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Jain M, Mohan S, van Dijk EHC. Central serous chorioretinopathy: Pathophysiology, systemic associations, and a novel etiological classification. Taiwan J Ophthalmol 2022; 12:381-393. [PMID: 36660127 PMCID: PMC9843580 DOI: 10.4103/2211-5056.362601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/04/2022] [Indexed: 12/08/2022] Open
Abstract
Central serous chorioretinopathy (CSC) has remained an enigmatic disease since its initial description by Von Graefe. Over the years, multiple risk factors have been recognized: these include psychological stress, behavioral traits, and corticosteroids. The basic pathophysiology of CSC involves choroidal thickening, vascular congestion, altered choroidal blood flow (ChBF), and choroidal hyperpermeability, leading to retinal pigment epithelium decompensation and subsequent neurosensory detachment. Multiple organ systems, mainly the nervous, cardiovascular, endocrinal, and renal systems participate in the control of the vascular tone and the ChBF via hypothalamus-pituitary-adrenal axis and renin-angiotensin-aldosterone system, while others such as the hepatic system regulate the enzymatic degradation of corticosteroids. Many vasoactive and psychotropic drugs also modulate the ocular perfusion. In addition, there are anatomical and genetic predispositions that determine its progression to the chronic or recurrent form, through cellular response and angiogenesis. We herein review the basic pathophysiology and immunogenetics in CSC along with the role of multiple organ systems. With this background, we propose an etiological classification that should provide a framework for customized therapeutic interventions.
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Affiliation(s)
- Manish Jain
- Department of Ophthalmology, Al Dhannah Hospital, Abu Dhabi, United Arab Emirates,Address for correspondence: Dr. Manish Jain, Department of Ophthalmology, Al Dhannah Hospital, Abu Dhabi, United Arab Emirates. E-mail:
| | - Sashwanthi Mohan
- Department of Vitreous and Retina, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
| | - Elon H. C. van Dijk
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
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Penas S, Araújo T, Mendonça AM, Faria S, Silva J, Campilho A, Martins ML, Sousa V, Rocha-Sousa A, Carneiro Â, Falcão-Reis F. Retinal and choroidal vasoreactivity in central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:3825-3836. [PMID: 35838808 DOI: 10.1007/s00417-022-05757-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study aims to investigate retinal and choroidal vascular reactivity to carbogen in central serous chorioretinopathy (CSC) patients. METHODS An experimental pilot study including 68 eyes from 20 CSC patients and 14 age and sex-matched controls was performed. The participants inhaled carbogen (5% CO2 + 95% O2) for 2 min through a high-concentration disposable mask. A 30° disc-centered fundus imaging using infra-red (IR) and macular spectral domain optical coherence tomography (SD-OCT) using the enhanced depth imaging (EDI) technique was performed, both at baseline and after a 2-min gas exposure. A parametric model fitting-based approach for automatic retinal blood vessel caliber estimation was used to assess the mean variation in both arterial and venous vasculature. Choroidal thickness was measured in two different ways: the subfoveal choroidal thickness (SFCT) was calculated using a manual caliper and the mean central choroidal thickness (MCCT) was assessed using an automatic software. RESULTS No significant differences were detected in baseline hemodynamic parameters between both groups. A significant positive correlation was found between the participants' age and arterial diameter variation (p < 0.001, r = 0.447), meaning that younger participants presented a more vasoconstrictive response (negative variation) than older ones. No significant differences were detected in the vasoreactive response between CSC and controls for both arterial and venous vessels (p = 0.63 and p = 0.85, respectively). Although the vascular reactivity was not related to the activity of CSC, it was related to the time of disease, for both the arterial (p = 0.02, r = 0.381) and venous (p = 0.001, r = 0.530) beds. SFCT and MCCT were highly correlated (r = 0.830, p < 0.001). Both SFCT and MCCT significantly increased in CSC patients (p < 0.001 and p < 0.001) but not in controls (p = 0.059 and 0.247). A significant negative correlation between CSC patients' age and MCCT variation (r = - 0.340, p = 0.049) was detected. In CSC patients, the choroidal thickness variation was not related to the activity state, time of disease, or previous photodynamic treatment. CONCLUSION Vasoreactivity to carbogen was similar in the retinal vessels but significantly higher in the choroidal vessels of CSC patients when compared to controls, strengthening the hypothesis of a choroidal regulation dysfunction in this pathology.
