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Oquendo PL, Sodhi GS, Naidu SC, Martins Melo I, Pecaku A, Demian S, Belin PJ, Lee WW, Christakis PG, Hamli H, Bansal A, Andreoli MT, Tsui E, Muni RH. Optical Coherence Tomography Features in Fovea-Off Exudative vs Rhegmatogenous Retinal Detachment. Am J Ophthalmol 2024; 268:212-221. [PMID: 39033833 DOI: 10.1016/j.ajo.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE To describe the optical coherence tomography (OCT) features that can differentiate eyes with fovea-off exudative retinal detachment (ERD) vs rhegmatogenous retinal detachment (RRD), with particular attention to outer retinal corrugations (ORCs). DESIGN Multicenter, retrospective cross-sectional study. METHODS Multicenter, retrospective cross-sectional study of patients diagnosed with unilateral or bilateral fovea-off ERD or primary, acute, fovea-off RRD between 2016 and 2021. This study was performed with the approval from the Research Ethics Board at the University of Toronto and was conducted in accordance with the Declaration of Helsinki. Patients with any ERD etiology and evidence of extensive, bullous fovea-off detachment and in the RRD group: consecutive patients with acute, primary fovea-off RRD with good quality baseline SD-OCT imaging were included. Patients with exudative choroidal neovascularization from any etiology, optic nerve pit, significant media opacity, or OCT images with poor quality or low signal strength were excluded. Primary outcome was to describe the morphological features of the macula using SD-OCT in patients diagnosed with ERD vs RRD, with specific interest in ORCs. RESULTS One hundred sixty-one eyes (51 ERD and 110 RRD) of 154 patients were included. Fifty-one eyes with ERD presented with 1 of 15 etiologies. ERD were associated with a greater risk of having hyperreflective dots in the outer retina (92.2% vs 74.5%, P = .009), hyperreflective material and dots in the subretinal fluid (72.5% vs 34.5%, P < .001), internal limiting membrane and inner retinal undulations (70.6% vs 39.4%, P < .001), and retinal pigment epithelium undulations (44.9% vs 6.4%, P < .001) compared to RRD. RRD was associated with a greater risk of outer retinal corrugations (80% vs 0%, P < .001), intraretinal fluid (90.9% vs 41.2%, P < .001) and ellipsoid zone thickening (90% vs 66.7%, P < .001) compared to ERD. CONCLUSION The presence of ORCs are highly specific for RRD and absent in ERD. This is likely related to differences in the pathophysiology of the diseases process, specifically the content of the subretinal fluid. Understanding the differences in OCT morphological features of ERD vs RRD may aid with diagnosis and management.
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Affiliation(s)
- Paola L Oquendo
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (P.L.O., I.M.M., A.P., S.D., W.W.L., P.G.C., H.H., A.B., R.H.M.), Toronto, Ontario, Canada
| | - Guneet S Sodhi
- Vitreo Retinal Surgery, P.L.L.C. (G.S.S., P.J.B.), Minneapolis, Minnesota, USA
| | - Sumana C Naidu
- Temerty Faculty of Medicine, University of Toronto (S.C.N., R.H.M.), Toronto, Ontario, Canada
| | - Isabela Martins Melo
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (P.L.O., I.M.M., A.P., S.D., W.W.L., P.G.C., H.H., A.B., R.H.M.), Toronto, Ontario, Canada
| | - Aurora Pecaku
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (P.L.O., I.M.M., A.P., S.D., W.W.L., P.G.C., H.H., A.B., R.H.M.), Toronto, Ontario, Canada
| | - Sueellen Demian
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (P.L.O., I.M.M., A.P., S.D., W.W.L., P.G.C., H.H., A.B., R.H.M.), Toronto, Ontario, Canada
| | - Peter J Belin
- Vitreo Retinal Surgery, P.L.L.C. (G.S.S., P.J.B.), Minneapolis, Minnesota, USA
| | - Wei Wei Lee
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (P.L.O., I.M.M., A.P., S.D., W.W.L., P.G.C., H.H., A.B., R.H.M.), Toronto, Ontario, Canada
| | - Panos G Christakis
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (P.L.O., I.M.M., A.P., S.D., W.W.L., P.G.C., H.H., A.B., R.H.M.), Toronto, Ontario, Canada
| | - Hesham Hamli
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (P.L.O., I.M.M., A.P., S.D., W.W.L., P.G.C., H.H., A.B., R.H.M.), Toronto, Ontario, Canada
| | - Aditya Bansal
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (P.L.O., I.M.M., A.P., S.D., W.W.L., P.G.C., H.H., A.B., R.H.M.), Toronto, Ontario, Canada
| | | | - Edmund Tsui
- UCLA Stein Eye Institute, University of California (E.T.), Los Angeles, California, USA
| | - Rajeev H Muni
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (P.L.O., I.M.M., A.P., S.D., W.W.L., P.G.C., H.H., A.B., R.H.M.), Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto (S.C.N., R.H.M.), Toronto, Ontario, Canada.
