1
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Feenstra HMA, van Dijk EHC, Cheung CMG, Ohno-Matsui K, Lai TYY, Koizumi H, Larsen M, Querques G, Downes SM, Yzer S, Breazzano MP, Subhi Y, Tadayoni R, Priglinger SG, Pauleikhoff LJB, Lange CAK, Loewenstein A, Diederen RMH, Schlingemann RO, Hoyng CB, Chhablani JK, Holz FG, Sivaprasad S, Lotery AJ, Yannuzzi LA, Freund KB, Boon CJF. Central serous chorioretinopathy: An evidence-based treatment guideline. Prog Retin Eye Res 2024; 101:101236. [PMID: 38301969 DOI: 10.1016/j.preteyeres.2024.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.
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Affiliation(s)
- Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Suzanne Yzer
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA; Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Siegfried G Priglinger
- Department of Ophthalmology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Laurenz J B Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Clemens A K Lange
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Ocular Angiogenesis Group, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jay K Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York, USA; Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
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2
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Bordbar DD, Skrehot HC, Weng CY. Update on the Management of Central Serous Chorioretinopathy. Int Ophthalmol Clin 2024; 64:179-193. [PMID: 38146890 DOI: 10.1097/iio.0000000000000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
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3
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Singh SR, Goté JT, Chhablani J. Randomized controlled trials in central serous chorioretinopathy: A review. Eye (Lond) 2023; 37:3306-3312. [PMID: 36997794 PMCID: PMC10630374 DOI: 10.1038/s41433-023-02509-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/02/2023] [Accepted: 03/16/2023] [Indexed: 04/01/2023] Open
Abstract
Central serous chorioretinopathy (CSCR), a common chorioretinal disease, presents with a myriad of manifestations. Acute CSCR presents with localized neurosensory detachment whereas chronic CSCR may show widespread retinal pigment epithelium (RPE) changes, chronic shallow subretinal fluid, and choroidal neovascularization (CNV) suggestive of a variable natural history leading to suboptimal visual outcomes. Even though multiple treatment options including laser photocoagulation, photodynamic therapy, micropulse laser, anti-vascular endothelial growth factors, and systemic drugs (spironolactone, eplerenone, melatonin, mifepristone) are available, there is an absence of any standardized treatment protocol or gold standard treatment modality. Moreover, their performance compared to observation especially in acute CSCR is still debatable. Compared to other chorioretinal diseases such as age-related macular degeneration, diabetic retinopathy, diabetic macular oedema, and retinal vein occlusion, there is a relative dearth of randomized controlled trials in CSCR. Multiple inconsistencies including reliance on history of disease duration, variable inclusion criteria/disease descriptors/study endpoints, and availability of multiple treatment modalities lead to difficulties in designing RCTs. A consensus-based treatment protocol, therefore, is still elusive. We reviewed the literature and compiled the list of papers published to date, wherein we analyse and compare the inclusion criteria, imaging modalities, study endpoints, study duration, and study results. Correcting these discrepancies and deficiencies will help standardize future study designs, facilitating a next step toward a standardized treatment protocol.
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Affiliation(s)
- Sumit Randhir Singh
- Sri Sai Eye Hospital, Kankarbagh, Patna, Bihar, India
- Nilima Sinha Medical College & Hospital, Rampur, Madhepura, Bihar, India
| | | | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA.
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Goté JT, Singh SR, Chhablani J. Comparing treatment outcomes in randomized controlled trials of central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2023; 261:2135-2168. [PMID: 36862202 DOI: 10.1007/s00417-023-05996-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/06/2023] [Accepted: 02/04/2023] [Indexed: 03/03/2023] Open
Abstract
PURPOSE To perform a qualitative analysis of outcomes published from randomized controlled trials (RCTs) on central serous chorioretinopathy (CSCR) from 1979 to 2022. DESIGN Systematic review. METHODS All RCTs (including both therapeutic and non-therapeutic interventions) on CSCR available online till July 2022 were included after an electronic search in multiple databases such as PubMed, CENTRAL, MEDLINE, EMBASE, BIOSIS, Scopus, and Cochrane database. We analyzed and compared the inclusion criteria, imaging modalities, study endpoints, duration, and the results of the study. RESULTS The literature search yielded 498 potential publications. After excluding duplicate studies and studies that met clear exclusion criteria, 64 were screened for further evaluation, of which 7 were removed due to a lack of necessary inclusion criteria. A total of 57 eligible studies are described in this review. CONCLUSION This review provides a comparative overview of key outcomes reported between RCTs investigating CSCR. We describe the current landscape of treatment modalities for CSCR and note the discrepancies between results in these published studies. Challenges arise when attempting to compare similar study designs without comparable outcome measures (i.e., clinical vs. structural) which may limit the overall evidence presented. To mitigate this issue, we present the collected data from each study in tables detailing the measures that are and are not assessed in each publication.
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Affiliation(s)
| | | | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA.
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5
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Saberi S, Esmaeili M, Saghiri R, Shekari F, Mohammadi M. Assessment of the mixed origin of the gastric epithelial extracellular vesicles in acellular transfer of Helicobacter pylori toxins and a systematic review. Microb Pathog 2023; 177:106024. [PMID: 36758823 DOI: 10.1016/j.micpath.2023.106024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND H. pylori are generally considered as extracellular organisms, with exclusive colonization of the gastric milieu. Yet, several extra gastric manifestations are associated with this infection. The aim of the present study was to investigate the feasibility of toxin transfer by extracellular vesicles, from bacterial and epithelial origins. METHODS Tox-positive H. pylori and its two cagA and vacA mutant strains were used to produce bacterial vesicles (BVs) and to infect AGS cells. The produced BVs and the infected cell vesicles (ICVs) were collected by ultracentrifugation and evaluated by western blotting, DLS and electron microscopy. These two sets of vesicles were applied to a second set of recipient AGS cells, in which the acellular transfer of toxins, IL-8 production and downstream morphologic changes were assessed, by western blotting, ELISA and light microscopy, respectively. RESULTS The BVs were positive for H. pylori membrane markers (BabA and UreB), VacA and CagA toxins, except for from the corresponding mutant strains. The ICVs were larger in size and positive for bacterial markers, as well as epithelial markers of CD9, LGR5, but negative for nuclear (Ki76) or cytoplasmic (β-actin) markers. Bacteria-independent transfer of CagA and VacA into the recipient cells occurred upon treatment of cells with BVs and ICVs, followed by cellular vacuolation and elongation. IL-8 production was induced in recipient AGS cells, treated with BVs (1279.4 ± 19.79 pg/106 cells), early (8 h, 1171.4 ± 11.31 pg/106 cells) and late (48 h, 965.4 ± 36.77 pg/106 cells) ICVs (P < 0.0001). CONCLUSION Our data indicates that ICVs, with mixed bacterial and epithelial constituents, similar to BVs, are capable of transferring bacterial toxins into the recipient cells, inducing IL-8 production and subsequent morphologic changes, in an acellular manner.
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Affiliation(s)
- Samaneh Saberi
- HPGC Research Group, Department of Medical Biotechnology, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Maryam Esmaeili
- HPGC Research Group, Department of Medical Biotechnology, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Reza Saghiri
- Department of Biochemistry, Pasteur Institute of Iran, Tehran, Iran
| | - Faezeh Shekari
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran; Advanced Therapy Medicinal Product Technology Development Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Marjan Mohammadi
- HPGC Research Group, Department of Medical Biotechnology, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran.