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Affiliation(s)
- Susana Penas
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal. .,Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Teresa Araújo
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Ana Maria Mendonça
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Simão Faria
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Jorge Silva
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Aurélio Campilho
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Maria Lurdes Martins
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Vânia Sousa
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Amândio Rocha-Sousa
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
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Di Raimondo D, Musiari G, Rizzo G, Pirera E, Signorelli SS. New Insights in Prevention and Treatment of Cardiovascular Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042475. [PMID: 35206661 PMCID: PMC8872199 DOI: 10.3390/ijerph19042475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Domenico Di Raimondo
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, Division of Internal Medicine and Stroke Care, University of Palermo, 90100 Palermo, Italy; (G.M.); (G.R.); (E.P.)
- Correspondence: ; Tel.: +39-091-6552180
| | - Gaia Musiari
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, Division of Internal Medicine and Stroke Care, University of Palermo, 90100 Palermo, Italy; (G.M.); (G.R.); (E.P.)
| | - Giuliana Rizzo
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, Division of Internal Medicine and Stroke Care, University of Palermo, 90100 Palermo, Italy; (G.M.); (G.R.); (E.P.)
| | - Edoardo Pirera
- Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, Division of Internal Medicine and Stroke Care, University of Palermo, 90100 Palermo, Italy; (G.M.); (G.R.); (E.P.)
| | - Salvatore Santo Signorelli
- Medical Angiology Unit, Department of Clinic and Experimental Medicine, University of Catania, 95124 Catania, Italy;
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Intima-Media Thickness Measurements of the Common Carotid Artery in Patients with Central Serous Chorioretinopathy: A Case-Control Study. J Ophthalmol 2021; 2021:6652373. [PMID: 34527376 PMCID: PMC8437640 DOI: 10.1155/2021/6652373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 07/25/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the intima-media thickness (IMT) of the left and right common carotid arteries (CCA) as an indicator of subclinical atherosclerosis in patients with central serous chorioretinopathy (CSCR). Methods This was a case-control study involving patients with CSCR and a matched healthy control group. The mean and difference of the left and right CCA IMT were determined and compared between the two groups using carotid duplex high-resolution B-mode ultrasound equipment. Results The study enrolled 32 CSCR patients (68.8% female, mean age 38.22 ± 5.42 years) and 32 controls (65.6% female, mean age 39.56 ± 5.33 years). The difference in common carotid IMT between the right and left sides was significantly greater in the CSCR group than in the control group (p < 0.001). Additionally, according to logistic regression analysis, patients with CSCR had a greater chance of having differences in IMT between the two sides when compared to the control group (OR: 1.29, 95% CI: 1.09–1.52). Conclusion Our findings indicated that in the CSCR group, the difference between the right and left sides of CCA IMT was significantly greater than in the control group.