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Suwal B, Khadka D, Shrestha A, Suwal R, Khatri B. Quantification of Metamorphopsia in Resolved Idiopathic Central Serous Chorioretinopathy: An Analysis Using M-CHARTS, Amsler Grid, and Optical Coherence Tomography. Clin Ophthalmol 2024; 18:937-942. [PMID: 38562644 PMCID: PMC10982064 DOI: 10.2147/opth.s456556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose To quantify metamorphopsia in patients with resolved idiopathic Central Serous Chorioretinopathy (CSCR) using M-CHARTS and compare the results with the traditional Amsler grid and optical coherence tomography (OCT). Patients and Methods For the purpose of this study, all consecutive cases of patients with resolved CSCR were evaluated for metamorphopsia (using the standard Amsler grid and M-CHARTS) and spectral domain OCT. The OCT images were analyzed for the following five parameters: central macular thickness, pigment epithelial detachment, retinal pigment epithelial bumps, discontinuation in the inner segment/outer segment junction or the external limiting membrane, fibrinous exudates in the subretinal space, and hyperreflective dots in the intraretinal and/or subretinal layer. Binary logistic regression was used to find the association between metamorphopsia and foveal morphology. Cohen's Kappa was used to determine the agreement between the M-CHARTS and Amsler grid for diagnosing metamorphopsia. The sensitivity, specificity, and accuracy in the diagnosis of metamorphopsia were calculated against the Amsler grid. Results Of 41 eyes, Amsler Grid detected metamorphopsia in 39.02%, and M-CHARTS detected metamorphopsia in 53.66%. The agreement rate of detection between the two tests was moderate (Kappa=0.52). M-CHARTS had a sensitivity of 87.50%, a specificity of 68.00%, a positive predictive value of 63.64%; and a negative predictive value of 89.47% for the diagnosis of metamorphopsia compared to the Amsler grid. The presence of PED in OCT was significantly associated with metamorphopsia. Conclusion M-CHARTS can be a useful ancillary test to detect and quantify metamorphopsia even after fluid resolution in CSCR. Structural changes in macular morphology as observed with OCT can predict the likelihood of metamorphopsia.
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Affiliation(s)
- Barsha Suwal
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Deepak Khadka
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Arjun Shrestha
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Rinkal Suwal
- Department of Optometry, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Bijay Khatri
- Academic and Research Department, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
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Kaplan FB, Açıkalın B, Ergin A, Kocapınar Y. PROGNOSIS EVALUATION WITH OPTICAL COHERENCE TOMOGRAPHY IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY. Photodiagnosis Photodyn Ther 2023; 42:103552. [PMID: 37023997 DOI: 10.1016/j.pdpdt.2023.103552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Central serous chorioretinopathy (CSCR) is the fourth most common retinopathy that causes severe vision loss and is frequently seen in young and active patients. Our aim in this study is to evaluate whether a foresight about the prognosis of patients with CSCR can be obtained by optical coherence tomography (OCT) findings. MATERIALS AND METHODS Patients diagnosed with chronic CSCR at Fatih Sultan Mehmet Research and Training Hospital, Ophthalmology Department, were screened between January 2017 and September 2019, and 30 patients were included in the study. The anatomical and functional changes of the patients during the 6-month follow-up and the relationship between the OCT findings at baseline and the best corrected visual acuity (BCVA) in the sixth month were evaluated. RESULTS All of the participants were treated with subthreshold micropulse laser therapy. BCVA increased significantly at first month and sixth month examinations compared to baseline, while the central macular thicknesses decreased significantly (p=0.01, p=0.00). Among the parameters examined in the baseline OCT, a positive correlation was found between the thickness of the outer nuclear layer (r=-0.520, p=0.003) and BCVA at sixth month. In addition, subretinal fluid density and the number of intra-subretinal hyperreflective dots negatively affected BCVA (r=0.371, p=0.044 and r=0.509, p=0.004). CONCLUSION Outer nuclear layer thickness, subretinal fluid density and intra-subretinal hyperreflective dots were the OCT biomarkers related to sixth month BCVA. The clinical use of these biomarkers will help evaluate the prognosis of the CSCR.
