, UPMC Eye Center, Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA 15213, USA
| |
Collapse
|
40
|
Sudharshan S, Kumar KD, Bhende M, Biswas J, Selvamuthu P. Efavirenz-Associated Retinal Toxicity Presenting with Night Vision Defects in Patients with Human Immunodeficiency Virus. Ocul Immunol Inflamm 2020; 28:1076-1084. [PMID: 32870052 DOI: 10.1080/09273948.2020.1791347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ocular lesions in patients with human immunodeficiency virus (HIV) are commonly due to underlying opportunistic infections. With highly active antiretroviral therapy (HAART), infectious lesions have reduced and noninfectious ocular manifestations including drug-related side effects have been noted. While retinal toxicity has been noted with few other HAART drugs, there are not many on the same with Efavirenz usage. We report a series of five patients with possible efavirenz-related retinal toxicity, visual function abnormalities, and its management. Efavirenz was replaced with alternate anti-retroviral drug. Reversal of ocular side effects were noted subjectively in the form of symptom amelioration of the patients. Objectively, it could be documented with electroretinogram changes and other visual function tests reverting back to normal after change in HAART regime. Early identification of this uncommon side effect in select patients can prevent irreversible vision loss due to efavirenz-associated retinal toxicity.
Collapse
Affiliation(s)
| | - Kolli Dileep Kumar
- Department of Uvea, Medical Research Foundation , Sankara Nethralaya, Chennai
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation , Sankara Nethralaya, Chennai, India
| | - Jyotirmay Biswas
- Department of Uvea, Medical Research Foundation , Sankara Nethralaya, Chennai
| | - Poongulali Selvamuthu
- VHS Infectious Diseases Medical Center, Chennai Antiviral Research and Treatment (CART) Clinical Research Site, Voluntary Health Services , Chennai, India
| |
Collapse
|
41
|
Venkatesh R, Pereira A, Jayadev C, Prabhu V, Aseem A, Jain K, Bavaharan B, Yadav NK, Chhablani J. Oral Eplerenone Versus Observation in the Management of Acute Central Serous Chorioretinopathy: A Prospective, Randomized Comparative Study. Pharmaceuticals (Basel) 2020; 13:ph13080170. [PMID: 32751370 PMCID: PMC7463844 DOI: 10.3390/ph13080170] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022] Open
Abstract
In this prospective, interventional case-control study, 58 patients with unilateral acute central serous chorioretinopathy (CSCR) were recruited. Patients ≥ 18 years age, presenting with first episodes of acute CSCR, were included. Acute CSCR was defined by the presence of subretinal fluid (SRF) and symptoms for <12 weeks duration with no clinical or imaging features of chronicity. Patients were alternately divided into treatment (Table Eplerenone 50 mg/day for minimum 1 month) and observation groups. Vision, SRF height and subfoveal choroidal thickness (SFCT) were checked at 1-, 2- and 3-months in both eyes of each group. Each group had 29 eyes. Mean age was 40.4 ± 7.1 and 43.3 ± 8.34 years in treatment and observation group, respectively. Mean symptom duration was 6.46 ± 1.45 and 5.87 ± 2.09 weeks, respectively. Vision improvement to 6/6 was seen in 92%, 100% and 100% cases in treatment group and 74%, 86% and 100% in control group at each visit, respectively. Complete SRF resolution in the treatment group was noted in 45%, 55% and 62% cases at each respective monthly visit. In the observation group, complete SRF resolution was noted in 10%, 21% and 31% at 1-, 2- and 3-month visits, respectively. SRF (p < 0.001) and SFCT (p < 0.001) reduction was noted in the affected eye of both groups. SFCT was reduced in the fellow eye after treatment (p = 0.005) compared to the observation group (p = 0.276). In conclusion, oral eplerenone achieves faster SRF resolution and vision improvement in acute CSCR. Additionally, it shows beneficial effects on the fellow eye.
