1
|
Kaye RA, Peto T, Hogg R, Griffiths H, Sivaprasad S, Lotery AJ. CHOROIDAL VASCULARITY IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY AND ITS ASSOCIATION WITH RISK SINGLE-NUCLEOTIDE POLYMORPHISMS. Retina 2024; 44:837-843. [PMID: 38109714 PMCID: PMC11027981 DOI: 10.1097/iae.0000000000004024] [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] [Indexed: 12/20/2023]
Abstract
PURPOSE To analyze the choroidal parameters of patients with chronic central serous chorioretinopathy (cCSC) and the association with central serous chorioretinopathy susceptibility genes. METHODS The choroidal vascular index (CVI) was obtained by binarizing spectral domain optical coherence tomography enhanced depth images of patients with cCSC and healthy age-matched controls. Patients with cCSC were genotyped for three central serous chorioretinopathy susceptibility single-nucleotide polymorphisms: rs4844392 ( mir-29b-2/CD46 ), rs1329428 ( CFH ), and rs2379120 (upstream GATA5 ). RESULTS One hundred three eyes with cCSC and 53 control eyes were included. There was a significant increase in the subfoveal choroidal area in both the affected (2.4 ± 0.6 mm 2 ) and fellow (2.2 ± 0.6 mm 2 ) eyes of patients with cCSC compared with controls (1.8 ± 0.5 mm 2 , P < 0.0001 and P < 0.0001). The CVI was reduced in patients with cCSC 63.5% ± 3.1% compared with controls 65.4% ± 2.3% ( P < 0.001) and also in the affected compared with the fellow eyes 64.6% ± 2.9% ( P < 0.01). There was a significant association between CVI in the cCSC group and presence of the risk single-nucleotide polymorphisms rs2379120 at GATA5 ( P < 0.01). CONCLUSION The relative reduction of CVI in patients with cCSC may suggest a persistence of vessel hyperpermeability over dilation in chronic disease. GATA5 is associated with CVI in patients with cCSC and therefore may have a role in choroidal vascularity.
Collapse
Affiliation(s)
- Rebecca A. Kaye
- Department of Ophthalmology, University Hospital Southampton, Southampton, United Kingdom
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Tunde Peto
- School of Medicine, Dentistry and Biomedical Science, Queens University Belfast, Belfast, United Kingdom
- The VICI Trial, ISRCTN92746680
| | - Ruth Hogg
- School of Medicine, Dentistry and Biomedical Science, Queens University Belfast, Belfast, United Kingdom
| | - Helen Griffiths
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Sobha Sivaprasad
- University College London Institute of Ophthalmology, London, United Kingdom; and
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Andrew J. Lotery
- Department of Ophthalmology, University Hospital Southampton, Southampton, United Kingdom
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- The VICI Trial, ISRCTN92746680
| |
Collapse
|
2
|
Aksu Ceylan N, Cebeci Z. Relationship between macular intervortex vein anastomosis and optical coherence tomography biomarkers in chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2023; 42:103559. [PMID: 37028692 DOI: 10.1016/j.pdpdt.2023.103559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUNDS To evaluate the optical coherence tomography (OCT) biomarkers of patients with central serous chorioretinopathy (CSC) according to the presence or absence of direct anatomical relation to intervortex vein anastomosis (IVA) on indocyanine green angiography. METHODS We reviewed the records of 39 patients with chronic CSC. Patients were categorized in 2 groups: presence of IVA(Group A) or absence of IVA(Group B) in the macular region. Localization of IVA was categorized in 3 areas according to ETDRS grid:inner 1 mm circle (area-1), 1-3 mm middle circle (area-2) and 3-6 mm outer circle (area-3). RESULTS There were 31 eyes in Group A,21 eyes in Group B. Mean age of the patients was 52.5 ± 11.3years in Group A,47.2 ± 11years in Group B(p<0.001).Mean initial visual acuity (VA) was 0.38±0.38LogMAR in Group A, 0.19±0.21LogMAR in Group B(p<0.001).Mean subfoveal choroidal thickness(SFCT) was 436.3 ± 134.3µ in Group A,480.2 ± 136.6µ in Group B(p<0.001).Localization of IVA in area-1 was correlated with inner choroidal attenuation (ICA) and leakage on IVA(p = 0.011,p = 0.02). Localization of IVA in area-3 was correlated with irregular lesions on RPE(p = 0.042).Smokestack configuration,intraretinal cysts and ICA were correlated with worse initial VA(p<0.001,p = 0.001 and p = 0.04).Shaggy subtype of photoreceptor disruption was associated with better initial VA(p = 0.003). CONCLUSIONS We detected older age, worse initial VA and thinner SFCT in patients with chronic CSC and macular region IVA(m-IVA). Long term follow-up of patients with and without m-IVA may exhibit the difference in treatment outcomes and development of neovasculopathy.
Collapse
Affiliation(s)
- Nihan Aksu Ceylan
- Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey.
| | - Zafer Cebeci
- Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey
| |
Collapse
|
3
|
Krytkowska E, Grabowicz A, Safranow K, Machalińska A. Does the Presence of the Cilioretinal Artery Affect the Incidence, Clinical Picture and Progression of Age-Related Macular Degeneration? Diagnostics (Basel) 2023; 13:diagnostics13091593. [PMID: 37174984 PMCID: PMC10177825 DOI: 10.3390/diagnostics13091593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
The aims of this study were to analyze the relationship between the presence of the cilioretinal artery (CRA) and the incidence, severity and progression of age-related macular degeneration (AMD) and to estimate the influence of the CRA on choroidal and retinal parameters. A total of 287 patients with AMD and 110 healthy controls were enrolled in the study. CRA occurrence was determined using color fundus images. AMD progression was assessed after 3 years. There was no difference in the incidence of CRA between the AMD and control groups (23.34% vs. 24.55%; p = 0.8). Lower-stage AMD was more frequently observed in eyes with the CRA than in eyes without the artery (p = 0.016). The CRA did not influence disease progression (p = 0.79). The CRA did not influence retinal and choroidal thickness and volume parameters or the retinal vessel caliber and functionality in either the AMD or control groups. There was no relationship between CRA presence and CFH Y402H and ARMS2 A69S risk variants. The results did not show a protective effect of the CRA on the incidence and progression of AMD. The CRA may affect the severity of AMD; however, the mechanism of this phenomenon is unclear.
Collapse
Affiliation(s)
- Elżbieta Krytkowska
- First Department of Ophthalmology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Aleksandra Grabowicz
- First Department of Ophthalmology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Anna Machalińska
- First Department of Ophthalmology, Pomeranian Medical University, 70-111 Szczecin, Poland
| |
Collapse
|
4
|
Influence of Clinical and Genetic Factors on the Progression of Age-Related Macular Degeneration: A 3-Year Follow-Up. J Clin Med 2023; 12:jcm12051963. [PMID: 36902750 PMCID: PMC10004408 DOI: 10.3390/jcm12051963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/08/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
The aim of the present study was to analyze the relationship of age-related macular degeneration (AMD) progression with clinical characteristics, demographic, and environmental risk factors that would affect disease development. In addition, the influence of three genetic AMD polymorphisms (CFH Y402H, ARMS2 A69S, and PRPH2 c.582-67T>A) on AMD progression was investigated. In total, 94 participants with previously diagnosed early or intermediate AMD in at least one eye were recalled for an updated re-evaluation after 3 years. The initial visual outcomes, medical history, retinal imaging data, and choroidal imaging data were collected to characterize the AMD disease status. Among the AMD patients, 48 demonstrated AMD progression, and 46 showed no disease worsening at 3 years. Disease progression was significantly associated with worse initial visual acuity (OR = 6.74, 95% CI = 1.24-36.79, p = 0.03) and the presence of the wet AMD subtype in fellow eyes (OR = 3.79, 95%CI = 0.94-15.2, p = 0.05). In addition, a higher risk of AMD progression appeared in the patients with active thyroxine supplementation (OR = 4.77, CI = 1.25-18.25, p = 0.002). The CC variant of CFH Y402H was associated with AMD advancement compared to the TC+TT phenotype (OR = 2.76, 95% CI: 0.98-7.79, p = 0.05). Identifying risk factors of AMD progression may lead to earlier intervention and better outcomes, preventing the expansion of the late stage of the disease.
