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Akilesh MS, Kumar V, Sinha A, Azad S, Chawla R, Vohra R, Venkatesh P. Ultra-wide field indocyanine green angiography in central serous chorioretinopathy. Indian J Ophthalmol 2024; 72:S606-S609. [PMID: 38770620 DOI: 10.4103/ijo.ijo_1852_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/16/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE To study ultra-widefield indocyanine green angiography (ICGA) patterns in central serous chorioretinopathy (CSC). METHODS A cross-sectional observational study was undertaken on 30 patients aged 20 to 60 years with CSC at the retina clinic of a tertiary care center. Of them, 43 eyes were affected by CSC, whereas 17 eyes were unaffected as the bilateral disease was observed in 13 patients. All patients were evaluated for best-corrected visual acuity, intraocular pressure, detailed slit-lamp bio-microscopy, indirect ophthalmoscopy, ultra-widefield imaging for pseudo color photograph, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), and ICGA, and macular swept-source optical coherence tomography (SSOCT) characteristics. RESULTS The mean age of patients was 41.43 ± 8.81 years (range: 25-59 years). The median log MAR visual acuity in CSC eyes was 0.30 (range: 0.17-1.0), whereas it was 0 in non-CSC fellow eyes ( P < 0.001). Pachy-vessels and late hyperpermeability on ultra-widefield ICGA were observed in all eyes. Vortex vein anastomosis was present in 93% of the affected eyes versus 88.2% in unaffected fellow eyes ( P = 0.61). Disc and posterior poles were the sites of the maximum number of anastomoses in both affected and unaffected eyes ( P = 0.77). Asymmetry in vortex vein drainage of the macula was present in 88.4% of affected eyes and 88.2% of unaffected eyes. CONCLUSION Studying the ICGA findings in CSC patients emphasized the role of choroidal circulation in pathogenesis as Pachy vessels were observed in all eyes affected with CSC and even fellow eyes of patients. Vortex vein anastomosis around the disc or posterior pole and asymmetric drainage from the macula were noted and could be contributing to CSC pathology.
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Affiliation(s)
- M S Akilesh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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2
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Tang Y, Chen H, Lin W, Wei Y. Perfluorocarbon liquid-assisted subretinal fluid drainage via the choroid as a treatment for bullous central serous chorioretinopathy in a nanophthalmic eye. Eur J Ophthalmol 2024:11206721241259798. [PMID: 38856976 DOI: 10.1177/11206721241259798] [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: 06/11/2024]
Abstract
PURPOSE The report presents a modified surgical technique wherein the perfluorocarbon liquid (PFCL)-assisted drainage of subretinal fluid (SRF) through the choroid was combined with partial-thickness sclerectomy (PTS) and punch sclerostomy as a treatment for bullous central serous chorioretinopathy (bCSCR) in a nanophthalmic eye. METHODS The developed surgical approach is herein discussed together with a corresponding surgical video. Briefly, two 5 × 4 mm half-thickness sclerectomies and a punch sclerostomy (diameter: 2 mm) to the choroid were performed in the inferior quadrants. Following vitrectomy, SRF was drained through the exposed choroid in the region where the punch sclerostomy was performed, whereafter PFCL was instilled into the vitreous cavity. RESULTS The complete resolution of SRF accumulation was evident at one-week post-surgery, with no evidence of recurrence over an 18-month follow-up period. No abnormal fluorescent leakage or choroidal vasodilation were evident via fundus fluorescein angiography and indocyanine green angiography examination at the patient's final follow-up visit. CONCLUSION PFCL-assisted SRF drainage through the choroid combined with PTS and punch sclerostomy may represent a viable approach to treating patients with bCSCR and nanophthalmic eyes, providing a rapid and long-lasting means of eliminating SRF accumulation.