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Affiliation(s)
- Fatih Bilgehan Kaplan
- University of Health Sciences, Department of Ophthalmology Ataşehir, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy mahallesi Hastane sokak No: 1/8, Istanbul 34752, Türkiye.
| | - Banu Açıkalın
- University of Health Sciences, Department of Ophthalmology Ataşehir, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy mahallesi Hastane sokak No: 1/8, Istanbul 34752, Türkiye
| | - Ayşe Ergin
- University of Health Sciences, Department of Ophthalmology Ataşehir, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy mahallesi Hastane sokak No: 1/8, Istanbul 34752, Türkiye
| | - Yıldırım Kocapınar
- Department of Ophthalmology, Siirt Training and Research Hospital, Siirt, Türkiye
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Vienola KV, Lejoyeux R, Gofas-Salas E, Snyder VC, Zhang M, Dansingani KK, Sahel JA, Chhablani J, Rossi EA. Autofluorescent hyperreflective foci on infrared autofluorescence adaptive optics ophthalmoscopy in central serous chorioretinopathy. Am J Ophthalmol Case Rep 2022; 28:101741. [PMID: 36345414 PMCID: PMC9636439 DOI: 10.1016/j.ajoc.2022.101741] [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: 08/17/2022] [Revised: 10/12/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose To test the hypothesis that hyperreflective foci in central serous chorioretinopathy (CSCR) are autofluorescent and may represent macrophages that have engulfed outer retinal fluorophores from the retinal pigment epithelium (RPE) and photoreceptors. Methods Enrolled subjects underwent spectral domain and swept-source optical coherence tomography, adaptive optics flood-illumination, and adaptive optics scanning laser ophthalmoscopy (AOSLO), including near-infrared autofluorescence (AO-IRAF). For the AO-IRAF imaging, retinal fluorophores were excited using 795 nm light and collected in an emission band from 814 to 850 nm. Results In 2 of 3 eyes, a hyperautofluorescent signal was detected with an elliptical shape and punctate, granular aspects surrounded by a hypoautofluorescent halo. The size of these structures in the active case was measured to be 17 ± 4 μm in diameter, with at least 45 individual hyperautofluorescent foci identified from the AO-IRAF montage in the active stage of patient 2. In the asymptomatic case there were fewer structures visible (∼10) and their size was smaller (11 ± 4 μm). These hyper-AF foci were colocalized with hyperreflective foci on OCT and visible in simultaneously acquired confocal AOSLO images in active stage. The hyperautofluorescent foci in the patient with active CSCR disappeared coincident with clinical resolution. Conclusion and importance We show here the first AO-IRAF images from patients with CSCR, demonstrating hyper-autofluorescent punctate foci, colocalized with hyper-reflective foci on confocal AOSLO images and in OCT. The autofluorescence of these foci may be driven by the accumulation of photoreceptor and RPE fluorophores within macrophages during the active stage of the disease.