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6
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Mărginean CD, Mărginean CO, Meliț LE. Helicobacter pylori-Related Extraintestinal Manifestations—Myth or Reality. CHILDREN 2022; 9:children9091352. [PMID: 36138661 PMCID: PMC9497822 DOI: 10.3390/children9091352] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022]
Abstract
It is well documented that Helicobacter pylori (H. pylori) can cause both gastrointestinal and extraintestinal manifestations. The latter one represents a major burden in terms of diagnosis and treatment. H. pylori-associated systemic subclinical inflammation is mostly responsible for the development of extraintestinal manifestations, and its early eradication might result in preventing all adverse events related to their occurrence. Thus, it was suggested that H. pylori might be associated with iron deficiency anemia, thrombocytopenia (immune thrombocytopenic purpura), Schonlein Henoch purpura, failure to thrive, vitamin B12 deficiency, diabetes mellitus, body mass index, cardiovascular diseases, as well as certain neurological conditions. Nevertheless, studies showed both pros and cons in terms of the role of H. pylori in the development of previously mentioned clinical entity underlining the crucial need for further studies on these topics. Although most of these extraintestinal manifestations occur during adulthood, we must not forget that H. pylori infection is acquired mainly during childhood, and thus its early diagnosis and eradication might represent the cornerstone in the prevention of H. pylori-induced inflammatory status and consequently of all related extraintestinal conditions.
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Affiliation(s)
- Cristian Dan Mărginean
- Department of Pediatrics I, County Emergency Hospital Târgu Mureș, Gheorghe Marinescu Street No. 50, 540136 Târgu Mureș, Romania
| | - Cristina Oana Mărginean
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania
- Correspondence:
| | - Lorena Elena Meliț
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania
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7
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Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou JM, Schulz C, Gasbarrini A, Hunt RH, Leja M, O'Morain C, Rugge M, Suerbaum S, Tilg H, Sugano K, El-Omar EM. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut 2022; 71:gutjnl-2022-327745. [PMID: 35944925 DOI: 10.1136/gutjnl-2022-327745] [Citation(s) in RCA: 413] [Impact Index Per Article: 206.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/21/2022] [Indexed: 01/06/2023]
Abstract
Helicobacter pyloriInfection is formally recognised as an infectious disease, an entity that is now included in the International Classification of Diseases 11th Revision. This in principle leads to the recommendation that all infected patients should receive treatment. In the context of the wide clinical spectrum associated with Helicobacter pylori gastritis, specific issues persist and require regular updates for optimised management.The identification of distinct clinical scenarios, proper testing and adoption of effective strategies for prevention of gastric cancer and other complications are addressed. H. pylori treatment is challenged by the continuously rising antibiotic resistance and demands for susceptibility testing with consideration of novel molecular technologies and careful selection of first line and rescue therapies. The role of H. pylori and antibiotic therapies and their impact on the gut microbiota are also considered.Progress made in the management of H. pylori infection is covered in the present sixth edition of the Maastricht/Florence 2021 Consensus Report, key aspects related to the clinical role of H. pylori infection were re-evaluated and updated. Forty-one experts from 29 countries representing a global community, examined the new data related to H. pylori infection in five working groups: (1) indications/associations, (2) diagnosis, (3) treatment, (4) prevention/gastric cancer and (5) H. pylori and the gut microbiota. The results of the individual working groups were presented for a final consensus voting that included all participants. Recommendations are provided on the basis of the best available evidence and relevance to the management of H. pylori infection in various clinical fields.
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Affiliation(s)
- Peter Malfertheiner
- Medical Department 2, LMU, Munchen, Germany
- Department of Radiology, LMU, Munchen, Germany
| | - Francis Megraud
- INSERM U853 UMR BaRITOn, University of Bordeaux, Bordeaux, France
| | - Theodore Rokkas
- Gastroenterology, Henry Dunant Hospital Center, Athens, Greece
- Medical School, European University, Nicosia, Cyprus
| | - Javier P Gisbert
- Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Jyh-Ming Liou
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Christian Schulz
- Medical Department 2, LMU, Munchen, Germany
- Partner Site Munich, DZIF, Braunschweig, Germany
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Richard H Hunt
- Medicine, McMaster University, Hamilton, Ontario, Canada
- Farncombe Family Digestive Health Research Institute, Hamilton, Ontario, Canada
| | - Marcis Leja
- Faculty of Medicine, University of Latvia, Riga, Latvia
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Colm O'Morain
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Massimo Rugge
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padova, Padova, Italy
- Veneto Tumor Registry (RTV), Padova, Italy
| | - Sebastian Suerbaum
- Partner Site Munich, DZIF, Braunschweig, Germany
- Max von Pettenkofer Institute, LMU, Munchen, Germany
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medizinische Universitat Innsbruck, Innsbruck, Austria
| | - Kentaro Sugano
- Department of Medicine, Jichi Medical School, Tochigi, Japan
| | - Emad M El-Omar
- Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
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8
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Spaide RF, Gemmy Cheung CM, Matsumoto H, Kishi S, Boon CJF, van Dijk EHC, Mauget-Faysse M, Behar-Cohen F, Hartnett ME, Sivaprasad S, Iida T, Brown DM, Chhablani J, Maloca PM. Venous overload choroidopathy: A hypothetical framework for central serous chorioretinopathy and allied disorders. Prog Retin Eye Res 2021; 86:100973. [PMID: 34029721 DOI: 10.1016/j.preteyeres.2021.100973] [Citation(s) in RCA: 145] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 12/19/2022]
Abstract
In central serous chorioretinopathy (CSC), the macula is detached because of fluid leakage at the level of the retinal pigment epithelium. The fluid appears to originate from choroidal vascular hyperpermeability, but the etiology for the fluid is controversial. The choroidal vascular findings as elucidated by recent optical coherence tomography (OCT) and wide-field indocyanine green (ICG) angiographic evaluation show eyes with CSC have many of the same venous patterns that are found in eyes following occlusion of the vortex veins or carotid cavernous sinus fistulas (CCSF). The eyes show delayed choroidal filling, dilated veins, intervortex venous anastomoses, and choroidal vascular hyperpermeability. While patients with occlusion of the vortex veins or CCSF have extraocular abnormalities accounting for the venous outflow problems, eyes with CSC appear to have venous outflow abnormalities as an intrinsic phenomenon. Control of venous outflow from the eye involves a Starling resistor effect, which appears to be abnormal in CSC. Similar choroidal vascular abnormalities have been found in peripapillary pachychoroid syndrome. However, peripapillary pachychoroid syndrome has intervortex venous anastomoses located in the peripapillary region while in CSC these are seen to be located in the macular region. Spaceflight associated neuro-ocular syndrome appears to share many of the pathophysiologic problems of abnormal venous outflow from the choroid along with a host of associated abnormalities. These diseases vary according to their underlying etiologies but are linked by the venous decompensation in the choroid that leads to significant vision loss. Choroidal venous overload provides a unifying concept and theory for an improved understanding of the pathophysiology and classification of a group of diseases to a greater extent than previous proposals.
