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Kiraly P, Smrekar J, Jaki Mekjavić P. Morphological parameters predicting subthreshold micropulse laser effectiveness in central serous chorioretinopathy. Lasers Med Sci 2022; 37:3129-3136. [PMID: 35579726 DOI: 10.1007/s10103-022-03574-4] [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: 02/10/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this prospective study was to predict the effectiveness of subthreshold micropulse laser (SML) based on morphological parameters in patients with central serous chorioretinopathy (CSC). METHODS Thirty-one patients were examined at presentation, 3 months, and 6 months after the disease onset. In patients with persistent subretinal fluid (SRF) at 3 months, SML was performed. The following morphological parameters were observed just before treatment: central retinal thickness (CRT), maximal SRF, choroidal thickness (CT), pigment epithelial detachment (PED) height and width, number of hyperreflective foci (HF) at fovea and leakage site, secondary choroidal neovascularization (CNV), and severity of retinal pigment epithelium (RPE) alterations using multimodal imaging. RESULTS Good response was associated with lower SRF (p = 0.038), narrower PED (p = 0.078), and decreasing number of HF at fovea (difHFf) (p = 0 .016) just before the treatment. From a bivariate and multivariate point of view, the two groups differed significantly in the pair (SRF, PED width) (p = 0.048) and in the triple (SRF, PED width, difHFf) (p = 0.026). CONCLUSION Lower SRF, narrower PED, and decreasing HF could be associated with good response to SML in CSC patients.
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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.
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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.
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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;
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Predictive factors of selective mineralocorticoid receptor antagonist treatment in chronic central serous chorioretinopathy. Sci Rep 2020; 10:16621. [PMID: 33024222 PMCID: PMC7538998 DOI: 10.1038/s41598-020-73959-4] [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: 06/15/2020] [Accepted: 09/21/2020] [Indexed: 11/08/2022] Open
Abstract
AbstractTo compare the macular morphology of good and poor responders to eplerenone treatment in chronic central serous chorioretinopathy (CSCR) patients. Thirty eyes of 29 patients with chronic CSCR were treated with 50 mg/day oral eplerenone and followed up for 1 year. The integrity of outer retinal layers at baseline was assessed using optical coherence tomography. Patients who showed complete resolution of subretinal fluid at 1 year were assigned to the good responder group (Group 1), whilst those who showed moderate or no resolution were classified as poor responders (Group 2). Ellipsoid zone interruption, ELM interruption and hyperreflective foci in outer segment (OS) and outer nuclear layer (ON layer) was significantly more frequent in Group 2 than in Group 1 (p < 0.05 for all parameteres). Outer segment elongation was significantly more frequently seen in Group 1 than in Group 2 (p < 0.05) Multivariable regression analysis showed that intact ellipsoid zone at baseline is an independent predictor of good therapeutic response, with an odds ratio of 26.00 (95% CI 3.69–183.45; p = 0.001) after controlling for the effect of hyperreflective foci and ELM integrity. There is higher chance of the resolution of subretinal fluid after eplerenone treatment in CSCR patients with intact outer retinal layers at baseline. Baseline morphologic evaluation of the outer retinal layers on OCT scans can be useful in predicting the response to mineralocorticoid antagonist therapy in these patients.
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Sahoo NK, Govindhari V, Bedi R, Goud A, Singh R, Wu L, Chhablani J. Subretinal hyperreflective material in central serous chorioretinopathy. Indian J Ophthalmol 2020; 68:126-129. [PMID: 31856489 PMCID: PMC6951218 DOI: 10.4103/ijo.ijo_265_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To describe the the appearance and behavior of subretinal hyperreflective material (SHRM) in eyes with central serous chorioretinopathy (CSCR). Methods: This retrospective study included 20 eyes of 20 patients with CSCR presenting with SHRM, defined as sub-retinal deposits that appear hyper-reflective on OCT The eyes underwent either laser (15 eyes) or observation (5 eyes). Optical coherence tomography and fundus fluorescein angiography (FFA) characteristics were analyzed at baseline and resolution of neurosensory detachment, which were then co-related with the visual acuity at resolution. Results: Improvement in vision was seen in 16 eyes. Ellipsoid zone damage (P = 0.03) and external limiting membrane (ELM) damage (P = 0.000) at resolution; diffuse retinal pigment epithelium (RPE) abnormalities on FFA (P = 0.04), and the presence of scar (P = 0.000), were associated with poor visual outcome in univariate analysis. ELM damage at resolution was statistically significant (P = 0.001) in multivariate analysis. Conclusion: CSCR with SHRM have a good visual prognosis. ELM damage at resolution corelates with a poor visual acuity at resolution.
