Acute Central Serous Chorioretinopathy Subtypes as Assessed by Multimodal Imaging

Laser Treatment of Central Serous Chorioretinopathy - An Update

Laser treatment has been a mainstay for management of central serous chorioretinopathy for a few decades. Different types of lasers have been used and non-damaging retinal laser is the most recent option. The aim of this review is to provide an update on this form of treatment, based on the research published during last 5 years, in comparison with earlier studies published. A MEDLINE database search was performed with a combination of the following terms: central serous chorioretinopathy and laser photocoagulation or subthreshold laser or subthreshold micropulse laser or nanosecond laser or microsecond laser or end-point management or photodynamic therapy. Results were analyzed separately for each modality of laser treatment. Reports published in recent years confirm findings of previous research and do not distinguish treatments of this clinical entity. Among all analyzed laser options, photodynamic therapy provides the fastest and most prominent morphological improvements, including subretinal fluid resorption and reduction of choroidal thickness. This modality is also associated with fewer recurrences than with other treatments. Subthreshold micropulse laser allows the physician to maintain and, in selected cases, improve the patient's vision. Conventional photocoagulation is still effective, especially with the introduction of navigated laser systems. Despite the availability of variable laser treatment options, long-term functional improvements in chronic cases are minor for each modality. Long-lasting central serous chorioretinopathy cases with significantly altered retinal morphology do not usually present with functional improvement, despite satisfactory morphological outcomes. Early initiation of treatment has the potential to prevent visual loss and to improve the patient's quality of life.

Crossover to PDT after the unsuccessful micropulse laser treatment of central serous chorioretinopathy

Purpose

Subthreshold micropulse laser (SML) and photodynamic therapy (PDT) are among the most effective therapeutic modalities applied to central serous chorioretinopathy (CSCR). This study aimed to evaluate the efficacy and durability of PDT in CSCR cases unresponsive to at least two SML treatments.

Methods

The study included 26 consecutive eyes of 24 patients (21 males and three females) with chronic CSCR. In all cases, a lack of reduction in subretinal fluid (SRF) levels was noted after at least two consecutive SML sessions. The parameters of best corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT) were evaluated at baseline and 1, 3 and 12 months post-PDT.

Results

The mean duration of symptoms in the group was 53.81 ± 39.48 months, the mean age of the patients was 49.26 ± 12.91 years, and the mean subfoveal choroidal thickness (SFCT) was 572.11 ± 116.21 mm. Complete resorption of SRF was observed in 21 out of 26 eyes (80.77%) at 1 month and sustained in 18 cases (69.23%) at 12 months. At 12 months, in the sustained group, BCVA improved significantly from 0.39 ± 0.18 to 0.19 ± 0.2 logMAR (P = 0.01), central subfoveal thickness (CST) reduced from 316.44 ± 75.83 mm to 197.67 ± 22.99 mm (P < 0.0001), and SFCT reduced from 579.28 mm to 446.78 mm (P < 0.0001).

Conclusions

PDT provides the opportunity for the successful treatment of CSCR unresponsive to SML treatment. Improvements are possible even in cases with a long duration of symptoms and significant alterations in retinal morphology. Thus, PDT should be considered for patients with prominently increased choroidal thickness.

Presentation and outcome of central serous chorioretinopathy with and without pachychoroid

BACKGROUND

The present study compared clinical features and outcomes of central serous chorioretinopathy (CSC) with and without pachychoroid.

METHODS

It was a retrospective, longitudinal, record-based study which included eyes with CSC. Patients underwent spectral domain optical coherence tomography and differentiated between pachychoroid and non-pachychoroid groups. Eyes were divided into pachychoroid and non-pachychoroid groups based on the subfoveal choroidal thickness of 300 microns and the presence of pachyvessels.

RESULTS

A total of 250 eyes of 250 patients were divided into pachychoroid and non-pachychoroid with 125 eyes in each group. Mean ages of patients in pachychoroid and non-pachychoroid groups were 45.7 ± 9.4 years and 47.4 ± 10.2 years, respectively. Mean initial best-corrected visual acuity (BCVA) was 0.40 ± 0.42 in pachychoroid and 0.39 ± 0.38 in non-pachychoroid group (p = 0.9). Mean final BCVA was 0.37 ± 0.9 in pachychoroid and 0.21 ± 0.33 in non-pachychoroid group (p = 0.04). 36 (28.8%) eyes in pachychoroid and 60 (48%) eyes in non-pachychoroid group had spontaneous resolution of CSC (p = 0.007). A total of 39 (31.2%) eyes in pachychoroid and 13 (10.4%) in non-pachychoroid group had recurrent CSC at the end of follow-up.

