Morphologic changes in acute central serous chorioretinopathy using spectral domain optical coherence tomography

The Uses of Photodynamic Therapy Versus Anti-vascular Endothelial Growth Factor in the Management of Acute Central Serous Chorioretinopathy: A Systematic Review and Meta-Analysis

Central serous chorioretinopathy (CSCR) is an idiopathic chorioretinal disease characterized by localized serous detachment of the neurosensory retina at the macula. To date, there is no high-quality evidence of recent updates on treating acute CSCR, focusing on photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF). Hence, this review aims to conduct a comprehensive systematic review of the most recent therapeutic approaches for acute CSCR using the following electronic databases for a comprehensive and systematic literature review: MEDLINE, EMBASE, and Cochrane. In addition, we analyzed studies comparing PDT with placebo, anti-VEGF with placebo, or PDT with anti-VEGF in treating acute CSC eyes with no previous intervention. Seven studies were included, with a total of 292 eyes. The overall positive results were significantly higher among patients who received PDT compared to control groups (odds ratio [OR] = 7.96, 95% confidence interval [CI], 3.02 to 20.95, p < 0.001). The proportions of positive results were 81.0% and 97.1% among patients who received anti-VEGF and PDT, respectively, with no statistically significant differences between the groups. In addition, there were no significant differences between anti-VEGF and control groups. In contrast, PDT was significantly associated with lower recurrence odds than the control groups (OR = 0.12, 95% CI, 0.04 to 0.39, p = 0.042). According to our findings, PDT showed higher positive results than anti-VEGF in acute CSCR. In addition, PDT was significantly associated with a lower recurrence rate than the control group. However, the analysis needs to be confirmed and updated by large-scale, well-designed randomized clinical trials.

Bridge arch-shaped subretinal fluid in neovascular age-related macular degeneration - evolution and outcomes

PURPOSE

To study factors leading to bridge arch-shaped subretinal fluid (SRF) on optical coherence tomography (OCT) in wet age-related macular degeneration and evaluate its anatomical and functional outcomes.

METHODS

In this single-center, retrospective study, patients with bridge arch-shaped SRF and choroidal neovascular membrane (CNVM) were included.

RESULTS

We identified 623 eyes in 431 patients with chronic CNVM and 24 (4%) eyes in 21 patients showed bridge arch-shaped SRF. Mean age of patients was 69.19 ± 12.0 years. Type 1 CNVM was noted in 79% cases before development of bridge arch-shaped SRF. Mean ETDRS letters visual acuity was 53.93 ± 32.19. Time interval to develop bridge arch-shaped SRF was 21.9 ± 30.63 months. Mean number of intravitreal anti-VEGF injections given before developing bridge arch-shaped SRF was 6.5 ± 7.09. During development of bridge arch-shaped SRF, visual acuity reduced by -20.57 ± 31.13 letters (p=0.033) and fibrotic type 2 CNVM (n=18, 75%) was noted. RPE tear was noted in 8 (33%) eyes. At final visit, further reduction in visual acuity of -7.136 ± 13.73 ETDRS letters (p=0.011) after developing bridge arch-shaped SRF was seen. Mean number of injections given after developing bridge arch shaped SRF was 4.76 ± 3.76.

CONCLUSION

Bridge arch-shaped SRF is an uncommon finding seen in eyes with type 2 chronic CNVMs. Presence of RPE breach and tear and non-aggressive treatment regimen with intravitreal anti-VEGF injections could be responsible for its pathogenesis. It is a marker of fibrotic enlargement, leading to poor visual outcomes despite showing favourable therapeutic response.

Applications of Multimodal Imaging in Central Serous Chorioretinopathy Evaluation

Central serous chorioretinopathy (CSCR) is a macular disease characterized by serous retinal detachment commonly involving the macular region. CSCR has a wide spectrum of clinical presentations. Although a significant proportion of CSCR cases are self-limiting, patients can suffer from persistent or recurrent disease, sometimes complicated with choroidal neovascularization, resulting in permanent visual loss. Multimodal imaging, including fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and optical coherence tomography, has advanced the diagnosis and classification of CSCR cases. Evolution of new imaging techniques including optical coherence tomography angiography, wide-field imaging, and en face reconstruction imaging has also contributed to better understandings of the pathophysiology of CSCR. This review article summarizes the features of multimodal imaging for CSCR and discusses the application of such features in evaluating the disease.