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Affiliation(s)
- Yongping Tang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hao Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yong Wei
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Imanaga N, Terao N, Wakugawa S, Miyara Y, Sawaguchi S, Oshiro A, Yamauchi Y, Koizumi H. Scleral Thickness in Simple Versus Complex Central Serous Chorioretinopathy. Am J Ophthalmol 2024; 261:103-111. [PMID: 38281567 DOI: 10.1016/j.ajo.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE To evaluate the association between scleral thickness and a newly developed multimodal imaging-based classification of central serous chorioretinopathy (CSC). DESIGN Retrospective, cross-sectional study. METHODS This study included 217 eyes of 217 patients classified as simple or complex CSC based on the established protocols. Clinical and anatomical factors were compared between the 2 types. The scleral thickness was measured at 4 locations using anterior-segment optical coherence tomography. RESULTS Of the 217 eyes, 167 were classified as simple CSC and 50 as complex CSC. The complex CSC group showed older age (P = .011), higher male ratio (P = .001), more bilateral involvement (P < .001), poorer visual acuity (P < .001), greater subfoveal choroidal thickness (P = .025), and higher frequency of loculation of fluid (P < .001) and ciliochoroidal effusion (P < .001) than the simple CSC group. The complex CSC group had significantly greater scleral thicknesses in the superior, temporal, inferior, and nasal directions (all P < .001) than the simple CSC group. Multivariable analysis revealed that older age (odds ratio [OR] 1.054, 95% confidence interval [CI] 1.013-1.097, P < .001), male sex (OR 10.445, 95% CI 1.151-94.778, P < .001), bilateral involvement (OR 7.641, 95% CI 3.316-17.607, P < .001), and the mean value of scleral thicknesses in 4 directions (OR 1.022, 95% CI 1.012-1.032, P < .001) were significantly associated with the complex CSC. CONCLUSIONS Older age, male sex, bilateral involvement, and thick sclera were associated with the complex CSC. Scleral thickness seemed to determine the clinical manifestations of CSC.
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Affiliation(s)
- Naoya Imanaga
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Nobuhiro Terao
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Sorako Wakugawa
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yasunori Miyara
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shota Sawaguchi
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Ayano Oshiro
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yukihide Yamauchi
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hideki Koizumi
- From the Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
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Mansour AM, López-Guajardo L, Özdek Ş, Popov I, Parodi Battaglia M. Surgical Approaches to Serous Retinal Detachment With Retina-Lens Touch in Eyes With Nanophthalmos. JOURNAL OF VITREORETINAL DISEASES 2024; 8:173-180. [PMID: 38465360 PMCID: PMC10924594 DOI: 10.1177/24741264231220157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Purpose:To describe the visual outcomes and problems that resulted from surgical treatment of nanophthalmic complete retinal detachment (RD) with retina-lens contact. Methods: A multicenter retrospective case series with deep sclerectomy as a treatment was performed. Results: Five cases had extensive deep sclerectomies, 3 with intended drainage of subretinal fluid (SRF). The RD resolved 1 week postoperatively in 4 cases and within 1 month in 1 case. The visual acuity improved from light perception to a median of 20/100. Three cases had longstanding lens touch beyond 1 year and improved VA to 20/100, 20/150, and hand motions, respectively. Complications included focal lens dialysis in 2 cases (passive drainage of SRF) and lens or intraocular lens dislocation in 1 case each (active drainage of SRF). Ultrasound biomicroscopy and anterior optical coherence tomography showed a very narrow angle and short zonules. Conclusions: Deep sclerectomy results in good anatomic and functional improvements in advanced cases of nanophthalmos exudative detachment, which is often considered to be incurable.
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Affiliation(s)
- Ahmad M. Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
- Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon
| | | | - Şengül Özdek
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Ivajlo Popov
- Department of Ophthalmology, Comenius University, Bratislava, Slovakia
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5
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Bordbar DD, Skrehot HC, Weng CY. Update on the Management of Central Serous Chorioretinopathy. Int Ophthalmol Clin 2024; 64:179-193. [PMID: 38146890 DOI: 10.1097/iio.0000000000000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
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Boulanger E, Bonnin S, Delahaye-Mazza C, Tadayoni R, Gaudric A. CENTRAL SEROUS CHORIORETINOPATHY MIMICKING IDIOPATHIC UVEAL EFFUSION SYNDROME. Retin Cases Brief Rep 2023; 17:288-293. [PMID: 34081041 DOI: 10.1097/icb.0000000000001170] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe central serous chorioretinopathy cases presenting as uveal effusion syndrome, providing new insights into "pachychoroid spectrum" diseases. METHODS Clinical charts, color fundus photographs, fluorescein angiography, indocyanine green angiography, optical coherence tomography, ultrasound imaging, cerebral magnetic resonance imaging, and biometry of four eyes of three patients were assessed. A literature review was conducted. RESULTS The three patients had peripheral choroidal detachment and inferior bullous retinal detachment associated with central serous chorioretinopathy features detected using multimodal imaging, including fluorescein and indocyanine green angiography. The choroid was thick in the three patients, and uveal effusion occurred after steroid treatment in all cases. Subretinal fluid drainage and deep sclerectomy with flaps of 4 × 4 mm in both inferior quadrants were performed in three eyes of two patients with good outcomes. One patient was treated with photodynamic therapy. All three patients developed a typical leopard-spot pigmentary pattern in the fundus. CONCLUSION A severe presentation of highly exudative central serous chorioretinopathy may occur in rare cases with a peripheral choroidal detachment mimicking uveal effusion syndrome. These severe cases highlighted the role of choroidal thickening and hyperpermeability, choroidal vein dilation, and possible scleral thickening in both entities.