Collapse
|
5
|
Faatz H, Lommatzsch A. [Pachychoroid Disease]. Klin Monbl Augenheilkd 2023; 240:218-232. [PMID: 36395810 DOI: 10.1055/a-1967-2522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pachychoroid spectrum disorders include uncomplicated pachychoroid, pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularisation, focal choroidal excavation and peripapillary pachychoroid syndrome. They are characterized by a thickened and hyperpermeable choroid and thinning of the choriocapillaris. The disorders are being diagnosed with increasing frequency and differentiation due to the advancement of multimodality imaging. Current understanding of the development, course, possible complications and treatment of these diseases is growing rapidly, but not all mechanisms have yet been elucidated. A correct diagnosis is important, especially the differentiation between the presence of active neovascularisation or a purely exudative stage, in order to initiate a therapy. It is also not yet clear why patients have a thickened choroid and why some of these patients develop pathological changes such as subretinal fluid, RPE changes or neovascularisation.
Collapse
|
6
|
Fung AT, Yang Y, Kam AW. Central serous chorioretinopathy: A review. Clin Exp Ophthalmol 2023; 51:243-270. [PMID: 36597282 DOI: 10.1111/ceo.14201] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/18/2022] [Accepted: 12/18/2022] [Indexed: 01/05/2023]
Abstract
Central serous chorioretinopathy (CSC) is the fourth most common non-surgical retinopathy associated with fluid leakage. The pathogenesis is not yet completely understood, but changes in the choroid, sclera and RPE have been described associated with venous congestion of choroidal outflow. CSC can be categorised into acute, chronic, and recurrent subtypes with recent classifications of simple and complex based on the area of RPE change seen on fundus autofluorescence. A multimodal imaging approach is helpful in the diagnosis and management of CSC and secondary complications such as type 1 neovascularisation. Although spontaneous resolution with relatively good visual outcomes is common, treatment should be considered in patients with persistent or recurrent SRF. Treatment options include laser, systemic medications, intravitreal therapy, and surgery. Of these, argon laser for focal extramacular fluid leaks and photodynamic therapy of leakage identified by indocyanine-green angiography currently have the greatest supportive evidence.
Collapse
Affiliation(s)
- Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Yi Yang
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Andrew W Kam
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
7
|
Faatz H, Lommatzsch A. Pachychoroidale Erkrankungen. AUGENHEILKUNDE UP2DATE 2022. [DOI: 10.1055/a-1676-0740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
ZusammenfassungPachychoroidale Erkrankungen umfassen eine Gruppe von Erkrankungen, die charakteristische choroidale Merkmale zeigen. Diese können heutzutage durch multimodale Bildgebung immer
differenzierter beschrieben werden und umfassen fokale oder diffuse Aderhautverdickungen mit erweiterten und hyperpermeablen choroidalen Gefäßen. Die richtige Diagnose und Abgrenzung von
anderen exsudativen Erkrankungen ist für eine mögliche Therapie von großer Bedeutung.
Collapse
|
8
|
Differentiating a pachychoroid and healthy choroid using an unsupervised machine learning approach. Sci Rep 2022; 12:16323. [PMID: 36175534 PMCID: PMC9523041 DOI: 10.1038/s41598-022-20749-9] [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: 11/05/2021] [Accepted: 09/19/2022] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study was to introduce a new machine learning approach for differentiation of a pachychoroid from a healthy choroid based on enhanced depth-optical coherence tomography (EDI-OCT) imaging. This study included EDI-OCT images of 103 eyes from 82 patients with central serous chorioretinopathy or pachychoroid pigment epitheliopathy, and 103 eyes from 103 age- and sex-matched healthy subjects. Choroidal features including choroidal thickness (CT), choroidal area (CA), Haller layer thickness (HT), Sattler-choriocapillaris thickness (SCT), and the choroidal vascular index (CVI) were extracted. The Haller ratio (HR) was obtained by dividing HT by CT. Multivariate TwoStep cluster analysis was performed with a preset number of two clusters based on a combination of different choroidal features. Clinical criteria were developed based on the results of the cluster analysis, and two independent skilled retina specialists graded a separate testing dataset based on the new clinical criteria. TwoStep cluster analysis achieved a sensitivity of 1.000 (95-CI: 0.938-1.000) and a specificity of 0.986 (95-CI: 0.919-1.000) in the differentiation of pachy- and healthy choroid. The best result for identification of pachychoroid was obtained for a combination of CT, HR, and CVI, with a correct classification rate of 0.993 (95-CI: 0.980-1.000). Based on the relative variable importance (RVI), the cluster analysis prioritized the choroidal features as follows: HR (RVI: 1.0), CVI (RVI: 0.87), CT (RVI: 0.70), CA (RVI: 0.59), and SCT (RVI: 0.27). After performing a receiver operating characteristic curve analysis on the cluster membership variable, a cutoff point of 389 µm and 0.79 was determined for CT and HR, respectively. Based on these clinical criteria, a sensitivity of 0.793 (95-CI: 0.611-0.904) and a specificity of 0.786 (95-CI: 0.600-0.900) and 0.821 (95-CI: 0.638-0.924) were achieved for each grader. Cohen's kappa of inter-rater reliability was 0.895. Based on an unsupervised machine learning approach, a combination of the Haller ratio and choroidal thickness is the most valuable factor in the differentiation of pachy- and healthy choroids in a clinical setting.
Collapse
|
9
|
Chung YR, Lee SJ, Song JH. Changes in the Choroidal Thickness following Intravitreal Bevacizumab Injection in Chronic Central Serous Chorioretinopathy. J Clin Med 2022; 11:jcm11123375. [PMID: 35743446 PMCID: PMC9224583 DOI: 10.3390/jcm11123375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 12/18/2022] Open
Abstract
We evaluated the effect of intravitreal bevacizumab injection (IVB) on choroidal thickness, and studied its association with the therapeutic response in chronic central serous chorioretinopathy (CSC). The clinical features of 78 eyes with chronic CSC treated with IVB from October 2014 to June 2020 were retrospectively evaluated. Visual acuity (VA), central retinal thickness (CRT), and sub-foveal choroidal thickness (SFCT) were analyzed at baseline, 1 month following initial IVB, and the last follow-up examination. Cases showing complete recovery (resolved eyes; n = 60) were compared with those with persistent subretinal fluid (refractory eyes; n = 18). The relationship between the potential risk factors and subretinal fluid resolution was examined using logistic regression. SFCT was significantly decreased along with the CRT following IVB at the resolved state. SFCT reduction following 1 month of IVB was notably greater in the resolved eyes. The association of refractory eyes with hypertension (p = 0.003) and a thinner baseline SFCT (p = 0.024) was significant. In most of the patients with chronic CSC, VA and CRT remarkably improved following treatment with IVB. Early changes in the SFCT following IVB were associated with the therapeutic response. Patients with hypertension and a thinner baseline SFCT could be unresponsive to IVB.