The morphology of choroidal neovascularization in chronic central serous chorioretinopathy presenting with flat, irregular pigment epithelium detachment

Purpose

To evaluate morphological characteristics of choroidal neovascularization in chronic central serous chorioretinopathy (CSC) presenting with flat and irregular pigment epithelium detachment (FIPED) by means of innovative multimodal imaging.

Methods

In this observational cross-sectional study, we examined 10 consecutive patients affected by chronic CSC and FIPED using fluorescein angiography (FA), indocyanine-green angiography (ICGA) and optical coherence tomography angiography (OCTA). A qualitative analysis of the nature and characteristics of neovascular membrane was performed, combining available multimodal imaging and literature data.

Results

Multiple areas of retinal pigment epithelium alterations, macular hypo- and hyperpigmentation and atrophic areas were identified. Spectral domain OCT (SD-OCT) showed subretinal fluid in 80% of eyes and the ‘double layer sign’ in all patients. Late FA phases showed staining areas without leakage in all eyes; ICGA showed a hyperfluorescent plaque with surrounding hypofluorescence in 80% of patients. OCTA detected characteristic neovascular networks in the outer retina within the FIPEDs, classified as filamentous vessels with a pruned tree-like pattern in five eyes and a tangled pattern in three eyes. The choriocapillaris network showed dark areas in 80% of eyes and diffuse dark spots in all eyes.

Conclusion

Multimodal imaging completes clinical characterization of FIPEDs in chronic CSC. This study using OCTA technology describes the phenotype of hidden neovascular lesions in shape and morphology.

Dynamic changes and correlation analysis of outer retinal microstructure in macular area of central serous chorioretinopathy patients during restoration period

PURPOSE

To investigate the dynamic changes and possible affecting variables of outer retinal microstructure in macular area of central serous chorioretinopathy (CSC) patients.

METHODS

This was a retrospective study. The data of optical coherence tomography (OCT) and autofluoroscopy (AF) of 36 CSC patients admitted to our hospital from February 2012 to February 2013 were included. Dynamic variations and possible correlated variables of central retinal thickness (CRT), subretinal fluid diameter (SRFD), ellipsoid zone (EZ), interdigitation zone (IZ) and/or hyperautofluorescent spot (HAS) were analyzed.

RESULTS

The outer retinal microstructure was gradually restored along with the subretinal fluid absorption during the follow-up. EZ in 94.4% (34/36) and the IZ in 100% (36/36) eyes were completely disappeared at baseline and restored (completed or incomplete) in 88.9% (8/9) and 44.4% (4/9) eyes, respectively, after 6-month follow-up. HAS was evident in 25% eyes (8/32 eyes) at baseline, and the density was initially increased and then declined during follow-up. Correlation analysis demonstrated that the restoration of EZ and IZ was correlated with the restoration period and subretinal fluid absorption.

CONCLUSION

The outer retinal microstructure was restored during the subretinal fluid absorption in CSC patients, with EZ restored earlier than IZ. The restoration period and the absorption of subretinal fluid were two closely correlated variables of macular microstructure restoration.

Axial length as a basic anatomical predictor for morphological and clinical characteristics in acute central serous chorioretinopathy

OBJECTIVES

To study the association between axial length (AL) and morphological and clinical characteristics in acute central serous chorioretinopathy.

METHODS

All patients received optical coherence tomography, fluorescein angiography (FA), optical biometry, and retro-mode scanning laser ophthalmoscopy. The distance between the leakage point and the centre of the fovea were defined using FA images, and its correlation with AL, subfoveal choroidal thickness (SCT), central retinal thickness (CRT), and neurosensory detachment (NSD) area was calculated. The number of leaks, rate of bilateral involvement, and recurrence rate was evaluated.

RESULTS

Forty-seven patients (47 eyes) were included in this study (38 males, 9 females, mean age 43.5 ± 10.8 years). The distance between the leakage point and the centre of the fovea had a correlation with AL (r = -0.38, p = 0.008), SCT (r = 0.51, p = 0.0004), and the area of NSD (r = 0.5, p = 0.0006) but not with CRT (r = -0.11, p = 0.45). A statistically significant difference in the distance between the leakage point and the centre of the fovea was found between eyes with short (<23.0 mm), medium (23.0-24.0 mm), and long (>24.0 mm) AL (p = 0.014). Number of leaks, rate of bilateral involvement, and recurrence rate had a negative linear association with AL (p < 0.05).

