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Fung AT, Yang Y, Kam AW. Central serous chorioretinopathy: A review. Clin Exp Ophthalmol 2023; 51:243-270. [PMID: 36597282 DOI: 10.1111/ceo.14201] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/18/2022] [Accepted: 12/18/2022] [Indexed: 01/05/2023]
Abstract
Central serous chorioretinopathy (CSC) is the fourth most common non-surgical retinopathy associated with fluid leakage. The pathogenesis is not yet completely understood, but changes in the choroid, sclera and RPE have been described associated with venous congestion of choroidal outflow. CSC can be categorised into acute, chronic, and recurrent subtypes with recent classifications of simple and complex based on the area of RPE change seen on fundus autofluorescence. A multimodal imaging approach is helpful in the diagnosis and management of CSC and secondary complications such as type 1 neovascularisation. Although spontaneous resolution with relatively good visual outcomes is common, treatment should be considered in patients with persistent or recurrent SRF. Treatment options include laser, systemic medications, intravitreal therapy, and surgery. Of these, argon laser for focal extramacular fluid leaks and photodynamic therapy of leakage identified by indocyanine-green angiography currently have the greatest supportive evidence.
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Affiliation(s)
- Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Yi Yang
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Andrew W Kam
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital, Sydney, New South Wales, Australia
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2
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Kang HG, Woo SJ, Lee JY, Cho HJ, Ahn J, Yang YS, Jo YJ, Kim SW, Kim SJ, Sagong M, Lee JJ, Kang M, Park HS, Byeon SH, Kim SS, Kang SW, Park KH, Lee CS. Pathogenic Risk Factors and Associated Outcomes in the Bullous Variant of Central Serous Chorioretinopathy. Ophthalmol Retina 2022; 6:939-948. [PMID: 35476957 DOI: 10.1016/j.oret.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To compare the clinical features, treatments, and outcomes between bullous and chronic variants of central serous chorioretinopathy (CSC). DESIGN Retrospective, observational case series. PARTICIPANTS Sixty-two eyes of 44 patients with bullous-variant CSC (bvCSC) and 97 eyes of 85 patients with nonbullous CSC. METHODS We conducted a national survey between September 1, 2020, and March 31, 2021, of members of the Korean Retina Society and obtained data of patients with bvCSC from 11 retinal centers. A comparator group comprised consecutive chronic CSC patients without bullous detachment. MAIN OUTCOME MEASURES Baseline demographics and patient characteristics were compared between groups. Secondary outcomes included factors associated with visual prognosis within the bvCSC group. RESULTS Compared with the nonbullous CSC group, the bvCSC group presented at a younger age (49 vs. 52 years; P = 0.047) and with more bilateral involvement (41% vs. 14%; P < 0.001). Systemic corticosteroid use was more prevalent in the bvCSC group, both in terms of any exposure (50% vs. 20%; P = 0.001) and long-term exposure (36% vs. 9%; P < 0.001). The bvCSC group had distinct imaging features (all P < 0.05): retinal folding (64% vs. 1%), subretinal fibrin (75% vs. 13%), multiple retinal pigment epithelium tears (24% vs. 2%), and multifocal fluorescein leakages with terminal telangiectasia (36% vs. 1%). Although bvCSC patients had worse vision at diagnosis (20/80 vs. 20/44; P = 0.003), treatment response was more robust (fluid resolution by final follow-up, 84% vs. 68%; P = 0.034) even with conservative management, resulting in similar final vision (20/52 vs. 20/45; P = 0.52). History of kidney-related (odds ratio [OR] 5.4; 95% confidence interval [CI] 1.3-18.5; P = 0.045) and autoimmune/rheumatoid diseases (OR 25.4, 95% CI 2.8-195.0; P = 0.004) showed associations with the bvCSC group. Apart from vision at diagnosis (OR 0.1, 95% CI 0.05-0.36; P < 0.001), a history of renal transplantation was most predictive of visual prognoses for bvCSC eyes (OR 0.2, 95% CI 0.04-0.75; P = 0.020). CONCLUSIONS Bullous-variant CSC may be associated with pathogenic risk factors based on underlying medical conditions and systemic corticosteroid use. Poor vision at diagnosis and history of renal transplantation were associated with poor visual outcome.
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Affiliation(s)
- Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea; Translational Genome Informatics Laboratory, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joo Yong Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Han Joo Cho
- Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jeeyun Ahn
- Department of Ophthalmology, Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yun Sik Yang
- Department of Ophthalmology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea
| | - Young-Joon Jo
- Department of Ophthalmology, Chungnam National University Hospital, Daejon, Korea
| | - Seong-Woo Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Jae Jung Lee
- Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Minjae Kang
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Song Park
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Xu C, Prager AJ, Alonso CD, Pawar AS. Insights From the Eye for Patients With Kidney Transplant. Transplant Proc 2022; 54:2182-2191. [PMID: 36096946 DOI: 10.1016/j.transproceed.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
The eye and the kidney share structural and developmental similarities on a cellular and clinical level, and they are often affected by the same disease processes. Performing an eye exam to look for signs of conditions such as hypertension and diabetes can provide a helpful window into the health of the kidney. Patients with kidney transplants (KT) are a unique population that require close monitoring. These patients are maintained on a number of immunosuppressive medications and may face complications such as medication side effects, infections, and graft rejection. Patients with KT are at higher risk of both infectious and noninfectious eye conditions related to underlying systemic disease or use of immunosuppressive medications. Screening for eye conditions is important because preserving visual function is integral to quality of life, and also because the eye exam can help with early detection and treatment of systemic conditions. Here we describe some of the common eye findings and conditions in patients with KT. We recommend that patients with KT receive annual eye exams, and we hope that the information provided here can help nephrologists become more familiar with eye findings and identify situations where a referral to ophthalmology is warranted.