Collapse
Affiliation(s)
- Ramesh Venkatesh
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Arpitha Pereira
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Chaitra Jayadev
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Vishma Prabhu
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Aditya Aseem
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Kushagra Jain
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Bharathi Bavaharan
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Naresh Kumar Yadav
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Jay Chhablani
- Department of Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA 15213, USA
- Correspondence: or
| |
Collapse
|
42
|
Missotten TO, Hoddenbach JG, Eenhorst CA, van den Born LI, Martinez Ciriano JP, Wubbels RJ. A randomized clinical trial comparing prompt photodynamic therapy with 3 months observation in patients with acute central serous chorioretinopathy with central macular leakage. Eur J Ophthalmol 2020; 31:1248-1253. [PMID: 32264706 DOI: 10.1177/1120672120915168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to demonstrate whether photodynamic therapy in patients with acute central serous chorioretinopathy, with the leakage point within one optic disk diameter from the fovea, can be safely deferred. METHODS A single-center, randomized, controlled trial was conducted. Patients were randomized to photodynamic therapy within a week after presentation (Group I, 26 patients) or observation during 3 months (Group II, 26 patients). If leakage or subretinal fluid was observed during any control visit, photodynamic therapy was performed (again) within a week. PRIMARY OUTCOME Primary outcome was change of visual acuity (Early Treatment Diabetic Retinopathy Study) after 12 months. Secondary outcomes were visual acuity, central foveal thickness, metamorphopsia, and color discrimination. RESULTS Photodynamic therapy procedures: group I, 26 at baseline, 2 retreatments at 3 months; group II, 10 at 3 months, 1 at 6 months (2 subjects refusing treatment), 2 retreatments at 6 months. At 12 months, mean visual acuity of all patients had improved by 6.5 letters (P < 0.001), mean central foveal thickness was 172 µm less (P < 0.001). After photodynamic therapy, visual acuity recovered faster and metamorphopsia significantly improved (3 months, P < 0.001). Differences between groups at 12 months were not significant. CONCLUSION The (intended) number of photodynamic therapy (re)treatments in group II (n = 15) was 46% less than in group I (n = 28). Visual acuity and central foveal thickness at 12 months were similar. Therefore, the preferred management of acute central serous chorioretinopathy at presentation appears to be observation for 3 months.
Collapse
Affiliation(s)
| | - Johan G Hoddenbach
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands.,Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | - Christine Ae Eenhorst
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands.,Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | | | | | - René J Wubbels
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands.,Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| |
Collapse
|
43
|
Semeraro F, Morescalchi F, Russo A, Gambicorti E, Pilotto A, Parmeggiani F, Bartollino S, Costagliola C. Central Serous Chorioretinopathy: Pathogenesis and Management. Clin Ophthalmol 2019; 13:2341-2352. [PMID: 31819359 PMCID: PMC6897067 DOI: 10.2147/opth.s220845] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/21/2019] [Indexed: 01/15/2023] Open
Abstract
Central serous chorioretinopathy (CSC) is a common retina disease and has a relative high recurrence rate, etiology, and pathogenesis of which remains largely ambiguous. The effects on the retina are usually self-limited, although some people are left with permanent vision loss due to progressive and irreversible photoreceptor damage or retinal pigment epithelium atrophy. There have been a number of interventions used in CSC, including, but not limited to, laser treatment, photodynamic therapy (PDT), intravitreal injection of anti-vascular endothelial growth factor agents, and subthreshold lasers. It is not clear whether there is a clinically important benefit to treating acute CSC, which often resolves spontaneously as part of its natural history. Of the interventions studied to date, PDT and micropulse laser treatment appear the most promising.
Collapse
Affiliation(s)
- Francesco Semeraro
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Morescalchi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Russo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Elena Gambicorti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Francesco Parmeggiani
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Silvia Bartollino
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Ciro Costagliola
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| |
Collapse
|
44
|
van Rijssen TJ, van Dijk EHC, Yzer S, Ohno-Matsui K, Keunen JEE, Schlingemann RO, Sivaprasad S, Querques G, Downes SM, Fauser S, Hoyng CB, Piccolino FC, Chhablani JK, Lai TYY, Lotery AJ, Larsen M, Holz FG, Freund KB, Yannuzzi LA, Boon CJF. Central serous chorioretinopathy: Towards an evidence-based treatment guideline. Prog Retin Eye Res 2019; 73:100770. [PMID: 31319157 DOI: 10.1016/j.preteyeres.2019.07.003] [Citation(s) in RCA: 255] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 12/17/2022]
Abstract
Central serous chorioretinopathy (CSC) is a common cause of central vision loss, primarily affecting men 20-60 years of age. To date, no consensus has been reached regarding the classification of CSC, and a wide variety of interventions have been proposed, reflecting the controversy associated with treating this disease. The recent publication of appropriately powered randomised controlled trials such as the PLACE trial, as well as large retrospective, non-randomised treatment studies regarding the treatment of CSC suggest the feasibility of a more evidence-based approach when considering treatment options. The aim of this review is to provide a comprehensive overview of the current rationale and evidence with respect to the variety of interventions available for treating CSC, including pharmacology, laser treatment, and photodynamic therapy. In addition, we describe the complexity of CSC, the challenges associated with treating CSC, and currently ongoing studies. Many treatment strategies such as photodynamic therapy using verteporfin, oral mineralocorticoid antagonists, and micropulse laser treatment have been reported as being effective. Currently, however, the available evidence suggests that half-dose (or half-fluence) photodynamic therapy should be the treatment of choice in chronic CSC, whereas observation may be the preferred approach in acute CSC. Nevertheless, exceptions can be considered based upon patient-specific characteristics.