CONCLUSIONS

AL appears to be the basic anatomical predictor, which associated with morphological and clinical characteristics in acute central serous chorioretinopathy.

Abnormal retrobulbar blood flow variables in central serous chorioretinopathy

PURPOSE

To evaluate if the retrobulbar blood flow variables were deteriorated in central serous chorioretinopathy (CSC) patients.

METHODS

We included 25 CSC patients and 25 healthy subjects. We used color Doppler ultrasonography to assess the ophthalmic artery (OA), the central retinal artery (CRA), and the posterior ciliary arteries (PCA) for peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI).

RESULTS

Mean ages of the patients and controls were 42.3 ± 8.5 and 41.3 ± 9.4 years, respectively (P = .853). There were no significant differences between the two groups with regard to the values of PSV, EDV, and RI of CRA (P = .406, P = .627, P = .227) and PCA (P = .785, P = .403, P = .935, respectively). The PSV and EDV of OA were lower in the CSC patients (P = .005, P = .024, respectively). Whereas the RI of OA was not significantly different (P = .729). Submacular choroidal thickness (SCT) was greater in CSC patients (P < .001). There was a negative correlation between SCT and PSV of PCA (P = .022, r = -0.457) and between SCT and EDV of PCA (P = .004, r = -0.560) in CSC patients.

CONCLUSION

Hemodynamic changes in OA and a negative correlation between PCA values and SCT suggest ocular circulatory dysfunction in patients with CSC.

Risk of Recurrence and Transition to Chronic Disease in Acute Central Serous Chorioretinopathy

Purpose

To study the risk of recurrence in acute central serous chorioretinopathy (aCSC) and to evaluate the risk of transitioning to chronic CSC.

Patients and Methods

The medical records and multimodal imaging data of 295 aCSC cases were reviewed. Typical aCSC was defined as the presence of serous subretinal fluid (SRF), one focal leakage spot on fluorescein angiography (FA), retinal pigment epithelium (RPE) alterations limited in area to less than one optic disc diameter, and complete recovery from this first CSC episode. An increase in RPE alterations combined with persistent SRF was considered a sign of chronicity, which was determined in cases with >12 months follow-up. The main outcome measures included final visual acuity, percentage of disease recurrence, and percentage of cases moving toward a chronic phenotype. Treatment strategies and their efficacy were also reviewed.

Results

A total of 295 eyes in 291 patients with aCSC were included. Spontaneous recovery was awaited in 154 eyes (52%), whereas 141 eyes (48%) recovered following treatment. SRF recurrence occurred in 24% of untreated cases and in 4% of treated cases (p<0.001). An analysis of 61 eyes that underwent an FA after ≥12 months of follow-up revealed increased RPE alterations in 22 eyes (36%), and 14 eyes (23%) had both an increase in RPE alterations and SRF recurrence.

Conclusion

All aCSC cases recovered from the first disease episode, and none of the cases developed persistent SRF leakage. Among the cases for which long-term follow-up information was available, 36% showed a tendency toward chronicity in terms of increased RPE alterations, whereas 23% showed both an increase in RPE alterations and recurrent SRF. Early photodynamic therapy (PDT) may decrease the risk of recurrences.

Comparison of the outcomes of photodynamic therapy for central serous chorioretinopathy with or without subfoveal fibrin

BACKGROUND

To compare the outcomes of half-dose verteporfin photodynamic therapy (vPDT) for central serous chorioretinopathy (CSCR) with or without subfoveal fibrin.

METHODS

One hundred seventy-three cases of CSCR treated with half-dose vPDT between September 2008 and February 2018 were retrospectively reviewed and classified into two groups: CSCR with subfoveal fibrin (fibrin group) and without subfoveal fibrin (no-fibrin group). The changes in best-corrected visual acuity (BCVA) from baseline and in central macular thickness (CMT) were recorded at 1, 3, and 6 months after the treatment.