Collapse
|
10
|
Gerardy M, Yesilirmak N, Legras R, Behar-Cohen F, Bousquet E. CENTRAL SEROUS CHORIORETINOPATHY: High-Resolution Imaging of Asymptomatic Fellow Eyes Using Adaptive Optics Scanning Laser Ophthalmoscopy. Retina 2022; 42:375-380. [PMID: 34620798 PMCID: PMC8765211 DOI: 10.1097/iae.0000000000003311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate cone density in the asymptomatic fellow eye of patients with unilateral central serous chorioretinopathy (CSCR). METHODS Seventeen asymptomatic fellow eyes of patients with unilateral CSCR and 17 eyes of aged-matched and gender-matched healthy controls underwent adaptive optics ophthalmoscopy. Cone density and spacing were assessed at the fovea. Clinical and multimodal imaging findings were also recorded. RESULTS In the CSCR group, the patient mean age was 48.9 ± 9.8 years. The mean (±SD) subfoveal choroidal thickness was 417.8 ± 125.2 µm. The foveal external limiting membrane and ellipsoid zone were intact in all patients. Adaptive optics fundus imaging showed a significant decrease in cone density at 2° of eccentricity nasal and temporal to the fovea in asymptomatic fellow eyes of patients with unilateral CSCR compared with controls (P = 0.001 and P = 0.027, respectively). No statistically significant difference in cone density was found at 4° of eccentricity nasal and temporal to the fovea between both groups. CONCLUSION Asymptomatic fellow eyes of patients with unilateral CSCR showed a reduced density of foveal cones in the absence of a decreased visual acuity and photoreceptor line disruption on optical coherence tomography. These results suggest that the photoreceptors could be damaged independently of the occurrence of a serous retinal detachment.
Collapse
Affiliation(s)
- Melvin Gerardy
- Department of Ophthalmology, OphtalmoPôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
| | - Nilufer Yesilirmak
- Department of Ophthalmology, OphtalmoPôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
| | - Richard Legras
- Laboratoire Lumière, Matière et Interfaces, CNRS, ENS Paris-Saclay, Centrale Supelec, Université Paris Saclay, Orsay, France; and
| | - Francine Behar-Cohen
- Department of Ophthalmology, OphtalmoPôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
- Centre de Recherche des Cordeliers, INSERM U1138, Physiopathology of Ccular Diseases: Therapeutic Innovations, Université de Paris, Paris, France.
| | - Elodie Bousquet
- Department of Ophthalmology, OphtalmoPôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
- Centre de Recherche des Cordeliers, INSERM U1138, Physiopathology of Ccular Diseases: Therapeutic Innovations, Université de Paris, Paris, France.
| |
Collapse
|
11
|
Azad AD, Davila JR, Rayess N, Cao M, Mruthyunjaya P, Pan CK. The Effect of Obstructive Sleep Apnea Treatment and Severity on Choroidal Thickness in Patients With Central Serous Chorioretinopathy. JOURNAL OF VITREORETINAL DISEASES 2022; 6:22-30. [PMID: 37007726 PMCID: PMC9976222 DOI: 10.1177/24741264211009677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This work aimed to analyze the association of obstructive sleep apnea (OSA) with choroidal thickness (CT) in patients with central serous chorioretinopathy (CSC). Methods: We identified patients in the Stanford Research Repository with a diagnosis of CSC and OSA. Age- and sex-matched controls with either CSC or OSA only were also identified. CT was measured at 5 points (subfoveal, and 1500 and 3000 µm nasal and temporal) by 2 graders. In addition to OSA treatment and severity, we also investigated the association of Oxygen Desaturation Index and nocturnal oxygen saturation nadir with subfoveal CT (SFCT). Results: A total of 57 patients and 72 eyes met the study inclusion criteria. The mean SFCT was significantly different across the 3 groups: OSA-only was the thinnest, followed by CSC with OSA, and CSC-only was the thickest (194.2 μm, 295.1 μm, and 357.8 μm, respectively, P < .001). SFCT was thicker in CSC with OSA compared with those with only OSA ( P < .05). OSA treatment status and OSA severity did not show a significant difference in SFCT in multivariable modeling. Nocturnal oxygen saturation nadir was positively associated with SFCT, but this did not reach significance.. Conclusions: SFCT is significantly different in patients with OSA alone, CSC with OSA, and CSC alone. While OSA treatment status did not demonstrate a significant difference in SFCT in this study, future studies should evaluate patients for OSA in patients known to have CSC and atypically thin CT to further investigate the novel metrics leveraged in this study.
Collapse
Affiliation(s)
- Amee D. Azad
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jose R. Davila
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Nadim Rayess
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Michelle Cao
- Stanford Sleep Medicine Clinic, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Prithvi Mruthyunjaya
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Carolyn K. Pan
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| |
Collapse
|
12
|
Ravenstijn M, van Dijk EHC, Haarman AEG, Kaden TR, Vermeer KA, Boon CJF, Yannuzzi LA, Klaver CCW, Yzer S. MYOPIC PRESENTATION OF CENTRAL SEROUS CHORIORETINOPATHY. Retina 2021; 41:2472-2478. [PMID: 34483315 DOI: 10.1097/iae.0000000000003297] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To increase insight into the myopic presentation of central serous chorioretinopathy (CSC) by comparing a large group of myopic patients with CSC with reference groups with only one of the diagnoses. METHODS Myopic patients with CSC (spherical equivalent ≤-3D, n = 46), emmetropic patients with CSC (spherical equivalent -0.5 to 0.5 D, n = 83), and myopic, non-CSC patients (n = 50) were included in this multicenter cross-sectional study. Disease characteristics and imaging parameters, such as subfoveal choroidal thickness and indocyanine green angiography patterns, were compared between cases and reference groups. RESULTS In myopic patients with CSC, median subfoveal choroidal thickness (286 µm [IQR 226-372 µm]) was significantly thicker than subfoveal choroidal thickness in myopic, non-CSC patients (200 µm [IQR 152-228 µm], P < 0.001) but thinner than emmetropic patients with CSC (452 µm [IQR 342-538 µm], P < 0.001). They also had pachyvessels in 70% of the eyes comparable with emmetropic CSC (76%, P = 0.70). Choroidal hyperpermeability was frequently present on indocyanine green angiography in both myopic and emmetropic CSC eyes. Need for treatment, treatment success, and recurrence rate were not significantly different between CSC groups. CONCLUSION Myopic CSC presents with similar imaging and clinical characteristics as emmetropic CSC, apart from their thinner choroids. Keeping in mind the structural changes of myopia, other imaging characteristics could aid the diagnostic process.
Collapse
Affiliation(s)
- Monica Ravenstijn
- Rotterdam Ophthalmic Institute, the Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Annechien E G Haarman
- Departments of Ophthalmology, and
- Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Talia R Kaden
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Koenraad A Vermeer
- Rotterdam Ophthalmic Institute, the Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Ophthalmology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
| | | | - Caroline C W Klaver
- Departments of Ophthalmology, and
- Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, the Netherlands; and
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Suzanne Yzer
- Rotterdam Ophthalmic Institute, the Rotterdam Eye Hospital, Rotterdam, the Netherlands
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, the Netherlands; and
| |
Collapse
|
13
|
Enders C, Lang GE, Mayer B, Werner JU. Central Serous Chorioretinopathy: Morphological and Functional Outcome after Subthreshold Thermal Laser Coagulation with a Frequency-Doubled Nd:YAG Continuous-Wave Laser. Ophthalmologica 2021; 245:59-68. [PMID: 34517369 DOI: 10.1159/000519234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Central serous chorioretinopathy (CSCR) presents itself as a serous detachment of the central neurosensory retina (NR), which may be accompanied by focal detachment of the retinal pigment epithelium (RPE) and changes in the RPE itself. It is often self-limiting; however, if the macular region is affected, visual impairment can be serious. If spontaneous remission does not occur, data on the effectiveness of further treatment options are sparse. We therefore decided to examine the effectiveness of subthreshold laser photocoagulation (ST-LP) on best-corrected visual acuity (BCVA) and subretinal fluid (SRF) resorption. We conducted a retrospective analysis of all patients who underwent ST-LP based on the diagnosis of CSCR in a German university eye hospital from 2009 to 2014. METHODS The diagnosis of CSCR was based on the following criteria: detachment of the NR and possibly the RPE visible on ophthalmoscopy, evidence of SRF on optical coherence tomography (OCT), visualization of one or more source points typical for CSCR in fluorescein angiography, and exclusion of differential diagnoses. The time between the anamnestic onset of symptomatic complaints and ST-LP was determined as well as BCVA and OCT before ST-LP. ST-LP was performed as a subthreshold thermal laser coagulation with a frequency-doubled Nd:YAG continuous-wave laser. Follow-up examinations were scheduled at 4, 8, and 12 weeks after ST-LP. RESULTS Fifty-four eyes of 49 patients were included in the study. The median age of patients was 47 years. Eighty-nine percent of the included patients were male. Twenty percent of patients had a first manifestation of CSCR, 69% had a recurrence, and 11% had persistent SRF for >6 months. The median visual acuity rose from 0.30 at baseline (BL) to 0.10 at 4 weeks and 0.00 at 8 weeks, before dropping slightly to 0.05 at 12 weeks. Changes of visual acuity in comparison to BL were statistically significant (p < 0.05). The initial median retinal thickness of 397 μm at BL decreased to 264 μm at 4 weeks, to 236 μm at 8 weeks, and to 239 μm at 12 weeks (decreases to BL all statistically significant p < 0.05). CONCLUSION In our cohort, we were able to achieve substantial and significant clinical benefit through ST-LP measured by improvement in BCVA. Furthermore, we were also able to demonstrate measurable, significant morphological improvements as decreased retinal thickness and increased resorption of SRF as probable mechanisms explaining clinical improvement of CSCR with ST-LP. The advantage of ST-LP over other methods is the low risk of adverse events and its high availability. Controlled, randomized studies are necessary to confirm the data and demonstrate the effect over a longer period of time.
