1
|
Tsai YC, Chen YG, Lee YC, Hwang YS, Hsieh YH. Diagnosis and Treatment of Central Serous Chorioretinopathy in Patients with Scleritis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050949. [PMID: 37241181 DOI: 10.3390/medicina59050949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/18/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Central serous chorioretinopathy (CSCR) is characterized by central neurosensory retinal detachment from the retinal pigment epithelium. While the association between CSCR and steroid use is widely recognized, it is difficult to distinguish whether the subretinal fluid (SRF) in ocular inflammatory disease results from steroid use or an inflammation-related uveal effusion. We report the case of a 40-year-old man who presented to our department with intermittent redness and dull pain in both eyes that had persisted for three months. He was diagnosed with scleritis with SRF in both eyes and steroid therapy was started. Inflammation improved with steroid use, but SRF increased. This indicated that the fluid was not caused by the posterior scleritis-related uveal effusion but by steroid use. SRF and clinical symptoms subsided after steroids were discontinued completely and immunomodulatory therapy was initiated. Our study highlights that steroid-associated CSCR must be considered in the differential diagnosis of patients with scleritis, and prompt diagnosis with an immediate shift from steroids to immunomodulatory therapy can resolve SRF and clinical symptoms.
Collapse
Affiliation(s)
- Yu-Chien Tsai
- Department of Ophthalmology, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yann-Guang Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yueh-Chang Lee
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Xiamen 361000, China
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung 41265, Taiwan
| | - Yun-Hsiu Hsieh
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| |
Collapse
|
2
|
Liu PK, Chang YC, Tai MH, Tsai RK, Chong IW, Wu KY, Wu WC, Hsu CY, Tsai MJ. THE ASSOCIATION BETWEEN CENTRAL SEROUS CHORIORETINOPATHY AND SLEEP APNEA: A Nationwide Population-Based Study. Retina 2021; 40:2034-2044. [PMID: 31800457 DOI: 10.1097/iae.0000000000002702] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To identify the association between sleep apnea (SA) and central serous chorioretinopathy (CSC). METHODS In this nationwide population-based study using the Taiwan National Health Insurance Database, we enrolled adult patients with a diagnosis of SA and matched each patient to 30 age- and gender-matched control subjects without any SA diagnosis. Using Poisson regression analyses, the incidence rate of CSC was compared between SA patients and control subjects. RESULTS A total of 10,753 SA patients and 322,590 control subjects were identified. After adjusting for age, gender, residency, income level, and comorbidities, the incidence rate of CSC was significantly higher in SA patients than in the control subjects (adjusted incident rate ratio for probable SA: 1.2 [95% CI: 1.1-1.4], P < 0.0001). Analyses of the propensity score-matched subpopulations also confirmed our findings. Risk factors for CSC in SA patients included male gender, age ≤50 years, higher income, presence of heart disease, absence of chronic pulmonary disease, and presence of liver disease. In SA patients, those who had received continuous positive airway pressure titration had a significantly lower incidence rate of CSC than the others. CONCLUSION Our study revealed a significantly higher incidence rate of CSC in SA patients compared with the control subjects.
Collapse
Affiliation(s)
- Pei-Kang Liu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Ophthalmology, Yuan's General Hospital, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yo-Chen Chang
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Hong Tai
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan.,Center for Neuroscience, National Sun Yat-Sen University, Kaohsiung, Taiwan.,Graduate Program in Marine Biotechnology, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Rong-Kung Tsai
- Institute of Eye Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Inn-Wen Chong
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kwou-Yeung Wu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chuan Wu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Yao Hsu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and
| | - Ming-Ju Tsai
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
3
|
Central serous retinopathy associated with topical oral corticosteroid use: a case report. J Med Case Rep 2019; 13:201. [PMID: 31262360 PMCID: PMC6604175 DOI: 10.1186/s13256-019-2143-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background Oral topical corticosteroid gels are widely used in dental medicine. Case studies of central serous retinopathy have been reported following administration of corticosteroids, but none so far coinciding with the use of topical fluocinonide gel. This case report further contributes to the database of potential risks of corticosteroid use. Case presentation A 40-year-old South Asian woman presented with decreased vision, pigment epithelial detachments, and serous retinal detachments in both eyes 1 month after starting treatment with topical fluocinonide 0.05%, a topical oral corticosteroid gel. Her condition resolved 6 months after discontinuing the use of the steroid. Conclusions To the best of our knowledge, this is the first case of idiopathic central serous retinopathy associated with the use of oral fluocinonide gel. Discontinuing the use of the steroid may result in resolution of the serous retinal detachment and improvement of visual symptoms. Patients and their doctors who prescribe this medication should be aware of this association.