RESULTS

Forty-eight eyes were included in the fibrin group and 125 eyes in the no fibrin group. There were no statistical differences in the baseline characteristics including age, gender, duration of symptoms, and CMT between the groups. The baseline mean BCVA of the fibrin group was significantly worse than that of the no fibrin group (0.47 ± 0.32 versus 0.32 ± 0.31 in logMAR; p = 0.003). There was no statistically significant difference between the two groups in the improvement of BCVA at each follow-up point (1 month: p = 0.069; 3 months: p = 0.111; 6 months: p = 0.172, respectively) and in the reduction of CMT (1 month: p = 0.367; 3 months: p = 0.767; 6 months: p = 0.496, respectively). In the fibrin group, the rates of complete resolution of the subretinal fibrin at 1, 3, and 6 months after vPDT were 72.9%, 95.8%, 95.8%, respectively. The SRF resolution rate at 1, 3, and 6 months was 72.9%, 89.6% and 91.7% respectively in the fibrin group and was 62.4%, 83.2% and 84.0% in the no fibrin group. There was no significant difference of SRF resolution rate between the two groups at 1 month (p = 0.216), 3 months (p = 0.350), and 6 months (p = 0.228). No ocular adverse event was encountered in both groups.

CONCLUSION

Half-dose vPDT was effective and safe for CSCR patients with subfoveal fibrin.

Multimodal Imaging in Fibrinous Central Serous Chorioretinopathy Compared with Exudative Maculopathy

AIMS

To analyze ocular fundus characteristics of patients finally diagnosed with fibrinous central serous chorioretinopathy (CSC) using multimodal imaging and compare the characteristics with images of other confusable exudative maculopathies.

METHODS

We retrospectively reviewed the records from 189 patients with CSC and found records on 16 patients with fibrinous CSC. Some of these 16 patients were misdiagnosed with another exudative maculopathy and were treated inappropriately. Multimodal imaging comprised fundus photography, spectral-domain optical coherence tomography (OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), and OCT angiography (OCTA), and the results were compared with those of other exudative maculopathy patients from this study.

RESULTS

Twenty-one eyes of 16 patients with a mean age of 45.44 ± 10.66 years were included in the study. The mean central choroidal thickness was 401.6 ± 47.6 μm. Eight of the 16 patients with fibrinous CSC had initially been misdiagnosed (such as with uveitis or exudative retinal detachment). On fundoscopy, a typical dark spot was seen in 19 eyes, surrounded by yellow-white exudate, corresponding to the site of leakage on FA. A hyporeflective oval-shaped vacuole-like area was observed in 14 patients. All patients showed FA signs of dye leakage and dilated choroidal vessels on ICGA. Among the patients misdiagnosed with choroidal neovascularization (CNV), OCTA showed a legible branching vessel and no signs of a blood flow signal breaking Bruch's membrane.

CONCLUSIONS

A dark spot on fundus photography images and a hyporeflective vacuole on OCT are important clinical signs that can help avoid misdiagnosing fibrinous CSC. With some small confusing lesions suspected as CNV or chronic CSC in elderly patients, OCTA may help in their identification. FA/ICGA still helps to show dye leakage sites and typical dilated choroidal vessels in fibrinous CSC, similar to other common CSCs. Multimodal imaging is mandatory in order to establish an appropriate diagnosis.

Association of Irregular Pigment Epithelial Detachment in Central Serous Chorioretinopathy with Genetic Variants Implicated in Age-related Macular Degeneration

We evaluated phenotype and genotype correlation of central serous chorioretinopathy (CSC) patients with or without irregular pigment epithelial detachment (PED) on optical coherence tomography (OCT). For CSC, a flat, irregular protrusion of retinal pigment epithelium (RPE) with hyper-reflective sub-RPE fluid on OCT was defined as an irregular PED. Participants were classified into 5 subgroups; (1) total CSC (n = 280) (2) CSC with irregular PED (n = 126) (3) CSC without irregular PED (n = 154) (4) typical choroidal neovascularization (CNV) (n = 203) and (5) polypoidal choroidal vasculopathy (PCV) (n = 135). Ten known major AMD-associated single-nucleotide polymorphisms (SNPs) were analyzed. Age, sex adjusted logistic regression was performed for the association between subgroups. Association analysis between CSC without irregular PED and CNV revealed that significant difference for rs10490924 in ARMS2, rs10737680 in CFH, and marginally significant difference for rs800292 in CFH. Between CSC without irregular PED and PCV, rs10490924, rs10737680, and rs800292 were significantly different. In contrast, CSC with irregular PED and CNV revealed no SNP showing significant difference. Between CSC with irregular PED and PCV, only rs10490924 was significantly different. CSC with irregular PED and CSC without irregular PED revealed significant difference for rs800292, and marginal difference for rs10737680. These findings suggest CSC patients with irregular PED are genetically different from those without irregular PED and may have genetic and pathophysiologic overlap with AMD patients.