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Affiliation(s)
- Etienne Boulanger
- Ophthalmology Department, Université de Paris, APHP, Hôpital Lariboisière, Paris, France; and
| | - Sophie Bonnin
- Ophthalmology Department, Université de Paris, APHP, Hôpital Lariboisière, Paris, France; and
| | | | - Ramin Tadayoni
- Ophthalmology Department, Université de Paris, APHP, Hôpital Lariboisière, Paris, France; and
| | - Alain Gaudric
- Ophthalmology Department, Université de Paris, APHP, Hôpital Lariboisière, Paris, France; and
- Centre d'Imagerie et Laser, Paris, France
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7
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Mohapatra T, Trehan H, Kurumkattil R, Gupta R, Yadav Y, Singh P. Anterior scleral thickness in patients of central serous chorioretinopathy: A Case–control study. Oman J Ophthalmol 2023; 16:12-17. [PMID: 37007248 PMCID: PMC10062104 DOI: 10.4103/ojo.ojo_3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 06/01/2022] [Accepted: 06/11/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The aim of this study was to determine whether anterior scleral thickness (AST) varies significantly between patients with central serous chorioretinopathy (CSCR) versus normal individuals. To validate scleral thickness measurements by ultrasound biomicroscopy (UBM) vis a vis anterior segment optical coherence tomography (ASOCT). METHODS This case-control study analyzed 50 eyes of 50 patients with CSCR (cases) and compared it with that of 50 eyes of 50 age- and gender-matched controls. In cases, AST was measured at 1 mm and 2 mm temporal to the temporal scleral spur by ASOCT and UBM. In controls, AST was measured only by ASOCT. In all participants, posterior choroidal thickness (CT) was measured subfoveally, 1 mm nasal and 1 mm temporal to fovea by enhanced depth imaging optical coherence tomography. RESULTS The mean AST, as measured by ASOCT among cases and controls was 703.86 μm and 667.54 μm, respectively (P = 0.006). The mean AST by ASOCT and UBM in cases were 703.86 μm and 657.42 μm, respectively (P = 0.001). AST measurement by ASOCT and UBM showed a positive and statistically significant correlation (r = 0.431, P = 0.000). The mean CT among cases and controls was 443.56 μm and 373.88 μm, respectively (P = 0.000). We found a weak positive correlation (r = 0.11) in cases and weaker positive correlation in controls, between CT and AST measured by ASOCT. CONCLUSIONS Our findings suggest that AST varies significantly between patients with CSCR versus normal individuals. We found poor agreement of AST when measured by ASOCT and UBM.
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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: 13] [Impact Index Per Article: 6.5] [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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9
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Clinical Factors Related to Loculation of Fluid in Central Serous Chorioretinopathy. Am J Ophthalmol 2022; 235:197-203. [PMID: 34547278 DOI: 10.1016/j.ajo.2021.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To elucidate clinical factors related to the presence of loculation of fluid (LOF) in the posterior choroid in central serous chorioretinopathy (CSC). DESIGN Retrospective, cross-sectional study. METHODS This single-center study included 158 eyes from 158 patients with CSC who were classified into LOF and non-LOF groups. The groups were compared for age, sex, spherical equivalent, axial length, subfoveal choroidal thickness (SCT), and scleral thickness. Using swept-source optical coherence tomography (OCT), we determined the presence of LOF based on B-scan and en face images. Scleral thickness was measured 6 mm posterior to the scleral spur in 4 directions using anterior-segment OCT. RESULTS The 158 eyes were classified into 98 eyes in the LOF group and 60 eyes in the non-LOF group. In univariable analyses, the LOF group was younger (P = .01) and had a higher male ratio (P = .03) and greater SCT (P < .001) than the non-LOF group. All scleral thicknesses at the superior, temporal, inferior, and nasal points were greater in the LOF group than in the non-LOF group (426.2 vs 395.1 μm, 445.7 vs 414.9 μm, 459.2 vs 428.8 μm, 445.4 vs 414.3 μm, all P < .05). Multivariable analyses found that SCT (odds ratio [OR] 1.02, 95% CI 1.01-1.02, P < .001) and mean scleral thickness (OR 1.02, 95% CI 1.02-1.03, P = .002) were significantly associated with the presence of LOF. CONCLUSION A thick choroid and thick sclera appeared to be related to the presence of LOF in CSC.