Collapse
|
4
|
Doğanay N, Balıkoğlu Yılmaz M, Orduyılmaz B, Aydın E, Saatçi AO. Central Serous Chorioretinopathy: A Complication Associated with Behçet’s Disease Treatment. Turk J Ophthalmol 2019; 49:40-43. [PMID: 30829024 PMCID: PMC6416479 DOI: 10.4274/tjo.galenos.2018.83479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Central serous chorioretinopathy (CSCR) is characterized by a well-defined serous choroidal detachment of the retinal pigment epithelium with one or more focal lesions of the neurosensory retina. Risk factors for CSCR are psychosocial stress, increased endogenous catecholamine, and increased endogenous cortisol. Systemic steroids can cause ocular side effects such as cataract development, increased intraocular pressure, and less frequently the development of CSCR, which can resolve spontaneously with close follow-up and simple treatment modification. CSCR should be considered in patients who complain of worsening vision under steroid treatment for pathologies requiring steroid therapy. In this study we present two patients, one man and one woman, who developed acute CSCR while under systemic steroid treatment for Behçet’s disease.
Collapse
Affiliation(s)
- Nur Doğanay
- İzmir Katip Çelebi University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Melike Balıkoğlu Yılmaz
- İzmir Katip Çelebi University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Betül Orduyılmaz
- İzmir Katip Çelebi University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Erdinç Aydın
- İzmir Katip Çelebi University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Ali Osman Saatçi
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| |
Collapse
|
5
|
Kisma N, Loukianou E, Pal B. Central Serous Chorioretinopathy Associated with Desmopressin Nasal Spray: Causality or Unfortunate Association. Case Rep Ophthalmol 2018; 9:120-125. [PMID: 29643793 PMCID: PMC5892319 DOI: 10.1159/000485912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/29/2017] [Indexed: 11/19/2022] Open
Abstract
<b><i>Purpose:</i></b> To describe the possible association between central serous chorioretinopathy (CSCR) and desmopressin use. <b><i>Methods:</i></b> The case histories of 2 middle-aged men with CSCR using desmopressin nasal spray were studied. <b><i>Results:</i></b> The diagnosis of CSCR was made on the basis of clinical features and ancillary testing (fluorescein angiography and optical coherence tomography). Both patients were using desmopressin nasal spray for polyuria when they developed the first ocular symptoms. Both of them also had an independent risk factor for developing CSCR. <b><i>Conclusion:</i></b> We suggest that desmopressin-induced hypercortisolism might implicate the development of CSCR in some patients. A larger study on patients using desmopressin nasal spray would be beneficial to confirm the possible association between this form of therapy and the development of CSCR.
Collapse
Affiliation(s)
| | - Eleni Loukianou
- *Dr. Eleni Loukianou, 100 Petrou Tsirou st., CY-3076 Limassol (Cyprus), E-Mail
| | | |
Collapse
|
6
|
Abstract
PURPOSE To evaluate choroidal thickness (CT) in patients with Cushing syndrome (CS) with enhanced depth imaging optical coherence tomography. METHODS Twenty-eight patients with CS and 38 healthy volunteers were enrolled in this observational cross-sectional study. Patients with newly diagnosed CS who have been admitted to Erciyes University Department of Endocrinology in 3 years time interval were compared with age- and sex-matched healthy volunteers. Choroidal thickness was measured at the fovea and 2 points nasal and 2 points temporal to the fovea with 500-μm intervals each. RESULTS Choroidal thickness measurements were higher in patients with CS than in the control group at all examination points; however, the difference was found to be significant at the center of the fovea (367.8 ± 94.4 μm vs. 329 ± 90.5 μm) and 1,000 μm temporal to the fovea. Choroidal thickness measurements were significantly higher in adrenocorticotrophic hormone (ACTH)-dependent CS group than in the control group at all measurement points (CT at fovea 388.2 ± 92.4 μm vs. 329.1 ± 90.5 μm). All CT measurements were found to be correlated with ACTH levels. CONCLUSION Cushing syndrome is associated with increased CT. The ACTH-dependent CS may increase CT more than ACTH-independent CS. This effect may be directly related to ACTH itself or increased plasma cortisol levels or both.
