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Toh N, Hashimoto Y, Kuwahara F, Yoshimura M, Imabayashi S, Yoshitomi T. Choroidal Thickness Increases During Parasympathetic Dominance After Immersion of the Foot in Warm Water. Cureus 2024; 16:e53194. [PMID: 38425624 PMCID: PMC10902740 DOI: 10.7759/cureus.53194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE This study aimed to assess the course of changes in choroidal morphology after immersion of the foot in warm water at 40°C using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS Forty-three right eyes of 43 healthy participants were included. Changes in choroidal morphology were determined using EDI-OCT to evaluate subfoveal choroidal thickness (SCT). Systolic, diastolic, and mean blood pressures (SBP, DBP, and MBP, respectively) were also measured to determine systemic circulatory dynamics at baseline, immediately after immersion (0 min), and 10, 20, and 30 min after immersion. RESULTS Immediately after immersion, SBP, DBP, and MBP were significantly declined versus baseline. In contrast, the SCT was significantly increased after warm water immersion. However, all these parameters did not change significantly compared to the baseline within 30 min. CONCLUSION In the normal eye, parasympathetic nerve activity induced by warming stimuli increases choroidal morphology in response to a decrease in systemic circulatory activity, which normalizes within 30 min. The findings of this study may provide basic data for the prevention and treatment of various choroidal diseases in which sympathetic hyperactivity is involved in the pathogenesis.
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Affiliation(s)
- Natsumi Toh
- Department of Orthoptics, Fukuoka International University of Health and Welfare, Fukuoka, JPN
| | - Yuki Hashimoto
- Department of Orthoptics, Fukuoka International University of Health and Welfare, Fukuoka, JPN
| | - Fuka Kuwahara
- Department of Orthoptics, Fukuoka International University of Health and Welfare, Fukuoka, JPN
| | - Miki Yoshimura
- Department of Orthoptics, Fukuoka International University of Health and Welfare, Fukuoka, JPN
| | - Sakurako Imabayashi
- Department of Orthoptics, Fukuoka International University of Health and Welfare, Fukuoka, JPN
| | - Takeshi Yoshitomi
- Department of Orthoptics, Fukuoka International University of Health and Welfare, Fukuoka, JPN
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Huang YT, Wan L, Cheng YD, Yu TS, Hung YT, Rujikajorn K, Chen JJY, Wu MY, Tsai FJ, Lin HJ, Tien PT. Increased risk of glaucoma development in patients with central serous chorioretinopathy: results of a 11-year population-based cohort study. Graefes Arch Clin Exp Ophthalmol 2023; 261:3457-3464. [PMID: 37581651 DOI: 10.1007/s00417-023-06201-2] [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: 06/02/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023] Open
Abstract
PURPOSE To investigate whether patients with central serous chorioretinopathy (CSC) have increased risk of developing glaucoma. METHODS Patients diagnosed with CSC between 1 January 2008 and 31 December 2018 were included in this study using data from the Taiwanese National Health Insurance Research Database (NHIRD). The CSC cohort was matched with a non-CSC cohort using the propensity score matching method, based on sex, age (in 10-year intervals), index date year, comorbidities, and steroid use, resulting in equal numbers of patients in both cohorts. Patients were followed up until 31 December 2019 or until they were withdrawn from the NHIRD. The incidence of glaucoma was compared between the two cohorts using the Cox regression model, and the risk of developing glaucoma was estimated using the Kaplan-Meier method. RESULTS After adjusting for sex, age, comorbidities, and steroid use, the CSC cohort showed a significantly higher risk of developing glaucoma compared to those without CSC (adjusted HR = 3.99; 95% CI = 3.44-4.62). The cumulative incidence of glaucoma in the CSC cohort was also significantly higher than in the non-CSC cohort (log-rank test, p < 0.001). Among the glaucoma subtypes, normal tension glaucoma had the highest risk (adjusted HR = 5.79; 95% CI = 3.41-9.85), followed by primary open-angle glaucoma (adjusted HR = 2.77; 95% CI = 2.12-3.62). CONCLUSIONS In conclusion, our study shows that CSC patients are at a higher risk of developing glaucoma, especially NTG. Awareness and regular glaucoma screenings are essential for patients with CSC.
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Affiliation(s)
- Yu-Te Huang
- Eye Center, China Medical University Hospital, Taichung, 40402, Taiwan
| | - Lei Wan
- School of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan
- Department of Obstetrics and Gynecology, China Medical University, Taichung, Taiwan
| | - Yih-Dih Cheng
- School of Pharmacy, China Medical University, Taichung, Taiwan
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan
| | - Teng-Shun Yu
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Tung Hung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Kewalee Rujikajorn
- Department of General Medicine, Medical University of Lublin, Bangkok, Thailand
| | | | - Ming-Yen Wu
- Eye Center, China Medical University Hospital, Taichung, 40402, Taiwan
| | - Fuu-Jen Tsai
- School of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, 40402, Taiwan
| | - Hui-Ju Lin
- Eye Center, China Medical University Hospital, Taichung, 40402, Taiwan.
- School of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan.
| | - Peng-Tai Tien
- Eye Center, China Medical University Hospital, Taichung, 40402, Taiwan.
- School of Medicine, College of Medicine, China Medical University, Taichung, 40402, Taiwan.
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Zhou X, Fukuyama H, Sugisawa T, Okita Y, Kanda H, Yamamoto Y, Araki T, Gomi F. Pupillary Light Reflex and Multimodal Imaging in Patients With Central Serous Chorioretinopathy. Invest Ophthalmol Vis Sci 2023; 64:28. [PMID: 37850945 PMCID: PMC10593139 DOI: 10.1167/iovs.64.13.28] [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: 10/19/2023] Open
Abstract
Purpose The purpose of this study was to investigate and compare the corresponding alterations of the pupillary response between acute and chronic central serous chorioretinopathy (CSC) and between different disease categories. Methods We recruited patients with unilateral acute and chronic CSC. An eye tracker was applied to determine the pupillary light reflex (PLR) and evaluate the following PLR metrics in healthy eyes: pupil diameter, diameter changes, including relative constriction amplitude (AMP%), and re-dilation ratio (D1%). Baseline optical coherence tomography (OCT), and fluorescein and indocyanine green angiography (FA/ICGA) were performed to analyze the relationship between pupillary response and retinal/choroidal architecture. Results In total, 52 patients were enrolled, including 25 with acute CSC and 27 with chronic CSC. Compared to the chronic CSC group, the acute CSC group displayed a significantly larger baseline pupil diameter (BPD; of 5.51 mm, P = 0.015), lower AMP% (34.40%, P = 0.004), and higher D1% (93.01%, P = 0.002), indicating sympathetic overactivity. On OCT, the total macular volume was positively correlated with the D1% (r = 0.48, P = 0.005) and negatively with AMP (r = -0.47, P = 0.007). On ICGA, the intense choroidal vascular hyperpermeability (CVH) group displayed a greater BPD than the nonintense CVH group. Additionally, 9 cases with later recurrent episodes following therapy showed a lower AMP% and higher D1% than the nonrecurrent group. Conclusions The PLR revealed sympathetic excitation in patients with acute CSC. The stronger D1% was significantly associated with greater total macular volume, and it may be a potential biomarker for predicting the later recurrence of CSC.
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Affiliation(s)
- Xiaoyin Zhou
- Department of Ophthalmology, Hyogo Medical University, Hyogo, Japan
- Department of Ophthalmology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hisashi Fukuyama
- Department of Ophthalmology, Hyogo Medical University, Hyogo, Japan
| | - Takaaki Sugisawa
- Department of Ophthalmology, Hyogo Medical University, Hyogo, Japan
| | - Yoichi Okita
- Department of Ophthalmology, Hyogo Medical University, Hyogo, Japan
| | - Hiroyuki Kanda
- Department of Ophthalmology, Hyogo Medical University, Hyogo, Japan
| | - Yuki Yamamoto
- Department of Ophthalmology, Hyogo Medical University, Hyogo, Japan
| | - Takashi Araki
- Department of Ophthalmology, Hyogo Medical University, Hyogo, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo Medical University, Hyogo, Japan
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Nordsten CB, Molbech CR, Mehlsen J, Sørensen TL. Heart-Rate Variability Correlates to Choroidal Thickness in Central Serous Chorioretinopathy. Clin Ophthalmol 2023; 17:2443-2447. [PMID: 37609645 PMCID: PMC10441633 DOI: 10.2147/opth.s405529] [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: 01/20/2023] [Accepted: 05/03/2023] [Indexed: 08/24/2023] Open
Abstract
Purpose Patients with central serous chorioretinopathy (CSC) have previously been shown to have a lower heart rate variability (HRV), implying a lower vagal tone. Vagal tone alters mineralocorticoids, which in turn affect the thickness of the choroid. Since increased choroidal thickness is characteristic of CSC, we wanted to investigate its correlation with HRV. Patients and Methods In this case-control study, 21 acute CSC patients and 31 healthy controls were included. Diagnosis was confirmed by optical coherence tomography (OCT) and retinal examination. HRV was evaluated following accepted standards. Outcome measures were chosen beforehand as follows: Standard deviation of N-N intervals (SDNN), root mean square of successive differences (RMSDD), low frequency/high frequency ratio (LF/HF ratio), and standard deviation ratio from commonly used Poincare plot (SD2/SD1 ratio). Choroidal thickness was measured using OCT directly under the foveola. Results Patients and healthy controls did not differ in health and medical characteristics in addition to CSC disease. Choroidal thickness was greatest in patients with CSC (mean±SD: 342±80 μm) compared to controls (235±60 μm, p<0.0001). A correlation was observed between LF/HF ratio and choroidal thickness in patients with CSC (Pearson correlation 0.63, p=0.02), where the CSC group had a lower LF/HF ratio (Median 2.39 ms2, IQR: 1.2-4.34 ms2) compared to controls (Median 1.2 ms2, IQR: 0.9-2.4 ms2, p=0.06) and SD2/SD1 ratio (CSC 0.59±0.2 vs controls 0.74±0.3, p=0.06). Conclusion We found a correlation between the thickness of the choroid and the HRV-measured LF/HF ratio in patients with CSC and showed a borderline significant reduction in HRV measurements in patients with CSC. The data imply that vagal alterations exist in patients with CSC. Due to the low n, this should be considered as a pilot study. Further studies are warranted to elucidate mechanisms and validate findings.