Collapse
Affiliation(s)
- Christian Enders
- Department of Ophthalmology, Ulm University, Ulm, Germany.,MVZ Prof. Neuhann GmbH, Munich, Germany
| | | | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | |
Collapse
|
14
|
Multimodal Imaging in Pachychoroid Spectrum. Surv Ophthalmol 2021; 67:579-590. [PMID: 34331955 DOI: 10.1016/j.survophthal.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/21/2022]
Abstract
Diagnostic investigation on pachychoroid spectrum disease (PSD) has been growing along with the rapid advancement of imaging technology. In optical coherence tomography (OCT)-based studies, choroidal thickness profile, luminal and stromal choroidal ratio, and abnormalities in the neurosensory retina have demonstrated various patterns in different clinical entities related to PSD. The emerging role of OCT angiography (OCTA) has been expanded to involve the quantitative analysis of the OCTA parameters in different clinical entities of PSD and to evaluate the choriocapillaris signal void and vessel density as indicators of choriocapillaris ischemia. OCTA has broadened our knowledge in characterization and assessment of both active and quiescent choroidal neovascularization and its association with treatment response. Recent studies using indocyanine green angiography (ICG) have focused on the evaluation of choroidal vascular hyperpermeability and its relationship with other pachychoroid related features. Ultrawidefield ICG enables observation and characterization of peripheral choroidal pathologies and their associations with macular abnormalities. Multicolor imaging is an emerging modality with the capability to demonstrate early abnormalities in PSD. We summarize all investigations reflecting the new insights into the application of multimodal imaging for PSD and focuses on novel findings observed in different clinical entities with each imaging modality.
Collapse
|
15
|
Kovacs KD, Young B, Adelman RA. Quantitative Modeling of Ultra-Widefield Choroidal Indocyanine Green Angiography in Systemic Vascular Diseases. Ophthalmic Surg Lasers Imaging Retina 2021; 52:281-287. [PMID: 34044717 DOI: 10.3928/23258160-20210429-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate quantitative measurements of choroidal vasculature as obtained via ultra-widefield indocyanine green angiography (ICGA) in patients with systemic vascular diseases. PATIENTS AND METHODS Retrospective chart review and image analysis of 38 eyes from 21 patients with ICGA as part of routine retinal care. Images were binarized with lines drawn at specific antero-posterior landmarks. The vessel density and mean vessel caliber were measured along these lines and correlated with systemic vascular disease status. RESULTS Unlike those with other systemic vascular diseases, patients with obstructive sleep apnea (OSA) were found to have increased choroidal vascular density and vessel caliber in all measurements of the peripheral choroid compared with those patients without (P < .05 for all measurements). CONCLUSIONS Patients with OSA may have increased vascular density secondary to increased choroidal vessel caliber. Further work is needed to validate the modeling and confirm the association. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:281-287.].
Collapse
|
16
|
Ayyildiz T, Dulkadiroglu R, Yilmaz M, Polat OA, Gunes A. Evaluation of macular, retinal nerve fiber layer and choroidal thickness by optical coherence tomography in children and adolescents with vitamin B 12 deficiency. Int Ophthalmol 2021; 41:2399-2404. [PMID: 33768408 DOI: 10.1007/s10792-021-01794-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 03/06/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate macular, Retinal Nerve Fiber Layer (RNFL) and choroidal thickness in children and adolescents with vitamin B12 deficiency and no neurological examination finding. METHODS The study group includes of thirty-three children aged 8-17 years who were brought to the Pediatric outpatient clinic with the symptoms of fatigue and forgetfulness and whose Vitamin B12 levels were detected < 200 pg/ml. The control group was the 30 children and adolescents applied to the same policlinic with various symptoms and whose Vitamin B12 levels were found normal. Children and adolescents with chronic systemic/ocular disease history and myopia or hyperopia more than 4 diopters were not included in both groups. Spectral Domain-Optical Coherence Tomography (SD-OCT) was used for measurements. RESULTS Mean Macular thickness value was 261.2 ± 17.6 in the Vitamin B12 deficiency group and 267.7 ± 17.4 in the control group. Mean value of Retinal Nerve Fiber Layer (RNFL) thickness was 103.5 ± 7.5 in the Vitamin B12 deficiency group and 104.3 ± 8.9 in the control group. The mean values of Choroidal thickness were 360.1 ± 59.8 and 316.9 ± 95.4 in Vitamin B12 deficiency and control groups, respectively. There was a statistically significant increase in choroidal thickness in Vitamin B12 deficiency group compared to controls. CONCLUSION Statistically significant increase in the Choroidal thicknesses of children and adolescents with Vitamin B12 deficiency is important in terms of shedding light on studies that will contribute to a better understanding of the relationship between vitamin B12 and inflammation. CLINICAL TRIAL REGISTRATION This study is an observational study.
Collapse
Affiliation(s)
- Taha Ayyildiz
- Ophthalmology Department, Bursa City Hospital, Bursa, Turkey
| | - Ramazan Dulkadiroglu
- Department of Pediatrics, Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey.
| | - Mevlüt Yilmaz
- Ophthalmology Department, Ulucanlar Eye Hospital, Ankara, Turkey
| | - Osman Ahmet Polat
- Ophthalmology Department, Faculty of Medicine, Kayseri Erciyes University, Kayseri, Turkey
| | - Ali Gunes
- Department of Pediatrics, Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey
| |
Collapse
|
17
|
Viggiano P, Toto L, Ferro G, Evangelista F, Porreca A, Mastropasqua R. Choroidal structural changes in different intermediate AMD patterns. Eur J Ophthalmol 2021; 32:460-467. [PMID: 33506710 DOI: 10.1177/1120672121992009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To report variation of choroidal thickness (CT) and choroidal vascularity index (CVI) in subjects with drusen and subjects with reticular pseudodrusen (RPD) compared with healthy individuals using the Spectral-domain (SD)-Optical Coherence Tomography with enhanced depth imaging (EDI) system. DESIGN A prospective, observational, cross-sectional study. SUBJECTS Eighty-four participants. METHODS The patients were imaged using the Heidelberg Spectralis device (Heidelberg Engineering, Heidelberg, Germany) with EDI mode. EDI-OCT images were exported and then imported into image analysis ImageJ software (National Institutes of Health, Bethesda) and a semiautomated algorithm was used for subsequent quantitative analysis. MAIN OUTCOME MEASURES This study evaluated two choroidal parameters: (i) choroidal thickness (CT); (ii) choroidal vascularity index (CVI). RESULTS CT analysis was performed in three different regions: (i) foveal region, (ii) parafoveal region; (iii) perifoveal region. All the analyzed regions were significantly decreased in RPD pattern, as compared with both the drusen group (p < .005) and healthy eyes (p < .005). CVI was significantly decreased in the RPD pattern, as compared with healthy eyes (p < 0.001). However, the drusenoid pattern did not have statistical significance in comparison with the control group suggesting the lower incidence of this pattern on choroidal vasculopathy. CONCLUSIONS We report CT and CVI difference in RPD and drusen eyes. The RPD pattern seems to be a consequence of an alteration in the choroidal vascularity resulting in severe ischemia and excessive hypoxia inducing an increased risk of late AMD compared to the drusenoid pattern.