Collapse
|
7
|
Stefaniotou M, Vourda E, Katsanos A, Aspiotis M. Multifocal central serous chorioretinopathy associated with steroids in a patient with myasthenia gravis. Case Rep Ophthalmol 2013; 4:1-6. [PMID: 23898284 PMCID: PMC3725012 DOI: 10.1159/000351856] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We present a case of bilateral multifocal central serous chorioretinopathy in a 40-year-old male who suffered from myasthenia gravis and was receiving oral prednisolone. Due to the severity of the underlying disease, it was not possible to reduce the corticosteroid dose. After initial unsuccessful treatment with an intravitreal injection of ranibizumab, low-fluence photodynamic therapy was performed, followed by gradual tapering of the corticosteroids. Visual acuity improved significantly in both eyes. Different therapeutic approaches are discussed.
Collapse
|
8
|
Ponce CMP, Mohidat HM, Garcia CA. Central serous chorioretinopathy after blunt trauma. BMJ Case Rep 2012; 2012:bcr.01.2012.5626. [PMID: 22669212 DOI: 10.1136/bcr.01.2012.5626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors report a case of a 46-year-old Hispanic male with central serous chorioretinopathy (CSC) following blunt trauma to the left eye. The patient presented with a complaint of throbbing headache and blurry vision in left eye. The patient was diagnosed with diabetes mellitus 1 year previous to the event. On examination, uncorrected visual acuity was 20/20 OD, 20/200 OS. No anisocoria or afferent pupillary defect was present. Intraocular pressure was normal. Subconjunctival haemorrhage and lid ecchymosis were present in OS and fundus examination showed serous macular detachment and central retinal pigment epithelium detachment, and no evidence of diabetic retinopathy. Optical coherence tomography OS showed subretinal fluid and fluorescein angiography demonstrated the typical 'smokestack' pattern of leakage into the subretinal space. The patient received observational therapy for 4 months and the CSC spontaneously resolved with visual acuity of 20/20 in left eye.
Collapse
|
9
|
Shah SP, Desai CK, Desai MK, Dikshit RK. Steroid-induced central serous retinopathy. Indian J Pharmacol 2011; 43:607-8. [PMID: 22022013 PMCID: PMC3195140 DOI: 10.4103/0253-7613.84985] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 04/17/2011] [Accepted: 07/01/2011] [Indexed: 11/18/2022] Open
Abstract
A-24 year-old male was prescribed prednisolone (60 mg/day) for left sided facial palsy. After three days of therapy, the patient complained of black spots in his vision in right eye. Fluorescein angiography of right eye showed evidence of central serous retinopathy (CSR). Prednisolone dose was withdrawn gradually and the patient improved within a week. There were no other systemic or ophthalmic diseases reported by the patient, which could have caused this condition. An improvement after dechallenge confirmed steroid-induced CSR. Recurrent CSR is known to cause permanent loss of vision. Hence, awareness regarding this adverse drug reaction (ADR) with steroids and its reporting can minimize this complication and help in better patient management.
Collapse
Affiliation(s)
- Samidh P Shah
- Department of Pharmacology, B. J. Medical College, Ahmedabad, Gujarat, India
| | | | | | | |
Collapse
|
10
|
Marcuson J, Riley T. Central serous chorioretinopathy. ACTA ACUST UNITED AC 2008; 79:241-51. [DOI: 10.1016/j.optm.2007.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Accepted: 02/28/2007] [Indexed: 11/17/2022]
|
11
|
Loo JL, Lee SY, Ang CL. Can Long-term Corticosteroids Lead to Blindness? A Case Series of Central Serous Chorioretinopathy Induced by Corticosteroids. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006. [DOI: 10.47102/annals-acadmedsg.v35n7p496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Introduction: Long-term, high-dose corticosteroid therapy is well-known to cause systemic and ocular complications. A lesser known complication is chronic central serous chorioretinopathy (CSCR). Although idiopathic central serous chorioretinopathy (CSCR) is known to be mild with spontaneous recovery and minimal effects on the final visual acuity, chronic CSCR as a complication of long- term steroid therapy behaves differently, and may cause irreversible visual impairment.
Clinical Picture: Three cases of chronic, recurrent CSCR were precipitated by long-term corticosteroids prescribed for post-renal transplant immunosuppressive therapy, post-pituitary surgery and pemphigus vulgaris.
Treatment and Outcome: Two cases resolved with tapering of corticosteroids while one case was treated by focal laser photocoagulation. Two eyes had severe impairment of vision as a result of subretinal scar formation while the other 4 eyes had mild reduction of visual acuity from retinal epithelium pigment atrophy.
Conclusion: Long-term corticosteroid therapy can be complicated by severe, chronic and recurrent CSCR and occasionally peripheral exudative retinal detachment. This may result in subretinal fibrosis and permanent loss of vision.