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Affiliation(s)
- Niroj K Sahoo
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases , L V Prasad Eye Institute, Hyderabad, India
| | - Vishal Govindhari
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases , L V Prasad Eye Institute, Hyderabad, India
| | - Rumneek Bedi
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases , L V Prasad Eye Institute, Hyderabad, India
| | - Rishi Singh
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lihteh Wu
- Department of Ophthalmology, Instituto de Cirugia Ocular, San Jose, Costa Rica
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases , L V Prasad Eye Institute, Hyderabad, India
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Suwal B, Khadka D, Shrestha A, Shrestha S, Shrestha N, Khatri B. Baseline Predictive Factors of Visual Outcome and Persistence of Subretinal Fluid Based on Morphologic Changes in Spectral Domain Optical Coherence Tomography in Patients with Idiopathic Central Serous Chorioretinopathy. Clin Ophthalmol 2019; 13:2439-2444. [PMID: 31849441 PMCID: PMC6910099 DOI: 10.2147/opth.s233273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background To determine the influence of spectral domain optical coherence tomography (OCT) changes on visual outcome and persistence of subretinal fluid (SRF) in patients with idiopathic central serous chorioretinopathy (CSCR). Materials and methods In a retrospective study done in 48 eyes of 45 patients diagnosed as CSCR, all eyes were subjected to fundus photography, spectral domain OCT, and fluorescein angiography (FA) in selected cases. Results Retinal pigment epithelium detachment was present in 22.91% of the cases at presentation. The logMar best corrected visual acuity improved from 0.46±0.29 at presentation to 0.18±0.22 at 3 months (P-value<0.01). The mean foveal thickness was 486.81±146.06 µm at presentation and 259±94.5 µm at 3 months (P-value<0.01) (paired T-test). OCT factors that were associated with poor visual outcome (BCVA>0.3 logMar) were disruption in the inner segment (IS)/outer segment (OS) junction or external limiting membrane (ELM) line and hyper-reflective dots in the intra/subretinal layer (P-value<0.05) (Fischer’s Exact test). Out of the total 48 eyes, 26 had persistent SRF at 3 months. The presence of discontinuation in IS/OS junction and hyper-reflective dots in the intra/subretinal layer were the only two OCT factors that were associated with the persistence of SRF (P-value<0.01) (Pearson’s Chi-square test). Conclusion Visual outcome and persistence of subretinal fluid at 3 months can be predicted on the basis of early morphologic changes in OCT. This will aid in counseling patients regarding its course and may guide us in its management.
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Affiliation(s)
- Barsha Suwal
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
| | - Deepak Khadka
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
| | - Arjun Shrestha
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
| | - Sangeeta Shrestha
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
| | - Nirsara Shrestha
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
| | - Bijay Khatri
- Department of Academics and Research, Hospital for Children, Eye, ENT, Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
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Gender variation in central serous chorioretinopathy. Eye (Lond) 2018; 32:1703-1709. [PMID: 29988073 DOI: 10.1038/s41433-018-0163-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/06/2018] [Accepted: 05/27/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Comparison of presentation and outcomes of central serous chorioretinopathy (CSC) between male and female subjects in different ethnic populations. METHODS Retrospective comparison between male and female subjects with CSC was completed. Demographic details, clinical presentations, imaging features and treatment outcomes were compared at baseline and at last follow-up. RESULTS This study included 155 male and 155 female subjects with a mean (CSD) age of 43.8 ± 10.3 and 57.0 ± 12.1 years, respectively, and a mean duration of follow-up of 8.49 ± 12.6 months. At presentation, there was no difference in visual acuity; however, visual acuity was significantly higher for female subjects at last follow-up (p = 0.02). Optical coherence tomography (OCT) analysis showed that subretinal deposits (p < 0.001), hyperreflective foci (p = 0.001), retinal pigment epithelial detachment (p = 0.01) and retinal pigment epithelium (RPE) irregularities (p = 0.03) were higher in male subjects at presentation. Angiographic analysis showed that diffuse leakage and RPE tracts were common in males (p = 0.01 and p = 0.02). No significant differences in choroidal dilatation or diffuse choroidal leakages were noted. CONCLUSIONS Female subjects with CSC appear to have better outcomes, with less chances of diffuse RPE damage and other OCT features compared to males.