Collapse
Affiliation(s)
- Thomas J van Rijssen
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Suzanne Yzer
- Department of Ophthalmology, Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Graduate School, Tokyo, Japan
| | - Jan E E Keunen
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre 162, London, United Kingdom
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, West Wing, Oxford, United Kingdom
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Jay K Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, India
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong; 2010 Retina & Macula Centre, Tsim Sha Tsui, Kowloon, Hong Kong
| | - Andrew J Lotery
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands.
| |
Collapse
|
45
|
Romdhane K, Zola M, Matet A, Daruich A, Elalouf M, Behar-Cohen F, Mantel I. Predictors of treatment response to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for choroidal neovascularisation secondary to chronic central serous chorioretinopathy. Br J Ophthalmol 2019; 104:910-916. [PMID: 31615761 DOI: 10.1136/bjophthalmol-2019-314625] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/02/2019] [Accepted: 10/02/2019] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of anti-vascular endothelial growth factor (VEGF) therapy on choroidal neovascularisation (CNV) complicating central serous chorioretinopathy (CSC) using multimodal imaging, and to identify possible predictive factors of the treatment response. DESIGN Retrospective study. METHODS Data of 27 eyes with CNV complicating CSC treated with anti-VEGF therapy (either ranibizumab or aflibercept) were reviewed. Response to anti-VEGF treatment was evaluated by change in visual acuity, intra/subretinal fluid modifications and CNV changes on optical coherence tomography angiography (OCTA). Univariate and multivariate analyses were performed to identify predictive factors for central retinal thickness (CRT) change and for the relative degree of treatment response (complete, incomplete or absent fluid reduction). RESULTS CRT was significantly reduced at 32±15 days after 2.8±1.3 injections (p=0.0004) as was the subretinal fluid (p=0002). Complete fluid resorption was observed in 45% of cases. Best corrected visual acuity did not significantly improve (p=0.18). CNV area (p=0.09) and CNV flow area (p=0.07) did not significantly decrease. No changes in CNV pattern were noted. Univariate analysis identified greater CRT at baseline (p<0.0001), greater amount of subretinal fluid (p<0.0001), a shorter period of retinal fluid (p=0.04) and female gender (p=0.04) as predictors for CRT reduction. After multivariate analysis the factor of greater CRT at baseline (p<0.0001) proved independent. The degree of treatment response was dependent on the size of CNV surface (p=0.05) and flow area (p=0.05) on OCTA in the univariate analysis, and the latter independent after multivariate analysis. In addition, a shorter time period of retinal fluid appeared to play a role (p=0.01 multivariate, p=0.19 univariate). CONCLUSION The anti-VEGF response was highly variable and often incomplete, suggesting that CNV was not solely responsible for the fluid accumulation. Predictive factors may guide indication for anti-VEGF in CNV associated with CSC.