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Affiliation(s)
| | - Christopher Rue Molbech
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Mehlsen
- Unit of Surgical Pathophysiology, University of Copenhagen, Rigshospitalet, Denmark
| | - Torben Lykke Sørensen
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Zhang X, Lim CZF, Chhablani J, Wong YM. Central serous chorioretinopathy: updates in the pathogenesis, diagnosis and therapeutic strategies. EYE AND VISION (LONDON, ENGLAND) 2023; 10:33. [PMID: 37430344 DOI: 10.1186/s40662-023-00349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 06/12/2023] [Indexed: 07/12/2023]
Abstract
Central serous chorioretinopathy (CSCR), first described by Albrecht von Graefe in 1866, is characterized by focal serous detachment of the neural retina and/or retinal pigment epithelium (RPE) in the posterior pole. CSCR is the first ever described pachychoroid disease. Most recently, hypothetical venous overload choroidopathy is also proposed due to its distinguished morphological and pathological characteristics, including choroidal thickening, choriocapillaris hyperpermeability, remodelling, and intervortex venous anastomoses. Identification of genetic variants is necessary to comprehend the pathophysiology of CSCR. The novel multimodality imaging platforms, including the ultra-widefield imaging system, flavoprotein fluorescence, fluorescence lifetime imaging ophthalmoscopy, and multispectral imaging system, have been used for diagnosing and managing CSCR. Half-dose photodynamic therapy (PDT) remains the mainstay of clinical practice, with about 95% of patients with chronic CSCR improving to visual acuity (VA) of 20/30 or better. The use of oral eplerenone for routine clinical care remains controversial, and long-term randomized clinical trials are warranted to investigate its efficacy in acute and chronic CSCR. While CSCR has generally been recognized as a self-limiting disease with good prognosis, the underlying pathogenesis is still not fully understood, and treatments are often not fully effective. With new evidence emerging about pachydrusen being a disease precursor in both CSCR and polypoidal choroidal vasculopathy (PCV), it would be interesting to investigate whether CSCR can be a precursor to PCV. In this review, we highlighted the currently available evidence on the pathogenesis, diagnosis, multimodality imaging features, and management strategies, including recent findings related to CSCR.
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Affiliation(s)
- Xinyuan Zhang
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Tongren Hospital, Capital Medical University, Beijing University of Medical Science, Beijing, 100730, People's Republic of China.
| | - Connie Zhi Fong Lim
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Tongren Hospital, Capital Medical University, Beijing University of Medical Science, Beijing, 100730, People's Republic of China
| | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
| | - Yew Meng Wong
- Southern Specialist Eye Center SDN, BHD, Malacca, Malaysia
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Maeda Y, Takata M, Gomi F. Choroidal Thickness is Increased following Restraint Stress in Rats. Curr Eye Res 2023; 48:506-511. [PMID: 36719150 DOI: 10.1080/02713683.2023.2171067] [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: 02/01/2023]
Abstract
PURPOSE Central serous chorioretinopathy is a stress-induced disease and often shows pachychoroid; however, the relationship between stress and choroid remains unlear. The purpose of this study was to investigate, using optical coherence tomography, whether the choroid thickens when rats are subjected to restraint stress. METHODS Eight-week-old male F334/Jcl rats were subjected to 30 min of restraint stress, and choroidal thickness was measured before and after stress loading using optical coherence tomography. In addition, salivary corticosterone levels were measured before and after stress loading. RESULTS Choroidal thickness was significantly increased from 30.1 ± 6.4 µm to 39.7 ± 9.2 µm just after stress loading (p = 0.001). Significant choroidal thickening was not observed on the next day. The salivary corticosterone concentration increased from 1575.3 ± 1040.6 pg/mL before stress loading to 6022.2 ± 6742.6 pg/mL after stress loading, but the difference was not significant (p = 0.10). CONCLUSIONS Choroidal thickness increased when rats were subjected to restraint stress, supporting the hypothesis that stress is one of the causes of pachychoroid spectrum disease, as exemplified by central serous chorioretinopathy.
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Affiliation(s)
- Yuki Maeda
- Department of Ophthalmology, Hyogo Medical University, Nishinomiya, Japan
| | - Masashi Takata
- Department of Ophthalmology, Hyogo Medical University, Nishinomiya, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo Medical University, Nishinomiya, Japan
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Tombolini B, Battista M, Sacconi R, Servillo A, Camisa L, Bandello F, Querques G. Functionality of retinal vessels in central serous retinopathy: A comparison between eplerenone and photodynamic therapy. Eur J Ophthalmol 2022; 33:1443-1451. [PMID: 36503297 DOI: 10.1177/11206721221145049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose To investigate retinal vessels functionality in patients with acute central serous chorioretinopathy (CSC) undergoing oral eplerenone or photodynamic therapy (PDT) using Retinal Vessel Analyzer (RVA) and Dynamic Vessel Analyzer (DVA), respectively. Methods Treatment naïve acute CSC patients presenting between May 2017 and June 2017 were recruited. A complete ophthalmological examination was performed in all participants before and after oral eplerenone (eplerenone group) or half-dose PDT (PDT group). Results Eighteen eyes of 18 patients affected by acute CSC underwent either oral eplerenone (10 eyes of 10 patients, 47.6 ± 8.9 years old) or half-dose PDT (8 eyes of 8 patients, 57.4 ± 6.2 years old), respectively. After 2 months of treatment, non-significant variations of static retinal vessels analysis, dynamic arterial and venous dilatation were reported in eplerenone group. Similarly, in PDT group non-significant variations of static retinal vessels analysis, dynamic arterial and venous dilatation were found after 2 months of treatment. Conclusions Static and dynamic retinal functionalities in acute CSC may not be significantly improved by oral eplerenone and half-dose PDT. Although their choroidal effects, these treatments could not exert a significant effect on retinal vessels motility. Thus, both local and systemic therapies might not help avoiding the onset of vascular and other retinal known alterations of CSC.
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Affiliation(s)
- Beatrice Tombolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Battista
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Servillo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ludovica Camisa
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Jain M, Mohan S, van Dijk EHC. Central serous chorioretinopathy: Pathophysiology, systemic associations, and a novel etiological classification. Taiwan J Ophthalmol 2022; 12:381-393. [PMID: 36660127 PMCID: PMC9843580 DOI: 10.4103/2211-5056.362601] [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: 09/15/2022] [Accepted: 10/04/2022] [Indexed: 12/08/2022] Open
Abstract
Central serous chorioretinopathy (CSC) has remained an enigmatic disease since its initial description by Von Graefe. Over the years, multiple risk factors have been recognized: these include psychological stress, behavioral traits, and corticosteroids. The basic pathophysiology of CSC involves choroidal thickening, vascular congestion, altered choroidal blood flow (ChBF), and choroidal hyperpermeability, leading to retinal pigment epithelium decompensation and subsequent neurosensory detachment. Multiple organ systems, mainly the nervous, cardiovascular, endocrinal, and renal systems participate in the control of the vascular tone and the ChBF via hypothalamus-pituitary-adrenal axis and renin-angiotensin-aldosterone system, while others such as the hepatic system regulate the enzymatic degradation of corticosteroids. Many vasoactive and psychotropic drugs also modulate the ocular perfusion. In addition, there are anatomical and genetic predispositions that determine its progression to the chronic or recurrent form, through cellular response and angiogenesis. We herein review the basic pathophysiology and immunogenetics in CSC along with the role of multiple organ systems. With this background, we propose an etiological classification that should provide a framework for customized therapeutic interventions.
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Affiliation(s)
- Manish Jain
- Department of Ophthalmology, Al Dhannah Hospital, Abu Dhabi, United Arab Emirates,Address for correspondence: Dr. Manish Jain, Department of Ophthalmology, Al Dhannah Hospital, Abu Dhabi, United Arab Emirates. E-mail:
| | - Sashwanthi Mohan
- Department of Vitreous and Retina, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
| | - Elon H. C. van Dijk
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
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Park JB, Kim K, Kang MS, Kim ES, Yu SY. Central serous chorioretinopathy: Treatment. Taiwan J Ophthalmol 2022; 12:394-408. [PMID: 36660123 PMCID: PMC9843567 DOI: 10.4103/2211-5056.362040] [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: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
Central serous chorioretinopathy (CSC) is a pachychoroid spectrum disease characterized by serous detachment of the neurosensory retina with subretinal fluid in young and middle-aged adults. The pathogenesis of CSC is not yet fully understood. However, it is considered a multifactorial disease that is strongly associated with choroidal dysfunction or vascular engorgement. Although there is no consensus on the treatment of CSC, photodynamic therapy has been effectively used to manage serous retinal detachment (SRD) in CSC. Moreover, micropulse diode laser photocoagulation and focal laser treatment have also been used. Recently, oral medications, including mineralocorticoid receptor antagonists, have been proposed for the management of CSC. Multimodal imaging plays a significant role in the diagnosis and treatment of CSC. Optical coherence tomography angiography (OCTA) has the advantage of detecting vascular flow in the retina and choroid layer, allowing for a better understanding of the pathology, severity, prognosis, and chronicity of CSC. In addition, early detection of choroidal neovascularization in CSC is possible using OCTA. This review article aims to provide a comprehensive and updated understanding of CSC, focusing on treatment.
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Affiliation(s)
- Jong Beom Park
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Kiyoung Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Min Seok Kang
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Eung Suk Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea,Address for correspondence: Prof. Seung-Young Yu, Department of Ophthalmology, Kyung Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-Gu, Seoul 02447, Korea. E-mail:
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Jain M, Garg SJ, Khan M, Chaudhary V, Zeraatkar D, Kurian D, Lal S. The associations between central serous chorioretinopathy and muscle relaxants: A case-control study. Taiwan J Ophthalmol 2022; 12:415-422. [PMID: 36660119 PMCID: PMC9843563 DOI: 10.4103/2211-5056.361975] [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: 08/02/2022] [Accepted: 10/09/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the role of muscle-relaxants as risk factors for the development of central serous chorioretinopathy (CSC) - the second most common retinopathy in our settings; despite multiple risk factors seen in our patients, 21% were initially labelled as idiopathic. MATERIALS AND METHODS Retrospective case-control study at a tertiary hospital in the United Arab Emirates, where we reviewed the medical records of 273 patients with CSC examined between 2010 and 2019 for use of muscle-relaxants including tolperisone/eperisone, carisoprodol and gabapentin/pregabalin within a year of onset/recurrence of the disease. Intake of drugs with known association with CSC (including corticosteroids/sympathomimetics) was also recorded. Two hundred eighty-six subjects with adverse events seen at the same institute during the same study period served as controls. Odds ratios, Chi-Square tests and multivariate logistic regression were carried out to determine any associations with the muscle-relaxants and other pharmacological confounders - corticosteroids/sympathomimetics. RESULTS Muscle relaxants may increase the risk of CSC as evident on multivariate regression analysis (OR: 2.55; confidence interval [CI]: 1.208-5.413); the significance was retained on removing the 6 subjects who had corticosteroids/sympathomimetics (OR: 2.30; CI: 1.073-4.939). Univariate analysis yielded an OR of 2.52 for muscle relaxants (CI: 1.2149-5.2276), 2.96 for eperisone/tolperisone (CI: 1.3531-6.5038), and 6.26 for eperisone as an individual agent (CI: 1.8146-21.6252). CONCLUSION We found muscle relaxants to be associated factors of CSC regardless of inclusion of corticosteroids/sympathomimetics (P < 0.05). Among individual classes of muscle relaxants in this study, only eperisone/tolperisone posed a significant risk (P < 0.05). The vascular smooth muscle relaxation could be the possible mechanism that affects the choroidal blood flow and indirectly predisposes to CSC.