Collapse
Affiliation(s)
- Pasquale Viggiano
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Giada Ferro
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Federica Evangelista
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Annamaria Porreca
- Department of Economic Studies, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
18
|
Kaye R, Chandra S, Sheth J, Boon CJF, Sivaprasad S, Lotery A. Central serous chorioretinopathy: An update on risk factors, pathophysiology and imaging modalities. Prog Retin Eye Res 2020; 79:100865. [PMID: 32407978 DOI: 10.1016/j.preteyeres.2020.100865] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/02/2020] [Accepted: 04/27/2020] [Indexed: 02/08/2023]
Abstract
Central serous chorioretinopathy (CSC) is a common form of vision loss, typically seen in working-age men. The pathophysiology behind CSC still eludes us, however significant advances have been made in understanding this disease over the last decade using information from genetic and cell-based studies and imaging modalities. This review aims to give an overview of the current pathophysiology hypotheses surrounding CSC in addition to future directions in cellular work from human induced pluripotent stem cell derived choroidal endothelial cells from CSC patients. Furthermore, this review will provide the reader with an update on the clinical aspects of CSC including risk factors, diagnostic challenges and findings from multimodal imaging.
Collapse
Affiliation(s)
- Rebecca Kaye
- Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, SO16 6YD, United Kingdom
| | - Shruti Chandra
- NIHR Moorfields Biomedical Research Centre, 162, City Road, London, EC1V 2PD, United Kingdom
| | - Jay Sheth
- Surya Eye Institute and Research Center, Mumbai, India
| | - Camiel J F Boon
- Leiden University Medical Centre, Department of Ophthalmology, P.O. Box 9600, 2300 RC, Leiden, the Netherlands; Amsterdam University Medical Centers, Department of Ophthalmology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, 162, City Road, London, EC1V 2PD, United Kingdom
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, SO16 6YD, United Kingdom.
| |
Collapse
|
19
|
Castro-Navarro V, Behar-Cohen F, Chang W, Joussen AM, Lai TYY, Navarro R, Pearce I, Yanagi Y, Okada AA. Pachychoroid: current concepts on clinical features and pathogenesis. Graefes Arch Clin Exp Ophthalmol 2020; 259:1385-1400. [PMID: 33057904 PMCID: PMC8166704 DOI: 10.1007/s00417-020-04940-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/28/2020] [Accepted: 09/17/2020] [Indexed: 01/02/2023] Open
Abstract
PURPOSE The term "pachychoroid" refers to a newly described phenotype in which functional and structural choroidal changes are thought to play a key pathogenic role in a spectrum of related retinal disorders. A more detailed understanding of how the choroid is involved within this spectrum and a better knowledge of the most relevant clinical signs of the pachychoroid phenotype are important to differentiate these disorders from other retinal conditions. Our objectives are to provide a literature review of pachychoroid and the commonalities that may be present across pathologies included in the spectrum, and to provide details on the examination, monitoring, and management of these disorders. METHODS We searched the PubMed web platform to identify relevant studies using the following keywords: pachychoroid, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, aneurysmal type 1 neovascularization, focal choroidal excavation, peripapillary pachychoroid syndrome, vasculopathy pachysclera, pachychoroid geographic atrophy, and pachydrusen. We selected 157 publications and identified the most important features related to pachychoroid. RESULTS The presence of hypertrophic or congested vessels in the choroid, not thickened choroid per se, under an area of reduced or absent choriocapillaris in the posterior pole seems to be the most salient feature of pachychoroid. However, other qualitative/quantitative features are needed to differentiate the uncomplicated pachychoroid from the pathological pachychoroid clinical spectrum, which may be associated with exudation, neovascularization, and/or retinal pigment epithelium and photoreceptor atrophy. CONCLUSIONS The most salient feature of pachychoroid appears to be the presence of large vessels under an area of reduced or absent choriocapillaris. Knowledge of the features and pathogenesis of the different disorders in the pachychoroid spectrum may assist in the management of patients.
Collapse
Affiliation(s)
| | - Francine Behar-Cohen
- Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Ophtalmopole, Paris, France.,Centre de Recherche des Cordeliers UMRS1138, INSERM, Paris, France
| | | | | | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Ian Pearce
- Royal Liverpool University Hospital, Liverpool, UK
| | - Yasuo Yanagi
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan.,Singapore National Eye Centre, Singapore, Singapore
| | - Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan.
| |
Collapse
|
20
|
Demirel S, Özcan G, Yanık Ö, Batıoğlu F, Özmert E. A comparative study of the choroidal vascularity indexes in the fellow eyes of patients with pachychoroid neovasculopathy and central serous chorioretinopathy by binarization method. Graefes Arch Clin Exp Ophthalmol 2020; 258:1649-1654. [DOI: 10.1007/s00417-020-04740-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/24/2020] [Accepted: 05/06/2020] [Indexed: 01/15/2023] Open
|
21
|
CHANGES IN CHORIOCAPILLARIS, SATTLER, AND HALLER LAYER THICKNESSES IN CENTRAL SEROUS CHORIORETINOPATHY AFTER HALF-FLUENCE PHOTODYNAMIC THERAPY. Retina 2020; 40:2373-2378. [PMID: 31985718 DOI: 10.1097/iae.0000000000002764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determinate the variation in thickness of the individual choroidal layers in patients with central serous chorioretinopathy treated with half-fluence photodynamic therapy. METHODS Twenty-two eyes were evaluated with spectral-domain optical coherence tomography. The images were taken before photodynamic therapy, 3 months, and 6 months after the treatment. Two investigators performed these measurements: 1) choroidal thickness (CT), 2) Haller layer thickness, defined as the most external layer containing a 100-μm vessel, and 3) choriocapillaris + Sattler layer (C&S). Nine measurements were taken in the macular region. RESULTS Choroidal thickness before photodynamic therapy was 471.8 µm ± 145.8. The Haller layer was 358.4 µm ± 122.6, and C&S was 114.3 µm ± 27.8. At 3-month follow-up, CT was 441.1 µm ± 150.7, Haller layer 348.8 µm ± 127.6, and C&S 92.4 µm ± 27.9. At 6-month follow-up, CT was 420.4 µm ± 118.4, Haller layer 331.8 µm ± 97.2, and C&S 89.5 µm ± 28.0. Using a multilevel mixed-effects linear regression, CT was found to be reduced at both 3 months (P < 0.03) and at 6 months (P < 0.001), Haller layer showed no significant reduction at 3 months (P = 0.483) or at 6 months (P = 0.055), and C&S showed reduction at 3 months (P < 0.001) and at 6 months (P < 0.001). Fellow nonaffected eyes showed no statistical variation at 3-month and 6-month follow-up. CONCLUSION Reduction in CT in patients affected by central serous chorioretinopathy after half-fluence photodynamic therapy occurs primarily in the choriocapillaris and medium diameter vessel layers of the choroid in a short- and medium-term follow-up.