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Affiliation(s)
| | - Alisa J Prager
- Harvard Medical School, Boston, Massachusetts; Division of Ophthalmology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Carolyn D Alonso
- Harvard Medical School, Boston, Massachusetts; Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Aditya S Pawar
- Harvard Medical School, Boston, Massachusetts; Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Bullous Central Serous Chorioretinopathy: A Rare and Atypical Form of Central Serous Chorioretinopathy. A Systematic Review. Pharmaceuticals (Basel) 2020; 13:ph13090221. [PMID: 32872388 PMCID: PMC7559580 DOI: 10.3390/ph13090221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 01/23/2023] Open
Abstract
Bullous central serous chorioretinopathy (bCSCR) is a rare variant of the central serous chorioretinopathy, complicated by an exudative retinal detachment with shifting fluid. This systematic review aims to present the epidemiology, the pathogenesis, the clinical presentation, the imaging, the differential diagnosis, and the latest treatments of this disease. A total of 60 studies were identified following a literature search adhering to PRISMA guidelines. After full-text evaluation, 34 studies about bCSCR were included. bCSCR usually affects middle-aged men, and the principal risk factor is corticosteroid medications. Pathogenesis is related to an increased choroidal vessel and choriocapillaris permeability, with subsequent subretinal fluid accumulation, rich in fibrin, which may provoke the exudative retinal detachment. Clinical presentation and imaging are fundamental to distinguish bCSCR from other pathologies, avoiding unappropriated treatment. Corticosteroid withdraws (if assumed) and laser photocoagulation of leakage sites seen at angiography may speed up retinal reattachment. Verteporfin photodynamic therapy, transpupillary thermal therapy, oral eplerenone and scleral thinning surgery are other therapeutic options. An early diagnosis might prevent disease progression due to harmful medications as well as unnecessary surgery.
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Azadi P, Lashay A, Esfahani MR. Bilateral Multiple Serous Retinal Detachments Following Bone Marrow Transplantation. J Ophthalmic Vis Res 2019; 14:219-222. [PMID: 31114660 PMCID: PMC6504720 DOI: 10.4103/jovr.jovr_139_17] [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] [Indexed: 11/18/2022] Open
Abstract
Purpose: To describe a case of bilateral multiple serous retinal detachments (SRD) following bone marrow transplantation (BMT), which showed bilateral response to a single unilateral intravitreal bevacizumab injection. Case Report: A 37-year-old man with acute myelogenous leukemia who had received bone marrow transplantation four months prior was referred to our clinic with the chief complaint of gradually decreasing vision in both eyes for three months. During the funduscopic examination, multiple serous retinal detachments (SRD) were observed bilaterally, and he was diagnosed with multiple foci of central serous chorioretinopathy (CSCR). He was advised to discontinue the steroid dosage, which did not make significant improvement, and he was treated with intravitreal bevacizumab injection in the more severely affected eye. One month later, significant improvement was noticed in both eyes. Conclusion: Serous retinal detachment is a rare complication following BMT. Significant bilateral improvement after single unilateral intravitreal bevacizumab injection shows not only the possible role of increased level of vascular endothelial growth factor (VEGF) in this case, but also the systemic diffusion of the drug and effect on the contralateral eye following unilateral injection.
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Affiliation(s)
- Pejvak Azadi
- Eye Research Center, Emam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Lashay
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Riazi Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
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Tang PH, Shields R, Silva RA. Optical Coherence Tomography Angiography Findings in Chronic Central Serous Chorioretinopathy After Photodynamic Therapy. Ophthalmic Surg Lasers Imaging Retina 2019; 50:25-32. [DOI: 10.3928/23258160-20181212-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/02/2018] [Indexed: 11/20/2022]
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Photodynamic therapy for bullous retinal detachment: a single-center experience of case series with a 6-month follow-up study. Graefes Arch Clin Exp Ophthalmol 2018; 256:1429-1439. [PMID: 29869216 PMCID: PMC6060766 DOI: 10.1007/s00417-018-4015-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/16/2018] [Accepted: 05/21/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the efficacy of half-dose photodynamic therapy (PDT) for the treatment of bullous retinal detachment. Methods Interventional prospective case series in six eyes from six consecutive patients with bullous retinal detachment. The effected eyes were treated with indocyanine green angiography (ICGA)-guided half-dose PDT with multifocal and large laser spots. Clinical evaluations included best-corrected visual acuity (BCVA), ophthalmoscopy, ophthalmic B scan, fundus fluorescein angiography (FFA), optical coherence tomography (OCT), and ICGA at each scheduled visit at baseline; at 1, 3, and 6 months after PDT; and during follow-up after 6 months. Results All six eyes received half-dose verteporfin PDT with a mean number of therapeutic spots 2.83 ± 1.47 and a mean spot size of 4647 ± 996 μm in diameter. Three months after PDT, retinal reattachment was observed on B scans and resolution of sub-retinal fluid (SRF) was observed in OCT images for five eyes. There was no significant difference in the mean logMAR BCVA between the baseline and the value at 1 month after PDT (P = 0.477). At 3 months after PDT, the mean logMAR BCVA improved significantly from a baseline value of 1.02 to 0.54 (P = 0.044). At 6 months after PDT, the mean logMAR BCVA further improved to 0.46 (P = 0.025) and remained stable. One affected eye received a second half-dose PDT for SRF not reduced until the second month after PDT. Retinal reattachment and SRF resolution were observed at 1 and 3 months after the second therapy, respectively. BCVA improved from a baseline value of 20/63 to 20/20 at 1 month after the second PDT and remained stable until the sixth month after the second PDT. During follow-up after more than 6 months, recurrence occurred in no cases. Conclusions This study demonstrated half-dose PDT with multifocal and large laser spots was an effective treatment for bullous retinal detachment contributing to the retinal reattachment, a resolution of SRF, and an improvement of BCVA. Thus, PDT for the treatment of bullous retinal detachment is considered to be a worthwhile endeavor.
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Ambiya V, Goud A, Rasheed MA, Gangakhedkar S, Vupparaboina KK, Chhablani J. Retinal and choroidal changes in steroid-associated central serous chorioretinopathy. Int J Retina Vitreous 2018; 4:11. [PMID: 29619248 PMCID: PMC5880079 DOI: 10.1186/s40942-018-0115-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/09/2018] [Indexed: 11/19/2022] Open
Abstract
Background To evaluate the retinal and choroidal alterations in steroid-associated central serous chorioretinopathy (CSC) in comparison to idiopathic CSC. Methods In this retrospective cohort study, swept source optical coherence tomography scans of eyes with steroid-associated CSC (group A) were compared with the same in idiopathic CSC (group B). The key features included central subfield retinal thickness, subfoveal choroidal thickness, subfoveal large choroidal vessel diameter, subretinal deposits, retinal pigment epithelial irregularities, double layer sign, hyperreflective dots, intraretinal fluid, and choroidal vascularity index (ratio of choroidal luminal area and total choroidal area, measured on a high definition horizontal 9 mm OCT B-scan. Results There were 20 eyes in group A and 30 in group B. Group A had a higher female proportion (60 vs. 16.67%; P < 0.01) and higher bilaterality (30 vs. 6.67%; P = 0.03). The height of neurosensory detachment was lower in group A (153.1 ± 175.70 µm vs. 312.9 ± 223.06 µm; P < 0.01). There was no significant difference in the prevalence of subretinal deposits, retinal pigment epithelial irregularities, pigment epithelial detachments, double layer sign, outer retinal layer disruption, and intraretinal fluid. Hyperreflective dots (HRDs) were less common in group A (15 vs. 46.67%; P = 0.03). The subfoveal choroidal thickness (P = 0.65) and subfoveal large choroidal vessel diameter (P = 0.78) were comparable. There was a trend towards a higher choroidal vascularity index (CVI) in group A (A: mean, 82%, 95% CI, 66–99%; B: mean, 58%, 95% CI, 57–59%; P = 0.10). Conclusion Steroid-associated CSC has a marginally higher CVI and less common association with HRDs as compared to idiopathic CSC.