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Affiliation(s)
- Manish Jain
- Department of Ophthalmology, Veer Chandra Singh Garhwali, Government Institute of Medical Sciences and Research, Srinagar, Uttarakhand, India,Department of Ophthalmology, NMC Hospital, Al Ain, United Arab Emirates,Address for correspondence: Dr. Manish Jain, Department of Ophthalmology, Veer Chandra Singh Garhwali, Government Institute of Medical Sciences and Research, Srinagar - 246 174, Uttarakhand, India. E-mail:
| | - Sunir J. Garg
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mohammad Khan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada
| | - Varun Chaudhary
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Dhanya Kurian
- Department of Ophthalmology, NMC Hospital, Al Ain, United Arab Emirates
| | - Sarath Lal
- Department of Ophthalmology, NMC Hospital, Al Ain, United Arab Emirates
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Zhou X, Fukuyama H, Okita Y, Kanda H, Yamamoto Y, Araki T, Gomi F. Pupillary Responses Reveal Autonomic Regulation Impairments in Patients With Central Serous Chorioretinopathy. Invest Ophthalmol Vis Sci 2022; 63:2. [PMID: 36066317 PMCID: PMC9463716 DOI: 10.1167/iovs.63.10.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose This study assessed the autonomic nervous system in patients with central serous chorioretinopathy (CSC) by simultaneously measuring pupillary responses and heart rate variability (HRV). Methods We recruited 33 patients with CSC and 26 age- and sex-matched healthy controls. Using a pupillometry and acceleration plethysmography system, we measured the participants’ pupillary light reflex and HRV simultaneously, and compared the following parameters between the two groups: the pupil diameters, diameter changes, and time and frequency domain HRV indices (high frequency power: HF; low frequency power: LF; log LF/HF ratio). Additional data from the Profile of Mood States (POMS) and pupillary responses during mental tasks were also analyzed. Results The CSC group had a significantly lower constriction amplitude and a higher re-dilation ratio compared with the control group, indicating parasympathetic inhibition and sympathetic activation. For the HRV measures, the CSC group demonstrated significantly lower HF and higher LF and log LF/HF ratio, indicative of higher sympathetic activity. The CSC group also showed significantly larger pupil dilation during tasks of moderate difficulty, and higher negative/lower positive POMS mood scores. Further analyses also revealed that the baseline pupil diameter was significantly larger in patients with active as opposed to chronic CSC. Conclusions Pupillary responses and HRV measures both revealed sympathetic activation and parasympathetic attenuation in patients with CSC. Larger pupil dilation during mental tasks in CSC could be a potential marker of psychophysiological stress.
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Affiliation(s)
- Xiaoyin Zhou
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
| | - Hisashi Fukuyama
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan.,Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Yoichi Okita
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
| | - Hiroyuki Kanda
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
| | - Yuki Yamamoto
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
| | - Takashi Araki
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
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12
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Penas S, Araújo T, Mendonça AM, Faria S, Silva J, Campilho A, Martins ML, Sousa V, Rocha-Sousa A, Carneiro Â, Falcão-Reis F. Retinal and choroidal vasoreactivity in central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:3825-3836. [PMID: 35838808 DOI: 10.1007/s00417-022-05757-9] [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: 03/10/2022] [Revised: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study aims to investigate retinal and choroidal vascular reactivity to carbogen in central serous chorioretinopathy (CSC) patients. METHODS An experimental pilot study including 68 eyes from 20 CSC patients and 14 age and sex-matched controls was performed. The participants inhaled carbogen (5% CO2 + 95% O2) for 2 min through a high-concentration disposable mask. A 30° disc-centered fundus imaging using infra-red (IR) and macular spectral domain optical coherence tomography (SD-OCT) using the enhanced depth imaging (EDI) technique was performed, both at baseline and after a 2-min gas exposure. A parametric model fitting-based approach for automatic retinal blood vessel caliber estimation was used to assess the mean variation in both arterial and venous vasculature. Choroidal thickness was measured in two different ways: the subfoveal choroidal thickness (SFCT) was calculated using a manual caliper and the mean central choroidal thickness (MCCT) was assessed using an automatic software. RESULTS No significant differences were detected in baseline hemodynamic parameters between both groups. A significant positive correlation was found between the participants' age and arterial diameter variation (p < 0.001, r = 0.447), meaning that younger participants presented a more vasoconstrictive response (negative variation) than older ones. No significant differences were detected in the vasoreactive response between CSC and controls for both arterial and venous vessels (p = 0.63 and p = 0.85, respectively). Although the vascular reactivity was not related to the activity of CSC, it was related to the time of disease, for both the arterial (p = 0.02, r = 0.381) and venous (p = 0.001, r = 0.530) beds. SFCT and MCCT were highly correlated (r = 0.830, p < 0.001). Both SFCT and MCCT significantly increased in CSC patients (p < 0.001 and p < 0.001) but not in controls (p = 0.059 and 0.247). A significant negative correlation between CSC patients' age and MCCT variation (r = - 0.340, p = 0.049) was detected. In CSC patients, the choroidal thickness variation was not related to the activity state, time of disease, or previous photodynamic treatment. CONCLUSION Vasoreactivity to carbogen was similar in the retinal vessels but significantly higher in the choroidal vessels of CSC patients when compared to controls, strengthening the hypothesis of a choroidal regulation dysfunction in this pathology.
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Affiliation(s)
- Susana Penas
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal. .,Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Teresa Araújo
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Ana Maria Mendonça
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Simão Faria
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Jorge Silva
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Aurélio Campilho
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Maria Lurdes Martins
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Vânia Sousa
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Amândio Rocha-Sousa
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
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13
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Accommodation is Decreased in Eyes with Acute Central Serous Chorioretinopathy. Optom Vis Sci 2022; 99:687-691. [PMID: 35678631 DOI: 10.1097/opx.0000000000001914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE This is a case-control study showing changes in accommodation in eyes with acute central serous chorioretinopathy. Decreased accommodative amplitude we found in affected eyes may indicate suppression of parasympathetic activity in those eyes as one of the pathophysiological mechanisms controlling choroidal thickness and perfusion. PURPOSE To evaluate the changes of accommodation in patients with acute central serous chorioretinopathy (CSC). METHODS Patients with unilateral CSC, with and without foveal involvement as well as patients after resolution of subretinal fluid, and healthy age-matched controls were included. Accommodative amplitude was measured and compared between eyes with active or resolved CSC, fellow eyes of active CSC individuals and eyes of controls. Correlation between accommodative amplitude and ocular and demographic parameters was calculated. RESULTS Nineteen acute CSC patients (16 males and 3 females, 38.1 ± 5.1 years) and 17 age-matched controls (13 males and 4 females, 37.2 ± 5.4 years) were included. Accommodative amplitude in study eyes of CSC patients was lower than in the fellow unaffected eyes, 1.25 ± 1.0 D and 2.54 ± 0.94 D, respectively (P = .002) or in the eyes of healthy controls (2.41 ± 1.38 D, P = .002). In CSC eyes after resolution of subretinal fluid or without foveal involvement the median accommodative amplitude was lower than in fellow eyes, 1.6 D (95% CI 0.83 to 1.75) and 2.7 D (95% CI 1.23 to 3.61), respectively (P = .004). No correlation was found between accommodative amplitude in affected CSC eyes and different parameters, except for age (r = -0.47, P = .04). CONCLUSIONS Acute CSC is associated with a substantial reduction of accommodative amplitude.
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14
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Alsberge JB, Lee DY, Jumper JM. Central serous chorioretinopathy associated with Adderall (dextroamphetamine-amphetamine) and topical steroid use. Am J Ophthalmol Case Rep 2022; 26:101482. [PMID: 35308586 PMCID: PMC8924628 DOI: 10.1016/j.ajoc.2022.101482] [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: 11/11/2021] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose To report a case of central serous chorioretinopathy (CSC) associated with Adderall (dextroamphetamine-amphetamine) and topical steroid use. Observations A 34-year-old man presented for evaluation of a “cloud” in his vision for three months. He was taking Adderall for attention deficit hyperactivity disorder and mometasone 0.1% topical cream for eczema. He was found to have subretinal fluid in the left eye consistent with CSC. The subretinal fluid persisted despite cessation of the steroid cream but resolved after cessation of the Adderall. The subretinal fluid returned when the patient restarted Adderall and again resolved after he stopped it for a second time. Conclusions Though we cannot prove causality, the course of events was suggestive of a direct relationship between Adderall use and CSC in this patient, with exogenous steroid as a possible modifying factor.
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15
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Kanda P, Gupta A, Gottlieb C, Karanjia R, Coupland SG, Bal MS. Pathophysiology of central serous chorioretinopathy: a literature review with quality assessment. Eye (Lond) 2022; 36:941-962. [PMID: 34654892 PMCID: PMC9046392 DOI: 10.1038/s41433-021-01808-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/15/2021] [Accepted: 10/01/2021] [Indexed: 01/31/2023] Open
Abstract
The pathogenesis of central serous chorioretinopathy (CSCR), a pachychoroid disease, is poorly understood. While choroid hyperpermeability and retinal pigment epithelium dysfunction are cornerstones for developing CSCR, the mechanisms at the retinal, vascular, retinal pigment epithelium, and cellular level continue to be an enigma. A few preclinical studies and the development of small-sized, poorly controlled clinical trials have resulted in limited insight into the disease mechanism. Effective treatments for CSCR are still lacking as current trials have produced inconsistent results for functional and structural gains. Thus, critically evaluating the literature to explore disease mechanisms and provide an up-to-date understanding of pathophysiology can provide valuable information and avenues to new treatments. In this study, a comprehensive summary of the mechanistic insight into CSCR is presented while highlighting the shortcomings of current literature. The mechanism was divided into seven sub-categories including mechanical obstruction, inflammation, oxidative stress, paracrine factors, autonomic dysfunction, mineralocorticoid receptors activation, and medications. We implemented validated tools like the JBI and CAMARADES to objectively analyze the quality of both clinical and preclinical studies, respectively. Overall, our analysis of the literature showed that no single mechanism was populated with a large number of sufficiently sized and good-quality studies. However, compiling these studies gave hints not only to CSCR pathogenesis but also pachychoroid disease in general while providing suggestions for future exploration.
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Affiliation(s)
- Pushpinder Kanda
- grid.28046.380000 0001 2182 2255Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON Canada
| | - Arnav Gupta
- grid.28046.380000 0001 2182 2255Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Chloe Gottlieb
- grid.28046.380000 0001 2182 2255Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Rustum Karanjia
- grid.28046.380000 0001 2182 2255Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108Ottawa Hospital Research Institute, Ottawa, ON Canada ,grid.280881.b0000 0001 0097 5623Doheny Eye Institute, Los Angeles, CA 90033 USA ,grid.19006.3e0000 0000 9632 6718Doheny Eye Centers UCLA, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA 91105 USA
| | - Stuart G. Coupland
- grid.28046.380000 0001 2182 2255Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Manpartap Singh Bal
- grid.511274.4Queen’s University School of Medicine, Department of Ophthalmology, Kingston Health Science Centre, Kingston, ON Canada
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16
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Mentes J, Oztas Z, Gobeka HH. Do mydriatics affect serous pigment epithelial detachment elevation? A case report on central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2022; 39:102877. [PMID: 35472641 DOI: 10.1016/j.pdpdt.2022.102877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/14/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jale Mentes
- Ege University, Faculty of Medicine, Department of Ophthalmology, Izmir, Turkey
| | - Zafer Oztas
- Medstar Antalya Hospital, Department of Ophthalmology, Antalya, Turkey
| | - Hamidu Hamisi Gobeka
- Afyonkarahisar Health Sciences University, Faculty of Medicine, Department of Ophthalmology, Afyonkarahisar, Turkey.