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Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, NY, USA.
| | | | - Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Japan.
| | | | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | | | | | | | | | | | | | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA.
| | - Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.
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9
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Yang Y, Dunbar H. Clinical Perspectives and Trends: Microperimetry as a trial endpoint in retinal disease. Ophthalmologica 2021; 244:418-450. [PMID: 33567434 DOI: 10.1159/000515148] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/03/2021] [Indexed: 11/19/2022]
Abstract
Endpoint development trials are underway across the spectrum of retinal disease. New validated endpoints are urgently required for the assessment of emerging gene therapies and in preparation for the arrival of novel therapeutics targeting early stages of common sight-threatening conditions such as age-related macular degeneration. Visual function measures are likely to be key candidates in this search. Over the last two decades, microperimetry has been used extensively to characterize functional vision in a wide range of retinal conditions, detecting subtle defects in retinal sensitivity that precede visual acuity loss and tracking disease progression over relatively short periods. Given these appealing features, microperimetry has already been adopted as an endpoint in interventional studies, including multicenter trials, on a modest scale. A review of its use to date shows a concurrent lack of consensus in test strategy and a wealth of innovative disease and treatment-specific metrics which may show promise as clinical trial endpoints. There are practical issues to consider, but these have not held back its popularity and it remains a widely used psychophysical test in research. Endpoint development trials will undoubtedly be key in understanding the validity of microperimetry as a clinical trial endpoint, but existing signs are promising.
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Affiliation(s)
- Yesa Yang
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Hannah Dunbar
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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10
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Gravina AG, Priadko K, Ciamarra P, Granata L, Facchiano A, Miranda A, Dallio M, Federico A, Romano M. Extra-Gastric Manifestations of Helicobacter pylori Infection. J Clin Med 2020; 9:jcm9123887. [PMID: 33265933 PMCID: PMC7761397 DOI: 10.3390/jcm9123887] [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: 10/14/2020] [Revised: 11/21/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022] Open
Abstract
Helicobacter Pylori (H. pylori) is a Gram-negative flagellated microorganism that has been extensively studied since its first isolation due to its widespread diffusion and association with numerous diseases. While the bacterium is proved to be a causative factor for a number of gastric diseases such as gastritis, gastric adenocarcinoma, and MALT-lymphoma, its role at other gastrointestinal levels and in other systems is being thoroughly studied. In this article, we reviewed the latest published clinical and laboratory studies that investigated associations of H. pylori with hematologic diseases such as Vitamin B12- and iron-deficiency anemia, primary immune thrombocytopenia, and with a number of dermatologic and ophthalmic diseases. In addition, the putative role of the bacterium in inflammatory bowel diseases, esophageal disorders, metabolic, diseases, neurologic diseases and allergy were outlined.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Marco Romano
- Correspondence: (A.G.G.); (M.R.); Tel.: +39-3382465767 (A.G.G.)
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11
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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: 126] [Impact Index Per Article: 31.5] [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.
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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.
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12
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Nicolò M, Ferro Desideri L, Vagge A, Traverso CE. Current Pharmacological Treatment Options for Central Serous Chorioretinopathy: A Review. Pharmaceuticals (Basel) 2020; 13:ph13100264. [PMID: 32977380 PMCID: PMC7597965 DOI: 10.3390/ph13100264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 12/22/2022] Open
Abstract
Central serous chorioretinopathy (CSC) is a common cause of visual impairment in patients generally aged 20 to 60 and it is characterized by acute or chronic neurosensory detachments of the retina. Although CSC resolves spontaneously in most cases, in some patients it may cause permanent visual impairment in the working population; for this reason, several approaches, including photodynamic therapy (PDT), subthreshold micropulse laser treatment and oral mineralocorticoid receptor antagonists, have been studied as first-line treatment options for CSC. To date, half-dose PDT has provided the most encouraging results in this regard, supported by large, multicenter, randomized clinical trials such as the “Prospective Randomized Controlled Treatment Trial for Chronic Central Serous Chorioretinopathy” (PLACE) trial; however, the role of novel possible non-invasive treatment options is attracting interest. This review article aims to discuss the current pharmacological treatment options investigated for the management of CSC, including aspirin, ketoconazole, beta blockers, rifampicin and many others. In particular, further evidence about oral mineralocorticoid receptor antagonists, firstly seen as promising non-invasive alternatives for treating CSC, will be provided and discussed in light of the recent “Eplerenone for chronic central serous chorioretinopathy in patients with active, previously untreated disease for more than 4 months” (VICI) trial results, which have largely resized their role as possible first-line oral treatment options for treating CSC.
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Affiliation(s)
- Massimo Nicolò
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, 16132 Genoa, Italy; (L.F.D.); (A.V.); (C.E.T.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16148 Genoa, Italy
- Macula Onlus Foundation, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-010-555-4191
| | - Lorenzo Ferro Desideri
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, 16132 Genoa, Italy; (L.F.D.); (A.V.); (C.E.T.)
| | - Aldo Vagge
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, 16132 Genoa, Italy; (L.F.D.); (A.V.); (C.E.T.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16148 Genoa, Italy
| | - Carlo Enrico Traverso
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, 16132 Genoa, Italy; (L.F.D.); (A.V.); (C.E.T.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16148 Genoa, Italy
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Moreno-Morillo FJ, Fernández-Vigo JI, Güemes-Villahoz N, Burgos-Blasco B, López-Guajardo L, Donate-López J. Update on the management of chronic central serous chorioretinopathy. ACTA ACUST UNITED AC 2020; 96:251-264. [PMID: 32891458 DOI: 10.1016/j.oftal.2020.07.023] [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: 05/07/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
Central serous chorioretinopathy (CSC) is one of the main causes of impaired visual acuity in patients younger than 60 years. Its pathophysiology remains partially unknown, although it has been postulated that choroidal hyper-permeability may be involved. This typically produces a neurosensory retinal detachment and/or a detachment of the retinal pigment epithelium in the posterior pole. Although acute CSC generally does not require treatment, when chronic it must be treated to avoid visual impairment. With the development of new imaging techniques, there has been an improvement in diagnosis, and different therapeutic strategies have been proposed. Various treatments for the management of chronic CSC have currently been shown to be useful to improve or stabilise visual acuity, the resolution of subretinal fluid, and to prevent recurrences. The most commonly used treatments today are photodynamic therapy, micropulse subthreshold laser, mineralocorticoid antagonists, or anti-vascular endothelial growth factor drugs. There are also other proposals and new treatments being developed, with promising results. This review aims to provide the reader with an overview of the current scientific evidence of the different treatment options available for CSC in order to help decision-making in clinical practice.