Key words: Opioid dependence, Partial agonist, Primary care setting
Collapse
|
12
|
Levy J, Marcus M, Belfair N, Klemperer I, Lifshitz T. Central serous chorioretinopathy in patients receiving systemic corticosteroid therapy. Can J Ophthalmol 2005; 40:217-21. [PMID: 16049541 DOI: 10.1016/s0008-4182(05)80040-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jaime Levy
- Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | | | | | | | | |
Collapse
|
13
|
Wong R, Chopdar A, Brown M. Five to 15 year follow-up of resolved idiopathic central serous chorioretinopathy. Eye (Lond) 2004; 18:262-8. [PMID: 15004575 DOI: 10.1038/sj.eye.6700637] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To recognize the long-term sequelae of resolved idiopathic central serous chorioretinopathy (ICSC) in relation to visual acuity, contrast sensitivity, and lesion size between time elapsed since disease onset. METHODS Patients were recruited from fluorescein angiogram records between January 1985 and December 1995 with confirmed ICSC. Visual acuity, contrast sensitivity, and digital fundus photographs were recorded on follow-up. Comparison with the initial red-free photographs were made. RESULTS There was no statistically significant deterioration of visual acuity over time compared to eyes with ICSC after initial resolution and the normal eyes. The change of lesion size over time was also statistically insignificant. Contrast sensitivity compared to visual acuity showed positive correlation in both ICSC and normal eyes, but the results were statistically insignificant. Lesion size correlates negatively with visual acuity and contrast sensitivity although this was statistically insignificant. CONCLUSION This study shows little, if any, correlation between time and progression of retinal pigment epitheliopathy following resolution of ICSC. Visual acuity did not seem to worsen over time. Our data were not statistically significant, but it does give insight into the natural history of what is still a relatively poorly understood disease.
Collapse
Affiliation(s)
- R Wong
- East Surrey Hospital, Canada Avenue, Redhill, Surrey, UK.
| | | | | |
Collapse
|
14
|
Tandon R, Vanathi M, Verma L, Bharadwaj A. Central serous retinopathy masquerading as sympathetic ophthalmia. Eye (Lond) 2003; 17:666-7. [PMID: 12855987 DOI: 10.1038/sj.eye.6700423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
15
|
Todd KC, Hainsworth DP, Lee LR, Madsen RW. Longitudinal analysis of central serous chorioretinopathy and sex. CANADIAN JOURNAL OF OPHTHALMOLOGY 2002; 37:405-8. [PMID: 12516721 DOI: 10.1016/s0008-4182(02)80043-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Stress has been proposed as one of the contributing factors of central serous chorioretinopathy (CSC). Because the number of women in the workforce has increased dramatically in past decades, their presumed additional stress may increase their risk for CSC. We performed a study to determine whether the ratio of men to women in whom CSC was diagnosed remained constant between 1970 and 2000 in our patient population. METHODS We reviewed the medical records of 88 patients (69 males and 19 females) in whom CSC was diagnosed between 1970 and 2000. Only patients who were noted to have subretinal fluid on stereoscopic colour fundus photographs and focal retinal pigment epithelial hyperfluorescence on fluorescein angiography were included. Logistic regression analysis was performed to determine the probability of a patient's being male over the study period. RESULTS No significant change was found in the proportion of male patients in whom CSC was diagnosed over the study period (p = 0.69). INTERPRETATION The ratio of males to females with a diagnosis of CSC did not change significantly over 30 years in our study population. If stress is a contributing factor of CSC and if women are experiencing increased stress from changing societal roles, women may have different adaptations to stress than men, or other mechanisms of CSC formation may be present.
Collapse
|
16
|
Carvalho-Recchia CA, Yannuzzi LA, Negrão S, Spaide RF, Freund KB, Rodriguez-Coleman H, Lenharo M, Iida T. Corticosteroids and central serous chorioretinopathy. Ophthalmology 2002; 109:1834-7. [PMID: 12359603 DOI: 10.1016/s0161-6420(02)01117-x] [Citation(s) in RCA: 224] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study is to investigate the relationship between corticosteroid use and central serous chorioretinopathy (CSC). DESIGN A prospective, case-controlled study. PARTICIPANTS AND CONTROLS A consecutive series of patients with acute manifestations of CSC and a control group matched for age, race, and gender were recruited between January 2000 and July 2000. METHODS A detailed clinical history was taken, and fundus examination with slit-lamp biomicroscopy was performed on all patients. Fluorescein angiography was obtained on the study patients. RESULTS A total of 50 patients was recruited. Twenty-six patients (52%) had a history of exogenous steroid use, including oral, intravenous, intranasal, and intraarticular administration. Two additional patients had a history of endogenous hypercortisolism (Cushing's syndrome). In a matched control group, eight patients (18%) had a history of steroid use. The difference in corticosteroid exposure between study patients and controls was statistically significant (P < 0.0001). MAIN OUTCOME MEASURES History of corticosteroid use or Cushing's syndrome. CONCLUSIONS This study is consistent with previous reports associating steroid use with CSC. It identifies corticosteroids as a significant risk factor for the development of acute, exudative macular manifestation and implicates hypercortisolism as a factor in the pathogenesis of this disorder. Several forms of corticosteroid administration were observed to be a risk factor for CSC. Accordingly, susceptible patients in need of corticosteroids should be advised of the risk of developing acute manifestations of CSC.