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Affiliation(s)
- Vikas Ambiya
- Base Hospital, Delhi Cantonment, New Delhi, 110010 India
| | - Abhilash Goud
- 2Srimati Kannuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, 500034 India
| | - Mohammed Abdul Rasheed
- 2Srimati Kannuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, 500034 India
| | - Sankeert Gangakhedkar
- 2Srimati Kannuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, 500034 India
| | - Kiran Kumar Vupparaboina
- 2Srimati Kannuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, 500034 India
| | - Jay Chhablani
- 2Srimati Kannuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, 500034 India
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DIFFUSE CHORIORETINOPATHY WITHOUT SEROUS DETACHMENT ASSOCIATED WITH CARDIAC TRANSPLANTATION. Retin Cases Brief Rep 2018; 14:282-288. [PMID: 29342012 DOI: 10.1097/icb.0000000000000700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze an unusual case of widespread chorioretinopathy after cardiac transplantation for its potential etiology and clinical significance. METHODS Clinical examinations included widefield and macular color and fundus autofluorescence photography, spectral domain optical coherence tomography, fluorescein angiography and indocyanine green angiography, full-field electroretinography, and Goldmann visual fields. PATIENT A 44-year-old Hispanic woman was referred to rule out retinitis pigmentosa. Medical history revealed cardiac transplantation 6 months previously for idiopathic cardiomyopathy. RESULTS Visual acuity was 20/20 in both eyes. The fundi showed widespread gray mottling and little pigmentation, but fundus autofluorescence revealed black speckling broadly across the fundus, and geographic retinal pigment epithelium loss in the nasal midperiphery of the left eye. Spectral domain optical coherence tomography showed normal inner retina, and surprising preservation of outer nuclear layer, but the ellipsoid zone line was fragmented, and the interdigitation zone line was replaced with irregular debris. Retinal pigment epithelium was very thin with occasional excrescences. Electroretinography showed mild loss of both rods and cones, with mild flicker peak delay only in the left eye. Fluorescein angiography showed no leakage, but a reticular pigment pattern in the macula. Indocyanine green angiography showed irregular arteriolar remodeling, and few large arteries. DISCUSSION AND CONCLUSION Serous retinopathy is well known after organ transplantations, but this patient had retinal pigment epithelium and retinal damage well into the periphery and no leakage. Retinal dystrophy was deemed unlikely given the relatively good electroretinography. The indocyanine green vascular changes raise the possibility of a transient choroidal ischemic event during or shortly after cardiac surgery. The event altered retinal pigment epithelium diffusely, but allowed for enough regeneration to sustain retinal function. Diffuse transplant chorioretinopathy may be discovered if postcardiac transplant patients get peripheral retinal examinations.
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Nicholson BP, Atchison E, Idris AA, Bakri SJ. Central serous chorioretinopathy and glucocorticoids: an update on evidence for association. Surv Ophthalmol 2018; 63:1-8. [DOI: 10.1016/j.survophthal.2017.06.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 11/30/2022]
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van Dijk EHC, Soonawala D, Rooth V, Hoyng CB, Meijer OC, de Vries APJ, Boon CJF. Spectrum of retinal abnormalities in renal transplant patients using chronic low-dose steroids. Graefes Arch Clin Exp Ophthalmol 2017; 255:2443-2449. [PMID: 29063192 PMCID: PMC5696484 DOI: 10.1007/s00417-017-3823-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/20/2017] [Accepted: 10/05/2017] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To assess the ophthalmological characteristics of asymptomatic patients with a renal transplant on chronic low-dose steroids for at least the last 2 years prior to examination. METHODS Cross-sectional study. All patients underwent an extensive ophthalmological examination. RESULTS Of the 37 included patients [25 male, 12 female; 59 ± 11 years (range, 38-77 years)] ophthalmological phenotyping revealed abnormalities in 22 patients (59%). Findings characteristic for (subclinical) central serous chorioretinopathy were detected in ten patients (27%), including two patients with serous subretinal fluid in the macula. An epiretinal membrane of the macula was present in six patients (16%). Mean subfoveal choroidal thickness was significantly increased in patients with ophthalmological abnormalities, in comparison with patients without abnormalities. CONCLUSIONS Retinal abnormalities are common in the majority of renal transplant patients using chronic low-dose steroids. These retinal changes may be associated with the renal disease and/or the effect of chronic steroid use on the choroid and retina.
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Affiliation(s)
- Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Darius Soonawala
- Department of Medicine, Division of Nephrology, and Leiden Transplant Center, Leiden University Medical Center, Leiden, the Netherlands.,Department of Medicine, Division of Nephrology, Haga Hospital, the Hague, the Netherlands
| | - Vera Rooth
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology, Donders Institute of Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Onno C Meijer
- Department of Medicine, Division of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, the Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Aiko P J de Vries
- Department of Medicine, Division of Nephrology, and Leiden Transplant Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands. .,Department of Ophthalmology, Academic Medical Center, University of Amsterdam, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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12
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Schwartz R, Rozenberg A, Loewenstein A, Goldstein M. The relation of somatotypes and stress response to central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2017; 255:2307-2315. [PMID: 28875245 DOI: 10.1007/s00417-017-3787-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 08/12/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To investigate a possible relationship between central serous chorioretinopathy (CSC) and specific body types and compositions (somatotypes), and to examine the cortisol stress response among CSC patients of different somatotypes in comparison with healthy subjects. METHODS Prospective case-control study. A group of 28 patients with a previous or current diagnosis of CSC was compared with a group of 26 healthy subjects. Anthropometric measurements were used to estimate somatotype ratings in all subjects. Serum cortisol was measured at rest and following a stress-inducing computerized test in order to estimate response to stress in both groups. The main outcome measures included somatotype categorization and the change in serum cortisol following stress in both groups. RESULTS No significant difference in somatotype composition was found between the groups. There was no statistically significant difference between the groups in the elevation of cortisol following the stress-inducing test. The sample size was too small to exclude or find any significant difference between the different 13 subgroups of somatotype composition in the elevation of cortisol. CONCLUSIONS Our study did not show a typical somatotype related to CSC. While previous studies showed higher cortisol values in CSC patients, we did not see a higher elevation in blood cortisol following a stress response in this group in comparison with healthy subjects.
