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Feenstra HMA, van Dijk EHC, Cheung CMG, Ohno-Matsui K, Lai TYY, Koizumi H, Larsen M, Querques G, Downes SM, Yzer S, Breazzano MP, Subhi Y, Tadayoni R, Priglinger SG, Pauleikhoff LJB, Lange CAK, Loewenstein A, Diederen RMH, Schlingemann RO, Hoyng CB, Chhablani JK, Holz FG, Sivaprasad S, Lotery AJ, Yannuzzi LA, Freund KB, Boon CJF. Central serous chorioretinopathy: An evidence-based treatment guideline. Prog Retin Eye Res 2024; 101:101236. [PMID: 38301969 DOI: 10.1016/j.preteyeres.2024.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.
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Affiliation(s)
- Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Suzanne Yzer
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA; Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Siegfried G Priglinger
- Department of Ophthalmology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Laurenz J B Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Clemens A K Lange
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Ocular Angiogenesis Group, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jay K Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York, USA; Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
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Sahu V, Nayak S, Kumar A, Kashyap H. Optical Coherence Tomography-Based Positive Predictors of Eplerenone Therapy in Chronic Central Serous Chorioretinopathy: A Retrospective Study. Cureus 2024; 16:e58791. [PMID: 38784343 PMCID: PMC11112395 DOI: 10.7759/cureus.58791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/21/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE This study aimed to investigate optical coherence tomography (OCT) biomarkers as potential predictors of treatment response in chronic central serous chorioretinopathy (CSCR). MATERIALS AND METHODS It was a retrospective cohort study that included 42 patients with chronic CSCR. After complete ocular and hematological examinations, all patients received 50 mg/day of oral eplerenone for three months and were followed for at least six months. All participants were divided into two groups: Group 1 participants with a positive response to treatment (complete resolution of subretinal fluid (SRF) at six months) and Group 2 poor responders (moderate or less than 50% reduction in SRF from baseline). The primary outcome measure was the resolution of SRF, and various OCT biomarkers like central macular thickness (CMT), pigment epithelial detachments (PED), double-layer sign, elongation of the photoreceptor's outer segment, the integrity of the external limiting membrane, the integrity of the ellipsoid zone, hyperreflective foci in the outer segment, and subretinal deposits in the SRF were assessed. RESULTS The mean age was 41.33 ± 10.75 years, and 34 participants were male. Thirty-seven (88.1%) of the participants had good responses to eplerenone, with the mean height of SRF decreasing significantly from a maximum of 269.74 µm to a minimum of 21.86 µm at six months (p<0.001). The mean CMT decreased from the first visit time point to the third visit time (p<0.001). Logistic regression analysis assessed the absence of PED and double-layer signs associated with a good response. CONCLUSION The eplerenone therapy seems to be efficient for chronic CSCR, and OCT can be an invaluable aid to the treating physician.
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Affiliation(s)
- Vijaya Sahu
- Ophthalmology, All India Institute of Medical Sciences, Raipur, IND
| | - Swatishree Nayak
- Ophthalmology, All India Institute of Medical Sciences, Raipur, IND
| | - Aseem Kumar
- Ophthalmology, All India Institute of Medical Sciences, Raipur, IND
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Singh SR, Goté JT, Chhablani J. Randomized controlled trials in central serous chorioretinopathy: A review. Eye (Lond) 2023; 37:3306-3312. [PMID: 36997794 PMCID: PMC10630374 DOI: 10.1038/s41433-023-02509-9] [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: 07/26/2022] [Revised: 02/02/2023] [Accepted: 03/16/2023] [Indexed: 04/01/2023] Open
Abstract
Central serous chorioretinopathy (CSCR), a common chorioretinal disease, presents with a myriad of manifestations. Acute CSCR presents with localized neurosensory detachment whereas chronic CSCR may show widespread retinal pigment epithelium (RPE) changes, chronic shallow subretinal fluid, and choroidal neovascularization (CNV) suggestive of a variable natural history leading to suboptimal visual outcomes. Even though multiple treatment options including laser photocoagulation, photodynamic therapy, micropulse laser, anti-vascular endothelial growth factors, and systemic drugs (spironolactone, eplerenone, melatonin, mifepristone) are available, there is an absence of any standardized treatment protocol or gold standard treatment modality. Moreover, their performance compared to observation especially in acute CSCR is still debatable. Compared to other chorioretinal diseases such as age-related macular degeneration, diabetic retinopathy, diabetic macular oedema, and retinal vein occlusion, there is a relative dearth of randomized controlled trials in CSCR. Multiple inconsistencies including reliance on history of disease duration, variable inclusion criteria/disease descriptors/study endpoints, and availability of multiple treatment modalities lead to difficulties in designing RCTs. A consensus-based treatment protocol, therefore, is still elusive. We reviewed the literature and compiled the list of papers published to date, wherein we analyse and compare the inclusion criteria, imaging modalities, study endpoints, study duration, and study results. Correcting these discrepancies and deficiencies will help standardize future study designs, facilitating a next step toward a standardized treatment protocol.