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Daruich A, Matet A, Dirani A, Bousquet E, Zhao M, Farman N, Jaisser F, Behar-Cohen F. Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis. Prog Retin Eye Res 2015; 48:82-118. [DOI: 10.1016/j.preteyeres.2015.05.003] [Citation(s) in RCA: 425] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/10/2015] [Accepted: 05/14/2015] [Indexed: 02/08/2023]
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Mansour AM, Arevalo JF, Badal J, Moorthy RS, Shah GK, Zegarra H, Pulido JS, Charbaji A, Amselem L, Lavaque AJ, Casella A, Ahmad B, Paschall JG, Caimi A, Staurenghi G. Paraproteinemic maculopathy. Ophthalmology 2014; 121:1925-32. [PMID: 24950591 DOI: 10.1016/j.ophtha.2014.04.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/06/2014] [Accepted: 04/09/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Paraproteinemia relates to monoclonal gammopathy-producing pathologic antibodies with serous macular detachment being an uncommon ocular manifestation. We ascertained the clinical course of maculopathy in paraproteinemia and investigated the effect of various therapeutic methods on the resolution of subretinal deposits. DESIGN Multicenter, retrospective, observational case series. PARTICIPANTS The records of patients with paraproteinemia with optical coherence tomography (OCT) documentation of serous macular detachment were reviewed. METHODS Data collection included coexisting morbidity, rheology data (immunoglobulin level, hematocrit, and blood viscosity), clinical examination results, and OCT findings. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), height and basal area of the serous macular detachment, and systemic versus local therapies. RESULTS A total of 33 cases were collected: 10 new and 23 previously reported in the literature. Diabetes was present in 7 patients, systemic hypertension in 9 patients, and anemia in 18. Mean initial immunoglobulin level was 6497 mg/dl, and mean serum viscosity was 5.5 centipoise (cP). Mean logarithm of the minimum angle of resolution initial vs. final BCVA was 0.55 (Snellen equivalent, 20/71) vs. 0.45 (20/56) in the right eye and 0.38 (20/48) vs. 0.50 (20/63) in the left eye. After mean follow-up of 7 months (range, 0-51 months). Systemic therapies included plasmapheresis (18), chemotherapy (30), blood transfusions (2), transplantation of progenitor hematopoietic cells (2), and oral rituximab (10). Immunoglobulin levels normalized in 8 patients and were unchanged in 1 after plasmapheresis, chemotherapy, or both. Ocular therapy in 8 patients included vitrectomy (1), laser photocoagulation (4), intravitreal bevacizumab (5), intravitreal triamcinolone (2), intravitreal dexamethasone implant (1), intravitreal rituximab (1), and sub-Tenon corticosteroid (1). The maculopathy resolved partially or completely in 17 patients and worsened or remained unchanged in 14 patients over median follow-up of 7 months. Maculopathy was unilateral in 9 cases and occurred at a lower initial immunoglobulin level in diabetics. There was a positive correlation between area of the detachment and serum viscosity. CONCLUSIONS Paraproteinemic maculopathy can be unilateral. Decreasing the blood immunoglobulin level is the primary goal of therapy for paraproteinemic maculopathy, and this can be achieved by a systemic route. Coexisting diabetes facilitates leakage of immunoglobulins at lower levels than in nondiabetics.
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Affiliation(s)
- Ahmad M Mansour
- Departments of Ophthalmology, American University of Beirut and Rafic Hariri University Hospital, Beirut, Lebanon.
| | - J Fernando Arevalo
- Retina Departments, The King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia, and Wilmer Eye Institute, The Johns Hopkins University, Baltimore, Maryland
| | - Josep Badal
- Department of Ophthalmology, Hospital Moises Broggi Sant Joan Despi, Barcelona, Spain
| | - Ramana S Moorthy
- Associated Vitreoretinal and Uveitis Consultants, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Abdulrazzak Charbaji
- Department of Statistics and Research Methodology, Lebanese American University and Lebanese University, Beirut, Lebanon
| | - Luis Amselem
- Department of Ophthalmology, Hospital Moises Broggi Sant Joan Despi, Barcelona, Spain
| | | | - Antonio Casella
- Department of Ophthalmology, Universidade Estadual de Londrina, Parana, Brazil
| | | | - Joshua G Paschall
- Associated Vitreoretinal and Uveitis Consultants, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Antonio Caimi
- Department of Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Department of Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy
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