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Affiliation(s)
- Roy Schwartz
- Ophthalmology Department, Tel Aviv Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, 6 Weissman st, 64239, Tel Aviv, Israel.
| | - Assaf Rozenberg
- Ophthalmology Department, Assaf Harofeh Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- Ophthalmology Department, Tel Aviv Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, 6 Weissman st, 64239, Tel Aviv, Israel
| | - Michaella Goldstein
- Ophthalmology Department, Tel Aviv Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, 6 Weissman st, 64239, Tel Aviv, Israel
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Altinkaynak H, Kurkcuoglu PZ, Caglayan M, Yorgun MA, Yuksel N, Kosekahya P, Koca C, Toklu Y. A novel marker in acute central serous chorioretinopathy: thiol/disulfide homeostasis. Int Ophthalmol 2017; 38:175-181. [PMID: 28108906 DOI: 10.1007/s10792-017-0444-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/02/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim of this study was to compare dynamic thiol/disulfide homeostatic status in acute central serous chorioretinopathy (CSCR) patients by using a novel and automated assay determining dynamic thiol/disulfide homeostasis. METHODS Fifty-one patients with acute CSCR (study group) and 65 healthy individuals (control group) were enrolled in this study. Diagnosis of acute CSCR was made clinically and using spectral-domain RTVue OCT (optical coherence tomography) (Optovue, Fremont, CA). Fluorescein angiography confirmed the diagnosis of acute CSCR in all subjects. Total thiol, native thiol, disulfide amount, and native thiol/disulfide ratio (TDR) were calculated in the blood samples. RESULTS Mean total thiol, native thiol, and native TDR values were lower in patients with acute CSCR (364.2 ± 14.1, 326.4 ± 13.2, 17.14 ± 1.9, respectively) than in healthy eyes (441.2 ± 16.3, 398.5 ± 16.4, 22.70 ± 2.15, respectively; mean total thiol, p = 0.017; native thiol, p = 0.011; native TDR, p = 0.031). CONCLUSIONS Total thiol, native thiol, and native TDR were significantly lower statistically in patients with acute CSCR when compared with healthy controls.
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Affiliation(s)
- Hasan Altinkaynak
- Department of Ophthalmology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey.
| | | | - Mehtap Caglayan
- Department of Ophthalmology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Mücella Arıkan Yorgun
- Department of Ophthalmology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Nilay Yuksel
- Department of Ophthalmology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Pınar Kosekahya
- Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Cemile Koca
- Department of Biochemistry, Yıldırım Beyazıt University, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Yasin Toklu
- Department of Ophthalmology, Yıldırım Beyazıt University, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
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Bullous Variant of Central Serous Chorioretinopathy. Ophthalmology 2016; 123:1541-52. [DOI: 10.1016/j.ophtha.2016.03.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/09/2016] [Accepted: 03/09/2016] [Indexed: 11/16/2022] Open
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Chronic Central Serous Chorioretinopathy as a Presenting Symptom of Cushing Syndrome. Eur J Ophthalmol 2016; 26:442-8. [DOI: 10.5301/ejo.5000790] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2016] [Indexed: 12/31/2022]
Abstract
Purpose To describe 4 patients who were diagnosed with chronic central serous chorioretinopathy (cCSC), which appeared to be the presenting symptom of Cushing syndrome (CS). Methods In this retrospective review of charts, all patients received extensive ophthalmologic examination and endocrinologic analyses. Results A 56-year-old man and a 49-year-old woman were treated because of bilaterally active, therapy-resistant cCSC. The clinical sign indicative for CS leading to referral to the endocrinologist was muscle weakness in the man and plethora in the woman. In a 37-year-old woman with known diabetes mellitus and central obesity, bilateral cCSC was diagnosed before CS screening. Another 49-year-old woman was treated for unilateral cCSC for 4 years. Complaints of fatigue, muscle weakness, central adiposity, and skin atrophy led to referral and a CS diagnosis due to bilateral macronodular adrenal hyperplasia. In all patients, CS surgery resulted in complete resolution of subretinal fluid. During postsurgical follow-up, no reactivation of cCSC was observed. Conclusions Chronic CSC can be the principal manifestation of relatively mildly symptomatic and unrecognized CS. In patients with cCSC, ophthalmologists should have a high index of suspicion for clinical signs of CS that warrant endocrinologic analysis. Cushing syndrome surgery can stop active subretinal fluid leakage in cCSC.
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Optical Coherence Tomography Angiography in Central Serous Chorioretinopathy. J Ophthalmol 2015; 2015:134783. [PMID: 26634150 PMCID: PMC4655052 DOI: 10.1155/2015/134783] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 01/10/2023] Open
Abstract
Purpose. To analyze optical coherence tomography angiography (OCTA) findings in eyes with central serous chorioretinopathy (CSC) and to compare them with those obtained with multimodal imaging. Methods. A series of consecutive patients diagnosed with CSC, underwent OCTA and multimodal imaging, including spectral domain OCT, fluorescein, and indocyanine green angiography. OCTA images were performed at three main depth intervals: automatically segmented outer retina, manually adjusted outer retina, and automatically segmented choriocapillaris. Results. Thirty-three eyes of 32 consecutive patients were analyzed. OCTA showed 3 main anomalies at the choriocapillaris: the presence of dark areas (19/33 eyes) which were frequently associated with serous retinal detachment, presence of dark spots (7/33 eyes) which were frequently associated with retinal pigment epithelium detachment, and presence of abnormal vessels (12/33 eyes) which were frequently, but not systematically, associated with choroidal neovascularization, as confirmed by multimodal imaging. Conclusions. OCTA revealed dark areas and dark spots, which were commonly observed. An abnormal choroidal pattern was also observed in one-third of cases, even when multimodal imaging did not evidence any choroidal neovascularization. Abnormal choroidal vessels should be interpreted with caution, and we could assume that this pathological choroidal vascular pattern observed in many CSC cases could be distinct from CNV.