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Affiliation(s)
- Sumit Randhir Singh
- Sri Sai Eye Hospital, Kankarbagh, Patna, Bihar, India
- Nilima Sinha Medical College & Hospital, Rampur, Madhepura, Bihar, India
| | | | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA.
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Venkatesh R, Prabhu V, Joshi A, Mangla R, Singh R, Wu L, Lanzetta P, Kuppermann B, Bandello F, Cohen FB, Chhablani J. Real-world practice patterns of eplerenone use for central serous chorioretinopathy. Int J Retina Vitreous 2023; 9:61. [PMID: 37784202 PMCID: PMC10544617 DOI: 10.1186/s40942-023-00500-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE To report eplerenone use by retina specialists worldwide for central serous chorioretinopathy (CSCR). METHODS A self-reporting questionnaire was distributed to retina specialists worldwide to gather clinicians' perspectives on CSCR cases treated, eplerenone dosage and duration, reasons to use it, and side effects. RESULTS The survey included 241 retina specialists (122 Indian and 119 international) with an average experience of 15.69 ± 9.59 years. Oral eplerenone was used to treat CSCR by 149 (62%) participants. Only 6% (n = 9) had easy access to verteporfin dye and photodynamic therapy. 30 (20%) of the 149 respondents changed their treatment with eplerenone after VICI trial results. Eplerenone was prescribed mostly for chronic CSCR (n = 86, 58%), regardless of involvement laterality. 62% (n = 92) had fewer than 25% CSCR cases treated with eplerenone. 85 (57%) respondents used eplerenone only when other treatments failed, while 36 (24%) used it as first-line treatment. 73 (49%) respondents, prescribed eplerenone at a 50 mg daily dose and 137 (92%) retina specialists used eplerenone for 0-3 months. The drug's efficacy dissatisfied 21 (14%) study participants. 124 (83%) study participants did not encounter any ocular or systemic side effects with eplerenone use. Eplerenone related kidney and electrolyte issues were noted by 11 (7%) study participants. CONCLUSION The treatment of CSCR varies around the world and is primarily influenced by the photodynamic therapy availability and the findings of VICI trial. Despite the limited benefit of eplerenone reported by the VICI trial, it is still used as evidenced by real-world experience. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, Bangalore, 560022, India.