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10
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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] [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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11
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Verma A, Bacci T, Sarraf D, Freund KB, Sadda SR. Vortex Vein Imaging: What Can It Tell Us? Clin Ophthalmol 2021; 15:3321-3331. [PMID: 34408390 PMCID: PMC8364369 DOI: 10.2147/opth.s324245] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022] Open
Abstract
This review article summarizes the patho-anatomy of the vortex veins, the major drainage channels for the choroid, and describes the various pathways of diseases associated with vortex vein abnormalities. This report also details the technical advancements to image the vortex veins, such as ultra-widefield indocyanine green angiography, which are critical to elucidate the importance of the vortices in various retino-choroidal disorders. Future applications of these advanced imaging systems to better understand the role of the vortex veins in health and disease are also discussed.
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Affiliation(s)
- Aditya Verma
- Doheny Eye Institute, Los Angeles, CA, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tommaso Bacci
- Vitreous Retina Macula Consultants of New York, New York, NY, USA.,Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY, USA
| | - David Sarraf
- Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA.,Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY, USA
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, CA, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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12
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Spaide RF, Gemmy Cheung CM, Matsumoto H, Kishi S, Boon CJF, van Dijk EHC, Mauget-Faysse M, Behar-Cohen F, Hartnett ME, Sivaprasad S, Iida T, Brown DM, Chhablani J, Maloca PM. Venous overload choroidopathy: A hypothetical framework for central serous chorioretinopathy and allied disorders. Prog Retin Eye Res 2021; 86:100973. [PMID: 34029721 DOI: 10.1016/j.preteyeres.2021.100973] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 12/19/2022]
Abstract
In central serous chorioretinopathy (CSC), the macula is detached because of fluid leakage at the level of the retinal pigment epithelium. The fluid appears to originate from choroidal vascular hyperpermeability, but the etiology for the fluid is controversial. The choroidal vascular findings as elucidated by recent optical coherence tomography (OCT) and wide-field indocyanine green (ICG) angiographic evaluation show eyes with CSC have many of the same venous patterns that are found in eyes following occlusion of the vortex veins or carotid cavernous sinus fistulas (CCSF). The eyes show delayed choroidal filling, dilated veins, intervortex venous anastomoses, and choroidal vascular hyperpermeability. While patients with occlusion of the vortex veins or CCSF have extraocular abnormalities accounting for the venous outflow problems, eyes with CSC appear to have venous outflow abnormalities as an intrinsic phenomenon. Control of venous outflow from the eye involves a Starling resistor effect, which appears to be abnormal in CSC. Similar choroidal vascular abnormalities have been found in peripapillary pachychoroid syndrome. However, peripapillary pachychoroid syndrome has intervortex venous anastomoses located in the peripapillary region while in CSC these are seen to be located in the macular region. Spaceflight associated neuro-ocular syndrome appears to share many of the pathophysiologic problems of abnormal venous outflow from the choroid along with a host of associated abnormalities. These diseases vary according to their underlying etiologies but are linked by the venous decompensation in the choroid that leads to significant vision loss. Choroidal venous overload provides a unifying concept and theory for an improved understanding of the pathophysiology and classification of a group of diseases to a greater extent than previous proposals.
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Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, NY, USA.
| | | | - Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Japan.
| | | | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | | | | | | | | | | | | | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA.
| | - Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.