CONCLUSION

CSC eyes with pachychoroid had more recurrent episodes and less spontaneous resolution compared to CSC eyes in non-pachychoroid group. Final visual acuity was worse in eyes with CSC and pachychoroid. These findings need to be validated in a larger sample size with a prospective study design.

Scanning Laser Ophthalmoscopy Retromode Imaging Compared to Fundus Autofluorescence in Detecting Outer Retinal Features in Central Serous Chorioretinopathy

Central serous chorioretinopathy (CSCR) is a retinal disease characterized by a heterogeneous clinical phenotype, depending on the influence of different factors in its pathogenesis, including the presence of subretinal fluid (SRF), trophism of the retinal pigmented epithelium (RPE) and choroidal hyper-permeability. Our study has the purpose of assessing the ability of scanning laser ophthalmoscopy (SLO) retromode imaging, compared to fundus autofluorescence (FAF), to identify outer retinal features in a cohort of patients with a diagnosis of CSCR. A total of 27 eyes of 21 patients were enrolled in our study. All patients underwent full ophthalmological examination, including fundus retinography, fundus fluorescein angiography, optical coherence tomography (OCT), FAF and SLO retromode imaging. For each patient, the following features were evaluated: SRF, the presence of pigmented epithelium detachment (PED), RPE dystrophy, and RPE atrophy. RPE dystrophy was further characterized according to the appearance in FAF of iso-, hyper- and hypo-autofluorescent dystrophy. The ability to identify each feature was evaluated for FAF and SLO retromode alone, compared to a multimodal imaging approach. FAF identified SRF in 11/14 eyes (78%), PED in 14/19 (74%), RPE dystrophy with iso-autofluorescence in 0/13 (0%), hyper-autofluorescence in 18/19 (95%), hypo-autofluorescence in 20/20 (100%), and RPE atrophy in 7/7 (100%). SLO retromode imaging identified SRF in 13/14 eyes (93%), PED in 15/19 (79%), RPE dystrophy with iso-autofluorescence in 13/13 (100%), hyper-autofluorescence in 13/19 (68%), hypo-autofluorescent in 18/20 (90%), and RPE atrophy in 4/7 (57%). SLO retromode imaging is able to detect retinal and RPE changes in CSCR patients with a higher sensitivity than FAF, while it is not able to identify the depth of lesions or supply qualitative information about RPE cells' health status, meaning that it is less specific. SLO retromode imaging may have a promising role in the assessment of patients with CSCR, but always combined with other imaging modalities such as OCT and FAF.

Efficacy of Navigated Laser Photocoagulation for Chronic Central Serous Chorioretinopathy: A Retrospective Observational Study

Background. No consensus has been reached regarding the management of central serous chorioretinopathy (CSCR). We aimed to investigate the efficacy of navigated laser treatment for chronic CSCR and changes in the morphology of the retinal pigment epithelium (RPE). In this retrospective observational study, 19 patients with subjective symptoms admitted to the Nanjing Medical University Affiliated Eye Hospital were included between January 2021 and August 2021. All patients underwent visual acuity and optical coherence tomography (OCT) examination during follow-up. Fluorescein angiography (FA) was performed at baseline and at the final follow-up to confirm the dye leakage sites. The mean logMAR BCVA at baseline and at the end of follow-up was 0.49 ± 0.24 and 0.24 ± 0.15, respectively. The mean logMAR BCVA 3 months after treatment was significantly better than that before treatment (p = 0.002). Significant improvements were observed in central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) after navigated laser photocoagulation (p < 0.0001). Subretinal fluid was completely resolved in 13 (68%) of 19 eyes at 3 months. RPE lesions on OCT images showed RPE detachment in 17 eyes (61.5%), small protrusion of the RPE layer in 5 eyes (7.5%), and a rough RPE layer in 4 eyes (31%). After laser treatment, 9 points (35%) showed retinal detachment, and 10 (38.5%) regions showed an irregular RPE layer. An irregularly protruded RPE layer was also observed in different regions of the leakage spot in 5 (19%) eyes, and RPE defects were seen in 2 (7.5%) eyes. Navigated laser photocoagulation for chronic CSCR can achieve substantial anatomical and visual improvement. OCT outcomes may provide new information to facilitate understanding of the mechanism of chronic CSCR. Navigated laser photocoagulation should be chosen as an optimal treatment option in patients with chronic CSCR who cannot afford photodynamic therapy.