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Affiliation(s)
- Kari V. Vienola
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
- Corresponding author. Laboratory of Biophysics, Institute of Biomedicine University of Turku Tykistönkatu 6A, Turku, Finland.
| | - Raphael Lejoyeux
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
- Rothschild Foundation Hospital, 29 rue Manin, Paris, France
| | - Elena Gofas-Salas
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
| | - Valerie C. Snyder
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
| | - Min Zhang
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
| | - Kunal K. Dansingani
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
| | - José-Alain Sahel
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
| | - Jay Chhablani
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
| | - Ethan A. Rossi
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
- University of Pittsburgh, Department of Bioengineering, Swanson School of Engineering, Pittsburgh, PA, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Chantarasorn Y, Rasmidatta K, Pokawattana I, Silpa-Archa S. Effects of Ketoconazole on the Clinical Recovery in Central Serous Chorioretinopathy. Clin Ophthalmol 2022; 16:1871-1882. [PMID: 35711967 PMCID: PMC9192783 DOI: 10.2147/opth.s368427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients with hypercortisolism have been associated with a higher prevalence of the pachychoroid spectrum including central serous chorioretinopathy (CSCR), which may explain the inconsistency of therapeutic responses of the mineralocorticoid receptor antagonist because hyperaldosteronism has rarely been detected in patients with CSCR. Therefore, this study aimed to evaluate the effects of ketoconazole, the first-line cortisol inhibitor, on the resolution of subretinal fluid (SRF) in CSCR and to analyze correlations between choroidal thickness and steroid hormones. Patients and Methods This retrospective cohort study included 41 naïve CSCR eyes of 41 patients categorized into control (20 eyes) and treatment (21 eyes) groups. Patients in the treatment group were administered oral ketoconazole at a daily dose of 400 or 600 mg for 3–6 weeks. At week 12, rescue laser therapy was applied to patients exhibiting persistent SRF. Thus, a survival analysis was performed to determine the time interval from presentation to clinical resolution of SRF. Secondary outcomes consisted of eyes with persistent SRF and factors affecting the therapeutic response. Results The mean 24-hour urinary free cortisol (UFC) levels were elevated at 181 ± 70 and 150 ± 68 µg/day (range: 20–150) in the treatment and control groups, respectively (p = 0.21). After controlling for age and gender, baseline UFC levels were significantly associated with choroidal thickness in both eyes (p < 0.05). Ketoconazole significantly increased the CSCR resolution with the median time to resolution of 7 vs 16 weeks (p < 0.01) and decreased the proportion of eyes receiving rescue therapy at 12 weeks (23.8% vs 50%; p = 0.01). Prolonged CSCR durations were likely found in elderly patients with thick choroids in fellow eyes. Conclusion Patients with CSCR showed elevated glucocorticoids, which further correlated with their choroidal thickness. Using cortisol blockers may shorten the duration of existing SRF.
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Affiliation(s)
- Yodpong Chantarasorn
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, 10300, Thailand
| | - Kochapong Rasmidatta
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, 10300, Thailand
| | - Itsara Pokawattana
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, 10300, Thailand.,Department of Ophthalmology, H.R.H Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, Nakhon Nayok, 26120, Thailand
| | - Sukhum Silpa-Archa
- Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, 10400, Thailand
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Visual acuity correlates with multimodal imaging-based categories of central serous chorioretinopathy. Eye (Lond) 2022; 36:517-523. [PMID: 34645969 PMCID: PMC8873496 DOI: 10.1038/s41433-021-01788-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/14/2021] [Accepted: 09/17/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To evaluate visual acuity (VA) and factors influencing VA using new multimodal imaging-based classification of central serous chorioretinopathy (CSCR). METHODS Retrospective, observational and cross-sectional study on 229 naïve eyes diagnosed as CSCR with available baseline data and multimodal imaging. Each case was classified into (i) simple/complex/atypical; (ii) primary/recurrent/resolved; (iii) persistent or not; (iv) outer retinal atrophy(ORA) present/absent; (v) foveal involvement present/absent; and (vi) macular neovascularization(MNV) present/absent. Best corrected visual acuity (BCVA) was correlated to the classification as well as every parameter of the classification. RESULTS Median BCVA was 0.18 logMAR [95% Confidence Interval (CI)0.16-0.18] with median duration of complaints of one month (95% CI,6.14-13.0 months). Age of the patient (r = -0.24, p = 0.002) and duration of the disease (r = -0.32, p < 0.001) correlated significantly with BCVA. Logistic regression model showed that older age [odds ratio (OR) = 0.96, p = 0.05], female gender (OR = 2.45, p = 0.046), presence of ORA(OR = 0.34, p = 0.012),and foveal involvement(OR = 0.18, p = 0.007) were statistically significantly associated with poorer BCVA. Eyes classified as complex, persistent CSCR, with ORA or foveal involvement demonstrated lower BCVA compared to those with simple, non-persistent CSCR, without ORA or without foveal involvement (p < 0.05). Eyes with complex CSCR (p < 0.001), atypical CSCR(p = 0.025), persistent subretinal fluid (SRF) (p = 0.001) and those with ORA (p < 0.001) demonstrated a trend towards severe visual loss. Prevalence of persistent SRF, recurrent episodes and ORA was significantly higher among eyes with complex CSCR (p < 0.001) while there was no difference in prevalence of resolved cases (p = 0.07), foveal involvement (p = 0.28) and MNV (p = 0.45) between simple and complex cases. CONCLUSION There is a strong correlation between VA and foveal involvement and ORA using the new classification. Thus, the objective parameters of the classification can be incorporated in establishing the treatment guidelines for CSCR.