Collapse
Affiliation(s)
- Khaled Romdhane
- Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Marta Zola
- Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Alexandre Matet
- Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Alejandra Daruich
- Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Martine Elalouf
- Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | | | - Irmela Mantel
- Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| |
Collapse
|
46
|
Focal and Diffuse Chronic Central Serous Chorioretinopathy Treated With Half-Dose Photodynamic Therapy or Subthreshold Micropulse Laser: PLACE Trial Report No. 3. Am J Ophthalmol 2019; 205:1-10. [PMID: 30951686 DOI: 10.1016/j.ajo.2019.03.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/14/2019] [Accepted: 03/22/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare the outcome between high-density subthreshold micropulse laser (HSML) treatment and half-dose photodynamic therapy (PDT) in chronic central serous chorioretinopathy (cCSC) patients, subdivided based on either focal or diffuse leakage on fluorescein angiography (FA). DESIGN Retrospective analysis of multicenter randomized controlled trial data. METHODS Patients were treated with either half-dose PDT or HSML (both indocyanine green angiography-guided) and categorized in 2 groups, based on focal or diffuse leakage on FA. Clinical outcomes were evaluated at baseline and during follow-up. RESULTS In the focal leakage group (63 patients), both at first evaluation and at final visit, more PDT-treated than HSML-treated patients demonstrated a resolution of subretinal fluid (evaluation visit 1: 57% in the PDT group and 17% in the HSML group, P = .007; final visit: 75% and 38%, P = .012). In the diffuse leakage group (93 patients), both at first evaluation and at final visit, more PDT-treated than HSML-treated patients showed a resolution of subretinal fluid (evaluation visit: 1:48% in the PDT group and 16% in the HSML group, P = .002; final visit: 67% and 21%, P = .002). PDT-treated patients in the focal and diffuse leakage group had a higher retinal sensitivity increase, comparing baseline and final visit (+3.1 ± 3.1 dB vs +1.2 ± 4.0 dB, P = .048, and +2.7 ± 3.3 dB vs +1.0 ± 3.8 dB, P = .036, respectively). Only in the diffuse leakage group, the increase in ETDRS letters was higher in the PDT-treated group when comparing baseline and first evaluation visit (+4.4 ± 6.1 vs +0.9 ± 10.0, P = .049). CONCLUSIONS Half-dose PDT is superior to HSML treatment in cCSC patients, regardless of the presence of focal or diffuse leakage on FA.
Collapse
|
47
|
Association between visual function and the integrity of residual ellipsoid zone in resolved central serous chorioretinopathy. Sci Rep 2019; 9:12433. [PMID: 31455795 PMCID: PMC6711978 DOI: 10.1038/s41598-019-48825-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022] Open
Abstract
Central serous chorioretinopathy (CSC) usually resolves spontaneously; however, in some patients, it can be chronic and visual impairment remains even after resolution of the serous retinal detachment. The impaired photoreceptor cells often present with disrupted ellipsoid zone (EZ) on optical coherence tomography (OCT). In this study, the integrity of EZ was quantified by calculating the index of residual EZ, identified on binarized OCT images from 25 eyes of 23 patients with resolved CSC. To estimate residual EZ, integrity of residual EZ with the central horizontal line on the fovea (rEZc) and average integrity of residual EZ within 3 × 3-mm macular area (rEZave) were investigated. The interrater reliability of the method was assessed using the intraclass correlation coefficient (ICC). The relationship between LogMAR VA and age, central retinal thickness, central choroidal thickness, rEZc, and rEZave were evaluated using the linear mixed model. Retinal sensitivity was measured with the MP-3 microperimeter and similar analyses were iterated for mean retinal sensitivity (MS). ICC values were 0.938 with rEZc and 0.979 with rEZave. rEZc was significantly related to LogMAR VA (p = 0.039). rEZave was significantly related to MS (p < 0.001). These results suggested potential usefulness of residual EZ to predict visual function in resolved CSC.