| | - Vishma Prabhu
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, Bangalore, 560022, India
| | - Aishwarya Joshi
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, Bangalore, 560022, India
| | - Rubble Mangla
- Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, Bangalore, 560022, India
| | - Rishi Singh
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
- Cleveland Clinic Martin Health, Stuart, FL, USA
| | - Lihteh Wu
- Macula, Vitreous and Retina Associates of Costa Rica, San José, Costa Rica
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| | - Baruch Kuppermann
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, 92697, USA
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francine Behar Cohen
- Centre de Recherche des Cordeliers, From Physiopathology of Retinal Diseases to Clinical Advances, Université de Paris Cité, Inserm, Paris, 75006, France
- Department of Ophthalmology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Ophtalmopôle, Paris, 75014, France
| | - Jay Chhablani
- Department of Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA
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Herrmann LM, Matthé E, Sandner D, Wittig D. Eplerenone for the Treatment of Chronic Recurrent Chorioretinopathy Centralis Serosa. Klin Monbl Augenheilkd 2023. [PMID: 37669743 DOI: 10.1055/a-2105-0892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
BACKGROUND Chorioretinopathy centralis serosa (CCS) is a common disease that leads to the loss of retinal ion/fluid homeostasis due to decompensation of the retinal pigment epithelium, resulting in fluid accumulation with detachment of the neurosensory retina and/or retinal pigment epithelium. We investigated the effect of eplerenone, a mineralocorticoid receptor inhibitor, on chronic recurrent CCS (cr-CCS). METHODS A retrospective study with data analysis of 17 eyes (12 patients) between 2014 - 2021 with cr-CCS in whom other methods were not effective, not applicable, or not desired, was performed. Duration of CCS was at least 12 months with at least one recurrence. Each patient received 25 mg (1st week) and 50 mg (from the 2nd week) for at least 3 months. In each case, best-corrected visual acuity and central and peripheral retinal thickness were measured by spectral-domain optical coherence tomography. Side effects were rated by the patients as "none", "mild" (noticeable but not affecting), "tolerable" (affecting but acceptable because of good effect), and "not tolerable" (then discontinuation of therapy). RESULTS There was no significant reduction in central or peripheral retinal thickness. A complete reduction of subretinal fluid was achieved in 5 of 17 eyes (29.4%). In 12 eyes, no effect of eplerenone could be detected, so other therapies were required. Visual acuity change was mainly dependent on the duration of CCS and the degree of photoreceptor damage. Side effects were reported by 11 patients as "none" and 1 patient as "mild" (arterial hypotension). No other side effects were observed. CONCLUSION The response rates of therapy with eplerenone were relatively low, and no significant effect could be demonstrated. Eplerenone should not (no longer) be routinely used in the therapy of cr-CCS.
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Affiliation(s)
- Lisa-Marie Herrmann
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Egbert Matthé
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Dirk Sandner
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Dierk Wittig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
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Goté JT, Singh SR, Chhablani J. Comparing treatment outcomes in randomized controlled trials of central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2023; 261:2135-2168. [PMID: 36862202 DOI: 10.1007/s00417-023-05996-4] [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: 08/18/2022] [Revised: 01/06/2023] [Accepted: 02/04/2023] [Indexed: 03/03/2023] Open
Abstract
PURPOSE To perform a qualitative analysis of outcomes published from randomized controlled trials (RCTs) on central serous chorioretinopathy (CSCR) from 1979 to 2022. DESIGN Systematic review. METHODS All RCTs (including both therapeutic and non-therapeutic interventions) on CSCR available online till July 2022 were included after an electronic search in multiple databases such as PubMed, CENTRAL, MEDLINE, EMBASE, BIOSIS, Scopus, and Cochrane database. We analyzed and compared the inclusion criteria, imaging modalities, study endpoints, duration, and the results of the study. RESULTS The literature search yielded 498 potential publications. After excluding duplicate studies and studies that met clear exclusion criteria, 64 were screened for further evaluation, of which 7 were removed due to a lack of necessary inclusion criteria. A total of 57 eligible studies are described in this review. CONCLUSION This review provides a comparative overview of key outcomes reported between RCTs investigating CSCR. We describe the current landscape of treatment modalities for CSCR and note the discrepancies between results in these published studies. Challenges arise when attempting to compare similar study designs without comparable outcome measures (i.e., clinical vs. structural) which may limit the overall evidence presented. To mitigate this issue, we present the collected data from each study in tables detailing the measures that are and are not assessed in each publication.
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Affiliation(s)
| | | | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA.