Collapse
|
22
|
Jaisankar D, Kumar M, Rishi P, Singh S, Raman R. Correlation of retinal changes with choroidal changes in acute and recurrent central serous chorioretinopathy assessed by swept-source optical coherence tomography. Ther Adv Ophthalmol 2020; 12:2515841419899823. [PMID: 32010882 PMCID: PMC6971962 DOI: 10.1177/2515841419899823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/10/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate affected choroidal regions and corresponding retinal changes in acute and recurrent central serous chorioretinopathy using swept-source optical coherence tomography. Methods The foveal and subfoveal choroidal thicknesses were measured with swept-source optical coherence tomography. The retina was divided into five zones on the swept-source optical coherence tomography image based on baseline choroidal thickness being <100, 100-199, 200-299, 300-399 and ⩾400 μm. The retinal and choroidal thicknesses in the same five regions were evaluated during follow-up. The measurements were then compared between baseline (when central serous chorioretinopathy was active) and follow-up (after complete resolution of disease). Results At baseline, in the acute group, the mean outer retinal layer thickness was significantly higher in areas with thicker choroid and lower in areas with thinner choroid. No such change was noticed in the recurrent group. In the acute group, the overall retinal thickness from baseline to follow-up decreased from 269.84 to 251.9 µm, ganglion cell layer thickness decreased from 107.14 to 101.28 µm, retinal nerve fibre layer thickness decreased from 56.96 to 49.33 µm, and no significant difference was noted in choroidal thickness. In the recurrent group, choroidal thickness significantly increased from 254.58 to 262.55 µm and ganglion cell layer decreased from 103.43 to 94.01 µm. No significant difference was noted in overall retina and retinal nerve fibre layer. Reduction in choroidal and retinal layer thicknesses was better in eyes which underwent laser treatment than the observation group. Conclusion Swept-source optical coherence tomography might serve as an important non-invasive tool for both evaluating the extent of pathology and to predict the recurrence rate.
Collapse
Affiliation(s)
- Durgasri Jaisankar
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Meenakshi Kumar
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Sumeer Singh
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai 600 006, Tamil Nadu, India
| |
Collapse
|
23
|
Hansen MH, Li XQ, Larsen M, Olsen EM, Skovgaard AM, Kessel L, Munch IC. Five-Year Change in Choroidal Thickness in Relation to Body Development and Axial Eye Elongation: The CCC2000 Eye Study. Invest Ophthalmol Vis Sci 2020; 60:3930-3936. [PMID: 31546258 DOI: 10.1167/iovs.19-26807] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We describe changes in choroidal thickness from age 11 to 16 years and its association with ocular biometrics and body development. Method In this longitudinal, population-based observational study, choroidal thickness was measured subfoveally and 1- and 3-mm temporal thereof using enhanced depth imaging spectral domain optical coherence tomography. Analyses were stratified by sex and adjusted for age and the time of day that the scan was performed. Results The study included 687 participants (304 boys). Median (interquartile range [IQR]) age was 11.5 (0.6) years at baseline and 16.6 (0.3) years at follow-up. Mean increase in choroidal thickness was 33, 27, and 11 μm at the three respective locations. The subfoveal choroid thickened less in eyes whose axial length increased more (boys, β = -85 μm/mm; 95% confidence interval [CI], -104 to -66, P < 0.0001; girls, β = -105 μm/mm; 95% CI, -121 to -89, P < 0.0001) and in eyes with a more negative refractive development (boys, 11 μm/diopters [D]; 95% CI, 4.0 to 18, P = 0.0022; girls, 22 μm/D; 95% CI, 16 to 27, P < 0.0001). Subfoveal choroidal thickness increased less in girls who underwent early puberty (Tanner stage 4 vs. 1; -39 μm' 95% CI, -72 to -5.9, P = 0.021) and who had a longer baseline axial length (β = -8.6 μm/mm; 95% CI, -15 to -2.7, P = 0.0043), and more in girls who grew taller (β = 0.9 μm/cm; 95% CI, 0.1 to 1.7, P = 0.026). Conclusions The choroid increased in thickness from age 11 to 16 years. The increase was greater in girls with later sexual maturation and smaller in eyes that added more axial length and had a relatively negative refractive development.
Collapse
Affiliation(s)
- Mathias Hvidtfelt Hansen
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Xiao Qiang Li
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Else Marie Olsen
- Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Research and Disease Prevention, Capital Region, Copenhagen, Denmark
| | - Anne Mette Skovgaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
24
|
Chen J, Zhu J, Chen L, Hu C, Du Y. Steroids in the treatment of nonarteritic anterior ischemic optic neuropathy: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2019; 98:e17861. [PMID: 31725628 PMCID: PMC6867765 DOI: 10.1097/md.0000000000017861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Non-arteritic anterior ischemic optic neuropathy (NAION) is the common cause of acute and subacute optic neuropathy in adults over the age of 50. Steroid administration in NAION seems to be in practice and is advised frequently by neurologists. The controversy regarding steroid usage in NAION is far from settled, with strong opinions on both sides. Despite a large amount of articles on this topic, but the results have not always been consistent. To address this gap, we decided to conduct a meta-analysis of all available published studies in order to better understand the effectiveness of steroids in treating NAION. OBJECTIVES To identify the effectiveness of steroids in treating NAION. METHODS We performed a meta-analysis using databases, including PUBMED EMBASE, and the Cochrane library, to find relevant studies. The weighted mean difference (WMD) was determined for BCVA in steroid and nonsteroid groups. RESULTS Eight studies were included and summarized in this analysis. The studies included 720 eyes (392 NAION eyes and 328 eyes of normal controls). Heterogeneity among these studies was low (I = 0%). Because of the presence of heterogeneity, we conducted a fixed effects model to assess the effect of steroids on visual acuity in patients with NAION. The meta-analysis clearly demonstrated that in NAION, steroids did not significantly improve visual acuity (WMD = -0.02 [95% CI: -0.10 to 0.06], Z = 0.40, P = .69). After sensitivity analysis via the leave-one-out method, WMD was not significantly changed. CONCLUSIONS Our meta-analysis found that steroids do not significantly improve visual acuity in NAION. In view of their long list of side effects, attempts at reversing ischemia should not involve the use of steroids.
Collapse
Affiliation(s)
- Jun Chen
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
| | - Jie Zhu
- Department of Ophthalmology, Affiliated Nanping First Hospital of Fujian Medical University, Nanping, Fujian, China
| | - Li Chen
- Department of Ophthalmology, Affiliated Nanping First Hospital of Fujian Medical University, Nanping, Fujian, China
| | - Chen Hu
- Department of Ophthalmology, Affiliated Nanping First Hospital of Fujian Medical University, Nanping, Fujian, China
| | - Yi Du
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
| |
Collapse
|
25
|
Faghihi H, Mohammadzadeh V, Nabavi A, Faghihi S, Kadivar S, Ghassemi F. Oral Mineralocorticoid-Receptor Antagonists: Choroidal Parameters Changes Using OCT in Central Serous Chorioretinopathy. Ophthalmic Surg Lasers Imaging Retina 2019; 50:726-733. [PMID: 31755972 DOI: 10.3928/23258160-20191031-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/22/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the efficacy and safety of oral eplerenone in the treatment of acute and chronic central serous chorioretinopathy (CSCR). PATIENTS AND METHODS Treatment-naïve patients with acute (< 3 months) and chronic (≥ 3 months) CSCR were enrolled in this prospective, nonrandomized, interventional, comparative case series. Patients with acute CSCR were either treated with oral eplerenone (acute case group; n = 16) or observed only (acute control group; n = 8). All chronic patients (chronic group; n = 25) were treated with oral eplerenone. Eplerenone was prescribed 25 mg twice per day for 3 months. Best-corrected visual acuity (BCVA) and optical coherence tomography measures, including subretinal fluid (SRF) height, subfoveal choroidal thickness (CT), central CT, central choroidal volume (CV), and total CV, were assessed at baseline and 3-month follow-up (FU) visit. RESULTS BCVA improvement and SRF reduction at 3-month FU relative to baseline were observed in all three study groups. SRF was completely resolved in 13 patients (81.2%) in the acute case group, four patients (50%) in the acute control group, and eight patients (32%) in the chronic group. The acute case group showed greater SRF decrease relative to baseline compared to the chronic group (P = .009), but the resolution of SRF between acute cases and an acute control group was not statistically significant (P = .076). Subfoveal CT, central CT, total CV, and central CV were significantly reduced at the 3-month FU compared to baseline in both affected and the fellow eyes in the acute case and chronic groups, whereas no change was observed in either eyes in the acute control group. At 3 months' FU, the mean logMAR visual acuity demonstrated no significant difference among the study groups (P = .08). Eplerenone was well-tolerated, and no serious side effect was detected. CONCLUSIONS Oral eplerenone is a safe and effective treatment option for both acute and chronic CSCR. Resolution of SRF was more significant in acute CSR cases comparative to chronic cases. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:726-733.].