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Affiliation(s)
- F J Moreno-Morillo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - J I Fernández-Vigo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España; Centro Internacional de Oftalmología Avanzada, Madrid, España.
| | - N Güemes-Villahoz
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - B Burgos-Blasco
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - L López-Guajardo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - J Donate-López
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
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Sinawat S, Thongmee W, Sanguansak T, Laovirojjanakul W, Sinawat S, Yospaiboon Y. Oral Spironolactone versus Conservative Treatment for Non-Resolving Central Serous Chorioretinopathy in Real-Life Practice. Clin Ophthalmol 2020; 14:1725-1734. [PMID: 32612347 PMCID: PMC7322117 DOI: 10.2147/opth.s260998] [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: 05/02/2020] [Accepted: 06/09/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the efficacy of oral spironolactone treatment versus conservative treatment for patients with persistent central serous chorioretinopathy (CSC) in real-life practice. Design Retrospective comparative study. Patients and Methods Medical records and retinal images of 62 patients with non-resolving CSC were reviewed. Twenty-one patients received oral spironolactone (50 mg/day) while 41 patients received conservative treatment. Primary outcome was proportion of eyes with complete resolution of subretinal fluid (SRF) within 6 months. Secondary outcome measures included changes in SRF height, central macular thickness (CMT), lesion size and best-corrected visual acuity (BCVA). The occurrence of drug side effect was also assessed. Results There was no significant difference in demographic data, clinical characteristics, optical coherence tomography parameters and leaking patterns in fluorescein fundus angiography between two groups. Complete resolution of SRF was significantly higher and faster in the spironolactone group than the conservative treatment group (p=0.03). Although significant anatomical improvement in SRF height, CMT and lesion size were observed in both groups (p < 0.001), final BCVA was improved significantly in only the spironolactone group (p < 0.05). The recurrence of SRF after complete resolution was observed in 4/12 eyes (33.33%) in the treatment group. None of the patients experienced any side effects of spironolactone. Conclusion Oral spironolactone (50 mg/day) could achieve both significant anatomical and visual improvement, while the significant visual gain could not be provided with the conservative treatment. Spironolactone should be considered as an alternative treatment option in non-resolving CSC patients who cannot afford the PDT treatment.
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Affiliation(s)
- Suthasinee Sinawat
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Watcharaporn Thongmee
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Thuss Sanguansak
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wipada Laovirojjanakul
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Supat Sinawat
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yosanan Yospaiboon
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Fusi-Rubiano W, Saedon H, Patel V, Yang YC. Oral medications for central serous chorioretinopathy: a literature review. Eye (Lond) 2020; 34:809-824. [PMID: 31527760 PMCID: PMC7182569 DOI: 10.1038/s41433-019-0568-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/04/2019] [Accepted: 07/27/2019] [Indexed: 02/08/2023] Open
Abstract
Central serous chorioretinopathy (CSCR) is characterised by acute or chronic neurosensory detachments of the retina, usually in the posterior pole, with or without associated detachments of retinal pigment epithelium. Although the condition often resolves spontaneously, chronic and recurrent cases can lead to significant visual loss in the working population and it is thus increasingly recognised as an important public health issue. The uncertainty regarding the underlying cause of CSCR has led to a wide range of therapies being tried for this condition including photodynamic therapy, laser photocoagulation, anti-VEGF injections and a multitude of oral agents. This article aims to review the current evidence for oral agents that have been used for treatment of CSCR. A systematic literature search was conducted for articles published between 1980 to July 2018. A total of 73 articles were included. These studied the following oral medications: eplerenone, spironolactone, beta blockers, H. pylori agents, omeprazole, rifampicin, methotrexate, aspirin, acetazolamide, mifepristone, melatonin, finasteride, ketoconazole, antioxidants and curcumin phospholipid. Although none of the studies showed robust evidence of efficacy, the mineralocorticoid receptor antagonists, particularly eplerenone, appear to demonstrate the highest quality evidence for use in this condition. The review aims to give the reader an overview of the current available evidence for oral medications used in the treatment of CSCR in order to provide an evidence-based discussion with the patient and guide through possible options for treatment.
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Affiliation(s)
- William Fusi-Rubiano
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK.
| | - Habiba Saedon
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK
| | - Vijay Patel
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK
| | - Yit C Yang
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK
- School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, UK
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16
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van Rijssen TJ, van Dijk EHC, Yzer S, Ohno-Matsui K, Keunen JEE, Schlingemann RO, Sivaprasad S, Querques G, Downes SM, Fauser S, Hoyng CB, Piccolino FC, Chhablani JK, Lai TYY, Lotery AJ, Larsen M, Holz FG, Freund KB, Yannuzzi LA, Boon CJF. Central serous chorioretinopathy: Towards an evidence-based treatment guideline. Prog Retin Eye Res 2019; 73:100770. [PMID: 31319157 DOI: 10.1016/j.preteyeres.2019.07.003] [Citation(s) in RCA: 274] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 12/17/2022]
Abstract
Central serous chorioretinopathy (CSC) is a common cause of central vision loss, primarily affecting men 20-60 years of age. To date, no consensus has been reached regarding the classification of CSC, and a wide variety of interventions have been proposed, reflecting the controversy associated with treating this disease. The recent publication of appropriately powered randomised controlled trials such as the PLACE trial, as well as large retrospective, non-randomised treatment studies regarding the treatment of CSC suggest the feasibility of a more evidence-based approach when considering treatment options. The aim of this review is to provide a comprehensive overview of the current rationale and evidence with respect to the variety of interventions available for treating CSC, including pharmacology, laser treatment, and photodynamic therapy. In addition, we describe the complexity of CSC, the challenges associated with treating CSC, and currently ongoing studies. Many treatment strategies such as photodynamic therapy using verteporfin, oral mineralocorticoid antagonists, and micropulse laser treatment have been reported as being effective. Currently, however, the available evidence suggests that half-dose (or half-fluence) photodynamic therapy should be the treatment of choice in chronic CSC, whereas observation may be the preferred approach in acute CSC. Nevertheless, exceptions can be considered based upon patient-specific characteristics.
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Affiliation(s)
- Thomas J van Rijssen
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Suzanne Yzer
- Department of Ophthalmology, Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Graduate School, Tokyo, Japan
| | - Jan E E Keunen
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre 162, London, United Kingdom
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, West Wing, Oxford, United Kingdom
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Jay K Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, India
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong; 2010 Retina & Macula Centre, Tsim Sha Tsui, Kowloon, Hong Kong
| | - Andrew J Lotery
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands.
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17
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Manayath GJ, Ranjan R, Karandikar SS, Shah VS, Saravanan VR, Narendran V. Central serous chorioretinopathy: Current update on management. Oman J Ophthalmol 2018; 11:200-206. [PMID: 30505108 PMCID: PMC6219318 DOI: 10.4103/ojo.ojo_29_2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Central serous chorioretinopathy (CSC), the fourth most common nonsurgical retinopathy with a usual self-limiting course, is known to present with persistent or recurrent form with distressing visual loss. Evolution of newer mutimodal imaging techniques have revolutionized the understanding about the pathophysiology of CSC, and hence the diagnosis and management. Multifactorial etiopathology of CSC promotes the use of multiple treatment modalities. With advances in investigative options, treatment options including conventional focal laser, micropulse laser, photodynamic therapy, and transpupillary thermotherapy are also advancing and refining. Medical management for CSC is also under evaluation with a wide spectrum of new drugs in vogue. However, standard of treatment is yet to be established through randomized clinical trials. This review article discusses the current approach to multimodal treatment options for CSC including conventional as well as newer therapeutic modalities.