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Huang L, Flaxel C, Suhler E, Lin P. Two Cases of Chronic Central Serous Chorioretinopathy Successfully Treated with Systemic Interferon Alpha. Ocul Immunol Inflamm 2023:1-10. [PMID: 37450492 PMCID: PMC10787811 DOI: 10.1080/09273948.2023.2226206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
Chronic central serous chorioretinopathy (CSCR) is a sight threatening disease that can lead to legal blindness. Verteporfin photodynamic therapy is the main treatment for chronic CSCR, however, there has been a critical worldwide shortage of verteporfin. Other medical treatments have been attempted with variable efficacy. Interferons have shown efficacy in treating uveitis and associated macular edema. We report 2 cases of treatment refractory chronic CSCR successfully treated with subcutaneous injection of interferon alpha with significant anatomical and functional improvement. To our knowledge, this is the first report observing the therapeutic potential of systemic interferon alpha in the treatment of chronic CSCR. A large randomized controlled clinical trial would help to better evaluate the safety and efficacy of systemic PEG-IFNα2a in treating chronic CSCR, and further define the optimal dose, treatment interval and duration.
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Affiliation(s)
- Lingling Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Christina Flaxel
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Eric Suhler
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Department of Ophthalmology, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Phoebe Lin
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Nguyen NV, Khan F, Emig M, Yeh S. Management of Atypical Central Serous Chorioretinopathy Mimicking Vogt-Koyanagi-Harada Disease. JOURNAL OF VITREORETINAL DISEASES 2023; 7:249-253. [PMID: 37188205 PMCID: PMC10170611 DOI: 10.1177/24741264231152675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Purpose: To report a case of multifocal central serous chorioretinopathy (CSCR) mimicking Vogt-Koyanagi-Harada (VKH) disease. Methods: A 42-year-old man was evaluated for an exudative retinal detachment (RD) with a presumptive diagnosis of VKH while being treated with corticosteroids. The examination showed subretinal fibrin deposition with a bullous, exudative, macula-involved RD in the left eye and a progressive decline in visual acuity (VA) to hand motions. Multimodal imaging showed multifocal hyperfluorescent leaks bilaterally by angiography, highly suggestive of CSCR exacerbated by corticosteroids. Results: After the multifocal CSCR diagnosis, the systemic corticosteroids were tapered and eventually discontinued. The patient was then managed with focal laser photocoagulation, photodynamic therapy, and acetazolamide. The VA improved to 20/30 with complete resolution of the bullous RD at the 12-month follow-up. Conclusions: Extensive bullous RD with subretinal fibrin deposition is an infrequent manifestation of CSCR commonly associated with corticosteroid use that can mimic VKH. Thus, it is important to distinguish CSCR from VKH and the potential of combination therapy in managing chronic multifocal CSCR with a bullous RD.
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Affiliation(s)
- Nam V. Nguyen
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Farid Khan
- Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Steven Yeh
- Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
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You EL, Hébert M, Jin TS, Bourgault S, Caissie M, Tourville É, Chen J, Ordóñez-Mena J, Dirani A. Comparing interventions for chronic central serous chorioretinopathy: A network meta-analysis. Surv Ophthalmol 2023:S0039-6257(23)00045-0. [PMID: 36931437 DOI: 10.1016/j.survophthal.2023.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
We compare efficacy of treatments for chronic central serous chorioretinopathy (CSCR) > 3 months. Four treatment classes were considered: photodynamic therapy (PDT), subthreshold laser therapies (SLT), mineralocorticoid receptor antagonists (MRA) and anti-vascular endothelial growth factor (anti-VEGF) agents. Pairwise and network meta-analyses of the primary outcomes (complete resolution of subretinal fluid (SRF), mean change in best corrected visual acuity (BCVA) (logMAR) and mean change in SRF) and secondary outcomes (mean change in central retinal thickness, and central choroidal thickness (μm), recurrence of SRF, and adverse events) at 3, 6 and 12 months were compared. Confidence in Network Meta-Analysis (CINeMA) informed the certainty of NMA evidence. Eleven RCTs of 458 eyes (450 patients) were included. NMA at 3 months showed that both PDT and SLT were superior to control for resolution of SRF (OR 4.83; 95% CI 1.72 to 13.55 and 2.27; 1.14 to 4.49, respectively) and SLT was superior to control for improving BCVA (MD -0.10; -0.17 to -0.04). PDT was superior to SLT for improving CRT (MD-42.88; -75.27 to -10.50). On probability ranking, PDT and SLT were consistently the best-ranked treatments for each outcome at 3 months, but low confidence of evidence and paucity of studies preclude definitive conclusions.