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17
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Jain M. Anxiolytics and psychotropic medications in central serous chorioretinopathy: Caveats and concerns. Indian J Ophthalmol 2022; 70:700-701. [PMID: 35086280 PMCID: PMC9023940 DOI: 10.4103/ijo.ijo_2917_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Manish Jain
- Department of Ophthalmology, VCSG Government Institute of Medical Science and Research, Srinagar, Uttarakhand, India
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18
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Hashida N, Asao K, Hara C, Quantock AJ, Saita R, Kurakami H, Maruyama K, Nishida K. Mitochondrial DNA as a Biomarker for Acute Central Serous Chorioretinopathy: A Case-Control Study. Front Med (Lausanne) 2022; 9:938600. [PMID: 35801206 PMCID: PMC9253465 DOI: 10.3389/fmed.2022.938600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022] Open
Abstract
Background The literature suggests that stress may play a pivotal role in the precipitation of acute central serous chorioretinopathy (CSC) because chorioretinal integrity can be affected by the psychosocial state of the patient, indicating the need for a biomarker. Not only physical stress but also psychological stress causes many types of physical disorders. However, little is known about the pathophysiology of stress-induced disease. The objective of this study was to investigate whether serum factors might be involved in the development of stress-induced ocular diseases. Methods This observational case series included 33 eyes of 33 consecutive patients with treatment-naïve acute CSC. Fifty eyes of 50 age-matched healthy volunteers were included in this study as non-CSC controls. Serum samples were collected from all participants, and the levels of mitochondrial DNA (mtDNA) were measured by quantitative real-time (RT)-PCR. Serum levels of high-mobility group box (HMGB) 1 and 8-hydroxy-2'-deoxyguanosine (8-OHdG), biological markers of acute/chronic inflammation and oxidative stress, were also measured. The relationships between serum mtDNA, 8-OHdG, and HMGB1 concentrations were investigated by multivariate regression analysis, alongside an assessment of clinical data. Results In the treatment-naïve acute CSC group, the serum mtDNA levels (36.5 ± 32.4 ng/mL) were significantly higher than the levels in the control group (7.4 ± 5.9 ng/mL; p < 0.001). Serum levels of 8-OHdG and HMGB1 in treatment-naïve acute CSC patients measured 0.12 ± 0.08 ng/mL and 18.1 ± 35.0 ng/mL, respectively, indicating that HMGB1 levels were elevated in CSC compared with the control group. Multivariable regression analysis demonstrated that increased serum mtDNA levels were significantly associated with the height of serous retinal detachment. Conclusion We showed serum mtDNA and HMGB1 level elevation and its relation to the clinical activities of CSC, indicating that serum mtDNA and HMGB1 could serve as biomarkers for the acute phase of the disease. The use of these biomarkers makes it possible to predict disease onset and determine disease severity.
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Affiliation(s)
- Noriyasu Hashida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
- *Correspondence: Noriyasu Hashida,
| | - Kazunobu Asao
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Chikako Hara
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Andrew J. Quantock
- Structural Biophysics Group, School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Ryotaro Saita
- Department of Medical Innovation, Osaka University Hospital, Osaka, Japan
| | - Hiroyuki Kurakami
- Department of Medical Innovation, Osaka University Hospital, Osaka, Japan
| | - Kazuichi Maruyama
- Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University Graduate School of Medicine, Osaka, Japan
- Kohji Nishida,
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19
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Scarinci F, Patacchioli FR, Costanzo E, Parravano M. Relationship of Choroidal Vasculature and Choriocapillaris Flow With Alterations of Salivary α-Amylase Patterns in Central Serous Chorioretinopathy. Invest Ophthalmol Vis Sci 2021; 62:19. [PMID: 34932061 PMCID: PMC8709932 DOI: 10.1167/iovs.62.15.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose An abnormality in choroidal vasculature is a known factor in the pathogenesis of central serous chorioretinopathy (CSC), a chorioretinal disease affecting mostly middle-aged males. The purpose of the present study was to investigate the role of the autonomic nervous system (ANS) in the pathophysiology of CSC. Methods This was a cross-sectional observational study in which characteristic choroidal vasculature metrics were assessed by measuring the subfoveal choroidal thickness (FCT) and the choroidal vascularity index (CVI) using the imaging technique of enhanced-depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT). Furthermore, flow signal void area features were also evaluated in the study population using OCT angiography (OCTA). Diurnal patterns of salivary α-amylase (a-AMY) production, proposed as a marker of autonomic activity, were assessed in an adult male study population affected by acute naïve CSC in comparison with matched healthy controls. Results Results include an overall higher diurnal output of salivary a-AMY production, which is in line with the phenomenon of a sympathetic “drive” playing a role in the pathophysiology of CSC, and a flattened diurnal percentage variation in α-AMY in CSC-affected subjects. Furthermore, Pearson's coefficient test revealed statistically significant correlations between salivary α-AMY diurnal percentage variation and selected choroidal imaging biomarkers (FCT, CVI, and flow signal void area). Finally, multiple linear regression analysis identified salivary α-AMY diurnal percentage production as the sole predictor of the CVI and flow signal void area in the study population. Conclusions Autonomic nervous system dysregulation was highlighted in CSC patients.
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20
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Scholz P, Altay L, Sitnilska V, van Dijk EHC, Pereira AM, van Haalen FM, Akhtar I, Boon CJF, Fauser S. SALIVARY ALPHA-AMYLASE LEVELS MAY CORRELATE WITH CENTRAL SEROUS CHORIORETINOPATHY ACTIVITY. Retina 2021; 41:2479-2484. [PMID: 34292222 DOI: 10.1097/iae.0000000000003266] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate and compare the salivary alpha-amylase (sAA) activity as an indicator of the sympathetic activity and stress response in patients with central serous chorioretinopathy (CSC) and healthy control subjects. METHODS Prospective multicenter case series, including 80 CSC patients and 88 healthy control subjects. Central serous chorioretinopathy status was classified as either active or inactive, depending on the presence of subretinal fluid on optical coherence tomography. Salivary samples were collected in the morning from patients and control subjects of the main cohort and at midnight for the additional cohort. Salivary alpha-amylase activity was determined in all patients and control subjects. RESULTS Morning sAA activity was significantly higher in patients with active CSC compared with inactive CSC (P = 0.049) and to healthy control subjects (P = 0.012). There was no significant difference in sAA activity between patients with inactive CSC and control subjects (P = 1.0). Nocturnal sAA activity did not show any significant difference between patients with active CSC and either inactive CSC or control subjects (P = 0.139). CONCLUSION Morning sAA activity is increased in patients with active CSC, although diurnal rhythmicity is preserved. Measurement of sAA is easy to perform and might be an eligible tool to further investigate the relation between stress and CSC.
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Affiliation(s)
- Paula Scholz
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Lebriz Altay
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Vasilena Sitnilska
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, Netherlands
| | - Femke M van Haalen
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, Netherlands
| | - Isha Akhtar
- Department of Ophthalmology, University of Cologne, Experimental Immunology of the Eye, Cologne, Germany
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
- Department of Ophthalmology, Academic Medical Center, Amsterdam, the Netherlands; and
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
- F. Hoffmann-La Roche, Basel, Switzerland
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21
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Keidel LF, Zwingelberg S, Schworm B, Luft N, Herold T, Priglinger SG, Siedlecki J. Pachychoroid disease and its association with retinal vein occlusion: a case-control study. Sci Rep 2021; 11:19854. [PMID: 34615888 PMCID: PMC8494827 DOI: 10.1038/s41598-021-99115-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/13/2021] [Indexed: 11/09/2022] Open
Abstract
The development of a retinal vein occlusion (RVO) is multifactorial. This study investigates pachychoroid as a risk factor for RVO or as an entity sharing common pathophysiology with RVO. A database screening at the University Eye Hospital, Ludwig-Maximilian University Munich, Germany was performed for patients diagnosed with central or branch RVO (CRVO/BRVO). In every patient a complete ophthalmologic examination was performed, including posterior segment enhanced depth spectral domain optical coherence tomography (EDI-SD-OCT). The SD-OCT scans of respective partner eyes without history of RVO were compared to an age- and refraction-matched, randomly recruited normal control group. In total, 312 eyes of 312 patients were included in this study, with 162 eyes in the RVO and 150 eyes in the control group. A significantly higher subfoveal choroidal thickness (SFCT) was found in the RVO (310.3 ± 72.5 (94 to 583) µm) as compared to the control group (237.0 ± 99.0 (62 to 498); p < 0.00001). Moreover, the RVO group showed a significantly higher prevalence of a symptomatic pachychoroid (22 vs. 9 eyes; odds ratio: 2.46; 95 CI: 1.10 to 5.53; p = 0.029). Since pachychoroid disease represents a bilateral entity, it might be a risk factor for RVO, or share risk factors with RVO.
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Affiliation(s)
- Leonie F Keidel
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Sarah Zwingelberg
- Department of Ophthalmology, University Hospital Cologne, Cologne, Germany
| | - Benedikt Schworm
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Nikolaus Luft
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Tina Herold
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Jakob Siedlecki
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
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22
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Salivary Alpha-Amylase Levels May Correlate With Central Serous Chorioretinopathy Activity. Retina 2021; 41:2007-2008. [PMID: 34292223 DOI: 10.1097/iae.0000000000003265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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23
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Gundlach BS, Tsui I. Post-Traumatic Stress Disorder Is a Significant Risk Factor for Central Serous Chorioretinopathy in Male Veterans. Am J Mens Health 2021; 15:15579883211034990. [PMID: 34546136 PMCID: PMC8461129 DOI: 10.1177/15579883211034990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The primary aim of this study was to determine whether psychosocial factors, such as post-traumatic stress disorder (PTSD) and anxiety, are independently associated with the development of central serous chorioretinopathy (CSCR), a predominantly male eye disorder. A secondary aim was to verify previously determined risk factors in a veteran population. All CSCR subjects seen in one year at a veteran eye clinic were included. Chart review was performed to identify general health information as well as eye history. Univariate and multivariate analysis was performed to identify factors that were independently associated with the development of CSCR. Fifty-one cases of CSCR were identified and an additional 51 age-matched controls with healthy eyes were used for analysis. Multivariate analysis revealed that history of PTSD was strongly associated with the development of CSCR (OR = 9.43, p = .002), even more so than previously reported risk factors. Anxiety was significant at the univariate level (OR = 6.48, p = .001) but lost significance at the multivariate level. At the multivariate level, several existing risk factors were confirmed including sleep apnea (OR = 5.76, p = .004), heart disease (OR = 7.06, p = .004), smoking (OR = 5.52, p = .003) and steroid use (OR = 4.55, p = .005). PTSD was strongly associated with the development of CSCR in the veteran population studied and may represent an important modifiable risk factor.