Topography-guided identification of leakage point in central serous chorioretinopathy: a base for fluorescein angiography-free focal laser photocoagulation

Purpose

To identify optical coherence tomography (OCT) findings associated with the leakage points in patients with central serous chorioretinopathy (CSC) to provide fluorescein angiography (FA)-free focal laser photocoagulation (FLP) of the leakage point.

Methods

A retrospective study included 48 patients with CSC (48 eyes). Colocalisation of leakage points with pigment epithelial detachments (PEDs) and with areas of photoreceptor outer segments (PROS) layer thinning was evaluated with OCT. Using FA for each leakage point, the relationship to neurosensory detachment was evaluated with retro-mode confocal scanning laser ophthalmoscopy.

Results

Coincidence with PED was found in 52 of 65 (80.0%) leakage points. The PROS thinning was found in 47 of 52 (90.4%) of the PEDs coincided with leakage point. The mean distance from the upper border of neurosensory detachment to the leakage point was 27.3%±13.0% of the vertical dimension of the neurosensory detachment.

Conclusion

This study demonstrates that PEDs localised in the upper half of the neurosensory detachment area and associated with the PROS thinning area coincided with the leakage point in a significant number of patients with CSC. The patients with non-resolving CSC with a small single PED localising in the upper one-third to one-half of the neurosensory detachment area with an area of PROS thinning above this PED may undergo FA-free OCT-guided FLP treating whole PED.

Acute syphilitic posterior placoid chorioretinopathy mimicking central serous chorioretinopathy: A case report

A 51-year-old man had experienced declining visual acuity for 4 months. His best-corrected visual acuity was 20/40 in both eyes. Ophthalmoscopic examination showed a yellowish placoid lesion over the macular area, and spectral-domain optical coherence tomography (SD-OCT) revealed subretinal fluid accumulation in the left eye, which resembled that seen with central serous chorioretinopathy (CSCR). Three days later, fluorescein angiography (FA) revealed fluorescein leakage, and indocyanine green angiography (ICGA) showed hypofluorescence over the lesion. Persistent ellipsoid zone loss as spontaneously resolved subretinal fluid was noted at the same time with SD-OCT. Laboratory examination disclosed positive rapid plasma reagin and Treponema pallidum particle agglutination tests (titer >1:1280), which confirmed the diagnosis of ocular syphilis. Acute syphilitic posterior placoid chorioretinopathy (ASPPC) could mimic CSCR with spontaneously resolved subretinal fluid observed in SD-OCT images. The acute loss of the ellipsoid zone, mismatched results from SD-OCT and FA, and picture of retinitis can also provide hints for differentiating the two diseases.

High-Resolution Imaging of Intraretinal Structures in Active and Resolved Central Serous Chorioretinopathy

Purpose

To improve our understanding of central serous chorioretinopathy (CSC), we performed an analysis of noninvasive, high-resolution retinal imaging in patients with active and resolved CSC.

Methods

Adaptive optics scanning light ophthalmoscopy (AOSLO) and spectral-domain optical coherence tomography (SD-OCT) were performed on five subjects with CSC. A custom AOSLO system was used to simultaneously collect confocal and split-detector images. Spectral domain–OCT volume scans were used to create en face views of various retinal layers, which then were compared to montaged AOSLO images after coregistration.

Results

Three distinct types of intraretinal hyperreflective clusters were seen with AOSLO. These clusters had a well-demarcated, round, and granular appearance. Clusters in active CSC over areas of serous retinal detachment were termed type-1. They were found primarily in the outer nuclear layer (ONL) and were associated with large defects in the photoreceptor mosaic and ellipsoid zone. Clusters in areas where the retina had reattached were termed type-2. They also were located primarily in the ONL but showed stability in location over a period of at least 8 months. Smaller clusters in the inner retina along retinal capillaries were termed type-3.

Conclusions

Retinal imaging in CSC using en face OCT and AOSLO allows precise localization of intraretinal structures and detection of features that cannot be seen with SD-OCT alone. These findings may provide greater insight into the pathophysiology of the active and resolved phases of the disease, and support the hypothesis that intraretinal hyperreflective foci on OCT in CSC are cellular in nature.