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Affiliation(s)
- Eunice Linh You
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Canada
| | - Mélanie Hébert
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Canada
| | | | - Serge Bourgault
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Canada
| | - Mathieu Caissie
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Canada
| | - Éric Tourville
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Canada
| | - John Chen
- Department of Ophthalmology, McGill University, Montreal, Canada
| | - José Ordóñez-Mena
- Nuffield Department of Primary Care Health, Oxford University, Oxford, England
| | - Ali Dirani
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Canada.
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van Dijk EHC, Feenstra HMA, Bjerager J, Grauslund J, Boon CJF, Subhi Y. Comparative efficacy of treatments for chronic central serous chorioretinopathy: A systematic review with network meta-analyses. Acta Ophthalmol 2023; 101:140-159. [PMID: 36178171 DOI: 10.1111/aos.15263] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/27/2022]
Abstract
Treatment of chronic central serous chorioretinopathy (cCSC) remains a topic of controversy. As cCSC is a disease that can wax and wane, treatment efficacy is difficult to assess especially when trials compare active treatments without any placebo/control group. In this study, we systematically reviewed short-term efficacies of any cCSC treatment tested in randomized controlled trials (RCT) and employed network meta-analyses to compare to non-treatment controls. We searched 11 literature databases on 20 March 2022 for RCTs of treatment of cCSC. We identified 17 RCTs including a total of 1172 eyes. Treatments included conventional laser (44 eyes), half-dose or half-fluence photodynamic therapy (PDT) (298 eyes), ranibizumab (16 eyes), antioxidants (50 eyes), mineralocorticoid receptor antagonists (187 eyes), rifampicin (91 eyes), selective retina therapy (SRT) (67 eyes) and subthreshold micropulse laser (192 eyes). Compared with controls, significant benefit on complete subretinal fluid resolution was only obtained from half-dose or half-fluence PDT (OR: 20.6; 95% CI: 6.3-66.7; p < 0.0001) and conventional laser (OR: 36.4; 95% CI: 2.0-655.7; p = 0.015), and at an order of magnitude lower degree from SRT (OR: 3.4; 95% CI: 1.7-6.8; p = 0.00075). Compared with controls and after sensitivity analyses, significant benefit in the change in best-corrected visual acuity was only obtained by half-dose/-fluence PDT (-0.13 logMAR; 95% CI: -0.20 to -0.06 logMAR; p = 0.00021). In conclusion, three treatment options provide significant improvement over no treatment: half-dose/-fluence PDT, conventional laser and to a much lesser degree SRT. Considering that conventional laser can only be applied for extrafoveal leaks, and the long-term data available for PDT-based treatments finding persisting treatment results, half-dose or half-fluence PDT is the only viable treatment option for patients with cCSC. Shortage issues with verteporfin should not lead to employment of ineffective treatment modalities, as they put patients at unnecessary risk of adverse events.