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Affiliation(s)
- George Joseph Manayath
- Department of Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Ratnesh Ranjan
- Department of Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Smita S. Karandikar
- Department of Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Vanee Sheth Shah
- Department of Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Veerappan R. Saravanan
- Department of Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Venkatapathy Narendran
- Department of Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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18
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Gravina AG, Zagari RM, De Musis C, Romano L, Loguercio C, Romano M. Helicobacter pylori and extragastric diseases: A review. World J Gastroenterol 2018; 24:3204-3221. [PMID: PMID: 30090002 PMCID: PMC6079286 DOI: 10.3748/wjg.v24.i29.3204] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/19/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection is very common and affects approximately half of the world population. It causes gastric diseases, but some authors have reported an association of H. pylori infection with other systemic manifestations beginning in 1994. The list of potential effects of H. pylori outside the stomach includes a number of extragastric manifestations and we focused on neurological, dermatological, hematologic, ocular, cardiovascular, metabolic, allergic, and hepatobiliary diseases. This review discusses these important reported manifestations that are not related to the gastrointestinal tract.
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Affiliation(s)
- Antonietta Gerarda Gravina
- Dipartimento di “Medicina di Precisione”, UOC Epatogastroenterologia, Università della Campania “Luigi Vanvitelli”, Napoli 80131, Italy
| | - Rocco Maurizio Zagari
- Dipertimento Di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna 40138, Italy
| | - Cristiana De Musis
- Dipartimento di “Medicina di Precisione”, UOC Epatogastroenterologia, Università della Campania “Luigi Vanvitelli”, Napoli 80131, Italy
| | - Lorenzo Romano
- Dipartimento di “Medicina di Precisione”, UOC Epatogastroenterologia, Università della Campania “Luigi Vanvitelli”, Napoli 80131, Italy
| | - Carmelina Loguercio
- Dipartimento di “Medicina di Precisione”, UOC Epatogastroenterologia, Università della Campania “Luigi Vanvitelli”, Napoli 80131, Italy
| | - Marco Romano
- Dipartimento di “Medicina di Precisione”, UOC Epatogastroenterologia, Università della Campania “Luigi Vanvitelli”, Napoli 80131, Italy
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19
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Horozoglu F, Sever O, Celik E, Mete R, Sahin E. Choroidal Thickness of Helicobacter-Positive Patients without Central Serous Chorioretinopathy. Curr Eye Res 2017; 43:262-265. [PMID: 29135305 DOI: 10.1080/02713683.2017.1397176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the effect of Helicobacter pylori (H. pylori) infection on subfoveal choroidal thickness (SFCT) in patients without clinical central serous chorioretinopathy (CSC). MATERIALS AND METHODS This prospective study included 50 patients with pathologically proven H. pylori infection (H. pylori (+)) and 50 patients without H. pylori infection (H. pylori (-)). All of the recruited patients were previously admitted to the Gastroenterology Department of the Namik Kemal University School of Medicine over the period of July 2014 to September 2015. All patients had 20/20 vision and underwent complete ophthalmological examination, macular optical coherence tomography (OCT), and enhanced depth imaging OCT. RESULTS All patients had 20/20 vision and similar macular thicknesses. The mean SFCT of patients in the H. pylori (+) group was 309 ± 41.1 µm and 315 ± 18.2 µm in the H. pylori (-) group (p = 0.174). The right and left eyes of patients in the H. pylori (+) and (-) groups were not statistically significantly different (p = 0.852, p = 0.937). The age, sex, and choroidal thicknesses of patients in the H. pylori (+) and (-) groups were not correlated. CONCLUSION H. pylori infection does not have an effect on choroidal thickness in patients without any ocular pathology.
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Affiliation(s)
- Fatih Horozoglu
- a Department of Ophthalmology , Namık Kemal University School of Medicine , Tekirdag , Turkey
| | - Ozkan Sever
- a Department of Ophthalmology , Namık Kemal University School of Medicine , Tekirdag , Turkey
| | - Ekrem Celik
- a Department of Ophthalmology , Namık Kemal University School of Medicine , Tekirdag , Turkey
| | - Rafet Mete
- b Department of Gastroenterology , Namık Kemal University School of Medicine , Tekirdag , Turkey
| | - Ertan Sahin
- c Department of Nuclear Medicine , Gaziantep University School of Medicine , Gaziantep , Turkey
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20
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Sun X, Shuai Y, Fang W, Li J, Ge W, Yuan S, Liu Q. Spironolactone versus observation in the treatment of acute central serous chorioretinopathy. Br J Ophthalmol 2017; 102:1060-1065. [DOI: 10.1136/bjophthalmol-2017-311096] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/13/2017] [Accepted: 09/30/2017] [Indexed: 11/03/2022]
Abstract
PurposeTo evaluate the efficacy of oral spironolactone in patients with acute central serous chorioretinopathy (CSC).MethodsThis is a prospective, randomised controlled clinical study. Thirty patients with acute CSC were the participants, including 18 patients who were treated with spironolactone (40 mg orally, twice daily) for 2 months in the experimental group and 12 patients who received observation in the control group. Main outcome measures included the proportion of eyes achieving complete resolution of subretinal fluid (SRF), changes in central macular thickness (CMT), the height of SRF (SRFH), best corrected visual acuity (BCVA) and subfoveal choroidal thickness (SFCT). The follow-up period was 2 months.ResultsComplete resolution of SRF was achieved in 55.6% (10/18) and 8.3% (1/12) of the eyes in the treatment group and the control group, respectively, at 2 months (p=0.018). The mean CMT and SRFH decreased significantly at each visit in both groups (p<0.05), and there was significant difference between the two groups at 2 months (p<0.05 and p<0.05, respectively). BCVA (in logarithm of the minimum angle of resolution; mean) improved in both groups at 2 months (p<0.05). In the treatment group, the mean baseline SFCT significantly decreased from 502.50±87.38 µm to 427.44±74.37 µm at 2 months (p<0.01), while the change from baseline (from 480.33±102.38 µm to 463.75±100.63 µm) was not significant in the control group (p=0.195). But the differences between the two groups in BCVA and SFCT were not significant.ConclusionsOral spironolactone is more effective with a faster absorption of SRF than observations. It is a promising treatment for acute CSC.Trial registration numberChiCTR-IPR-16008428, Results.
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21
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Goldhagen BE, Goldhardt R. Diagnosed a Patient with Central Serous Chorioretinopathy? Now What?: Management of Central Serous Chorioretinopathy. CURRENT OPHTHALMOLOGY REPORTS 2017; 5:141-148. [PMID: 28798899 DOI: 10.1007/s40135-017-0133-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW WHAT IS THE GOAL OF YOUR PAPER? WHAT QUESTIONS DID YOU SEEK TO ANSWER? The goal of this paper is to provide a comprehensive review of the management options for central serous chorioretinopathy (CSCR). RECENT FINDINGS SUMMARIZE THE LATEST RESEARCH ON YOUR TOPIC The majority of cases of acute CSCR may be managed with observation and cessation of corticosteroids, if possible, as well as life-style modifications including stress reduction and control of hypertension. The management of chronic disease is more challenging and may include either medication or laser-based treatment. SUMMARY WHAT ANSWERS DID YOU FIND? WHAT ARE THE MAJOR TAKEAWAYS/CONCLUSIONS OF YOUR EXAMINATION? WHAT’S THE IMPACT ON FUTURE RESEARCH? Management of CSCR necessitates an individualized and selective treatment approach. There is overall poor evidence for the use of systemic and intravitreal medications. From this class of treatments, mineralocorticoid receptor antagonists appear to have the greatest potential. Although conventional thermal photocoagulation may be used in select cases, the most promising treatment options at this time for chronic CSCR are photodynamic therapy, either half-dose or half-fluence, and non-damaging (subthreshold) retinal laser therapy.