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Ou-Yang PB, Qi X, Zhu XH, Duan XC. Central Serous Chorioretinopathy: Signal to Reduce Corticoid in Renal Transplant Recipients? Transplant Proc 2015; 47:2236-8. [PMID: 26361687 DOI: 10.1016/j.transproceed.2015.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this work was to report the treatment effectiveness of central serous chorioretinopathy (CSCR) in a renal transplant recipient who received conventional therapy with little effect, and then reducing corticoid successively and with a better outcome later. METHODS We performed a retrospective comparison of best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) of a 57-year-old renal transplant recipient who received conventional therapy and reducing corticoid successively after he was diagnosed as CSCR in the left eye. RESULTS The BCVA of the left eye stayed at 20/200 after 3 months' conventional therapy, but rapidly improved to 20/25 after reducing corticoid by one-half. At the same time, SD-OCT showed much more obvious absorption of retinal liquid in the left eye from reducing corticoid than from conventional therapy. Despite the reducing of corticoid by one-half, the patient did not show any signs of rejection of the renal transplant. CONCLUSIONS CSCR may be a sign in renal transplant recipients for reducing corticoid, and reducing corticoid might be a more reliable and safer treatment for such patients.
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Affiliation(s)
- P-B Ou-Yang
- Department of Ophthalmology, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, People's Republic of China; Institution of Ophthalmic Center, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, People's Republic of China
| | - X Qi
- Department of Ophthalmology, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, People's Republic of China; Institution of Ophthalmic Center, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, People's Republic of China
| | - X-H Zhu
- Department of Ophthalmology, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, People's Republic of China; Institution of Ophthalmic Center, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, People's Republic of China
| | - X-C Duan
- Department of Ophthalmology, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, People's Republic of China; Institution of Ophthalmic Center, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, People's Republic of China.
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Daruich A, Matet A, Dirani A, Bousquet E, Zhao M, Farman N, Jaisser F, Behar-Cohen F. Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis. Prog Retin Eye Res 2015; 48:82-118. [DOI: 10.1016/j.preteyeres.2015.05.003] [Citation(s) in RCA: 425] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/10/2015] [Accepted: 05/14/2015] [Indexed: 02/08/2023]
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Idiopathic organ transplant chorioretinopathy after liver transplantation. Case Rep Ophthalmol Med 2015; 2015:964603. [PMID: 25861498 PMCID: PMC4378334 DOI: 10.1155/2015/964603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 03/10/2015] [Indexed: 11/17/2022] Open
Abstract
Idiopathic organ transplant chorioretinopathy is a rare disease associated with kidney and heart transplantation. We present a case secondary to liver transplantation including its multimodal imaging, differential diagnosis, and physiopathology discussion.
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Munk MR, Shah R, Pappas F, Baddar D, Wong B, Jampol LM, Fawzi AA. Multimodal Imaging and Choroidal Volumetric Changes After Half-fluence PDT in Central Serous Chorioretinopathy. Curr Eye Res 2015; 41:97-106. [DOI: 10.3109/02713683.2014.1002047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Su CC, Chen JW, Chou NK, Chen YS, Huang SC, Chi NH, Wang SS. Ocular manifestations of patients receiving heart transplants: a single-center experience of 311 consecutive cases. Transplant Proc 2014; 46:937-40. [PMID: 24767385 DOI: 10.1016/j.transproceed.2013.11.149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 10/31/2013] [Accepted: 11/27/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate ocular manifestations of patients undergoing heart transplantations. METHOD We retrospectively reviewed the clinical data of 311 patients who underwent orthotropic heart transplantations from January 1989 to December 2007, including the demographic data, general conditions, medications, as well as the basic ophthalmic examinations, ophthalmic diagnosis, and management. RESULTS Of the 311 heart transplant recipients, common diagnoses included cataract (96 cases; 30.87%), dry eye syndrome (24 cases; 7.72%), allergic conjunctivitis (78 cases; 25.08%), and glaucoma (19 cases; 6.11%). The patients after heart transplantation had much lower incidences of severe opportunistic infections than patients undergoing the same procedure one decade ago. However, autoimmune-related endocrinopathy such as diabetes and Graves' disease became more prevalent. Diabetes-related complications were unexpectedly frequent, including nonproliferative diabetic retinopathy (6 cases; 1.93%), proliferative diabetic retinopathy (6 cases; 1.93%), retinal vein occlusion (6 cases; 1.93%), and neovascular glaucoma (4 cases; 1.29%). The occurrence of cataract formation and steroid glaucoma was often due to post-transplantation steroid use. CONCLUSION Ophthalmologists and cardiac surgeons should collaborate and perform regular ophthalmic examinations, especially for those who have new-onset diabetes and difficulty tapering off steroids.
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Affiliation(s)
- C-C Su
- Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - J-W Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - N-K Chou
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Y-S Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - S-C Huang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - N-H Chi
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - S-S Wang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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Liegl R, Ulbig MW. Central Serous Chorioretinopathy. Ophthalmologica 2014; 232:65-76. [DOI: 10.1159/000360014] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/18/2014] [Indexed: 11/19/2022]
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En face enhanced-depth swept-source optical coherence tomography features of chronic central serous chorioretinopathy. Ophthalmology 2013; 121:719-26. [PMID: 24289918 DOI: 10.1016/j.ophtha.2013.10.014] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/03/2013] [Accepted: 10/08/2013] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To characterize en face features of the retinal pigment epithelium (RPE) and choroid in eyes with chronic central serous chorioretinopathy (CSCR) using a high-speed, enhanced-depth swept-source optical coherence tomography (SS-OCT) prototype. DESIGN Consecutive patients with chronic CSCR were prospectively examined with SS-OCT. PARTICIPANTS Fifteen eyes of 13 patients. METHODS Three-dimensional 6×6 mm macular cube raster scans were obtained with SS-OCT operating at 1050 nm wavelength and 100000 A-lines/sec with 6 μm axial resolution. Segmentation of the RPE generated a reference surface; en face SS-OCT images of the RPE and choroid were extracted at varying depths every 3.5 μm (1 pixel). Abnormal features were characterized by systematic analysis of multimodal fundus imaging, including color photographs, fundus autofluorescence, fluorescein angiography, and indocyanine-green angiography (ICGA). MAIN OUTCOME MEASURES En face SS-OCT morphology of the RPE and individual choroidal layers. RESULTS En face SS-OCT imaging at the RPE level revealed absence of signal corresponding to RPE detachment or RPE loss in 15 of 15 (100%) eyes. En face SS-OCT imaging at the choriocapillaris level showed focally enlarged vessels in 8 of 15 eyes (53%). At the level of Sattler's layer, en face SS-OCT documented focal choroidal dilation in 8 of 15 eyes (53%) and diffuse choroidal dilation in 7 of 15 eyes (47%). At the level of Haller's layer, these same features were observed in 3 of 15 eyes (20%) and 12 of 15 eyes (80%), respectively. In all affected eyes, these choroidal vascular abnormalities were seen just below areas of RPE abnormalities. In 2 eyes with secondary choroidal neovascularization (CNV), distinct en face SS-OCT features corresponded to the neovascular lesions. CONCLUSIONS High-speed, enhanced-depth SS-OCT at 1050 nm wavelength enables the visualization of pathologic features of the RPE and choroid in eyes with chronic CSCR not usually appreciated with standard spectral domain (SD) OCT. En face SS-OCT imaging seems to be a useful tool in the identification of CNV without the use of angiography. This in vivo documentation of the RPE and choroidal vasculature at variable depths may help elucidate the pathophysiology of disease and can contribute to the diagnosis and management of chronic CSCR.