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Affiliation(s)
- Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Ophthalmology, Haga Hospital, The Hague, The Netherlands
| | - Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jakob Bjerager
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Jakob Grauslund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Clemente L, Cennamo G, Montorio D, Fossataro F, Passaro ML, Costagliola C. OCT-A in chronic central serous chorioretinopathy treated with oral eplerenone and half-fluence photodynamic therapy: A comparative study. Eur J Ophthalmol 2022; 33:11206721221131129. [PMID: 36214140 DOI: 10.1177/11206721221131129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
PURPOSE To evaluate retinal and choriocapillary vessel density (VD) changes in patients with chronic central serous chorioretinopathy (CSC) treated with half-fluence verteporfin photodynamic therapy (vPDT) or eplerenone, using optical coherence tomography angiography (OCTA). METHODS Patients affected by CSC and treated with vPDT and eplerenone were retrospectively studied. At baseline and 3 months after each treatment, all patients underwent a complete ophthalmological examination, including an evaluation of best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, fundus examination, fluorescein angiography (FA), indocyanine green angiography (ICGA), spectral-domain optical coherence tomography (SD-OCT) and OCTA. RESULTS Forty-eight eyes of patients with CSC were analysed. Twenty-four eyes were placed in the vPDT group, and 24 eyes formed the eplerenone group. In both groups, OCTA showed a significant improvement in the VD of deep capillary plexus (DCP) and choriocapillaris (CC) after treatments with respect to baseline (p < 0.001), whereas the VD of superficial capillary plexus (SCP) did not show significant differences (p > 0.05). The PDT group demonstrated a statistically significant increase in the VD of DCP and CC with respect to the eplerenone group (DCP p = 0.012; CC p = 0.004). A statistically significant reduction with respect to baseline in subfoveal choroidal thickness (SFCT) (p = 0.001 for vPDT group; p = 0.001 for eplerenone group) and in central foveal thickness (CFT) (p = 0.001 for vPDT group; p = 0.001 for eplerenone group) was also found. The SFCT was significantly thinnest in the PDT group with respect to the eplerenone group (p = 0.021). CONCLUSION OCTA allowed us to study retinal and choriocapillary vascular changes in patients with CSC treated with vPDT and eplerenone.
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Affiliation(s)
- Lidia Clemente
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
| | - Gilda Cennamo
- Eye Clinic, Public Health Department, 9307University of Naples "Federico II", Naples, Italy
| | - Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
| | - Federica Fossataro
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
| | - Maria Laura Passaro
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
| | - Ciro Costagliola
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
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12
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Beniwal A, Shaikh N, Chawla R, Azad SV, Kumar V, Vohra R. Comparison of two protocols of subthreshold micropulse yellow laser treatment for non-resolving central serous chorioretinopathy. Indian J Ophthalmol 2022; 70:3341-3345. [PMID: 36018117 PMCID: PMC9675531 DOI: 10.4103/ijo.ijo_228_22] [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: 11/29/2022] Open
Abstract
Purpose: To study the effect of subthreshold micropulse yellow laser treatment on central serous chorioretinopathy (CSC) and to compare two laser protocols. As per our knowledge, there are no studies comparing the two protocols of subthreshold laser. Methods: Twenty-three patients with non-resolving CSC of at least three months duration were treated with subthreshold laser (577 nm). Ten patients were treated with 5% duty cycle (group A) and 13 patients with 10% duty cycle (group B). At one month, best corrected visual acuity (BCVA), central macular thickness (CMT), subretinal fluid (SRF), choroidal thickness (CT) and choroidal vascularity index (CVI) were evaluated. Results: In group A, BCVA improved from 0.508 ± 504 to 0.174 ± 0.171 (P = 0.0058), CMT improved from 349.8 ± 168.9 micrometers (µm) to 183.3 ± 70.312 µm (P = 0.0093) and SRF reduced from 202.4 ± 158.024 to 43.8 ± 46.599 µm (P = 0.0069). In group B, BCVA improved from 0.437 ± 0.426 to 0.289 ± 0.470 (P = 0.0026), CMT improved from 280.846 ± 72.668 to 196.769 ± 72.62 µm (P = 0.0002) and SRF reduced from 110.385 ± 57.687 µm to 52.538 ± 52.111 µm (P = 0.0064). No significant difference was found in BCVA and CMT between the groups (P = 0.8716 and P = 0.8523, respectively). CSC completely resolved in 50% of cases in group A and in 69.2% of cases in group B. This difference was not statistically significant (0.423); however, the odds ratio of resolution was 2.25 times more with 10% duty cycle. No change was observed on fundus autofluorescence (FAF) following laser. Conclusion: Subthreshold micropulse laser can lead to resolution of SRF in 60.87% of cases (groups A and B combined). Ten per cent duty cycle had higher odds of resolution without causing any RPE damage.