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Latalska M, Bartosińska J, Kosior-Jarecka E, Krasowska D, Mackiewicz J. Nailfold Videocapillaroscopy in Patients with Central Serous Chorioretinopathy and Its Relationship to Morphological and Functional Findings. J Clin Med 2020; 9:jcm9123891. [PMID: 33265997 PMCID: PMC7759800 DOI: 10.3390/jcm9123891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 11/23/2022] Open
Abstract
The aim of the study was to evaluate the results of nailfold videocapillaroscopy (NVC) in patients with central serous chorioretinopathy (CSC) and their correlation with different functional, morphological features and general risk factors. Material and methods: The examined group included 59 CSC patients (14 F, 45 M, mean age 47.2 ± 9.4) and 53 healthy controls (13 F, 40 M, mean age 46 ± 11.5). The NVC was qualified as a normal or abnormal pattern. In the CSC group, the ophthalmoscopy, angio-Optical Coherence Tomography (OCT-A), OCT and microperimetry were performed. The medical history regarding CSC, chronic general disorders and known risk factors was recorded. Results: In the CSC group an abnormal NVC pattern was more common (33.88% CSC vs. 7.54%, p < 0.001). Dilated apical part of capillaries, microaneurysmal dilatation, megacapillaries, fresh microhaemorrhages, bizarre and broken capillaries were observed only in CSC patients. Dilation of capillaries (47.56% vs. 13.21%, p = 0.004), ramified capillaries and neoangiogenesis (38.98% vs. 5.66%, p < 0.001), glomerular loops (32.20% vs. 1.88% p < 0.001) were more frequent in the CSC group. Conclusions: The presence of various NVC abnormalities confirms microvascular involvement in CSC pathogenesis. The results correlate with visual acuity, microperimetry, OCT data and stress. The NVC technique may play a useful diagnostic and prognostic role in CSC.
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Affiliation(s)
- Małgorzata Latalska
- Department of Vitreoretinal Surgery, Medical University of Lublin, 20-079 Lublin, Poland;
- Correspondence: ; Tel.: +48-695-269-200
| | - Joanna Bartosińska
- Department of Cosmetology and Aesthetic Medicine, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Ewa Kosior-Jarecka
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, 20-079 Lublin, Poland;
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Jerzy Mackiewicz
- Department of Vitreoretinal Surgery, Medical University of Lublin, 20-079 Lublin, Poland;
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Penas S, Castro P, Pereira G, Oliveira AM, Carneiro AM, Rocha-Sousa A, Azevedo E, Falcão-Reis FM. Cerebral Neurovascular Coupling Impairment in Central Serous Chorioretinopathy. Ophthalmic Res 2020; 65:446-454. [PMID: 32564029 DOI: 10.1159/000509553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022]
Abstract
Background Central serous chorioretinopathy (CSCR) is a chorioretinal disorder resulting from choroidal hyperpermeability. Its comorbidities as hypertension, coronary disease and psychological stress, suggest that it might reflect a more generalized vascular dysfunction. Objectives To assess the cerebrovascular regulation integrity, using cerebral autoregulation (CA), carbon dioxide vasoreactivity (VR) and neurovascular coupling (NVC) in CSCR. Methods This observational pilot study included 20 CSCR patients and 14 age and sex-matched controls. A State-Trait Anxiety Inventory (STAI) inquiry was full-filled. Continuous measurement of cerebral blood flow velocity (CBFV), arterial blood pressure, heart rate and end-tidal carbon dioxide was performed. VR was assessed during hypercapnia (inhaling carbogen gas) and hypnocapnia (hyperventilation). For NVC, the CBFV relative increase during mental activation using the N-Back Task was calculated. Results No significant differences in systemic hemodynamic parameters, CA or VR were found between both groups. During the NVC performance, the average CBFV rise during mental stress was significantly lower in CSCR (p=0.011). A significant negative correlation was found between STAI scores and NVC. Conclusions CSCR patients presented a significantly impaired cerebral NVC compared to controls, supporting the theory of a potential systemic vascular dysfunction. Stress could be related to this NVC impairment.
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Affiliation(s)
- Susana Penas
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Pedro Castro
- Faculty of Medicine of University of Porto, Porto, Portugal
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Gilberto Pereira
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Ana Marta Oliveira
- Investigation Unit, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Angela M Carneiro
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Amândio Rocha-Sousa
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Elsa Azevedo
- Faculty of Medicine of University of Porto, Porto, Portugal
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Fernando M Falcão-Reis
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
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