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Liew G, Quin G, Gillies M, Fraser-Bell S. Central serous chorioretinopathy: a review of epidemiology and pathophysiology. Clin Exp Ophthalmol 2012; 41:201-14. [PMID: 22788735 DOI: 10.1111/j.1442-9071.2012.02848.x] [Citation(s) in RCA: 249] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Central serous chorioretinopathy (CSCR) is a common retinal cause of vision loss. This review surveys the epidemiology, risk factors, clinical presentation, natural history and pathophysiology of CSCR. Studies suggest an annual incidence rate of 10 per 100 000 in men, with CSCR occurring six times more commonly in men compared with women. Most acute CSCR cases resolve spontaneously within 2-3 months. Prognosis is highly dependent on presenting visual acuity; patients with initial visual acuities of 6/6 remain at that level, while patients with initial visual acuities of less than 6/9 recover on average two to three Snellen lines over the next few years. The main risk factors for CSCR are systemic corticosteroid use, type A personality, pregnancy and endogenous Cushing's syndrome. The pathophysiology of CSCR remains obscure, although disorders in both the choroidal circulation and retinal pigment epithelium are implicated.
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Affiliation(s)
- Gerald Liew
- Save Sight Institute, University of Sydney, Sydney, Australia
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Wang YL, Qi F, Xie JL, Qi L, Zhou C, Zhu XR, Ding X, Yang B, Jin P. Analysis of the relationship between postoperative ophthalmic complications and dialysis time of pre-kidney transplantation. Int J Ophthalmol 2012; 5:370-3. [PMID: 22773990 DOI: 10.3980/j.issn.2222-3959.2012.03.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 05/20/2012] [Indexed: 11/02/2022] Open
Abstract
AIM To determine the influence of the dialysis time before kidney transplantation on postoperative ophthalmic complications. METHODS One hundred and eighty three patients who were given the follow-up after kidney transplantation were selected, including 124 males and 59 females. The dialysis time before kidney transplantation was (2.9±2.1) years. Among them, there were 93 cases having cadaveric renal transplantation and 90 cases having living relative renal transplantation. The conditions of ophthalmic complications in all the patients after kidney transplantation were investigated and the incidence rate on ophthalmic complications having different dialysis time before kidney transplantation was given Chi-square test and Chi-square linear trend test. RESULTS Among 183 patients with kidney transplantation, 95 patients (51.9%) had at least one ophthalmic complication and the rest 88 patients (48.1%) had no significant abnormality at the eye region. The most common ophthalmic complications were pinguecula/conjunctival degeneration (31 cases), the following was caligo lentis (24 cases). The main manifestations were grayish white granule and plaque turbidity occurred in posterior capsule at the posterior pole of crystaline lens. The angulus iridocornealis of 5 patients (5.3%) with cataract and glaucoma were all open-angle through the detection by gonioscope. Through visual field examination, there were 2 patients with paracentral scotoma, 2 patients with arcuate scotoma and one case with nasal step. CONCLUSION The experiments verify that the incidence of glaucomawas relates to the dialysis time before kidney transplantation, and the incidence rate might be higher if the dialysis time is longer.
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Affiliation(s)
- Yao-Lei Wang
- Xiangya Hospital, Central South University, Xiangya Road No.87, Changsha 410008, Hunan Province, China
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Sabet-Peyman J, Salehi-Had H, Fawzi AA. Multimodal imaging in a case of central serous chorioretinopathy following renal transplantation. Ophthalmic Surg Lasers Imaging Retina 2012; 43 Online:e58-61. [PMID: 22731855 DOI: 10.3928/15428877-20120621-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 03/18/2012] [Indexed: 11/20/2022]
Abstract
A 33-year-old woman with a medical history of deceased donor renal transplant receiving immunosuppressive therapy with prednisone and sirolimus complained of progressive visual loss during hospitalization for an episode of recurrent transplant rejection a few months following transplantation. Dilated fundus examination revealed bilateral retinal pigment epithelium mottling, focal pigment epithelial detachments within the macula, and inferior serous retinal detachments. Fluorescein angiogram revealed multifocal expansile dots of leakage, consistent with multifocal central serous chorioretinopathy. Spectral-domain optical coherence tomography showed neurosensory detachments with subretinal deposits and well-defined hyperreflective membrane underlying elongated photoreceptor outer segments. This subretinal membrane, seen in the detached portion of retina, has not been described before in organ transplant patients with central serous chorioretinopathy. This finding may have relevance to the fibrinous deposits and septations described in patients with Vogt-Koyanagi-Harada syndrome.