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Affiliation(s)
- Abhijeet Beniwal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Nawazish Shaikh
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Rohan Chawla
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | | | - Vinod Kumar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Rajpal Vohra
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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13
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Statement of the Professional Association of Ophthalmologists in Germany (BVA), the German Society of Ophthalmology (DOG) and the German Retina Society (RG) on central serous chorioretinopathy : Status 18 October 2021. DIE OPHTHALMOLOGIE 2022; 119:108-122. [PMID: 35384482 DOI: 10.1007/s00347-022-01614-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 01/25/2023]
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14
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Felipe CQ, Biancardi AL, Civile VT, Carvas Junior N, Serracarbassa PD, Koike MK. Mineralocorticoid receptor antagonists for chronic central serous chorioretinopathy: systematic review and meta-analyses. Int J Retina Vitreous 2022; 8:34. [PMID: 35672807 PMCID: PMC9172176 DOI: 10.1186/s40942-022-00385-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mineralocorticoid receptor antagonists (MRAs) are widely used for chronic central serous chorioretinopathy (cCSCR), but their effectiveness remains unclear. This research was conducted to evaluate the efficacy of this drugs for cCSCR. METHODS This is a review of randomized clinical trials (RCT) comparing MRAs to placebo in adults with cCSCR, using the effects of MRAs on best-corrected visual acuity (BCVA) and adverse events as primary outcomes and the effects of MRAs on anatomical parameters as secondary outcomes: central subfield thickness (CST), subretinal fluid height (SFH) and central choroidal thickness (CCT). Our all-language online search included Medline (via PubMed), Central, Embase, Lilacs, Ibecs, and RCT registers platforms, as late as May 2021. We used the Cochrane risk-of-bias tool (version 2) to assess the methodological quality of each study and synthesized the results in meta-analyses using a random-effects model. RESULTS The search identified 302 records, five of which were eligible, totaling 225 cCSCR patients (aged 45-62 years; M/F ratio 3.1:1) treated for 1 to 12 months with spironolactone (50 mg/day) or eplerenone (50 mg/day) vs. placebo. Moderate-certainty evidence suggests MRAs result in little to no improvement in BCVA compared to placebo (SMD 0.22; 95% CI - 0.04 to 0.48; studies = 5; comparisons = 6; participants = 218; I2 = 0%). Very low-certainty evidence suggests that, when compared to placebo, MRAs have a very uncertain impact on adverse effects (no meta-analysis was performed), and CST (MD 18.1; 95% CI - 113.04 to 76.84; participants = 145; studies = 2; I2 = 68%). MRAs also result in little to no difference in SFH (SMD - 0.35; 95% CI - 0.95 to 0.26; studies = 5; comparisons = 6; participants = 221; I2 = 76%; moderate certainty) and CCT (MD - 21.23; 95% CI - 64.69 to 22.24; participants = 206; studies = 4; comparisons = 5; I2 = 85%; low certainty). CONCLUSION MRAs have little to no effect on BCVA. Evidence for adverse events and CST is very uncertain. MRAs also have little to no effect on SFH and CCT. These findings should be considered when prescribing MRAs for cCSCR. This research was previous registration in the PROSPERO platform (CRD42020182601).