Collapse
|
26
|
Combined Technique and Its Clinical and Pathogenetic Evaluation in Treatment of Central Serous Chorioretinopathy Using Subthreshold Microimpulse Laser Irradiation with a Wavelength of 577 nm in Combination with Injections of Platelet Autoplasma. ACTA BIOMEDICA SCIENTIFICA 2019. [DOI: 10.29413/abs.2019-4.4.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. Lack of a holistic understanding of the etiology and pathogenesis of central serous chorioretinopathy (CSH), which determines the conduct of pathogenetic therapy, as well as the lack of effectiveness of treatment methods aimed at developing new pathology methods.Aims. To conduct a comparative therapeutic potential of a combination of subthreshold micropulse laser irradiation (SMILV) with a course of injection of autologous plasma enriched with platelets (TP) in CSH. To evaluate the effectiveness of SMILV with a wavelength of 577 nm with wing-injection injections of TP compared with SMIV monotherapy in the treatment of CSH. Consider issues of modern treatment of CSH, as well as determine the levels of cytokines in the tear fluid of patients with CSH before and after SMILV and SMILV + TP treatment.Methods and methods. The study was conducted on 60 patients (60 eyes) with CSH. Patients were divided into 2 groups: in the comparison group, patients received treatment only SMILV wavelength 577 nm, and in the experimental group – SMILV followed by the introduction of TP. TP was prescribed after 72 hours, 3 injections in the region of the pterygomaxillary fossa on the side of damage to the eyes, with an interval between injections of 72 hours.SMILV was performed on a Supra 577 nm laser machine (Quantel Medical, France) over the entire area of macular edema. Conclusion. Comparative analysis of clinical and functional results of treatment of central serous chorioretinopathy SMILV with a wavelength of 577 nm and a combination of SMILV with injections of autologous plasma enriched with platelets and the outcome of the disease revealed a greater effectiveness of combining SMILV with a course of injections of autologous plasma enriched with platelets.
Collapse
|
27
|
Gulkas S, Sahin O. Microperimetric changes and fixation stability status after half-dose photodynamic therapy for chronic central serous chorioretinopathy. Eur J Ophthalmol 2019; 30:1053-1060. [PMID: 31256613 DOI: 10.1177/1120672119858877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of half-dose verteporfin photodynamic therapy on central retinal sensitivity, status of fixation stability, and choroidal thickness in patients with chronic central serous chorioretinopathy. METHODS In total, 22 eyes of 22 patients with chronic central serous chorioretinopathy were enrolled, and all the eyes received indocyanine green angiography-guided half-dose verteporfin photodynamic therapy. Best-corrected visual acuity, contrast sensitivity, and retinal sensitivity in the central 10° and status of the fixation stability are assessed by MAIA microperimetry, and optical coherence tomography findings (central macular thickness and subfoveal choroidal thickness) were evaluated at baseline and 1, 3, and 6 months after the half-dose verteporfin photodynamic therapy. RESULTS Subretinal fluid was completely resolved in 9 eyes at 1 month and in 17 eyes at 3 months. There was recurrence in two eyes at 6 months and five of the eyes had a persistent subretinal fluid through all the time points. Best-corrected visual acuity, contrast sensitivity, and retinal sensitivity improved significantly 6 months after half-dose verteporfin photodynamic therapy. Fixation stability did not change in either follow-up visit. Central macular thickness and subfoveal choroidal thickness decreased significantly at 6 months of the visits compared to baseline. There was not any systemic and ocular side effect after the treatment. CONCLUSION This study shows that there is significant improvement in best-corrected visual acuity, contrast sensitivity, and retinal sensitivity after half-dose verteporfin photodynamic therapy. The status of fixation stability remained unchanged in the eyes with chronic central serous chorioretinopathy after half-dose verteporfin photodynamic therapy. Furthermore, half-dose verteporfin photodynamic therapy is also effective in decreasing central macular thickness and subfoveal choroidal thickness.
Collapse
Affiliation(s)
- Samet Gulkas
- Department of Ophthalmology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Ozlem Sahin
- Department of Ophthalmology, School of Medicine, Marmara University, Istanbul, Turkey
| |
Collapse
|
28
|
Araki T, Ishikawa H, Iwahashi C, Niki M, Mitamura Y, Sugimoto M, Kondo M, Kinoshita T, Nishi T, Ueda T, Kato A, Yasukawa T, Takamura Y, Gomi F. Central serous chorioretinopathy with and without steroids: A multicenter survey. PLoS One 2019; 14:e0213110. [PMID: 30818363 PMCID: PMC6394983 DOI: 10.1371/journal.pone.0213110] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/14/2019] [Indexed: 11/19/2022] Open
Abstract
We investigated the rates of the use of steroids in Japanese central serous chorioretinopathy (CSC) cases and differences in the characteristics of CSC with and without steroids. A total of 538 eyes of 477 patients diagnosed with CSC, with 3 months or more of follow-up between April 2013 and June 2017 at 8 institutions. Patients with CSC with more than 3 months of follow-up were identified by OCT and fluorescein angiography at 8 institutions. Data collected included patient demographics, history of corticosteroid medication and smoking, spherical errors, findings of angiography, subfoveal choroidal thickness, and changes through the follow-up period. Differences in these findings were analyzed in cases with and without corticosteroid treatment. Among the 477 patients (344 men,133 women), 74 (15.5%) (39 men, 35 women) underwent current or prior steroid treatment. Cases with steroids were higher age (p = 0.0403) and showed no male prevalence, more bilateral involvement (p < 0.0001), and the affected eyes had multiple pigment epithelial detachment (p <0.0001), more fluorescein leakage sites (p < 0.0001), greater choroidal thickness (p = 0.0287) and a higher recurrence rate (p = 0.0412). Steroids can cause severer CSC through an effect on choroidal vessels and an impairment of retinal pigment epithelium.