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Affiliation(s)
- Jason Sabet-Peyman
- Department of Ophthalmology, Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Khairallah M, Kahloun R, Tugal-Tutkun I. Central Serous Chorioretinopathy, Corticosteroids, and Uveitis. Ocul Immunol Inflamm 2012; 20:76-85. [DOI: 10.3109/09273948.2011.650776] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tarabishy AB, Ahn E, Mandell BF, Lowder CY. Central serous retinopathy. Arthritis Care Res (Hoboken) 2011; 63:1075-82. [DOI: 10.1002/acr.20485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Edouard S, Douat J, Sailler L, Arlet P, Astudillo L. Bilateral choroidopathy in systemic lupus erythematosus. Lupus 2011; 20:1209-10. [PMID: 21511760 DOI: 10.1177/0961203311398510] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We report a case of bilateral choroidopathy in a 35-year-old woman with systemic lupus erythematosus (SLE) diagnosed 3 years previously, and treated with hydroxychloroquine and steroids that ceased 6 months before ocular signs. She complained about rapid bilateral blurred vision with a severe loss of visual acuity. Fluorescein angiography found multiple leakage points in the posterior pole of the pigment epithelium. Ocular coherence tomography (OCT) and fundoscopy showed bilateral retinal detachments. Lupus choroidopathy was diagnosed and high steroids were given intravenously and allowed a rapid improvement. Visual acuity, fundoscopy, retinal angiography and OCT were normalized at 2 months. Choroidopathy is rarely reported in lupus and only about 30 patients are found in the literature.
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Affiliation(s)
- S Edouard
- University School of Medicine, Department of Internal Medicine, Purpan Hospital, Toulouse, France
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Abstract
Central serous chorioretinopathy (CSC) is a chorioretinal disease, incompletely understood with systemic associations, a multifactorial aetiology, and a complex pathogenesis. Increased permeability from the choriocapillaris leads to focal or diffuse dysfunction of the retinal pigment epithelium causing a detachment of the neurosensory retina. CSC has been described in patients with endogenously high levels of corticosteroids as well as in patients with hypercortisolism due to the treatment of ocular or systemic diseases. It is therefore the only 'inflammatory' choroiditis, not proven to be associated with infection that is precipitated or worsened by glucocorticoids. Foveal attenuation, chronic macular oedema, and damage of the foveal photoreceptor layer have been reported as causes of visual loss in CSC. Photoreceptor atrophy in the fovea, despite successful retinal reattachment, typically occurs after a duration of symptoms of approximately 4 months. Treatment should therefore be considered after 3 months if there is angiographic evidence of ongoing foveal leakage in recurrent chronic CSC or in a single CSC episode accompanied by signs of chronic CSC alterations. Based on results of trials conducted so far, it appears that photodynamic therapy with verteporfin is effective and safer than argon laser treatment and should be considered as the treatment of choice, whereas micropulse diode laser photocoagulation seems to be an effective alternative. Glucocorticoid inhibitors are an interesting alternative treatment. Clinical trials are ongoing to test their efficacy. In addition, it is important, where possible, to discontinue any corticosteroid treatment. The possible association of CSC with stress should also be discussed with patients.
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Chan-Kai BT, Yeh S, Weleber RG, Francis PJ, Adamus G, Witherspoon SR, Lauer AK. Electroretinographic findings in transplant chorioretinopathy. Clin Ophthalmol 2010; 4:777-83. [PMID: 20689794 PMCID: PMC2915864 DOI: 10.2147/opth.s12057] [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: 07/10/2010] [Indexed: 11/25/2022] Open
Abstract
Aim: Transplant chorioretinopathy is a rare complication following solid organ or bone marrow transplantation and can result in severe vision loss. This series presents electroretinogram (ERG) results in patients with this condition. Methods: Patients who presented with bilateral vision loss following bone marrow or solid organ transplantation were identified. A complete ophthalmologic examination, fundus photography, and fluorescein angiography (FA) were performed. Full-field ERG was obtained in all patients and a multifocal ERG (mfERG) was obtained in two patients. Results: Four patients were identified. All patients had bilateral vision loss and displayed a characteristic pattern of mottled hyperfluorescence on FA. Three patients developed progressive vision loss ranging from 20/60 to hand motions whereas one retained 20/40 vision. All patients exhibited moderate to severe cone dysfunction, while the degree of rod abnormalities was varied. Two patients with severe cone dysfunction showed mild clinical changes initially, but later developed progressive vision loss and chorioretinal atrophy. Conclusion: Transplant chorioretinopathy patients undergoing ERG testing show cone dysfunction with a variable degree of rod dysfunction. ERG abnormalities preceded the visual acuity and clinical changes in two patients, suggesting that ERG may be a helpful predictor of the clinical course in this rare disease.
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Affiliation(s)
- Brian T Chan-Kai
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
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Central serous chorioretinopathy and phosphodiesterase-5 inhibitors: a case-control postmarketing surveillance study. Retina 2010; 30:271-4. [PMID: 20010456 DOI: 10.1097/iae.0b013e3181b7740f] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to determine if there is an increased risk of central serous chorioretinopathy (CSC) associated with prescription exposure to phosphodiesterase-5 (PDE-5) inhibitors. METHODS A case-control study linking 2 National Veterans Health Administration databases (clinical and pharmacy) for fiscal years 2004 to 2005. The likelihood of past exposure to PDE-5 inhibitors among newly diagnosed patients with CSC, identified through International Classification of Diseases, 9th Edition, Clinical Modification codes, was compared with 2 age-matched control groups after excluding subjects with risk factors for CSC. RESULTS Among 577 men, aged 59 years and younger with newly diagnosed CSC during the study year, 111 were prescribed a PDE-5 inhibitor (19.2%). The proportions of age-matched controls prescribed a PDE-5 inhibitor in the 2 groups were 18.5% and 21.5%. The odds ratio of exposure was 1.05 (95% confidence limit: 0.74-1.22) and 0.87 (95% confidence limit: 0.68-1.12). CONCLUSION Patients with CSC had no increase in prescription exposure to PDE-5 inhibitors than did age-matched control subjects. Although the findings in this study do not support an association between CSC and PDE-5 inhibitors, postmarketing surveillance methods for drug-related side effects have acknowledged limitations.
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Liu GT, Volpe NJ, Galetta SL. Vision loss. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kunavisarut P, Pathanapitoon K, van Schooneveld M, Rothova A. Chronic central serous chorioretinopathy associated with serous retinal detachment in a series of Asian patients. Ocul Immunol Inflamm 2009; 17:269-77. [PMID: 19657982 DOI: 10.1080/09273940802702579] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine clinical features of patients with severe chronic central serous chorioretinopathy (diffuse retinal pigment epitheliopathy, DRPE) associated with bullous retinal detachment in Thailand. METHODS The authors reviewed clinical and imaging characteristics, visual outcomes, and complications of 7 patients with severe DRPE associated with bullous retinal detachment. RESULTS Included were 6 males and 1 female with average age at onset of 39 years (range 30-46 years) diagnosed with DRPE. Although 4 patients had unilateral complaints, retinal pigment epithelium (RPE) changes on fluorescein angiography (FA) were visible in both eyes in all patients and 10 out of 14 affected eyes exhibited large exudative bullous retinal detachments (RD) and evidence of multiple characteristic leakage points. The disease was induced by steroid medications in 3 patients and an additional 3 patients received steroid treatment after they were initially considered to have Harada disease. The administration of steroids caused worsening in all cases. CONCLUSION Chronic central serous chorioretinopathy associated with bullous retinal detachment is a severe variant of DRPE, which might be mistaken for Harada disease. The early diagnosis of DRPE might prevent the complications from harmful medications as well as unnecessary surgery and visual loss.