The comparison of multimodal imaging findings of central serous chorioretinopathy patients in regard to the early anatomically treatment response to half-fluence photodynamic therapy: a retrospective case-control study

BACKGROUND

To compare the multimodal imaging findings of chronic central serous chorioretinopathy (CSC) patients who are good or poor responders to low-fluence photodynamic therapy (PDT).

METHODS

Retrospective, interventional comparative study. The CSC patients who were admitted to our clinic for the first time between January 2013 and December 2015 were included in the study. Patients were treated with PDT only if they did not show any sign of resolution after at least 6 months from the initial signs of the disease. The patients who showed full or partial response to PDT after 3 months of treatment were accepted as good responders, those who did not show any sign of resolution were accepted as poor responders. The optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA) findings were compared between the two groups.

RESULTS

A total of 101 eyes of 101 patients were included: 76 eyes (75.2%) were considered as good responders and 25 eyes (24.8%) as poor responders. In regards to OCT and FA findings there was not a significant difference between the two groups for all of the evaluated findings (p > 0.05 for all). In regards to ICGA findings, there was a statistically difference in the percentage of intense midphase hypercyanescence (p < 0.0001).

CONCLUSIONS

The multimodal imaging findings of CSC patients were compared in regard to their PDT response. The presence of midphase hypercyanescence in ICGA seemed to be positive predictive factor for the PDT response in CSC patients.

Factors affecting the visual outcome in acute central serous chorioretinopathy

Objective:

To determine the visual outcome in patients with acute Central serous chorioretinopathy (CSCR) and to analyze the association of clinical, angiographic and tomographic factors with final visual outcome in Pakistani population.

Methods:

This study was conducted at AFIO Rawalpindi and PNS Shifa Naval hospital Karachi from November 2011 to August 2016. Fifty five eyes of 53 patients with acute CSCR were included. All patients underwent a detailed ophthalmic examination including SD OCT imaging at baseline, One month and three month and FFA was performed at baseline. Primary outcome measures were measurement of initial and final BCVA and CFT. SPSS 13.0 was used for the analysis of data.

Results:

Mean age of study population was 36.66 ± 6.24 years. On OCT mean CFT at baseline was 467.49 ± 144.80 µm in affected eye, whereas mean CFT measurements at final follow up was 244.67 ± 32.99 µm (p <0.01). Presenting mean log MAR BCVA was 0.47 ± 0.25 and final mean log MAR BCVA was 0.18 ± 0.14 (p <0.01). Baseline BCVA showed statistically significant association with final BCVA (p=0.03).

Conclusion:

Presenting VA of 6/12 or better is associated with favorable visual outcome in patients with acute CSCR.

The time of resolution and the rate of recurrence in acute central serous chorioretinopathy following spontaneous resolution and low-fluence photodynamic therapy: a case-control study

PurposeTo evaluate the resolution time and the recurrence rate of acute central serous chorioretinopathy (CSC) after spontaneous resolution and low-fluence photodynamic therapy (PDT).MethodsCase-control study: The CSC patients who were admitted to our clinic for the first time were included. No treatment was given during the first 6 months. Patients were treated with PDT after 6 months from the initial signs of the disease, if they did not show any sign of resolution. The patients who showed a significant decrease in subretinal fluid after month 6 were not scheduled for PDT. The primary outcomes were the resolution time and the recurrence rate after the first episode. Secondary outcome measures were the change in BCVA and CRT during the follow up.ResultsA total of 77 consecutive eyes of 77 patients were included, 41 eyes (53.2%) with spontaneously resolved CSC and 36 eyes (46.8%) with PDT-treated CSC. The initial resolution time was 4.1±3.2 months in spontaneous resolution group, and 8.1±0.8 months in PDT group, respectively (P<0.001). The recurrence rate was 51.2% in spontaneous resolution group, and 25% in PDT group (P=0.01). The change in BCVA from baseline to the last follow-up visit was statistically significant in both groups (P=0.002, P=0.003, respectively). The change in CRT from baseline to the last follow up was also statistically significant in both groups (P=0.002, P=0.003, respectively).ConclusionsThe recurrence rate of acute CSC was lower in PDT-treated patients than the spontaneously resolved patients.