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Affiliation(s)
- Brian E Goldhagen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Raquel Goldhardt
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
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22
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Chatziralli I, Kabanarou SA, Parikakis E, Chatzirallis A, Xirou T, Mitropoulos P. Risk Factors for Central Serous Chorioretinopathy: Multivariate Approach in a Case-Control Study. Curr Eye Res 2017; 42:1069-1073. [PMID: 28306346 DOI: 10.1080/02713683.2016.1276196] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this prospective study was to investigate the potential risk factors associated independently with central serous retinopathy (CSR) in a Greek population, using multivariate approach. MATERIALS AND METHODS Participants in the study were 183 consecutive patients diagnosed with CSR and 183 controls, matched for age. All participants underwent complete ophthalmological examination and information regarding their sociodemographic, clinical, medical and ophthalmological history were recorded, so as to assess potential risk factors for CSR. Univariate and multivariate analysis was performed. RESULTS Univariate analysis showed that male sex, high educational status, high income, alcohol consumption, smoking, hypertension, coronary heart disease, obstructive sleep apnea, autoimmune disorders, H. pylori infection, type A personality and stress, steroid use, pregnancy and hyperopia were associated with CSR, while myopia was found to protect from CSR. In multivariate analysis, alcohol consumption, hypertension, coronary heart disease and autoimmune disorders lost their significance, while the remaining factors were all independently associated with CSR. CONCLUSIONS It is important to take into account the various risk factors for CSR, so as to define vulnerable groups and to shed light into the pathogenesis of the disease.
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Affiliation(s)
- Irini Chatziralli
- a 2nd Department of Ophthalmology , Ophthalmiatrion Athinon , Athens , Greece
| | - Stamatina A Kabanarou
- b Medical Retina Department , Korgialeneio Benakeio, Red Cross Hospital , Athens , Greece
| | | | | | - Tina Xirou
- b Medical Retina Department , Korgialeneio Benakeio, Red Cross Hospital , Athens , Greece
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Tripathy K. Is Helicobacter pylori the culprit behind central serous chorioretinopathy? Graefes Arch Clin Exp Ophthalmol 2016; 254:2069-2070. [PMID: 27364118 DOI: 10.1007/s00417-016-3418-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/21/2016] [Indexed: 01/25/2023] Open
Affiliation(s)
- Koushik Tripathy
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
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Wong KH, Lau KP, Chhablani J, Tao Y, Li Q, Wong IY. Central serous chorioretinopathy: what we have learnt so far. Acta Ophthalmol 2016; 94:321-5. [PMID: 26132864 DOI: 10.1111/aos.12779] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 05/11/2015] [Indexed: 11/26/2022]
Abstract
Central serous chorioretinopathy (CSCR) is a common retinal cause of visual loss. The mainstays of management are observation, photodynamic therapy (PDT) and laser procedures. Over the past decade, there has been rapid development in the existing and novel imaging techniques, functional testing and management of CSCR. However, there is no convincing treatment designed for CSCR yet. In recent years, the advances in PDT, with various adjustments in fluence and verteporfin dosage, and the comparisons between different types of PDT for acute and chronic CSCR in recent studies have provided greater insights into the role of PDT in treating CSCR. Novel laser procedures, such as the diode micropulse laser, have shown comparable efficacy to conventional lasers without laser-induced damage. Antivascular endothelial growth factor, which was originally developed for treating cancers, has emerged to be a potentially effective treatment for CSCR. The potential role of mineralocorticoid receptor antagonists in treating CSCR has provided greater understanding of the pathogenesis. Based on the relevant studies, mainly from the past decade, we discuss updates to the management of CSCR according to the risk factor modifications, pharmacological interventions, PDT and laser procedures and concluded that PDT is the current best option for CSCR.
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Affiliation(s)
- Kah Hie Wong
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Hong Kong
| | - Kin Pong Lau
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Hong Kong
| | - Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre; L. V. Prasad Eye Institute; Hyderabad India
| | - Yong Tao
- Department of Ophthalmology; People's Hospital; Peking University and Key Laboratory of Vision Loss and Restoration; Ministry of Education; Beijing China
| | - Qing Li
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Hong Kong
| | - Ian Y. Wong
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Hong Kong
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Clinical efficiency of Helicobacter pylori eradication in the treatment of patients with acute central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2016; 254:1737-42. [PMID: 26979068 DOI: 10.1007/s00417-016-3315-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/14/2016] [Accepted: 02/22/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although the majority of cases of acute central serous chorioretinopathy are self-limited, resolving spontaneously after a number of weeks, the recurrence rate is estimated to be 20-50 %, and some cases will be chronic, lasting 6 months or longer. The evidence of Helicobacter pylori infection appears more often in patients with central serous chorioretinopathy. The purpose of this work was to estimate the efficiency of H. pylori infection eradication in treatment of patients with acute central serous chorioretinopathy. METHODS Ninety-three patients with acute central serous chorioretinopathy participated in this study. Patients were divided into an experimental group (33 Helicobacter pylori-positive patients who received eradication treatment) and two control groups who did not receive eradication treatment: 29 H. pylori-positive patients and 31 H. pylori-negative patients. Research methods were best-corrected Snellen visual acuity, optical coherence tomography, fluorescein angiography. Research methods were best-corrected Snellen visual acuity, optical coherence tomography, static perimetry, and Amsler grid. The follow-up period was 2 years. RESULTS Helicobacter pylori eradication caused a decrease of disease duration at 3 months (p = 0.04) and recurrence frequency of 45.6 % (p = 0.03) as well as improvement of distant prognosis. After 2 years, visual acuity increased from 0.91 ± 0.07 to 0.99 ± 0.02 (p = 0.01), scotoma frequency decreased from 100 % eyes to 27.2 % (p = 0.001), and metamorphopsia frequency decreased from 57.6 % eyes to 39.4 % (p = 0.04). CONCLUSIONS Helicobacter pylori eradication is effective in the treatment of H. pylori-positive patients with acute central serous chorioretinopathy.