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Affiliation(s)
| | - Irena Tsui
- Stein Eye Institute, Doheny Eye Institute, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Irena Tsui, MD, 100 Stein Plaza, Los Angeles, CA 90095, USA.
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24
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Intima-Media Thickness Measurements of the Common Carotid Artery in Patients with Central Serous Chorioretinopathy: A Case-Control Study. J Ophthalmol 2021; 2021:6652373. [PMID: 34527376 PMCID: PMC8437640 DOI: 10.1155/2021/6652373] [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: 11/19/2020] [Revised: 07/25/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the intima-media thickness (IMT) of the left and right common carotid arteries (CCA) as an indicator of subclinical atherosclerosis in patients with central serous chorioretinopathy (CSCR). Methods This was a case-control study involving patients with CSCR and a matched healthy control group. The mean and difference of the left and right CCA IMT were determined and compared between the two groups using carotid duplex high-resolution B-mode ultrasound equipment. Results The study enrolled 32 CSCR patients (68.8% female, mean age 38.22 ± 5.42 years) and 32 controls (65.6% female, mean age 39.56 ± 5.33 years). The difference in common carotid IMT between the right and left sides was significantly greater in the CSCR group than in the control group (p < 0.001). Additionally, according to logistic regression analysis, patients with CSCR had a greater chance of having differences in IMT between the two sides when compared to the control group (OR: 1.29, 95% CI: 1.09–1.52). Conclusion Our findings indicated that in the CSCR group, the difference between the right and left sides of CCA IMT was significantly greater than in the control group.
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Optical coherence tomography angiography of central serous chorioretinopathy: quantitative evaluation of the vascular pattern and capillary flow density. Graefes Arch Clin Exp Ophthalmol 2021; 260:1015-1024. [PMID: 34505926 PMCID: PMC8850230 DOI: 10.1007/s00417-021-05306-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/22/2021] [Accepted: 06/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to evaluate the vascular pattern and capillary flow density (CFD) map on optical coherence tomography angiography (OCTA) images of patients affected by central serous chorioretinopathy (CSC). Methods In this retrospective cohort study, OCTA (AngioVue RTVue XR Avanti, Optovue) 3 × 3 mm macula scans of both eyes of patients with CSC were taken at baseline; the images were segmented and compared with OCTA scans of fellow eyes without CSC as well as age-matched healthy subjects. OCTA images were processed by quantitative textural analysis (ImageJ software) to provide an objective grading of choroidal capillary alterations. The texture of OCTA images was examined by the autocorrelation method. Results In eyes with CSC (40 eyes), we found six different morphological patterns of the choriocapillaris layer vasculature (CCL), likely corresponding to different grades of OCT choroidal hyporeflectivity and OCTA reduction of the decorrelation signal. Moreover, the OCTA capillary flow density map revealed capillary depletion in the superficial capillary plexus (p value = 0.0023), in the deep vascular network (p value = < 0.0001), and in the CCL (p value = 0.0001). Such findings were not observed in healthy subjects (13 eyes). Conclusions OCTA in CSC is a useful tool that allows the identification of the clinical type of CSC by means of specific CCL patterns. Moreover, CFD depletion is observed in association with the inner retinal layers, pointing to an involvement of the inner blood retinal barrier in CSC. According to our results, it is plausible that the patterns observed herein may correlate to the different clinical subtypes of the disease.
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Dursun ME, Erdem S, Karahan M, Ava S, Hazar L, Dursun B, Keklikçi U. Evaluation of parafoveal vascular density using optical coherence tomography angiography in patients with central serous chorioretinopathy. Lasers Med Sci 2021; 37:1147-1154. [PMID: 34218316 DOI: 10.1007/s10103-021-03366-2] [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: 03/05/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
Using optical coherence tomography angiography (OCTA), we sought to evaluate parafoveal vascular density (VD) in patients with central serous chorioretinopathy (CSCR). Our study included 43 patients with a diagnosis of CSCR and 40 healthy controls. Ophthalmologic examination findings and OCTA measurements of the participants were retrospectively analysed. Of the 43 patients with CSCR, 31 were males (72%) and 12 were females (28%); the control group was 30 males (75%) and 10 females (25%) (p = 0.657). There were significant differences between affected eyes, unaffected eyes and healthy control eyes for all parameters in the superficial capillary plexus (SCP) VD and deep capillary plexus (DCP) VD (p < 0.05 for all values). It was also determined that the affected eyes had lower SCP-VD and DCP-VD than the unaffected eyes and that the unaffected eyes had lower SCP-VD and DCP-VD than the healthy control eyes (p < 0.05 for all values). While there were no significant differences in the deep foveal avascular zone (FAZ) area, the superficial FAZ area was larger in affected eyes than in both unaffected eyes and healthy control eyes (p < 0.05). In most areas, the SCP-VD and DCP-VD values were lower and the FAZ larger in the chronic group than in the acute group (p < 0.05). Retinal vascular changes were found in patients with both acute and chronic CSCR, and the fellow eyes of these patients were also affected. OCTA can therefore be considered an easily applicable, non-invasive screening option for evaluating the microvascular structure in these patients.
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Affiliation(s)
- Mehmet Emin Dursun
- Department Ophthalmology, Medical Faculty, Dicle University, 21280, Diyarbakır, Turkey.
| | - Seyfettin Erdem
- Department Ophthalmology, Medical Faculty, Dicle University, 21280, Diyarbakır, Turkey
| | - Mine Karahan
- Department Ophthalmology, Medical Faculty, Dicle University, 21280, Diyarbakır, Turkey
| | - Sedat Ava
- Department Ophthalmology, Medical Faculty, Dicle University, 21280, Diyarbakır, Turkey
| | - Leyla Hazar
- Department Ophthalmology, Medical Faculty, Dicle University, 21280, Diyarbakır, Turkey
| | - Birgül Dursun
- Department Ophthalmology, Gazi Yasargil Education and Research Hospital, Diyarbakır, Turkey
| | - Uğur Keklikçi
- Department Ophthalmology, Medical Faculty, Dicle University, 21280, Diyarbakır, Turkey
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Yehezkeli V, Rotenstreich Y, Haim LNB, Sher I, Achiron A, Belkin A. Ophthalmic emergency-room visits during the Covid-19 pandemic - a comparative study. BMC Ophthalmol 2021; 21:210. [PMID: 33980214 PMCID: PMC8114655 DOI: 10.1186/s12886-021-01976-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/05/2021] [Indexed: 12/23/2022] Open
Abstract
Background The goal of this study is to compare ophthalmic emergency room (OER) visits during the Coronavirus disease-19 (Covid-19) pandemic to those during a control period. Methods We compared all visits to the OER to Meir Medical Center in Israel, from March 15th to April 15th, 2020, during the Covid-19 pandemic and government mandated quarantine, to the same period in 2019. Factors analyzed were patient demographics, chief complaints, referral patterns, exam findings, treatments given, hospitalizations and surgical interventions. Results We included in this study 1311 visits of 1158 patients, 477 during the 2020 Covid-19 pandemic and 834 during the same period in 2019. The demographic distribution (age, gender, and ethnicity) was similar between the two periods. LogMAR visual acuity at presentation was worse during the Covid-19 pandemic (0.42 ± 0.6 and 0.34 ± 0.5 in 2020 and 2019 respectively; p = 0.025) and the number of emergent surgeries was higher (3.7% in 2020 vs 1.8% in 2019, p = 0.026). In 2019 there was a higher likelihood of involvement of both segments of the eye (4.82% versus 1.2%, p < 0.01) and more diagnoses were given to each patient (1 ± 0.5 versus 0.93 ± 0.35, p = 0.001; During the Covid − 19 pandemic medications (both topical and systemic) were prescribed more often (1.22 ± 0.95 in 2020 and 0.84 ± 0.67 in 2019, p < 0.001). Conclusions OER visits were less frequent during the Covid − 19 pandemic as compared to 2019, though the demographics of the patients remained unchanged. Visits during the pandemic tended to be for more severe ocular conditions, with worse visual acuity at presentation and required more medical and surgical treatment which imply higher necessity of ocular evaluation. This analysis can aid healthcare resource management in similar scenarios in the future.
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Affiliation(s)
- Veronika Yehezkeli
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ygal Rotenstreich
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Liron Naftali Ben Haim
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ifat Sher
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Asaf Achiron
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Avner Belkin
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel. .,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Sahoo NK, Singh SR, Beale O, Nkrumah G, Rasheed MA, Jabeen A, Vupparaboina KK, Ibrahim MN, Tatti F, Chandra K, Lanza M, Iovino C, Peiretti E, Chhablani J. Choroidal Vascularity Map in Unilateral Central Serous Chorioretinopathy: A Comparison with Fellow and Healthy Eyes. Diagnostics (Basel) 2021; 11:diagnostics11050861. [PMID: 34064718 PMCID: PMC8150964 DOI: 10.3390/diagnostics11050861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background: To map the choroidal vascularity index and compare two eyes in patients with unilateral central serous chorioretinopathy (CSCR). Methods: This was a retrospective, observational study performed in patients with unilateral CSCR. Choroidal thickness (CT) and Choroidal vascularity index (CVI) were measured and mapped in various zones according to the early treatment diabetic retinopathy (ETDRS) grid. Results: A total of 20 CSCR patients (20 study and 20 fellow eyes) were included in the study. Outer nasal region CT was seen to be significantly lower than central CT (p = 0.042) and inner nasal CT (p = 0.007); outer ring CT was significantly less than central (p = 0.04) and inner ring (p = 0.01) CT in CSCR eyes. On potting all the CVI values against the corresponding CT values, a positive correlation was seen in CSCR eyes (r = 0.54, p < 0.01), which was slightly weaker in fellow eyes (r = 0.3, p < 0.01) and a negative correlation was seen in healthy eyes (r = −0.262, p < 0.01). Conclusions: Correlation between CVI and CT was altered in CSCR eyes as compared to fellow and normal eyes with increasing CVI towards the center of the macula and superiorly in CSCR eyes.
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Affiliation(s)
- Niroj Kumar Sahoo
- Department of Retina and Vitreous, L V Prasad Eye Institute, Vijayawada 521134, India;
| | - Sumit Randhir Singh
- Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, CA 92697, USA;
| | - Oliver Beale
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA 15213, USA; (O.B.); (G.N.); (K.K.V.)
| | - Gideon Nkrumah
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA 15213, USA; (O.B.); (G.N.); (K.K.V.)
| | - Mohammed Abdul Rasheed
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (M.A.R.); (A.J.)
| | - Asiya Jabeen
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (M.A.R.); (A.J.)
| | | | - Mohammed Nasar Ibrahim
- Department of Electrical Engineering, Indian Institute of Technology, Hyderabad 502285, India;
| | - Filippo Tatti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 9121 Cagliari, Italy; (F.T.); (E.P.)
| | - Khushboo Chandra
- Department of Vitreoretina, Disha Eye Hospitals Pvt Ltd., 88(63A) Ghosh Para Road, Barrackpore, Kolkata 700120, India;
| | - Michele Lanza
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.L.); (C.I.)
| | - Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.L.); (C.I.)
| | - Enrico Peiretti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 9121 Cagliari, Italy; (F.T.); (E.P.)
| | - Jay Chhablani
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA 15213, USA; (O.B.); (G.N.); (K.K.V.)