Modified Photodynamic Therapy Treatment of Central Serous Chorioretinopathy

PURPOSE

Central serous chorioretinopathy (CSC) is a condition characterized by serous detachment of the neurosensory retina at the level of the retinal pigmented epithelium (RPE) as a result of leakage from the choriocapillaris. The pathophysiology of CSC is not completely understood rendering treatment and management decisions more complex. When an observational approach and topical medical therapy are unsuccessful, a surgical intervention may be necessary. Here, we examine the role of modified photodynamic therapy (PDT) in recurrent CSC with multiple points of RPE leakage.

CASE REPORT

A 37-year-old male patient presented a case of recurrent CSC in the left eye. After an initial presentation of a large area of submacular fluid, near complete resolution was seen in 8 weeks using a topical NSAID protocol and close monitoring. Two weeks later, a second serous neurosensory detachment larger than the first occurred. The recurrent CSC was successfully treated with focal grid laser photocoagulation and modified PDT resulting in complete resolution and return of visual function 4 months after the initial presentation.

CONCLUSIONS

CSC is a multifactorial condition with the potential to severely impair daily visual function. Spectral domain optical coherence tomography retinal imaging has provided a remarkable tool in the diagnosis and monitoring of CSC. The addition of FA and ICG can create a highly precise picture of the subretinal fluid. Although most patients will spontaneously resolve, a subset of patients may benefit from medical therapy including topical nepafenac 0.1%. A smaller subset will require surgical intervention. Modified PDT with ICG-guided laser photocoagulation has a growing body of evidence as an effective treatment for recurrent CSC. Modified PDT may be the best course of action for chronic, non-resolving RPE leakage for both paramacular and foveal leaks leading to minimization of adverse visual effects.

[En face' optical coherence tomography guided focal navigated laser photocoagulation]

Aim - to prove the feasibility of focal navigated laser photocoagulation (LP) for central serous chorioretinopathy (CSC) that relies only on the data provided by optical coherence tomography (OCT) without considering fluorescein angiography (FA).

MATERIAL AND METHODS

Two patients with CSC were treated with focal navigated LP (NAVILAS laser system) basing on macular OCT findings (RTVue 100). Before the procedure, FA was not performed.

RESULTS

In both cases the leaking point was recognized by a solitary focal detachment of the pigment epithelium in 'en face' OCT scans. OCT images were then imported into the laser photocoagulator unit and superimposed on the basic image of the fundus, thus, enabling accurate focal LP. In both cases the serous retinal detachment resolved completely within 9-14 days.

CONCLUSION

In some CSC patients, 'en face' OCT data allow focal navigated laser photocoagulation without prior fluorescein angiography.

Structural and Functional Outcomes in Chronic Central Serous Chorioretinopathy Treated with Photodynamic Therapy

Purpose

To study the retinal pigment epithelium (RPE) and retinal alterations in chronic central serous chorioretinopathy treated with photodynamic therapy, and its correlation with functional parameters such as best-corrected visual acuity (BCVA) and contrast sensitivity (CS).

Methods

Retrospective, noncomparative, consecutive evaluation by optical coherence tomography and its correlation with BCVA and CS in 31 eyes of 26 patients.

Results

In all affected patients, 88.5% were male with a mean age of 42.9 years. The right eye was involved in 64.5% of cases, bilateral in 19% and 73.9% were hyperopic (spherical refraction between 0 and +5.0 diopters). Of these cases, 51.5% had peri-RPE abnormalities, 17.3% hyperreflective substances at RPE, 19.4% RPE atrophy, 55.3% foveolar atrophy, 3.1% pigment epithelial detachment, 5.2% subretinal fluid persistence, 8.3% fibrin deposits, 68.4% photoreceptor inner and outer segment line interruption and 31.1% external limiting membrane interruption.

Conclusions

Time evolution and number of outbreaks were related to the decrease in foveal and chorodial thickness and in those with worse BCVA and CS. RPE abnormalities and atrophy were related to the age of onset of symptoms. Photoreceptor elongation has been correlated with poor BCVA and inner and outer segment line destructuring and interruption with poor CS.

[Central serous chorioretinopathy: clinical-anatomic correlations]

INTRODUCTION

Central serous chorioretinopathy (CSCR) is a retinal disease characterized by a serous retinal detachment (SRD) responsible for a macular syndrome in young patients, often in the context of stress. In our study, we aimed to describe through multimodal analysis the clinical, angiographic and tomographic characteristics of CSCR while identifying prognostic factors and highlighting functional-anatomic correlations.