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13
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A pilot study of scleral thickness in central serous chorioretinopathy using anterior segment optical coherence tomography. Sci Rep 2021; 11:5872. [PMID: 33712652 PMCID: PMC7955033 DOI: 10.1038/s41598-021-85229-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/25/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of this study is to compare the scleral thickness of central serous chorioretinopathy (CSC) eyes with controls using anterior segment optical coherence tomography (AS OCT). This prospective case control study included 15 patients (15 eyes) with CSC and 15 age and gender matched healthy subjects. All subjects underwent spectral domain OCT with enhanced depth imaging and swept source AS OCT of temporal sclera. We investigated difference in scleral thickness between the two groups and relationship between choroidal and scleral thickness. Among the 15 eyes in the study group, 1 eye had acute CSC, 4 had recurrent CSC, 7 had inactive CSC, and 3 had chronic CSC. There was no significant difference in terms of age, gender, axial length and spherical equivalent between the two groups. The choroidal and scleral thickness of the study group were significantly greater than those of the control group (P < 0.001, P = 0.034). Choroidal thickness was positively correlated with scleral thickness (P = 0.031). A thick sclera along with a thick choroid were demonstrated in CSC eyes using AS OCT. Scleral characteristics might be involved in the pathogenesis of CSC by affecting outflow resistance of venous drainage in choroidal circulation.
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Imanaga N, Terao N, Nakamine S, Tamashiro T, Wakugawa S, Sawaguchi K, Koizumi H. Scleral Thickness in Central Serous Chorioretinopathy. ACTA ACUST UNITED AC 2021; 5:285-291. [DOI: 10.1016/j.oret.2020.07.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
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Jung JJ, Yu DJG, Ito K, Rofagha S, Lee SS, Hoang QV. Quantitative Assessment of Asymmetric Choroidal Outflow in Pachychoroid Eyes on Ultra-Widefield Indocyanine Green Angiography. Invest Ophthalmol Vis Sci 2021; 61:50. [PMID: 32735325 PMCID: PMC7425745 DOI: 10.1167/iovs.61.8.50] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose To quantitatively demonstrate asymmetric choroidal outflow in pachychoroid (central serous chorioretinopathy [CSC]/pachychoroid pigment epitheliopathy [PPE]) eyes using mid-phase, ultra-widefield indocyanine green angiography (UWF ICGA) images. Methods Eyes with a clinical diagnosis of CSC/PPE were imaged with multimodal imaging including UWF ICGA (Optos California). Quadrant brightness was measured by manually segmenting based on vortex vein location, calculating the brightness “max-min” value to assess nonuniformity between quadrants, and comparing between CSC/PPE and control eyes. A multivariate linear regression was performed to determine, across individual eyes, which specific quadrants have the greatest brightness in pachychoroid eyes, after taking into account patient-eye-specific variability. Results Thirty-three eyes (18 patients) with CSC/PPE along with 16 eyes of 9 controls had a mean age of 51.94 ± 9.72 vs. 53.78 ± 17.92 years (P = 0.731), respectively. Max-min analysis showed significantly increased likelihood of nonuniform drainage between vortex veins in both CSC/PPE and control eyes. Multivariate linear regression in control eyes showed that on average, the inferotemporal quadrant was significantly brighter than the superonasal quadrant (9.72 units, P < 0.001). Among CSC/PPE eyes, adjusting for the preferential, nonuniform drainage in control eyes, the inferonasal and inferotemporal quadrants in CSC/PPE eyes remained significantly brighter than the reference quadrant by 5.36 units (P = 0.034) and 7.51 units (P = 0.008), respectively. Conclusions Asymmetric choroidal venous outflow occurs in both control and CSC/PPE eyes based on UWF ICGA quantitative brightness levels in each quadrant. Increased brightness levels along inferior quadrants in mid-phase ICGA images suggest venous outflow congestion among eyes with CSC or PPE.
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Bullous Central Serous Chorioretinopathy: A Rare and Atypical Form of Central Serous Chorioretinopathy. A Systematic Review. Pharmaceuticals (Basel) 2020; 13:ph13090221. [PMID: 32872388 PMCID: PMC7559580 DOI: 10.3390/ph13090221] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 01/23/2023] Open
Abstract
Bullous central serous chorioretinopathy (bCSCR) is a rare variant of the central serous chorioretinopathy, complicated by an exudative retinal detachment with shifting fluid. This systematic review aims to present the epidemiology, the pathogenesis, the clinical presentation, the imaging, the differential diagnosis, and the latest treatments of this disease. A total of 60 studies were identified following a literature search adhering to PRISMA guidelines. After full-text evaluation, 34 studies about bCSCR were included. bCSCR usually affects middle-aged men, and the principal risk factor is corticosteroid medications. Pathogenesis is related to an increased choroidal vessel and choriocapillaris permeability, with subsequent subretinal fluid accumulation, rich in fibrin, which may provoke the exudative retinal detachment. Clinical presentation and imaging are fundamental to distinguish bCSCR from other pathologies, avoiding unappropriated treatment. Corticosteroid withdraws (if assumed) and laser photocoagulation of leakage sites seen at angiography may speed up retinal reattachment. Verteporfin photodynamic therapy, transpupillary thermal therapy, oral eplerenone and scleral thinning surgery are other therapeutic options. An early diagnosis might prevent disease progression due to harmful medications as well as unnecessary surgery.