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Esen E, Sizmaz S, Demircan N. Microstructural changes after half-dose photodynamic therapy in patients with chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2021; 35:102347. [PMID: 34033938 DOI: 10.1016/j.pdpdt.2021.102347] [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: 04/08/2021] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To evaluate the retinal and choroidal microstructural changes at fovea after half-dose photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (CSC), using optical coherence tomography (OCT). METHODS The study included 35 eyes with unilateral chronic CSC treated with half-dose PDT. The foveal outer nuclear layer (ONL) and subfoveal choroidal thickness (SFCT) in the affected eyes were compared with baseline measurements at month 1, 3, and 6 after half-dose PDT, and those of the healthy contralateral eyes. RESULTS The mean baseline ONL thickness of the affected eyes was thinner compared to unaffected fellow eyes (66.9 ± 16.5 μm vs 111.5 ± 11.6 μm, p<0.001), and increased significantly to 68.6 ± 17.0 μm at month 3 and 68.9 ± 17.3 μm at month 6 after treatment (p = 0.025 and p = 0.014 respectively). The mean baseline SFCT of the affected eyes was thicker compared to unaffected fellow eyes (399.9 ± 87.0 μm vs 338.2 ± 75.4 μm, p<0.001), and decreased significantly after treatment at month 1, 3, and 6 (374.0 ± 84.8 μm, 369.7 ± 81.8 μm, 367.3 ± 80.8 μm respectively, p<0.001 for all). The responder group (n = 26), in which subretinal fluid was completely resorbed, showed a significant increase in ONL thickness and decrease in SFCT after treatment, whereas in the non-responder group (n = 9) ONL thickness and SFCT did not differ after treatment. CONCLUSIONS In CSC patients, significant changes are observed in foveal ONL thickness and SFCT after half-dose PDT. ONL thickness and SFCT are suggested to be considered in the OCT examinations of CSC patients.
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Affiliation(s)
- Ebru Esen
- Department of Ophthalmology, School of Medicine, Cukurova University, Adana, Turkey.
| | - Selcuk Sizmaz
- Department of Ophthalmology, School of Medicine, Cukurova University, Adana, Turkey.
| | - Nihal Demircan
- Department of Ophthalmology, School of Medicine, Cukurova University, Adana, Turkey.
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Early alterations in retinal microvasculature on swept-source optical coherence tomography angiography in acute central serous chorioretinopathy. Sci Rep 2021; 11:3129. [PMID: 33542349 PMCID: PMC7862300 DOI: 10.1038/s41598-021-82650-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
The purpose of the study was to evaluate the retinal blood flow in patients with acute central serous chorioretinopathy (CSC) over an observational period of 1 month using swept-source optical coherence tomography (SS-OCTA), focusing especially on changes in the area of subretinal fluid (A-SRF). We correlated these findings with conventional indocyanine green angiography (ICGA). ICGA and SS-OCTA images were collected and analyzed of 12 eyes of 12 patients. The A-SRF was annotated and a qualitative analysis of choriocapillaris, the vessel density (VD) and perfusion density (PD) of the retinal superficial capillary plexus (SCP) and the deep capillary plexus (DCP) was performed in A-SRF and the unaffected remaining area (RA). The VD and PD in the DCP were statistically significantly lower in A-SRF than in the RA at baseline. (VD: p = 0.014; PD: p = 0.036). After 1 month, there was a statistically significant difference in the VD and PD of the DCP (VD: p = 0.015; PD: p = 0.014), and for the PD of the SCP between the A-SRF and the RA (p = 0.015), with lower values in the A-SRF. We found low perfused areas in choriocapillaris corresponding to hypofluorescent areas on ICGA. In conclusion there is a difference in VD and VD of the DCP in the area of SRF in acute CSC. These alterations may lead to a chronic change in the microvasculature and potentially to morphological changes.