METHODS

We conducted a retrospective, descriptive and analytic study over a period of 6 years on 35 eyes of 34 patients with CSCR. The simultaneous analysis of clinical exams and imaging allowed for correlation between the anatomic lesions and visual function.

RESULTS

A correlation was found between the leakage point on angiography and pigment epithelial detachments (PED) in 8 eyes (28.5%), and retinal pigment epithelial (RPE) irregularities in 6 eyes (21.4%) on optical coherence tomography (OCT). Factors associated with poor functional outcome were: poor initial visual acuity, greater subretinal fluid height (P=0.054), presence of highly reflective dots on OCT within the SRD (P<0.05) and the number of PED's (P=0.008).

CONCLUSION

Although CRSC often a resolves spontaneously, the functional prognosis can be affected by macular sequellae. A comprehensive assessment of the anatomical lesions is essential to detect poor prognostic factors.

Comparison of the optical coherence tomographic characters between acute Vogt-Koyanagi-Harada disease and acute central serous chorioretinopathy

Background

Acute Vogt-Koyanagi-Harada (VKH) disease and acute central serous chorioretinopathy (CSCR) are two common disorders with serous retinal detachment caused by dysfunction of choroid. The purpose of this study is to compare the morphological changes of these two diseases with spectral domain optical coherence tomography (SD-OCT).

Methods

In this retrospective comparative study, the SD-OCT images of 65 eyes with acute VKH and 52 eyes with acute CSCR were reviewed for the presence of subretinal fluid, folds of retinal pigment epithelial (RPE), fluctuation of internal limiting membrane (ILM), subretinal septa, retinal pigment epithelium detachment (PED) and bulge of RPE. The foveal thickness was measured using the manual caliper of OCT software. The characteristics of SD-OCT were compared between two diseases.

Results

Subretinal fluid was present in both diseases. Folds of RPE, fluctuation of ILM, subretinal septa were seen only in VKH. Bulge of RPE presented only in CSCR. PED was more common in CSCR than in VKH (44.2% vs 3.1%, p < 0.001). The thickness of fovea and RPE undulation index were significantly greater in VKH compared to that in CSCR (746.7 ± 423.8 vs 444.9 ± 158.8 μm, p < 0.001 and 1.0667 ± 0.0509 vs. 1.0177 ± 0.0023, p = 0.003).

Conclusion

Our study showed that although VKH and CSCR share similar features on SDOCT, there are characteristic differences between both disease entities.

Characteristics of intraretinal deposits in acute central serous chorioretinopathy

Purpose

To describe the temporal and spatial characteristics of intraretinal deposits in patients with acute central serous chorioretinopathy (CSC) using spectral domain optical coherence tomography (OCT).

Materials and methods

We retrospectively reviewed the medical records of all patients that presented with acute CSC to Weill Cornell Medical College from January 2012 to May 2013. Acute CSC was defined as a diagnosis of CSC within 4 months of the onset of symptoms. Only one eye per patient was included in the study. Each patient was imaged with spectral domain OCT at the initial office visit. The decision to reimage these patients was made by the treating physician.

Results

A total of 25 patients (25 eyes; 17 men and eight nonpregnant women) were included in this review. Seven of 25 patients (28%) demonstrated intraretinal deposits within the outer plexiform layer during the initial OCT, with deposits appearing as early as the same day as the onset of symptoms. A total of 25 of 25 patients (100%) demonstrated intraretinal deposits in the outer nuclear layer upon initial (76%) or follow-up OCT, as early as 2 days after the onset of symptoms. A total of 24 of 25 patients (96%) demonstrated deposits in the external limiting membrane upon a follow-up OCT, as early as 7 days from symptoms appearing. A total of 24 of 25 patients (96%) developed intraretinal deposits in the inner segment/outer segment layer upon follow-up OCT, appearing as early as 14 days after symptom onset. At the time of resolution of subretinal fluid, 20 of 25 patients (80%) demonstrated intraretinal deposits.

Conclusion

Intraretinal deposits are present in the outer retinal layers in patients with acute CSC, with the deposits appearing progressively deeper within the retina as the condition evolves. Upon resolution of subretinal fluid, the deposits slowly resolve.