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Maggio E, Mete M, Maraone G, Arena F, Pertile G. Scleral thinning surgery for bullous retinal detachment with retinal pigment epithelial tear in central serous chorioretinopathy: a case report. BMC Ophthalmol 2020; 20:133. [PMID: 32252699 PMCID: PMC7137444 DOI: 10.1186/s12886-020-01409-w] [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: 09/16/2019] [Accepted: 03/27/2020] [Indexed: 01/28/2023] Open
Abstract
Background Bullous serous retinal detachment (RD) with retinal pigment epithelial (RPE) tear is a rare and severe variant of chronic central serous chorioretinopathy (CSC). Due to its atypical presentation, it may raise diagnostic issues, leading to inappropriate therapeutic procedures. The optimum treatment for this CSC variant is still uncertain. Case presentation A 65-year-old male was referred for vitreo-retinal surgery with a provisional diagnosis of rhegmatogenous RD in his right eye. Dilated fundus examination showed an inferior bullous RD with no evidence of retinal breaks, while a large RPE tear was detected in the temporal quadrant. Ocular ultrasound showed no mass lesion. The axial length was 23.63 mm. Enhanced depth imaging optical coherence tomography (EDI-OCT) revealed a pachychoroid pattern in both eyes. The patient referred a history of CSC in the right eye and the recent use of intravenous corticosteroids for bronchitis. Laser therapy and photodynamic therapy were not applicable due to the extension and elevation of the RD. Two months after oral treatment with eplerenone, the subretinal fluid increased significantly. The patient underwent two 4 × 4 mm deep lamellar sclerectomies in the inferior quadrants. The surgical treatment resulted in complete RD resolution. Conclusion A correct diagnosis of bullous variant of chronic CSC with RPE tear is critical to avoid inappropriate procedures and to prevent severe visual loss as a result of neuroretinal damage. Scleral thinning surgery may be considered a valid option, resulting in rapid and long-lasting resolution of RD.
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Affiliation(s)
- Emilia Maggio
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5 - Negrar, 37024, Verona, Italy.
| | - Maurizio Mete
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5 - Negrar, 37024, Verona, Italy
| | - Giorgia Maraone
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5 - Negrar, 37024, Verona, Italy
| | - Fabrizio Arena
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5 - Negrar, 37024, Verona, Italy
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Ramos-Yau EC, Muñoz-Domínguez E, Contreras-Mérida SP, Valencia-Londoño LM. SPIRONOLACTONE AS A THERAPEUTIC ALTERNATIVE FOR THE BULLOUS VARIANT OF CENTRAL SEROUS CHORIORETINOPATHY. Retin Cases Brief Rep 2020; 14:381-385. [PMID: 29595560 DOI: 10.1097/icb.0000000000000719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To report a case of the bullous variant of central serous chorioretinopathy successfully treated with spironolactone, a mineralocorticoid receptor antagonist. METHODS Case report of a patient including fluorescein angiography, optical coherence tomography, and color fundus photography. RESULTS Initially managed as a multifocal choroiditis, the use of oral and peribulbar corticoids worsened the serous retinal detachment. Taking in consideration this response, she was then diagnosed with a bullous variant of central serous chorioretinopathy and treated with 50 mg of spironolactone per day. Resolution of the serous retinal detachment, decrease in choroidal thickness on optical coherence tomography, and absence of leaks in fluorescein angiography was achieved 2 months posterior to the first dose of oral spironolactone. CONCLUSION We suggest the use of mineralocorticoid receptor antagonists, such as spironolactone, as a therapeutic alternative to more aggressive available treatments for the bullous variant of central serous chorioretinopathy.