Collapse
Affiliation(s)
- Takashi Araki
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
- JCREST (Japan Clinical Retina Study) group, Kagoshima, Japan
| | - Hiroto Ishikawa
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
- JCREST (Japan Clinical Retina Study) group, Kagoshima, Japan
| | - Chiharu Iwahashi
- JCREST (Japan Clinical Retina Study) group, Kagoshima, Japan
- Department of Ophthalmology, Sumitomo Hospital, Osaka, Japan
| | - Masanori Niki
- JCREST (Japan Clinical Retina Study) group, Kagoshima, Japan
- Department of Ophthalmology, Tokushima University, Tokushima, Japan
| | - Yoshinori Mitamura
- JCREST (Japan Clinical Retina Study) group, Kagoshima, Japan
- Department of Ophthalmology, Tokushima University, Tokushima, Japan
| | - Masahiko Sugimoto
- JCREST (Japan Clinical Retina Study) group, Kagoshima, Japan
- Department of Ophthalmology, Mie University Graduate School of Medicine, Mie, Japan
| | - Mineo Kondo
- JCREST (Japan Clinical Retina Study) group, Kagoshima, Japan
- Department of Ophthalmology, Mie University Graduate School of Medicine, Mie, Japan
| | - Takamasa Kinoshita
- JCREST (Japan Clinical Retina Study) group, Kagoshima, Japan
- Ophthalmology, Sapporo City General Hospital, Hokkaido, Japan
| | - Tomo Nishi
- JCREST (Japan Clinical Retina Study) group, Kagoshima, Japan
- Ophthalmology, Nara Medical University, Nara, Japan
| | - Tetsuo Ueda
- JCREST (Japan Clinical Retina Study) group, Kagoshima, Japan
- Ophthalmology, Nara Medical University, Nara, Japan
| | - Aki Kato
- JCREST (Japan Clinical Retina Study) group, Kagoshima, Japan
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Tsutomu Yasukawa
- JCREST (Japan Clinical Retina Study) group, Kagoshima, Japan
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Yoshihiro Takamura
- JCREST (Japan Clinical Retina Study) group, Kagoshima, Japan
- Department of Ophthalmology, Fukui University, Fukui, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
- JCREST (Japan Clinical Retina Study) group, Kagoshima, Japan
- * E-mail:
| |
Collapse
|
29
|
Taha A, Mevlut Y, Didem A. The effect of allergic conjuctivitis on choroidal thickness. SANAMED 2019. [DOI: 10.24125/sanamed.v14i3.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: To examine the effects of allergic conjunctivitis and its treatment upon choroidal thickness (ChT) using topical antihistaminic agents. Methods: 60 eyes of 30 children and adolescents with allergic conjunctivitis and 60 eyes of 30 healthy controls participated in the study. Inclusion criteria for patient groups were best-corrected visual acuity 20/20 or better, normal intraocular pressure (IOP) and no systemic or ocular diseases other than allergic conjunctivitis. Healthy controls recruited from children and adolescents who had no ocular or chronic systemic disorders and had best-corrected visual acuity 20/20 or better and normal IOP. ChT was measuredby using Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT) before and after treatment by antihistamine agents. Results: Subfoveal choroidal thicknes mean value was 364.1 ± 63.8 m in the allergic conjunctivitis group and the first-month values after the treatment were 333.5 ± 52.1 m. Subfoveal choroidal thickness means value in the control group was 320.6 ± 80.9 m. There was a statistically significant decrease in ChT after treatment of allergic conjunctivitis patients and there was a significant difference in terms of baseline ChT values between the allergic conjunctivitis group and the control group. There was no significant difference between one month after treatment values and the mean values of the control group. Conclusions: Our results demonstrate that ChT can increase in allergic conjunctivitis patients and can become normal again with topical antihistamine treatment. In order to support choroidal thickness to be a marker for the diagnosis and follow-up of allergic conjunctivitis, further studies with larger samples and longitudinal studies are needed.
Collapse
|
30
|
Diagnostic and Therapeutic Challenges. Retina 2018; 38:2260-2266. [DOI: 10.1097/iae.0000000000001894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
31
|
van Rijssen TJ, van Dijk EHC, Dijkman G, Boon CJF. Clinical characteristics of chronic central serous chorioretinopathy patients with insufficient response to reduced-settings photodynamic therapy. Graefes Arch Clin Exp Ophthalmol 2018; 256:1395-1402. [PMID: 29732468 PMCID: PMC6060777 DOI: 10.1007/s00417-018-4003-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 11/26/2022] Open
Abstract
Purpose To identify characteristics of Caucasian chronic central serous chorioretinopathy (cCSC) patients without a complete resolution of subretinal fluid (SRF) after reduced-settings photodynamic therapy (PDT), or with a recurrence of SRF after PDT. Methods Chronic CSC patients treated with reduced-settings PDT were divided into a successful PDT group and unsuccessful PDT group. Patients in the successful PDT group did not have any subretinal fluid (SRF) during follow-up after PDT, whereas the unsuccessful PDT group was categorized based on either persistence or recurrence of SRF after PDT treatment. Data on age, sex, best-corrected visual acuity (BCVA), PDT spot size, characteristics on fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT) were obtained. Results Twenty-six patients in the successful PDT group (20 males, 6 females) had a mean age of 51 years (range, 25–78). In the unsuccessful PDT group, 20 males with a mean age of 60 years (range, 34–78) were included. At last visit before PDT, age, percentage of males, and percentage of patients with diffuse leakage > 1 optic disc diameter on FA were higher in the unsuccessful PDT group (p = 0.010, p = 0.029, and p = 0.008, respectively). At last visit before PDT, BCVA and the percentage of patients with intense hyperfluorescence on ICGA were lower in the unsuccessful group (p = 0.017 and p = 0.004, respectively). Patients with intense hyperfluorescence on ICGA were more likely (95% CI 1.3–333 times) to have a successful outcome (p = 0.045). A decrease in SFCT at final visit was observed in both groups (− 111 μm and p = 0.013, and − 141 μm and p = 0.007, respectively). BCVA only improved at final visit in the successful PDT group (5 Early Treatment of Diabetic Retinopathy Study letters, p < 0.001). Conclusions Chronic CSC patients with recurrent or persistent SRF after PDT are characterized by a higher percentage of males, more patients with diffuse leakage on FA, more patients without intense hyperfluorescence on ICGA, higher age, and lower pre-PDT and long-term BCVA than in the successful PDT group. A reduction in SFCT after PDT does not necessarily lead to complete resolution of SRF, while a resolution of SRF appears to be required to lead to a significant BCVA improvement in cCSC.
Collapse
Affiliation(s)
- Thomas J van Rijssen
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Greet Dijkman
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, 22660, 1100 DD, Amsterdam, The Netherlands.
| |
Collapse
|
32
|
Bhende M, Shetty S, Parthasarathy MK, Ramya S. Optical coherence tomography: A guide to interpretation of common macular diseases. Indian J Ophthalmol 2018; 66:20-35. [PMID: 29283118 PMCID: PMC5778576 DOI: 10.4103/ijo.ijo_902_17] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Optical coherence tomography is a quick, non invasive and reproducible imaging tool for macular lesions and has become an essential part of retina practice. This review address the common protocols for imaging the macula, basics of image interpretation, features of common macular disorders with clues to differentiate mimickers and an introduction to choroidal imaging. It includes case examples and also a practical algorithm for interpretation.
Collapse
Affiliation(s)
- Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Sharan Shetty
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Mohana Kuppuswamy Parthasarathy
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India; School of Optometry and Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - S Ramya
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
| |
Collapse
|
33
|
van Dijk EHC, Dijkman G, Boon CJF. Photodynamic therapy in chronic central serous chorioretinopathy with subretinal fluid outside the fovea. Graefes Arch Clin Exp Ophthalmol 2017; 255:2029-2035. [PMID: 28674835 PMCID: PMC5602371 DOI: 10.1007/s00417-017-3720-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/06/2017] [Accepted: 06/12/2017] [Indexed: 12/21/2022] Open
Abstract
Purpose To assess the efficacy of photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (cCSC), in whom subretinal fluid (SRF) was solely present outside the foveal area. Methods In this retrospective study, 16 eyes of 15 cCSC patients who received half-dose PDT because of notable subjective visual complaints due to the presence of extrafoveal SRF, were included. An ophthalmic examination was performed before treatment, including Early Treatment Diabetic Retinopathy Study best-corrected visual acuity measurement, applanation tonometry, slit-lamp examination, and indirect ophthalmoscopy, followed by multimodal imaging, including fundus photography, fundus autofluorescence, spectral-domain optical coherence tomography (OCT), enhanced-depth imaging OCT of the choroid, fluorescein angiography, and indocyanine green angiography. Results In 7 treated patients (47%), PDT led to a decrease in visual complaints at the first evaluation visit. At this visit, extrafoveal SRF on OCT had resolved in 14 eyes (88%), whereas a complete resolution of extrafoveal SRF had occurred in all eyes at final follow-up visit. At baseline, posterior cystoid retinal degeneration was also present in 5 eyes (31%) and this remained present at all evaluation visits in these patients. Choroidal thickness decreased statistically significantly in the treated eyes, both foveally and at the location of the maximum height of extrafoveal SRF. No complications of PDT were observed. Conclusions Half-dose PDT treatment of cCSC patients with visual complaints due to extrafoveal SRF accumulation is a safe procedure leading to complete SRF resolution, a decrease in choroidal thickness, and a reduction in visual symptoms. Electronic supplementary material The online version of this article (doi:10.1007/s00417-017-3720-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Greet Dijkman
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. .,Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|