- Correspondence: ; Tel.: +1-412-377-1943
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Plasma dopamine and catecholamine levels in patients with central serous chorioretinopathy. J Fr Ophtalmol 2021; 44:621-625. [PMID: 33865632 DOI: 10.1016/j.jfo.2020.08.032] [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: 06/17/2020] [Revised: 07/27/2020] [Accepted: 08/24/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate plasma dopamine and catecholamine levels in patients with central serous chorioretinopathy (CSCR). MATERIALS AND METHODS In this prospective study, 32 patients with acute CSCR were included, along with 32 age- and gender-matched healthy controls without CSCR. Complete ophthalmologic examinations were performed. Plasma dopamine, epinephrine, norepinephrine levels were measured in the morning after 8-12hours of fasting. A P-value of less than 0.05 was considered statistically significant. RESULTS While the mean age of the CSCR group was 40.12±7.96 years, the mean age of the control group was 37.81±7.26 years. There was no statistically significant difference between the groups in terms of age or gender (P=0.229, P=0.740, respectively). The plasma dopamine level was 29.85±9.39pg/ml in the CSCR group and 23.93±7.33pg/ml in the control group (P=0.001). The plasma epinephrine level was 60.73±25.69pg/ml in the CSCR group and 45.77±18.55pg/ml in the control group (P=0.021). The plasma norepinephrine level was 206.68±71.51pg/ml in the CSCR group and 149.33±49.69pg/ml in the control group (P=0.001). Plasma dopamine, epinephrine, and norepinephrine levels were statistically significantly higher in the CSCR group. CONCLUSION We concluded that dopamine may be a possible factor in the etiology of CSCR, both through its receptors and by enhancing sympathetic activity.
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Altunel O, Arifoglu HB. EVALUATION OF RETINAL VESSEL DIAMETERS IN EYES WITH ACTIVE CENTRAL SEROUS CHORIORETINOPATHY. Retina 2021; 41:861-866. [PMID: 32740489 DOI: 10.1097/iae.0000000000002932] [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: 11/25/2022]
Abstract
PURPOSE To compare the retinal vessel diameters of healthy eyes and active central serous chorioretinopathy (CSC) eyes, and to evaluate possible effect of retinal vessel diameter alterations on the pathogenesis of CSC. METHODS This retrospective study included 39 patients with CSC and 34 healthy individuals. Spectralis optical coherence tomography + HRA with an infrared reflectance image were used to evaluate structure of retinal vessels in the circular region around the optic disc. For each eye, vertical inner and outer diameters of the four major arteries and veins were measured using infrared reflectance images, and vessel wall thicknesses were also calculated based on inner and outer diameters. RESULTS The 304 vessels of the 39 active CSC eyes and 266 vessels of the 34 healthy eyes were used in the analyses. The mean venous wall thickness in active CSC eyes was significantly thicker than that in healthy eyes (40.0 ± 4.9 vs. 33.5 ± 4.1 μm, P = 0.001), whereas the mean venous inner diameter in active CSC eyes was significantly narrower (52.5 ± 9.7 vs. 61.3 ± 8.1 μm, P = 0.001). Also, the mean venous outer diameter was wider in CSC eyes, albeit not significantly (131.1 ± 7.0 vs. 128.5 ± 8.4 μm, P = 0.074). CONCLUSION Our results suggest that the alterations of retinal venous diameters may play a potential role in the pathogenesis of CSC in addition to alterations in choroidal thickness.
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Affiliation(s)
- Orhan Altunel
- Department of Ophthalmology, Kutahya Health Sciences University, Evliya Celebi Education and Research Hospital, Kutahya, Turkey ; and
| | - Hasan Basri Arifoglu
- Department of Ophthalmology, Kayseri City Education and Research Hospital, Kayseri, Turkey
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Kimura T, Araki T, Komuku Y, Iwami H, Gomi F. Central Serous Chorioretinopathy and Blood Serotonin Concentrations. J Clin Med 2021; 10:558. [PMID: 33546112 PMCID: PMC7913142 DOI: 10.3390/jcm10040558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To investigate blood serotonin (5-hydroxytryptamine (5-HT)) concentrations and their relationships with selected characteristics in patients with central serous chorioretinopathy (CSC). METHODS This was a prospective study including 93 patients with active CSC. Blood concentrations of 5-HT, adrenocorticotropic hormone, and cortisol were measured in patients with CSC. Selected patient characteristics, including disease history (acute or chronic), medication use, smoking history, mood status, best-corrected visual acuity (BCVA), subfoveal choroidal thickness (SCT), findings on fluorescein and indocyanine green angiography, and anatomical changes were evaluated during follow-up. RESULTS Eleven of the 93 patients had low 5-HT concentrations (<57 ng/mL) (12%, eight men and three women; mean age 55 years); we identified no significant relationship with acute/chronic disease status. The patients with low 5-HT were significantly more likely to have five or more fluorescein leakage sites (p = 0.0275), recurrence of subretinal fluids (p < 0.0001), and failure to achieve significant improvement in BCVA during follow-up (p = 0.862) than patients with 5-HT within the normal range. CONCLUSIONS Blood serotonin concentrations may influence the pathophysiology and prognosis of CSC.
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Affiliation(s)
| | | | | | | | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya 6638501, Japan; (T.K.); (T.A.); (Y.K.); (H.I.)
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Sesar AP, Sesar A, Bucan K, Sesar I, Cvitkovic K, Cavar I. Personality Traits, Stress, and Emotional Intelligence Associated with Central Serous Chorioretinopathy. Med Sci Monit 2021; 27:e928677. [PMID: 33423036 PMCID: PMC7805417 DOI: 10.12659/msm.928677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the relationship between personality traits, stress, emotional intelligence, and central serous chorioretinopathy (CSCR). MATERIAL AND METHODS This prospective case-control study included 57 patients with acute CSCR and 57 age- and sex-matched controls with refractive errors. Inclusion criteria for CSCR group were acute unilateral onset of visual disturbances within 2 weeks until the first visit to the ophthalmologist and ophthalmoscopic finding of a round or oval macular detachment confirmed by optical coherence tomography as a dome-shaped serous neuroretinal elevation. RESULTS Using the Sixteen Personality Factor Questionnaire (16 PF), patients with CSCR achieved slightly higher scores on primary characteristics such as warmth (P=0.612) and perfectionism (P=0.137) when compared to the control subjects. Mean scores measured with the Social Readjustment Rating Scale (SRRS) were significantly higher in patients with CSCR (P=0.004), which means that these patients had notably elevated average reactivity to stressful life events. In addition, the number of patients with a high stress level was higher in the CSCR group than in the control group. Considering the level of emotional intelligence measured with the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), patients with CSCR achieved significantly lower scores on well-being (P=0.003) and sociability (P=0.011) factors, as well as on total score (P=0.014). CONCLUSIONS A higher level of perceived stress is the most important psychological risk factor for CSCR. According to our results, a low level of emotional intelligence may be an additional factor that contributes to the occurrence of CSCR.
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Affiliation(s)
- Anita Pusic Sesar
- Department of Ophthalmology, University Clinical Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - Antonio Sesar
- Department of Ophthalmology, University Clinical Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - Kajo Bucan
- Department of Ophthalmology, University Hospital of Split, Split, Croatia
| | - Irena Sesar
- Department of Ophthalmology, University Clinical Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - Katarina Cvitkovic
- Department of Ophthalmology, University Clinical Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - Ivan Cavar
- Department of Physiology, School of Medicine University of Mostar, Mostar, Bosnia and Herzegovina
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Gungor Kobat S, Yusufoglu E, Gul FC, Celik F, Kalayci M. Plasma cerebellin levels in patients with central serous chorioretinopathy. J Fr Ophtalmol 2020; 44:218-223. [PMID: 33358442 DOI: 10.1016/j.jfo.2020.02.034] [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: 11/15/2019] [Revised: 01/22/2020] [Accepted: 02/27/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate levels of plasma cerebellin, cortisol, adrenaline and noradrenaline in patients with central serous chorioretinopathy (CSC). MATERIALS AND METHODS This prospective study included 30 patients diagnosed with acute CSC (Group 1) and a control group of 30 age-matched, healthy subjects without CSC (Group 2). Levels of plasma cerebellin, cortisol, adrenaline and noradrenaline were examined in blood samples taken after 8-12hours of fasting. A value of p<0.05 was considered statistically significant in the comparative analyses. RESULTS The mean plasma cerebellin level was found to be 232.56±113.28 pg/ml in Group 1 and 174.07±82.04 pg/ml in Group 2 (p=0.02). Mean plasma cortisol was 13.19±3.87μg/ml in Group 1 and 9.55±2.92μg/ml in Group 2 (p<0.01). Mean plasma adrenaline was 60.62±26.67 pg/ml in Group 1 and 46.17±19.20 pg/ml in Group 2 (p=0.03). Mean plasma noradrenaline was 206.66±73.90 pg/ml in Group 1 and 149.96±51.36 pg/ml in Group 2 (p<0.01). CONCLUSION It can be concluded that increased cerebellin may have a role in the etiology of CSC by increasing catecholamine expression from the adrenal medulla and indirectly by increasing cortisol levels via a paracrine effect from the adrenal cortex.
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Affiliation(s)
- S Gungor Kobat
- Elazıg Health Science University, Department of Ophthalmology, Elazıg, Turkey.
| | - E Yusufoglu
- Elazıg Health Science University, Department of Ophthalmology, Elazıg, Turkey
| | - F C Gul
- Elazıg Health Science University, Department of Ophthalmology, Elazıg, Turkey
| | - F Celik
- Elazıg Health Science University, Department of Ophthalmology, Elazıg, Turkey
| | - M Kalayci
- Elazıg Health Science University, Department of Biochemistry, Elazıg, Turkey
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Abstract
PURPOSE OF REVIEW The aim of this article is to summarize up-to-date research on the effects of obstructive sleep apnea (OSA) on retinal vascular conditions. RECENT FINDINGS OSA is associated with the development of diabetic retinopathy, retinal vein occlusion, and central serous chorioretinopathy. The severity of OSA and biomarkers such as the apnea-hypopnea index (AHI) correlate with the severity of retinal disease. Dysregulation of circadian locomotor output cycles kaput (CLOCK) genes that govern circadian rhythm is associated with development of proliferative retinal disease. SUMMARY OSA and retinal vascular disease have a high cost burden on the healthcare system. OSA creates systemic changes and hypoxic conditions that may incite or exacerbate retinal vascular diseases. Retinal changes may be the first clinical manifestation of otherwise undiagnosed OSA, so it is important to refer patients with new-onset retinal vascular disease for appropriate sleep testing.
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Affiliation(s)
| | - Kapil G Kapoor
- Eastern Virginia Medical School, Norfolk
- Wagner and Kapoor Research Institute, Virginia Beach, Virginia, USA
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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: 11] [Impact Index Per Article: 2.8] [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.