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Affiliation(s)
- Eva C Ramos-Yau
- Retina Service, Unidad Nacional de Oftalmología, Guatemala City, Guatemala
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Kumar V, Azad SV, Vohra R, Venkatesh P. Serous macular detachment in nanophthalmos: A manifestation of pachychoroid spectrum. Am J Ophthalmol Case Rep 2019; 15:100522. [PMID: 31384695 PMCID: PMC6661461 DOI: 10.1016/j.ajoc.2019.100522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose The purpose of this article is to report serous macular detachment (SMD) similar to that seen in central serous chorioretinopathy (CSCR) in patients with nanophthalmos. Observation It is a retrospective case series from a tertiary eye care center in India. Multi modal imaging features of eyes with serous macular detachment in patients with nanophthalmos including colour fundus photographs, short wave autofluorescence, fundus fluorescein angiography and optical coherence tomography were studied. In addition axial length, anterior chamber depth, lens thickness and subfoveal choroidal thickness were measured. The eyes were treated with laser photocoagulation to the focal leak seen on fluorescein angiography. The patients were followed up for 12–18 months. Results Three eyes of three patients having serous macular detachment in nanophthalmos were identified. All three eyes had axial length <21mm, subfoveal choroidal thickness >450 microns and a focal leak on fluorescein angiography. Two eyes had serous pigment epithelial detachments underneath the SMD as well. Two eyes had peripheral pigmentary changes due to resolved subretinal fluid. The SMD resolved completely in two eyes and partially in one eye following focal laser photocoagulation. Conclusion and importance Serous macular detachments bearing features similar to that of CSCR can occur in the setting of nanophthalmos. These may represent manifestation of thick choroid or may represent forme fruste choroidal effusion.
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Tong B, Wang C, Qi X. Unusual rapid resolution of postsclerectomy exudative retinal detachment with topical NSAIDs therapy in a case of nanophthalmos. J Int Med Res 2019; 48:300060519847376. [PMID: 31081412 PMCID: PMC7512026 DOI: 10.1177/0300060519847376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Nanophthalmos is a developmental ocular malformation that has been associated with high
risks of uveal effusion syndrome and exudative retinal detachment (ERD). A variety of
surgical procedures and systemic/topical steroids have been described as effective for
treatment of ERD. However, the possibility of side effects should be considered. Here, we
describe a patient with nanophthalmos who was treated for recurrent ERD during long-term
follow-up, and we discuss non-surgical treatment options that are available in such cases.
A 43-year-old woman with bilateral nanophthalmos exhibited ERD in her right eye for one
month. After partial thickness sclerectomy with central sclerostomy, the retina was
completely reattached. However, ERD recurred 3 years later. The patient refused surgery;
therefore, we employed conservative treatment of topical nonsteroidal anti-inflammatory
drugs (NSAIDs) and observation. One month later, the retina was completely reattached. To
the best of our knowledge, no previous report has described resolution of recurrent ERD in
a patient with nanophthalmos using NSAIDs during long-term follow-up after successful
surgical treatment. Our success using this approach suggests that it could be used as
alternative treatment for ERD in patients with nanophthalmos before application of further
treatments.