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Parajuli A, Joshi P. Factors influencing the episode duration and the anatomical and functional outcome in cases of acute central serous chorioretinopathy. BMJ Open Ophthalmol 2020; 5:e000540. [PMID: 33305002 PMCID: PMC7709512 DOI: 10.1136/bmjophth-2020-000540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/21/2020] [Accepted: 11/08/2020] [Indexed: 11/04/2022] Open
Abstract
Objective To investigate the factors affecting the duration of subretinal fluid (SRF) resolution and their correlation with the final anatomical and functional outcome in cases of treatment naïve acute central serous chorioretinopathy (CSCR). Methods and analysis We retrospectively studied 93 eyes of 93 patients diagnosed with treatment naïve acute CSCR presenting within 30 days of onset of symptoms. The eyes were divided into two groups (1 and 2) based on the duration of SRF resolution; which was ≤3 months in group 1 and >3 months in group 2. Demographic and medical history, and spectral domain optical coherence tomography features were noted and their association with duration for SRF resolution, final central macular thickness (CMT) and final best-corrected visual acuity (BCVA) were studied. All the patients were prescribed topical non-steroidal anti-inflammatory drug for 1 month at the diagnosis of CSCR. Results Longer duration of symptoms, female gender and baseline OCT factors like hyper-reflective dots and retinal pigment epithelial bumps were associated with longer duration for SRF resolution (p<0.001, p=0.04, p=0.001 and p=0.01, respectively). The SRF resolution time had strong correlations with the final CMT (r=-0.589, p<0.001) and final BCVA in logarithm of minimum angle of resolution (LogMAR) (r=+0.599, p<0.001). Group 2 eyes had worse final BCVA and thinner final CMT than Group 1 (both p<0.001). The final CMT of the patients of Group 1 was statistically thinner than the normal population (p<0.001). Conclusion Patient's baseline clinicodemographic and OCT features can be used to predict the course and visual outcome in cases of treatment naïve acute idiopathic CSCR.
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Affiliation(s)
| | - Purushottam Joshi
- Retina, Pediatric Ophthalmolgy and Strabismus, Cataract, Mechi Eye Hospital, Birtamode, Nepal
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Retinal Diseases that Can Masquerade as Neurological Causes of Vision Loss. Curr Neurol Neurosci Rep 2020; 20:51. [PMID: 32930896 DOI: 10.1007/s11910-020-01071-1] [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: 10/23/2022]
Abstract
PURPOSE OF REVIEW This review aims to discuss retinal diseases that may masquerade as neurological causes of vision loss and highlights modern ophthalmic ancillary testing that can help to establish these diagnoses. RECENT FINDINGS Retinal diseases with signs and symptoms overlapping with neurological causes of vision loss include central serous chorioretinopathy, retinal ischemia, acute macular neuroretinopathy, Acute zonal occult outer retinopathy (AZOOR) complex diseases, paraneoplastic retinopathy, retinal dystrophy, and toxic retinopathy. Diagnosis is facilitated by electrophysiologic studies and multimodal ophthalmic imaging including optical coherence tomography and fundus autofluorescence imaging. Looking into the future, translation of adaptive optics ophthalmoscopy into clinical practice may facilitate early detection of microscopic retinal abnormalities that characterize these conditions. With conventional methods of physical examination, diagnosis of retinal diseases that may masquerade as neurological causes of vision loss can be challenging. Current advance in multimodal ophthalmic imaging along with electrophysiologic studies enhances the provider's ability to make early diagnosis and monitor progression of these conditions.
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