Collapse
|
48
|
Kim YJ, Kim SY, Ha S, Moon D, Seong S, Kwon OW, Park HS. Short-duration multiple-session subthreshold micropulse yellow laser (577 nm) for chronic central serous chorioretinopathy: results at 3 years. Eye (Lond) 2019; 33:819-825. [PMID: 30610228 DOI: 10.1038/s41433-018-0309-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/01/2018] [Accepted: 11/17/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To review the 3-year follow-up results of subthreshold micropulse yellow laser (SMYL) delivered by a short-duration multiple-session method for treatment of chronic central serous chorioretinopathy (CSC). METHODS A total of 27 eyes from 27 patients with chronic CSC available for 3 years of follow-up were enrolled in this retrospective and interventional study. Patients were treated with 577-nm SMYL photocoagulation at a 15% duty cycle over multiple sessions, with low power ranging from 200 to 400 mW that was increased in 100 mW increments according to resolution of subretinal fluid at monthly follow-up. Laser titration was not performed. A treatment duration of 20 ms rather than the conventional duration (100-300 ms) was applied over the area of retinal pigment epithelium leakage and all areas of serous retinal detachment, including the fovea. RESULTS The mean follow-up period was 3.7 ± 0.8 years (range, 3-6 years). A total of 22 out of 27 eyes (81.5%) including six cases of recurrence during the follow-up period exhibited complete resolution of subretinal detachment at final follow-up, whereas only five eyes (15.5%) had either a partial or null response to SMYL treatment. The baseline best-corrected visual acuity was 0.26 ± 0.24 logarithm of the minimum angle of resolution (logMAR), which was improved to 0.08 ± 0.15 logMAR at 1-year (p = 0.005) and 3-year (p = 0.01) follow-up. The central macular thickness at baseline was 389.6 ± 103.4 μm, which was changed to 197.2 ± 40.0 μm (p < 0.001) at 1-year follow-up, 196.4 ± 40.2 μm (p < 0.001) at 3-year follow-up. CONCLUSION Short-duration multiple-session SMYL therapy may be effective for long-term treatment of chronic CSC.
Collapse
Affiliation(s)
- Yang Jae Kim
- Retina Center, Nune Eye Hospital, Daegu, Republic of Korea
| | - Si Yeol Kim
- Retina Center, Nune Eye Hospital, Daegu, Republic of Korea
| | - Seungmin Ha
- Retina Center, Nune Eye Hospital, Daegu, Republic of Korea
| | - Daruchi Moon
- Retina Center, Nune Eye Hospital, Daegu, Republic of Korea
| | - San Seong
- Retina Center, Nune Eye Hospital, Daegu, Republic of Korea
| | - Oh Woong Kwon
- Retina Center, Nune Eye Hospital, Seoul, Republic of Korea
| | - Han Sang Park
- Retina Center, Nune Eye Hospital, Daegu, Republic of Korea.
| |
Collapse
|
49
|
Sahoo NK, Singh SR, Rajendran A, Shukla D, Chhablani J. Masqueraders of central serous chorioretinopathy. Surv Ophthalmol 2019; 64:30-44. [DOI: 10.1016/j.survophthal.2018.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/23/2018] [Accepted: 09/07/2018] [Indexed: 11/26/2022]
|
50
|
Venkatesh R, Agarwal M, Kantha M. Efficacy of oral rifampicin in chronic central serous chorioretinopathy. Ther Adv Ophthalmol 2018; 10:2515841418807130. [PMID: 30349901 PMCID: PMC6195004 DOI: 10.1177/2515841418807130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/31/2018] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate the role of oral rifampicin in the management of chronic central serous chorioretinopathy. Methods: Retrospective analysis of patients diagnosed with chronic central serous chorioretinopathy (duration >3 months) and treated with oral rifampicin 600 mg daily for a maximum period of 3 months was carried out. Baseline visual acuity, fundus fluorescein angiography, and optical coherence tomography were recorded and the patients were followed up. Resolution of subretinal fluid and improvement in visual acuity were the main outcome measures. Recurrence of subretinal fluid was noted. Any adverse reaction to the drug was monitored. Results: Nine eyes of eight patients were included in the study. The average age of the patients was 41.90 years (range 32–52 years). Mean duration of symptoms was 16 months (range 3–60 months). Mean duration of follow-up was 10.11 months (range 3–33 months). Fluorescein angiography showed four eyes with subfoveal leaks and five eyes with diffuse retinal pigment epitheliopathy. Complete resolution of subretinal fluid was achieved in four of the nine eyes – two patients at the end of 1 month, one patient each at the end of 2 and 3 months, respectively. Visual acuity improvement was noted in four of the nine eyes. Three patients had one-line improvement and one patient had a two-line visual improvement. None of the patients had severe adverse events for which the drug had to be discontinued. None of the patients had recurrence of subretinal fluid after the discontinuation of the drug. Conclusion: Oral rifampicin could provide a useful, effective, and cost-effective alternative for treatment of patients with chronic central serous choroidopathy and evidence of healthier retinal pigment epithelium, those with focal leakage. It was not effective in eyes with diffuse retinal pigment epitheliopathy.
Collapse
Affiliation(s)
| | | | - Meha Kantha
- Dr. Shroff's Charity Eye Hospital, New Delhi, India
| |
Collapse
|