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Salehi M, Wenick AS, Law HA, Evans JR, Gehlbach P. Interventions for central serous chorioretinopathy: a network meta-analysis. Cochrane Database Syst Rev 2015; 2015:CD011841. [PMID: 26691378 PMCID: PMC5030073 DOI: 10.1002/14651858.cd011841.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Central serous chorioretinopathy (CSC) is characterized by serous detachment of the neural retina with dysfunction of the choroid and retinal pigment epithelium (RPE). The effects on the retina are usually self limited, although some people are left with irreversible vision loss due to progressive and permanent photoreceptor damage or RPE atrophy. There have been a variety of interventions used in CSC, including, but not limited to, laser treatment, photodynamic therapy (PDT), and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents. However, it is not known whether these or other treatments offer significant advantages over observation or other interventions. At present there is no evidence-based consensus on the management of CSC. Due in large part to the propensity for CSC to resolve spontaneously or to follow a waxing and waning course, the most common initial approach to treatment is observation. It remains unclear whether this is the best approach with regard to safety and efficacy. OBJECTIVES To compare the relative effectiveness of interventions for central serous chorioretinopathy. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2015, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to February 2014), EMBASE (January 1980 to October 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 5 October 2015. SELECTION CRITERIA Randomized controlled trials (RCTs) that compared any intervention for CSC with any other intervention for CSC or control. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and extracted data. We pooled data from all studies using a fixed-effect model. For interventions applied to the eye (i.e. not systemic interventions), we synthesized direct and indirect evidence in a network meta-analysis model. MAIN RESULTS We included 25 studies with 1098 participants (1098 eyes) and follow-up from 16 weeks to 12 years. Studies were conducted in Europe, North and South America, Middle East, and Asia. The trials were small (most trials enrolled fewer than 50 participants) and poorly reported; often it was unclear whether key aspects of the trial, such as allocation concealment, had been done. A substantial proportion of the trials were not masked.The studies considered a variety of treatments: anti-VEGF (ranibizumab, bevacizumab), PDT (full-dose, half-dose, 30%, low-fluence), laser treatment (argon, krypton and micropulse laser), beta-blockers, carbonic anhydrase inhibitors, Helicobactor pylori treatment, and nutritional supplements (Icaps, lutein); there were only one or two trials contributing data for each comparison. We downgraded for risk of bias and imprecision for most analyses, reflecting study limitations and imprecise estimates. Network meta-analysis (as planned in our protocol) did not help to resolve this uncertainty due to a lack of trials, and problems with intransitivity, particularly with respect to acute or chronic CSC.Low quality evidence from two trials suggested little difference in the effect of anti-VEGF (ranibizumab or bevacizumab) or observation on change in visual acuity at six months in acute CSC (mean difference (MD) 0.01 LogMAR (logarithm of the minimal angle of resolution), 95% confidence interval (CI) -0.02 to 0.03; 64 participants). CSC had resolved in all participants by six months. There were no significant adverse effects noted.Low quality evidence from one study (58 participants) suggested that half-dose PDT treatment of acute CSC probably results in a small improvement in vision (MD -0.10 logMAR, 95% CI -0.18 to -0.02), less recurrence (risk ratio (RR) 0.10, 95% CI 0.01 to 0.81) and less persistent CSC (RR 0.12, 95% CI 0.01 to 1.02) at 12 months compared to sham treatment. There were no significant adverse events noted.Low quality evidence from two trials (56 participants) comparing anti-VEGF to low-fluence PDT in chronic CSC found little evidence for any difference in visual acuity at 12 months (MD 0.03 logMAR, 95% CI -0.08 to 0.15). There was some evidence that more people in the anti-VEGF group had recurrent CSC compared to people treated with PDT but, due to inconsistency between trials, it was difficult to estimate an effect. More people in the anti-VEGF group had persistent CSC at 12 months (RR 6.19, 95% CI 1.61 to 23.81; 34 participants).Two small trials of micropulse laser, one in people with acute CSC and one in people with chronic CSC, provided low quality evidence that laser treatment may lead to better visual acuity (MD -0.20 logMAR, 95% CI -0.30 to -0.11; 45 participants). There were no significant adverse effects noted.Other comparisons were largely inconclusive.We identified 12 ongoing trials covering the following interventions: aflibercept and eplerenone in acute CSC; spironolactone, eplerenone, lutein, PDT, and micropulse laser in chronic CSC; and micropulse laser and oral mifepristone in two trials where type of CSC not clearly specified. AUTHORS' CONCLUSIONS CSC remains an enigmatic condition in large part due to a natural history of spontaneous improvement in a high proportion of people and also because no single treatment has provided overwhelming evidence of efficacy in published RCTs. While a number of interventions have been proposed as potentially efficacious, the quality of study design, execution of the study and the relatively small number of participants enrolled and followed to revealing endpoints limits the utility of existing data. It is not clear whether there is a clinically important benefit to treating acute CSC which often resolves spontaneously as part of its natural history. RCTs comparing individual treatments to the natural history would be valuable in identifying potential treatment groups for head-to-head comparison. Of the interventions studied to date, PDT or micropulse laser treatment appear the most promising for study in future trials.
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Affiliation(s)
- Mahsa Salehi
- Wilmer Eye Institute, Johns Hopkins University School of MedicineDepartment of OphthalmologyBaltimoreMarylandUSA
| | - Adam S Wenick
- Wilmer Eye Institute, Johns Hopkins University School of MedicineDepartment of OphthalmologyBaltimoreMarylandUSA
| | - Hua Andrew Law
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 N. Wolfe StreetBaltimoreMarylandUSA21205
| | - Jennifer R Evans
- London School of Hygiene & Tropical MedicineCochrane Eyes and Vision, ICEHKeppel StreetLondonUKWC1E 7HT
| | - Peter Gehlbach
- Johns Hopkins University School of MedicineRetina Division, Wilmer Eye Institute1550 Orleans StreetCancer Research Building #2BaltimoreMarylandUSA21231
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Daruich A, Matet A, Dirani A, Bousquet E, Zhao M, Farman N, Jaisser F, Behar-Cohen F. Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis. Prog Retin Eye Res 2015; 48:82-118. [DOI: 10.1016/j.preteyeres.2015.05.003] [Citation(s) in RCA: 425] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/10/2015] [Accepted: 05/14/2015] [Indexed: 02/08/2023]
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Abouammoh MA. Advances in the treatment of central serous chorioretinopathy. Saudi J Ophthalmol 2015; 29:278-86. [PMID: 26586979 PMCID: PMC4625218 DOI: 10.1016/j.sjopt.2015.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/18/2015] [Accepted: 01/19/2015] [Indexed: 02/06/2023] Open
Abstract
Central serous chorioretinopathy is a disease that is partly understood. Novel advancements have led to further understanding of the disease, and have identified choroidal dysfunction as the principal element in CSCR development. New imaging tools have aided in better monitoring disease response to various treatment models. Enhanced depth imaging optical coherence tomography, in particular, has helped in observing choroidal thickness changes after various treatment models. To date, photodynamic therapy and focal laser remain the main stay of treatment. More understanding of disease pathophysiology in the future will help in determining the drug of choice and the best management option for such cases.