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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
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Booth AEC, Hopkins AM, Rowland A, Kichenadasse G, Smith JR, Sorich MJ. Risk factors for MEK-associated retinopathy in patients with advanced melanoma treated with combination BRAF and MEK inhibitor therapy. Ther Adv Med Oncol 2020; 12:1758835920944359. [PMID: 32821295 PMCID: PMC7406936 DOI: 10.1177/1758835920944359] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 06/29/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Retinopathy is a common adverse event with mitogen-activated extracellular signal-regulated kinase (MEK) inhibitors. Little is known about the pathophysiology of MEK inhibitor-associated retinopathy (MEKAR). Since MEKAR has many similarities to central serous chorioretinopathy (CSCR), they may share common risk factors. The aim of this study was to evaluate the association between baseline characteristics and MEKAR in melanoma patients initiating MEK inhibitor treatment. METHODS Data from patients treated with cobimetinib and vemurafenib for advanced melanoma in the coBRIM trial were subjected to secondary analysis. Consistent with CSCR risk factors, assessed baseline characteristics included: age, gender, past ocular disease, weight, hypertension, diabetes, dyslipidemia, glomerular filtration rate (eGFR) and corticosteroid use. Associations between characteristics and retinopathy events (any grade and symptomatic) were evaluated using univariate logistic regression and represented as odds ratios (OR). RESULTS A total of 247 patients were treated with cobimetinib and vemurafenib, of whom 72 (29%) had retinopathy of any grade and 33 (13%) had symptomatic retinopathy. Patients with a history of ocular disease were at significantly higher risk of retinopathy (any grade, 44%; symptomatic, 22%) than those with no ocular disease history (any grade, 22%; symptomatic, 10%). Individuals with a history of ocular inflammation or infection were at highest risk: 4 of 5 developed symptomatic retinopathy during MEK inhibitor therapy. Increased age was associated with a higher risk of any grade retinopathy {decade increase OR [95% confidence interval (CI)] = 1.03 (1.01-1.05); p = 0.009}, while increasing eGFR was significantly associated with a decreased risk of any grade retinopathy [0.98 (0.96-0.99); p = 0.004]; the associations were not statistically significant with symptomatic retinopathy. Other assessed CSCR risk factors were not significantly associated with MEKAR. CONCLUSION Age, glomerular filtration rate and history of ocular disease (particularly inflammatory eye disease) were associated with a risk of MEK inhibitor induced retinopathy. Patients who are at increased risk of MEKAR may benefit from more regular ophthalmologic assessment during treatment.
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Affiliation(s)
- Andrew E. C. Booth
- College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA 5042, Australia
| | - Ashley M. Hopkins
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Andrew Rowland
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Justine R. Smith
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Michael J. Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Penas S, Castro P, Pereira G, Oliveira AM, Carneiro AM, Rocha-Sousa A, Azevedo E, Falcão-Reis FM. Cerebral Neurovascular Coupling Impairment in Central Serous Chorioretinopathy. Ophthalmic Res 2020; 65:446-454. [PMID: 32564029 DOI: 10.1159/000509553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022]
Abstract
Background Central serous chorioretinopathy (CSCR) is a chorioretinal disorder resulting from choroidal hyperpermeability. Its comorbidities as hypertension, coronary disease and psychological stress, suggest that it might reflect a more generalized vascular dysfunction. Objectives To assess the cerebrovascular regulation integrity, using cerebral autoregulation (CA), carbon dioxide vasoreactivity (VR) and neurovascular coupling (NVC) in CSCR. Methods This observational pilot study included 20 CSCR patients and 14 age and sex-matched controls. A State-Trait Anxiety Inventory (STAI) inquiry was full-filled. Continuous measurement of cerebral blood flow velocity (CBFV), arterial blood pressure, heart rate and end-tidal carbon dioxide was performed. VR was assessed during hypercapnia (inhaling carbogen gas) and hypnocapnia (hyperventilation). For NVC, the CBFV relative increase during mental activation using the N-Back Task was calculated. Results No significant differences in systemic hemodynamic parameters, CA or VR were found between both groups. During the NVC performance, the average CBFV rise during mental stress was significantly lower in CSCR (p=0.011). A significant negative correlation was found between STAI scores and NVC. Conclusions CSCR patients presented a significantly impaired cerebral NVC compared to controls, supporting the theory of a potential systemic vascular dysfunction. Stress could be related to this NVC impairment.
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Affiliation(s)
- Susana Penas
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Pedro Castro
- Faculty of Medicine of University of Porto, Porto, Portugal
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Gilberto Pereira
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Ana Marta Oliveira
- Investigation Unit, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Angela M Carneiro
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Amândio Rocha-Sousa
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Elsa Azevedo
- Faculty of Medicine of University of Porto, Porto, Portugal
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Fernando M Falcão-Reis
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
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38
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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.
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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
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OCULAR PERFUSION PRESSURE AND CHOROIDAL THICKNESS IN CENTRAL SEROUS CHORIORETINOPATHY AND PIGMENT EPITHELIOPATHY. Retina 2020; 39:143-149. [PMID: 29095356 DOI: 10.1097/iae.0000000000001916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate ocular perfusion pressure (OPP) in patients with central serous chorioretinopathy (CSC) and pigment epitheliopathy (PE). METHODS In this retrospective study, we included patients with acute idiopathic unilateral CSC and age- and sex-matched normal controls. The patients with CSC were classified into two groups according to the PE presence on their fellow eyes. We compared OPP among CSC patients with or without PE and normal controls. RESULTS Among a total of 47 patients with CSC, 21 were classified into the PE group and 26 into the non-PE group. The mean OPP (±SD) of CSC and fellow eyes in the PE group (50.02 ± 4.98 and 50.83 ± 4.12 mmHg, respectively) was greater than that in the non-PE group (43.69 ± 6.88 and 44.0 ± 6.57 mmHg, respectively) and normal controls (45.64 ± 8.73 mmHg) (all, P < 0.05). The mean macular choroidal thickness of CSC and fellow eyes in the PE group (344.4 ± 31.8 and 310.1 ± 37.0 μm, respectively) was thicker than that in the non-PE group (318.5 ± 43.8 and 282.8 ± 36.1 μm, respectively) (all, P < 0.05). Greater macular choroidal thickness and higher OPP were associated with PE (P = 0.002 and P = 0.003). CONCLUSION Forty-five percent of the patients with acute unilateral CSC had PE in their fellow eyes. Increased OPP may influence the development of bilateral CSC characteristics.
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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: 50] [Impact Index Per Article: 10.0] [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.
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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
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Loya H, Ghoghari H, Rizvi SF, Khan A. Effect of altering the regime of oral rifampicin therapy in the treatment of persistent central serous chorioretinopathy. Pak J Med Sci 2019; 35:1687-1690. [PMID: 31777516 PMCID: PMC6861499 DOI: 10.12669/pjms.35.6.990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To study the effect of reducing the duration of rifampicin therapy in the treatment of Chronic Central Serous Chorioretinopathy. Methods: This is interventional study conducted in Layton Rahmatullah Benevolent Trust, Free Base Eye Hospital Korangi, Karachi from February 2017 - December 2018. This randomized controlled comparative study included two groups, Groups-A comprised of 48 eyes of 40 cases with Chronic Central Serous Chorioretinopathy who were given reduced dose of oral rifampicin i.e. 600mg for one month, and Group-B consisted of 43 eyes of 40 controls with Chronic Central Serous Chorioretinopathy who were given reduced dose of oral rifampicin i.e. 300mg once daily for three months as previously stated in literature. To access the effect of therapy in both the groups, pre-treatment visual acuity on the logMAR and Optical Coherent Tomography (OCT, Heidelberg spectralis) for CMT were performed and repeated on the 1st and 3rd month post-treatment. Patients were also followed for 6 months to access any recurrence. Results: On comparing the two groups, Group-A had improvement in VA and CMT after one month therapy of Rifampicin, Pre-treatment mean VA in Group-A was 0.85 ± 0.19 as compared to the pre-treatment mean VA in Group-B i.e. 0.74+/- 0.208, while the pre-treatment mean CMT was 609.0 ± 178.29 µm in Group-A, and 600.0 +/- 155.09 µm in Group-B respectively. After 1 month of therapy, the visual status, and CMT in Group-A was 0.29+/- 0.21 and 311.6 +/- 89.9, while Group-B, VA was 0.598 +/- 0.23 (p value 0.001%) and CMT was 512.30 +/- 148.37 (p-value 0.001%). Rifampicin was continued in Group-B till three months, and patients were re-accessed but there was no difference in VA and CMT statically. During the 3rd and 6th months of follow up no relapses were reported. Conclusion: This comparative study showed that the group receiving oral rifampicin 600mg for one month showed better outcome at one month and third month than the group receiving oral rifampicin at a dose of 300mg once daily for three months. This gives a better compliance and lower the risk of drug induced side effects.
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Affiliation(s)
- Hina Loya
- Dr. Hina Loya, MBBS. Layton Rahamatullah Benevolent Trust (LRBT), Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Hunain Ghoghari
- Dr. Hunain Ghoghari, MBBS, MRCSEd (Ophth). Layton Rahamatullah Benevolent Trust (LRBT), Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Syed Fawad Rizvi
- Prof. Syed Fawad Rizvi, MCPS (Ophth), FCPS (Ophth). Layton Rahamatullah Benevolent Trust (LRBT), Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Abdullah Khan
- Dr. Abdullah Khan, MCPS (Ophth), FCPS (Ophth). Layton Rahamatullah Benevolent Trust (LRBT), Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
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42
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Sahoo NK, Maltsev DS, Goud A, Kulikov AN, Chhablani J. Choroidal Changes at the Leakage Site in Acute Central Serous Chorioretinopathy. Semin Ophthalmol 2019; 34:380-385. [PMID: 31257974 DOI: 10.1080/08820538.2019.1635171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose: To analyze the choroidal vasculature at leak site and at the center of macula in acute central serous chorioretinopathy (CSCR) and to evaluate their co-relation with eccentricity of leak site. Methods: This retrospective study involved optical coherence tomography analysis of 27 eyes with acute CSCR. Relationship between macular thickness; large choroidal vessels diameter; baseline subfoveal and leakage point choroidal thickness, and eccentricity of leak point was evaluated. Results: A larger choroidal vessel caliber/choroidal thickness ratio was found at the leak site than fovea in both active (p = 0.0001) and resolved (p = 0.003) CSCR. Ratio at leakage point decreased after resolution of SRF (p = 0.004). Choroidal thickness at subfovea (p = 0.004), leakage point (p = 0.02); and difference between central and leakage point choroidal thickness (r = 0.6, p = 0.009) were significantly associated with the eccentricity of leakage point. Conclusion: Subfoveal and leak site choroidal profile could predict the eccentricity of leakage in CSCR.