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Affiliation(s)
- Boding Tong
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan Province, China
| | - Chao Wang
- Department of Pathology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xin Qi
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan Province, China
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Kishi S, Matsumoto H, Sonoda S, Hiroe T, Sakamoto T, Akiyama H. Geographic filling delay of the choriocapillaris in the region of dilated asymmetric vortex veins in central serous chorioretinopathy. PLoS One 2018; 13:e0206646. [PMID: 30412594 PMCID: PMC6226146 DOI: 10.1371/journal.pone.0206646] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/16/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To investigate the correlation between geographic filling delays in the choriocapillaris using indocyanine green angiography (ICGA) images and dilated vortex veins in central serous chorioretinopathy (CSC). DESIGN Observational case series. PARTICIPANTS Thirty-two eyes of 32 patients, 21 with acute and 11 with chronic CSC. METHODS Digital ICGA and fluorescein angiography (FA), with videoangiography, and swept-source optical coherence tomography (SS-OCT) for B-scan and en-face choroidal imaging were performed. Overlapping of the filling delay areas in the choriocapillaris in the early-phase ICGA images and the region of dilated vortex veins in the en-face images were analyzed. The consistency of both areas was graded as follows. Grade 3: filling delay area is entirely involved in the dilated vortex vein region. Grade 2: 50% or more of filling delay area overlaps with the dilated vortex vein region. Grade 1: less than 50% of filling delay area overlaps with the dilated vortex vein region. Grade 0: no tendency for overlapping of two areas. We evaluated the asymmetry of upper and lower vortex veins in en-face images of the Haller layer. Using the binarization method, we quantified the luminal and stromal areas of the choroid. The ratios of the Haller layer area and luminal areas in the Haller layer to total choroidal area were examined. RESULTS The consistency of overlapping of the two areas was grade 2.62 ± 0.49 in acute CSC and grade 1.55 ± 0.78 in chronic CSC (p = 0.0005). Asymmetry of upper and lower vortex veins was seen in 17 of 22 eyes (81%) with acute CSC and 6 of 11 eyes (54.5%) with chronic CSC (p = 0.114). Central choroidal thickness was 411 ± 79 μm in acute CSC and 326 ± 64 μm in chronic CSC (p = 0.004). In the posterior fundus with a 4500 μm diameter, the ratio of the Haller layer area to total choroidal area was 63.7 ± 8.6% in acute CSC and 57.1 ± 7.9% in chronic CSC (p = 0.047). The ratio of the luminal area in the Haller layer area to total choroidal area was 46.9 ± 7.6% in acute CSC and 40.0 ± 6.9% in chronic CSC (p = 0.014). CONCLUSION Filling delay areas in the choriocapillaris and dilated vortex vein regions showed marked overlapping in acute CSC. Increased choroidal thickness was attributed to dilated vortex veins. These findings suggest that the blood flow into the choriocapillaris is delayed as a result of congestion of the dominant vortex veins that supply this geographic area. CSC may be a disease characterized by vortex vein congestion that develops in eyes with asymmetric vortex veins.
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Affiliation(s)
- Shoji Kishi
- Maebashi Central Eye Clinic, Maebashi, Japan
| | - Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shozo Sonoda
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takashi Hiroe
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hideo Akiyama
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Chawla R, Tripathy K, Meena S, Behera AK. Subretinal Hypopyon in Presumed Tubercular Uveitis: A Report of Two Cases. Middle East Afr J Ophthalmol 2018; 25:163-166. [PMID: 30765956 PMCID: PMC6348936 DOI: 10.4103/meajo.meajo_187_17] [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] [Indexed: 11/04/2022] Open
Abstract
Subretinal hypopyon is an uncommon entity which has been described in ocular infections and inflammations including endophthalmitis, acute retinal necrosis, and sympathetic ophthalmia. The authors report subretinal hypopyon in two cases of presumed tubercular uveitis which responded well to antitubercular therapy (ATT). The first case was a 47-year-old male with bilateral peripapillary chorioretinitis with a subretinal hypopyon. Tuberculosis was confirmed on biopsy of a cervical lymph node which revealed acid-fast bacilli. Case 2 was a 17-year-old male with unilateral involvement in the form of a choroidal granuloma with disc edema and retinitis. In addition, a subretinal hypopyon was evident. Both these cases showed dramatic anatomical improvement with ATT. A novel finding of subretinal hypopyon is described in these cases of presumed ocular tuberculosis. It may be prudent to start empirical ATT early on detection of a subretinal hypopyon along with other manifestations compatible with tubercular etiology.
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Affiliation(s)
- Rohan Chawla
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Koushik Tripathy
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Meena
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Aswini Kumar Behera
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Venkatesh P, Takkar B, Temkar S. Clinical manifestations of pachychoroid may be secondary to pachysclera and increased scleral rigidity. Med Hypotheses 2018. [PMID: 29523299 DOI: 10.1016/j.mehy.2018.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Current imaging advancements have led to emergence of pachychoroid as an association of important vision threatening diseases like chronic serous chorioretinopathy and polypoidal choroidal vasculopathy. While the precise relation between thick choroid and such disorder is being investigated, the etiology behind pachychoroid remains elusive. We hypothesize pachychoroid to be a resultant of impeded vascular outflow due to thick sclera and increased scleral rigidity. We discuss our hypothesis in the perspective of other choroidal manifestations of anomalously thick scleral structure.
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Affiliation(s)
- Pradeep Venkatesh
- Retina and Uvea Services, Dr. R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
| | - Brijesh Takkar
- Retina and Uvea Services, Dr. R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Shreyas Temkar
- Retina and Uvea Services, Dr. R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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