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Lai TYY, Wong RLM, Chan WM. Long-Term Outcome of Half-Dose Verteporfin Photodynamic Therapy for the Treatment of Central Serous Chorioretinopathy (An American Ophthalmological Society Thesis). TRANSACTIONS OF THE AMERICAN OPHTHALMOLOGICAL SOCIETY 2015; 113:T8. [PMID: 26755855 PMCID: PMC4692328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To evaluate whether half-dose verteporfin photodynamic therapy (PDT) is better than natural history for the treatment of central serous chorioretinopathy (CSC). METHODS Retrospective review of consecutive CSC patients treated with half-dose verteporfin PDT or untreated with observation and a minimum follow-up of 36 months. The main outcome measures included mean change in visual acuity and CSC recurrence. Survival analysis was performed to compare the CSC recurrence rates between the two groups. RESULTS A total of 192 eyes of 192 patients were included; 75 eyes were treated with half-dose verteporfin PDT and 117 were untreated. The mean follow-up duration was 74.1 months. At the last follow-up, the mean logMAR visual acuity was significantly better in the half-dose verteporfin PDT group compared with the untreated control group (P=.005). The mean visual improvement of the half-dose verteporfin PDT group at the last follow-up was 1.8 lines, compared with 0.0 line in the untreated control group (P<.001). Recurrence of CSC developed in 15 eyes (20%) in the half-dose verteporfin PDT group compared with 63 eyes (53.8%) in the untreated control group (P<.001). Survival analysis demonstrated that eyes treated with half-dose verteporfin PDT were significantly less likely to develop CSC recurrence compared with untreated controls (P<.001). Regression analysis showed that half-dose verteporfin PDT was the only significant factor in reducing the risk of CSC recurrence. CONCLUSIONS Half-dose verteporfin PDT for the treatment of CSC resulted in significantly better visual acuity outcomes and lower recurrence rate in the long term compared with untreated controls.
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Affiliation(s)
- Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong 2010 Retina & Macula Centre, Kowloon, Hong Kong
| | - Raymond L M Wong
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Wai-Man Chan
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong and Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong
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Abstract
The connection between Helicobacter pylori (Hp) infection and eye diseases has been increasingly reported in the literature and in active research. The implication of this bacterium in chronic eye diseases, such as blepharitis, glaucoma, central serous chorioretinopathy and others, has been hypothesized. Although the mechanisms by which this association occurs are currently unknown, this review describes shared pathogenetic mechanisms in an attempt to identify a lowest common denominator between eye diseases and Hp infection. The aim of this review is to assess whether different studies could be compared and to establish whether or not Hp infection and Eye diseases share common pathogenetic aspects. In particular, it has been focused on oxidative damage as a possible link between these pathologies. Text word search in Medline from 1998 to July 2014. 152 studies were included in our review. Were taken into considerations only studies that related eye diseases more frequent and/or known. Likely oxidative stress plays a key role. All of the diseases studied seem to follow a common pattern that implicates a cellular response correlated with a sublethal dose of oxidative stress. These alterations seem to be shared by both Hp infections and ocular diseases and include the following: decline in mitochondrial function, increases in the rate of reactive oxygen species production, accumulation of mitochondrial DNA mutations, increases in the levels of oxidative damage to DNA, proteins and lipids, and decreases in the capacity to degrade oxidatively damaged proteins and other macromolecules. This cascade of events appears to repeat itself in different diseases, regardless of the identity of the affected tissue. The trabecular meshwork, conjunctiva, and retina can each show how oxidative stress may acts as a common disease effector as the Helicobacter infection spreads, supported by the increased oxidative damage and other inflammation.
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Affiliation(s)
- Sergio Claudio Saccà
- From the IRCCS Azienda Ospedaliera Universitaria San Martino - IST Department of Head/Neck Pathologies, St Martino Hospital, Ophthalmology Unit, 16132 Genoa, Italy (SCS); Department of Neurosciences, Ophthalmology and Genetics, University of Genoa, Eye Clinic, 16132 Genoa, Italy (AV); Department of Health Sciences, University of Genoa, 16132 Genoa, Italy (AP, AI); Mutagenesis Unit, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, National Institute for Cancer Research, 16132 Genoa, Italy (AI)
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Testerman TL, Morris J. Beyond the stomach: An updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment. World J Gastroenterol 2014; 20:12781-12808. [PMID: 25278678 PMCID: PMC4177463 DOI: 10.3748/wjg.v20.i36.12781] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/17/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) is an extremely common, yet underappreciated, pathogen that is able to alter host physiology and subvert the host immune response, allowing it to persist for the life of the host. H. pylori is the primary cause of peptic ulcers and gastric cancer. In the United States, the annual cost associated with peptic ulcer disease is estimated to be $6 billion and gastric cancer kills over 700000 people per year globally. The prevalence of H. pylori infection remains high (> 50%) in much of the world, although the infection rates are dropping in some developed nations. The drop in H. pylori prevalence could be a double-edged sword, reducing the incidence of gastric diseases while increasing the risk of allergies and esophageal diseases. The list of diseases potentially caused by H. pylori continues to grow; however, mechanistic explanations of how H. pylori could contribute to extragastric diseases lag far behind clinical studies. A number of host factors and H. pylori virulence factors act in concert to determine which individuals are at the highest risk of disease. These include bacterial cytotoxins and polymorphisms in host genes responsible for directing the immune response. This review discusses the latest advances in H. pylori pathogenesis, diagnosis, and treatment. Up-to-date information on correlations between H. pylori and extragastric diseases is also provided.
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Franceschi F, Tortora A, Gasbarrini G, Gasbarrini A. Helicobacter pylori and extragastric diseases. Helicobacter 2014; 19 Suppl 1:52-8. [PMID: 25167946 DOI: 10.1111/hel.12159] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
While Helicobacter pylori infection was initially revealed to be associated only with some gastroduodenal diseases, further studies have shown its possible role in several extragastric diseases. For idiopathic thrombocytopenic purpura, sideropenic anemia, and vitamin B12 deficiency, the diagnosis of H. pylori infection is recommended, and there are many other conditions such as cardiovascular, neurological, dermatological, and respiratory diseases in which H. pylori may possibly play a role. Interestingly, a potential role has also been described for GI neoplastic diseases, including colorectal and pancreatic cancer. Different mechanisms of action have been proposed, ranging from the induction of a low grade inflammatory state to the occurrence of molecular mimicry mechanisms. This review summarizes the results of the most relevant studies published on this topic over the last year.
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Mateo-Montoya A, Mauget-Faÿse M. Helicobacter pylori as a risk factor for central serous chorioretinopathy: Literature review. World J Gastrointest Pathophysiol 2014; 5:355-358. [PMID: 25133035 PMCID: PMC4133532 DOI: 10.4291/wjgp.v5.i3.355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 05/04/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori), a Gram-negative bacterium, is one of the most frequent causes of gastrointestinal infections worldwide. It has been associated as a pathogen for the human body with many systemic diseases, including different eye diseases. We will focus on a specific eye disease called idiopathic central serous chorioretinopathy (ICSCR). This disease is characterized by a serous detachment of the neurosensory retina in the macular region, which affects the vision to different degrees. Currently, the pathophysiology of ICSCR is not clear and there is no effective treatment. However, several potential risk factors have been elucidated. One of the factors that has more frequently been associated with ICSCR is stress. As H. pylori was identified as a possible etiological factor for occlusive arterial diseases in young people who were particularly stressed, it was thought that H. pylori might also be present in ICSCR. Therefore, some physicians started to test its presence in patents with ICSCR. If H. pylori happened to be associated with ICSCR, the treatment of gastrointestinal infection could also improve visual symptoms and help to remediate this eye disease. Although H. pylori is highly prevalent in the general population, a true correlation seems to exist. We present a review on the relationship between ICSCR and H. pylori.
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Fine HF, Ober MD, Hariprasad SM. Current concepts in managing central serous chorioretinopathy. Ophthalmic Surg Lasers Imaging Retina 2014; 45:9-13. [PMID: 24392907 DOI: 10.3928/23258160-20131220-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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