Central Serous Chorioretinopathy and Blood Serotonin Concentrations

Pupillary Light Reflex and Multimodal Imaging in Patients With Central Serous Chorioretinopathy

Purpose

The purpose of this study was to investigate and compare the corresponding alterations of the pupillary response between acute and chronic central serous chorioretinopathy (CSC) and between different disease categories.

Methods

We recruited patients with unilateral acute and chronic CSC. An eye tracker was applied to determine the pupillary light reflex (PLR) and evaluate the following PLR metrics in healthy eyes: pupil diameter, diameter changes, including relative constriction amplitude (AMP%), and re-dilation ratio (D1%). Baseline optical coherence tomography (OCT), and fluorescein and indocyanine green angiography (FA/ICGA) were performed to analyze the relationship between pupillary response and retinal/choroidal architecture.

Results

In total, 52 patients were enrolled, including 25 with acute CSC and 27 with chronic CSC. Compared to the chronic CSC group, the acute CSC group displayed a significantly larger baseline pupil diameter (BPD; of 5.51 mm, P = 0.015), lower AMP% (34.40%, P = 0.004), and higher D1% (93.01%, P = 0.002), indicating sympathetic overactivity. On OCT, the total macular volume was positively correlated with the D1% (r = 0.48, P = 0.005) and negatively with AMP (r = -0.47, P = 0.007). On ICGA, the intense choroidal vascular hyperpermeability (CVH) group displayed a greater BPD than the nonintense CVH group. Additionally, 9 cases with later recurrent episodes following therapy showed a lower AMP% and higher D1% than the nonrecurrent group.

Conclusions

The PLR revealed sympathetic excitation in patients with acute CSC. The stronger D1% was significantly associated with greater total macular volume, and it may be a potential biomarker for predicting the later recurrence of CSC.

Choroidal Thickness is Increased following Restraint Stress in Rats

PURPOSE

Central serous chorioretinopathy is a stress-induced disease and often shows pachychoroid; however, the relationship between stress and choroid remains unlear. The purpose of this study was to investigate, using optical coherence tomography, whether the choroid thickens when rats are subjected to restraint stress.

METHODS

Eight-week-old male F334/Jcl rats were subjected to 30 min of restraint stress, and choroidal thickness was measured before and after stress loading using optical coherence tomography. In addition, salivary corticosterone levels were measured before and after stress loading.

RESULTS

Choroidal thickness was significantly increased from 30.1 ± 6.4 µm to 39.7 ± 9.2 µm just after stress loading (p = 0.001). Significant choroidal thickening was not observed on the next day. The salivary corticosterone concentration increased from 1575.3 ± 1040.6 pg/mL before stress loading to 6022.2 ± 6742.6 pg/mL after stress loading, but the difference was not significant (p = 0.10).

CONCLUSIONS

Choroidal thickness increased when rats were subjected to restraint stress, supporting the hypothesis that stress is one of the causes of pachychoroid spectrum disease, as exemplified by central serous chorioretinopathy.

A Review of Central Serous Chorioretinopathy: Clinical Presentation and Management

Central serous chorioretinopathy (CSC) may be understood as a disease of the chorioretina with the serous detachment of the neurosensory retina, which is secondary to single or multiple localized defects in retinal pigment epithelium (RPE). CSC is one of the common forms of loss of vision, usually seen in people who do belong to the working-age group. The most common symptoms are blurring of vision, usually unilateral and which is perceived as a scotoma in the center of the field of vision with associated metamorphopsia and micropsia. The risk factor associated with CSC is psychosocial stress, type A personality, pregnancy, and hypercortisolism. Normal vision is often restored within a span of a few months. After around three months, if the resolution of acute CSC did not change or, let us say, in the case of CSC that is chronic, one should consider treatment. In acute CSC, to resolve symptoms, especially in individuals who work in a field where eyesight is of utmost importance, for example, pilots, focal photocoagulation of leaking RPE lesions can be performed. CSC is a prototype cause of serous neuroretinal detachment, which involves the fovea. CSC symptoms reflect the separation between the RPE and the photoreceptors and the bullous distension of the foveal retina. The effect of therapy as such on the long-term outcome of vision visual is not sufficiently documented. The management would largely be dependent on the appropriate diagnosis made based on clinical presentations, and thus it becomes very much necessary to have knowledge about the same and counsel the patient regarding the association between stress and disease pathology. In acute CSC, retinal photocoagulation is successful to a good extent in eliminating or reducing the leakage of RPE and hence it induces resolution of the serous detachment. This review article is made to make sure the reader is updated about the various clinical and management aspects of CSC by providing a comprehensive idea that is obtained from various well-acknowledged databases across the globe on CSC.

Pathophysiology of central serous chorioretinopathy: a literature review with quality assessment

The pathogenesis of central serous chorioretinopathy (CSCR), a pachychoroid disease, is poorly understood. While choroid hyperpermeability and retinal pigment epithelium dysfunction are cornerstones for developing CSCR, the mechanisms at the retinal, vascular, retinal pigment epithelium, and cellular level continue to be an enigma. A few preclinical studies and the development of small-sized, poorly controlled clinical trials have resulted in limited insight into the disease mechanism. Effective treatments for CSCR are still lacking as current trials have produced inconsistent results for functional and structural gains. Thus, critically evaluating the literature to explore disease mechanisms and provide an up-to-date understanding of pathophysiology can provide valuable information and avenues to new treatments. In this study, a comprehensive summary of the mechanistic insight into CSCR is presented while highlighting the shortcomings of current literature. The mechanism was divided into seven sub-categories including mechanical obstruction, inflammation, oxidative stress, paracrine factors, autonomic dysfunction, mineralocorticoid receptors activation, and medications. We implemented validated tools like the JBI and CAMARADES to objectively analyze the quality of both clinical and preclinical studies, respectively. Overall, our analysis of the literature showed that no single mechanism was populated with a large number of sufficiently sized and good-quality studies. However, compiling these studies gave hints not only to CSCR pathogenesis but also pachychoroid disease in general while providing suggestions for future exploration.