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Affiliation(s)
- Niroj Kumar Sahoo
- a Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute , Hyderabad , India
| | - Dmitrii S Maltsev
- b Department of Ophthalmology, Military Medical Academy , St. Petersburg , Russia
| | - Abhilash Goud
- a Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute , Hyderabad , India
| | - Alexei N Kulikov
- b Department of Ophthalmology, Military Medical Academy , St. Petersburg , Russia
| | - Jay Chhablani
- a Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute , Hyderabad , India
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Arce-Alvarez A, Melipillán C, Andrade DC, Toledo C, Marcus NJ, Del Rio R. Heart rate variability alterations in infants with spontaneous hypertonia. Pediatr Res 2019; 86:77-84. [PMID: 30755711 DOI: 10.1038/s41390-019-0318-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hypertonia is characterized by increased resting muscle tone. Previous studies have shown that adult patients with hypertonia displayed autonomic imbalance. However, cardiac sympatho-vagal control in infants with hypertonia have not been explored. The main aim was to estimate cardiac autonomic control in infants with hypertonia using heart rate variability (HRV). METHODS Thirty infants (0-2 years old) were studied. Heart rate (HR) and R-R interval time series were obtained in 15 Control and 15 Hypertonia infants. HRV was analyzed in time and frequency domains. Additionally, non-linear analysis and entropy measurements were performed. RESULTS Infants with hypertonia showed cardiac autonomic imbalance as evidenced by alterations in HRV, characterized by an increased power spectral density of low frequency (LF) over high frequency (HF) components of HRV. Indeed, a ∼7% increase in LF, and ∼30% reduction in HF, were found in infants with hypertonia vs. control infants. In addition, time domain and non-linear HRV analysis (Root-mean-square of successive normal sinus R-R interval difference, entropy, and R-R interval variability) were all significantly decreased in hypertonia vs. control subjects. CONCLUSIONS Our results showed that hypertonia infants displayed HRV disturbances, which suggest an alteration in overall autonomic cardiac modulation in infants with hypertonia compared with healthy condition.
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Affiliation(s)
- Alexis Arce-Alvarez
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Facultad de Salud, Escuela de Kinesiología, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Claudia Melipillán
- Corporación de Rehabilitación Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - David C Andrade
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Investigación en Fisiología del Ejercicio, Universidad Mayor, Santiago, Chile
| | - Camilo Toledo
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Envejecimiento y Regeneración (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Noah J Marcus
- Department of Physiology and Pharmacology, Des Moines University, Des Moines, IA, USA
| | - Rodrigo Del Rio
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile. .,Centro de Envejecimiento y Regeneración (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile. .,Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile.
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Cardillo Piccolino F, Lupidi M, Cagini C, Fruttini D, Nicolò M, Eandi CM, Tito S. Choroidal Vascular Reactivity in Central Serous Chorioretinopathy. Invest Ophthalmol Vis Sci 2019; 59:3897-3905. [PMID: 30073350 DOI: 10.1167/iovs.18-23995] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate by optical coherence tomography angiography (OCT-A) the choroidal vascular response to experimentally increased blood pressure in patients with central serous chorioretinopathy (CSCR). Methods For this multicenter, observational, case-control study, we enrolled 35 patients with an established diagnose of CSCR and 25 age-matched healthy controls. All subjects underwent a handgrip isometric exercise to obtain elevation of blood pressure (BP). In the resting phase and during the physical effort, macular OCT-angiograms were acquired. Systemic hemodynamic data were recorded at baseline and during stress conditions using an electronic sphygmomanometer. The analysis of vascular density (VD) of the choriocapillaris (CC) was performed on OCT-angiograms. The results obtained in CSCR patients, both at baseline and during the stress test, were compared with those of healthy subjects. Results Baseline and under stress values of systolic BP, diastolic BP, and mean arterial pressure were significantly higher (P < 0.05) in CSCR patients compared to controls, reaching values in the range of hypertension during the exercise. Baseline VD values of the CC were significantly lower (P < 0.05) in CSCR cases compared to healthy subjects. We noticed a significant increase (P < 0.05) in these values under stress condition in CSCR patients and not in controls. Conclusions The present study suggests that choroidal blood flow is dysregulated in CSCR. During physical stress, CSCR patients easily reach critical values of BP that are not dampened by compensatory mechanisms in the choroidal vessels, as it happens in healthy subjects. The CC in CSCR could be particularly vulnerable to variations of systemic hemodynamics.
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Affiliation(s)
- Felice Cardillo Piccolino
- Fondazione per la Macula Onlus, Di.N.O.G.Mi, University Eye Clinic, Università di Genova, Genova, Italy
| | - Marco Lupidi
- Fondazione per la Macula Onlus, Di.N.O.G.Mi, University Eye Clinic, Università di Genova, Genova, Italy.,Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy.,Centre de l'Odéon, Paris, France
| | - Carlo Cagini
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Daniela Fruttini
- Department of Internal Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Massimo Nicolò
- Fondazione per la Macula Onlus, Di.N.O.G.Mi, University Eye Clinic, Università di Genova, Genova, Italy.,Clinica Oculistica Di.N.O.G.Mi, Università di Genova, Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Maria Eandi
- Fondazione per la Macula Onlus, Di.N.O.G.Mi, University Eye Clinic, Università di Genova, Genova, Italy.,Department of Surgical Sciences, Eye Clinic, University of Torino, Torino, Italy
| | - Silvia Tito
- Fondazione per la Macula Onlus, Di.N.O.G.Mi, University Eye Clinic, Università di Genova, Genova, Italy
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Tang PH, Shields R, Silva RA. Optical Coherence Tomography Angiography Findings in Chronic Central Serous Chorioretinopathy After Photodynamic Therapy. Ophthalmic Surg Lasers Imaging Retina 2019; 50:25-32. [DOI: 10.3928/23258160-20181212-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/02/2018] [Indexed: 11/20/2022]
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Abstract
PURPOSE To describe recurrence patterns and investigate candidate risk factors for recurrences of central serous chorioretinopathy. METHODS In 46 patients with acute central serous chorioretinopathy and follow-up >12 months after first episode resolution, parameters influencing recurrences were retrospectively evaluated using a frailty Cox proportional hazard survival model. Covariates included baseline systemic findings: age, gender, corticosteroid use, stress, shift work, sleep disorder, depression, allergy, cardiovascular risk; baseline optical coherence tomography findings: subfoveal choroidal thickness, pigment epithelial detachment pattern (regular/bump/irregular), number of subretinal hyperreflective foci at leakage site; baseline angiographic findings: fluorescein leakage intensity (intense/moderate/subtle/absent), hyperpermeability pattern on indocyanine-green angiography (focal/multifocal); and episode-related findings: duration and treatment of previous episode. RESULTS Twenty of 46 subjects (43%) presented ≥1 recurrences during a mean follow-up of 29.9 ± 9.5 months (range, 15-54 months). Follow-up duration did not differ between cases with or without recurrences (P = 0.3). Worse final visual acuity levels (logarithm of the minimal angle of resolution) were associated with a higher number of episodes during follow-up (P = 0.032, r = 0.28). In a univariate analysis, higher subfoveal choroidal thickness (P = 0.021), nonintense fluorescein leakage (= moderate/subtle/absent, P = 0.033), multiple subretinal hyperreflective foci (P = 0.026), and shift work (P < 0.0001) were significantly associated with recurrences, with a near-significant influence of irregular pigment epithelial detachment (P = 0.093). In a multivariate analysis, higher subfoveal choroidal thickness (P = 0.007), nonintense fluorescein leakage (P = 0.003) and shift work (P < 0.0001) remained significant and independent risk factors for recurrences. CONCLUSION Multiple factors influence the risk of central serous chorioretinopathy recurrence. These findings may contribute to identify patients at higher risk, who could benefit from earlier or more intensive treatment.
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Müller B, Tatsios J, Klonner J, Pilger D, Joussen AM. Navigated laser photocoagulation in patients with non-resolving and chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2018; 256:1581-1588. [DOI: 10.1007/s00417-018-4031-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/29/2018] [Accepted: 05/31/2018] [Indexed: 11/25/2022] Open
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48
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Eplerenone Versus Observation in the Treatment of Acute Central Serous Chorioretinopathy: A Retrospective Controlled Study. Ophthalmol Ther 2018; 7:109-118. [PMID: 29442283 PMCID: PMC5997595 DOI: 10.1007/s40123-018-0121-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION To investigate the effects of eplerenone compared to observation in the treatment of acute central serous chorioretinopathy (CSC). METHODS Charts of consecutive patients with a diagnosis of acute CSC (visual symptoms < 12 weeks) were reviewed. Included patients were divided into a treatment group (treated with eplerenone) and a control group (observation). Main outcome measures included changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), height of subretinal fluid (SRF) and subfoveal choroidal thickness (CT) at 1 and 3 months in the two groups. RESULTS Fifteen eyes of 15 patients (2 female, 13 male) and 12 eyes of 12 patients (1 female, 11 male [p = 1.000]) were included in the treatment and control groups, respectively. The mean age was 44 ± 9 (30-65) and 47 ± 11 years (28-66 years, p = 0.493), respectively. In the treatment group, BCVA improved significantly at 1 month (p = 0.018) and 3 months of follow-up (p = 0.011), while a non-significant improvement was seen in the control group. At 3 months, 12 of 15 eyes (80%) in the treatment group demonstrated complete SRF resolution, versus 3 of 12 eyes (25%) in the control group (p = 0.007). In the treatment group, SRF and CMT were significantly reduced at the 1-month follow-up (p = 0.014, p = 0.028, respectively) and the 3-month follow-up (p < 0.001 for both analyses), while in the control group the changes were not statistically significant. Eplerenone was well tolerated in all patients. CONCLUSION Patients affected by acute CSC treated with eplerenone achieved greater and faster resolution of the disease compared to the observation group. Eplerenone may represent an attractive new first-line treatment option for acute CSC.
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Temperament Profile in Patients with Central Serous Chorioretinopathy: A Case-Control Study. Eur J Ophthalmol 2018; 24:392-5. [DOI: 10.5301/ejo.5000377] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2013] [Indexed: 11/20/2022]
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Macular Retinal Vessel Oxygen Saturation Elevation in Chinese Central Serous Chorioretinopathy. J Ophthalmol 2017; 2017:5972418. [PMID: 29230322 PMCID: PMC5688345 DOI: 10.1155/2017/5972418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/02/2017] [Accepted: 09/24/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the retinal vessel oxygen saturation in central serous chorioretinopathy (CSC) cases among the Chinese. Methods Relative oxygen saturation of retinal blood vessels was measured in 33 Chinese patients with single-eye CSC using the Oxymap T1 retinal oximeter. The contralateral eyes were the control. The mean saturation of the retinal arteriole (AS) and venule (VS), arteriovenous difference (AVS), and arteriole and venule diameters (AD, VD) was analyzed in the optic disc area and macular region. Results In the optic disc area, the inferotemporal quadrant (TI) AS (93.2 ± 10.2%) and inferonasal quadrant (NI) VS (61.3 ± 7.3%) were higher in the affected eyes than in the contralateral eyes (88.7 ± 7.7% and 56.9 ± 6.5%) and AVS in NI (36.7 ± 10.4%) decreased compared to the contralateral eyes (41.5 ± 11.2%). The VD in TI was expanded (19.9 ± 2.5 pixels versus 18.1 ± 3.4 pixels). Around the macular region, AS was 93.6 ± 7.6%, higher than in the contralateral eyes (89.5 ± 6.3%). No other significant changes were found. Conclusions AS increased in the TI, and VS decreased in the NI in the eyes with CSC. In addition, AS also increased around the macular region, suggesting that these are contributors to CSC pathophysiology.
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