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Affiliation(s)
- Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Diagnostic and Therapeutic Challenges. Retina 2009; 29:556-9. [DOI: 10.1097/iae.0b013e31818d8973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rasouli M, Leung D, Gale JS. A unique presentation of bilateral central serous chorioretinopathy following bilateral renal transplantation surgery. Can J Ophthalmol 2008; 43:486-8. [PMID: 18711471 DOI: 10.3129/i08-073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Abstract
Central serous chorioretinopathy (CSC) is a disease of the retina characterized by serous detachment of the neurosensory retina secondary to one or more focal lesions of the retinal pigment epithelium (RPE). CSC occurs most frequently in mid-life and more often in men than in women. Major symptoms are blurred vision, usually in one eye only and perceived typically by the patient as a dark spot in the centre of the visual field with associated micropsia and metamorphopsia. Normal vision often recurs spontaneously within a few months. The condition can be precipitated by psychosocial stress and hypercortisolism. Ophthalmoscopic signs of CSC range from mono- or paucifocal RPE lesions with prominent elevation of the neurosensory retina by clear fluid - typical of cases of recent onset - to shallow detachments overlying large patches of irregularly depigmented RPE. The spectrum of lesions includes RPE detachments. Granular or fibrinous material may accumulate in the subretinal cavity. Serous detachment often resolves spontaneously. From first contact, counselling about the potential relation to stress and glucocorticoid medication is warranted. After 3 months without resolution of acute CSC or in chronic CSC, treatment should be considered. Resolution of detachment can usually be achieved in acute CSC by focal photocoagulation of leaking RPE lesions or, in chronic CSC, by photodynamic therapy. The effect of therapy on long-term visual outcome is insufficiently documented. Reattachment within 4 months of onset is considered a relevant therapeutic target because prolonged detachment is associated with photoreceptor atrophy. This suggests that the value of treatment depends upon proper selection of cases that will not resolve without therapy. Chronic CSC may be difficult to differentiate from occult choroidal neovascularization secondary to CSC. Patients with chronic CSC who receive glucocorticoid treatment for systemic disease can often be managed without having to discontinue this medication.
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Affiliation(s)
- Maria Wang
- Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
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Conrad R, Friederike Weber N, Lehnert M, Gerhard Holz F, Liedtke R, Eter N. Alexithymia and Emotional Distress in Patients With Central Serous Chorioretinopathy. PSYCHOSOMATICS 2007; 48:489-95. [PMID: 18071095 DOI: 10.1176/appi.psy.48.6.489] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Al-Dhibi H, Chaudhry IA, Al-Assiri A, Shamsi FA. Development of early choroidal neovascular membrane in a young myope after LASIK. Eur J Ophthalmol 2007; 17:262-5. [PMID: 17415702 DOI: 10.1177/112067210701700218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe development of early choroidal neovascular membrane (CNVM) after laser-assisted in situ keratomileusis (LASIK) procedure in a young myopic patient that was successfully managed by photodynamic therapy (PDT). METHODS A retrospective interventional case report. RESULTS A 20-year-old woman with myopic astigmatism underwent uneventful LASIK surgery resulting in best-corrected visual acuity (BCVA) of 20/20 bilaterally. One week later, the patient presented with decreased VA in the right eye and was found to have clinical evidence of central serous chorioretinopathy (CSC). She was treated with systemic corticosteroids without any improvement. Two weeks after LASIK, the patient's VA was 20/200 and clinical evidence of early CNVM was confirmed by fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT). PDT resulted in the regression of her CNVM with improvement in her VA and OCT findings. CONCLUSIONS Systemic corticosteroids may enhance CNVM in patients with LASIK-induced early CNVM. PDT may be effective in the resolution of LASIK-induced CNVM.
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Affiliation(s)
- H Al-Dhibi
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia
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Klatt C, Elsner H, Pörksen E, Brinkmann R, Bunse A, Birngruber R, Roider J. [Selective retina therapy in central serous chorioretinopathy with detachment of the pigmentary epithelium]. Ophthalmologe 2007; 103:850-5. [PMID: 16937094 DOI: 10.1007/s00347-006-1415-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Selective Retina Therapy (SRT) is a new and innovative laser treatment modality that selectively treats the retinal pigmentary epithelium while sparing the photoreceptors. This therapeutic concept appears to be particularly suitable for treating patients with acute or chronic central serous chorioretinopathy (CSC). We present preliminary results obtained in five patients who had CSC associated with pigmentary epithelium detachment (PED) and serous subretinal fluid (SRF) and who were treated with SRT. METHODS This case series was made up of five male patients (mean age 47 years) with chronic CSC and SRF resulting from PED. Examinations performed before and at 1 month and 3 months after the treatment were: BCVA, FLA, OCT (Zeiss OCT III). For SRT, confluent treatment of the PED (area of leakage) was carried out using a pulsed frequency-doubled, Q-switched Nd-YLF prototype laser (lambda=527 nm, t= 1.7 s, 100 Hz, energy = 150-250 J). RESULTS Best corrected visual acuity at baseline was 0.53, while after 4 weeks it was 0.56 and after 12 weeks, 0.5. At baseline leakage was seen at the PED on fluorescein angiography in all patients. After 4 weeks leakage activity was no longer noted on angiography in 4 of 5 patients. OCT at baseline showed SRF at the edge of the PED in all patients, but in 4 of the 5 patients this was no longer detectable after 4 weeks. CONCLUSION SRT is a safe and effective treatment for patients with CSC in which PED has caused SRF. Not a single case of rip syndrome was observed in this study, even though the PED was treated confluently. Since SRT spares the photoreceptors it is particularly suitable for the treatment of CSC, especially when the origin of leakage is located close to the fovea. The results indicate that SRT leads to reconstruction of the outer blood-retina barrier.
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Affiliation(s)
- C Klatt
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Hegewischstrasse 2, 24105 Kiel.
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