Collapse
Affiliation(s)
- Cynthia A Carvalho-Recchia
- LuEsther T. Mertz Retinal Research Department, Manhattan Eye, Ear and Throat Hospital, New York, New York 10021, USA
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Jampol LM, Weinreb R, Yannuzzi L. Involvement of corticosteroids and catecholamines in the pathogenesis of central serous chorioretinopathy: a rationale for new treatment strategies. Ophthalmology 2002; 109:1765-6. [PMID: 12359592 DOI: 10.1016/s0161-6420(02)01303-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
|
18
|
Abstract
Central serous chorioretinopathy is a relatively common retinal disease characterized by the accumulation of subretinal fluid at the posterior pole of the fundus, creating a circumscribed area of serous retinal detachment. It typically affects young and middle-aged men with no previous medical and family history, and no systemic symptoms or signs. However, it has been noted that central serous chorioretinopathy is associated with different conditions, characterized by exposure to increased levels of endogenous or exogenous glucocorticoids. In fact, central serous chorioretinopathy has been described in patients with endogenous Cushing's syndrome. It is also prevalent in patients with type-A behavior, and following stressful events, and pregnancy probably represents a risk factor for central serous chorioretinopathy; these conditions are characterized by endogenous hypercortisolism. In addition, many cases of central serous chorioretinopathy have been described during or following treatment with glucocorticoids, administrated by any route, for various systemic or ocular conditions. Central serous chorioretinopathy, when related to the exposure to exogenous glucocorticoids, has a less prominent male predilection, presents more often with a chronic or atypical form, and is frequently bilateral. Furthermore, treatment of central serous chorioretinopathy with glucocorticoids was found to exacerbate the clinical picture. Based on these observations it could be suggested that glucocorticoids may be involved in the development of central serous chorioretinopathy, even though the exact pathogenic mechanism remains unclear. Glucocorticoids should not be used in the treatment of central serous chorioretinopathy and central serous chorioretinopathy should be added to the list of ocular complications of glucocorticoids.
Collapse
|
19
|
Maaranen T, Mäntyjärvi M. Contrast sensitivity in patients recovered from central serous chorioretinopathy. Int Ophthalmol 2001; 23:31-5. [PMID: 11008896 DOI: 10.1023/a:1006496615006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To study contrast sensitivity in patients who have recovered from central serous chorioretinopathy (CSC). PATIENTS AND METHODS Thirty-one patients who had recovered from CSC were examined with the Vistech and Pelli-Robson contrast sensitivity charts. The time from the onset of the active disease varied from 10 to 166 months (mean 60.4 +/- 42.0, SD). The visual acuity was 1.0 (logMar 0) or better. RESULTS Contrast sensitivity of the affected eyes was significantly worse in the intermediate spatial frequencies of 3 and 6 cycles per degree (cpd) in the Vistech test compared to the fellow eyes (p = 0.032, 0.013, respectively). Contrast sensitivity of the affected eyes was significantly worse in all 5 spatial frequencies of the Vistech test and in the Pelli-Robson test compared to age-matched normal eyes (p = 0.006, 0.000, 0.000, 0.018, 0.000, 0.000, respectively). Contrast sensitivity of the fellow eyes was significantly worse in the spatial frequencies of 3 and 18 cpd in the Vistech test and in the Pelli-Robson test compared to age-matched normal eyes (p = 0.020, 0.019, 0.000, respectively). CONCLUSIONS Contrast sensitivity does not seem to recover in all eyes after CSC even if the visual acuity has returned to normal. Therefore, contrast sensitivity testing is recommended for the patients complaining of visual impairment in spite of good visual acuity.
Collapse
Affiliation(s)
- T Maaranen
- Department of Ophthalmology, University of Kuopio, Finland
| | | |
Collapse
|
20
|
Zamir E, Chowers I. Central serous chorioretinopathy in a patient with cryoglobulinaemia. Eye (Lond) 1999; 13 ( Pt 2):265-6. [PMID: 10450398 DOI: 10.1038/eye.1999.67] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
|