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Affiliation(s)
- Camila Q. Felipe
- Postgraduate Program in Health Sciences, Institute of Medical Care for Civil Servants in the State of São Paulo (IAMSPE), São Paulo, Brazil
| | - Ana Luiza Biancardi
- Laboratory of Infectious Diseases in Ophthalmology, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Vinicius T. Civile
- Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Nelson Carvas Junior
- Cochrane Brazil and Department of Physiotherapy, Paulista University, São Paulo, Brazil
| | | | - Marcia K. Koike
- Postgraduate Program in Health Sciences, IAMSPE and Laboratory of Medical Investigation 51 (LIM-51), University of São Paulo, São Paulo, Brazil
- Postgraduate Program in Health Sciences of the Institute of Medical Care for Civil Servants in the State of São Paulo (IAMSPE), Avenida Ibirapuera 981, 2 andar, Vila Clementino, São Paulo, SP CEP 04029-000 Brazil
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15
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Han JY, Kim YJ, Choi EY, Lee J, Lee JH, Kim M, Byeon SH, Kim SS, Lee CS. Therapeutic Efficacy of Spironolactone for Central Serous Chorioretinopathy. Yonsei Med J 2022; 63:365-371. [PMID: 35352888 PMCID: PMC8965434 DOI: 10.3349/ymj.2022.63.4.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the therapeutic effects and safety of oral spironolactone (SPRL) in patients with central serous chorioretinopathy (CSC). MATERIALS AND METHODS The medical records and imaging data of patients diagnosed with CSC and treated with SPRL were retrospectively reviewed. Central macular thickness (CMT), subretinal fluid (SRF) height, subfoveal choroidal thickness (SFCT), and best-corrected visual acuity (BCVA) at baseline, at 1, 3, and 6 months, and at the last visit after the treatment were analyzed. RESULTS In total, 103 patients with 107 eyes were included. The mean age of the patients was 51.5±9.3 years, and 77 (72.0%) were male. The mean follow-up duration was 48.6±40.2 weeks. The mean duration of oral SPRL therapy was 15.5±13.4 weeks. CMT, SRF height, and SFCT improved significantly at 1, 3, and 6 months after SPRL therapy and at the last follow-up. BCVA, however, showed no significant change at any time point. The rate of complete resolution of SRF at 1 month was higher in those with chronic CSC than in those with acute CSC (21.1% vs. 6.0%, respectively). Recurrence occurred in 14 (13.1%) eyes after the complete resolution of SRF. Older age (p=0.001), a greater number of previous intravitreal bevacizumab injections (p=0.006), and poor initial visual acuity (p=0.048) were associated with recurrence. No permanent adverse effects were observed. CONCLUSION Oral SPRL showed therapeutic benefits in patients with CSC in terms of SRF resolution, but relatively frequent recurrence was observed, especially in older patients.
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Affiliation(s)
- Jae Yong Han
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Joon Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Young Choi
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Junwon Lee
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hwan Lee
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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16
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Stellungnahme von BVA, DOG und RG zur Chorioretinopathia centralis serosa (CCS). Klin Monbl Augenheilkd 2022; 239:217-232. [PMID: 35211942 DOI: 10.1055/a-1725-3125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Abdelhakeem E, El-Nabarawi M, Shamma R. Eplerenone repurposing in management of chorioretinopathy: Mechanism, nanomedicine-based delivery applications and future trends. Br J Clin Pharmacol 2022; 88:2665-2672. [PMID: 34983084 DOI: 10.1111/bcp.15213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022] Open
Abstract
Chronic central serous chorioretinopathy (CSCR) is an ocular threatening disease, a common cause of central vision loss, affecting the posterior pole of the eye. Eplerenone (EPL) is a selective mineralocorticoid receptor antagonist that used primarily to treat hypertension. Recently, it has shown many benefits in modifying the physio-pathological processes occurring upon stimulation of renin-angiotensin aldosterone system at the ocular level. In CSCR treatment, several clinical studies and case reports prove the efficacy and safety of EPL. However, some setbacks for such studies as a relatively small number of participants and short follow-up periods. This review article is intended to describe theories about the nature and classification of CSCR and recapitulate EPL therapeutic benefits as selective mineralocorticoid receptor antagonist in the treatment of CSCR. Furthermore, a literature survey on clinical studies discussing the results of use of EPL in treatment of CSCR. In addition, EPL therapeutic formulations that were developed up to date, and the future potential delivery systems will be suggested.
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Affiliation(s)
- Eman Abdelhakeem
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Mohamed El-Nabarawi
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Rehab Shamma
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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van Rijssen TJ, van Dijk EH, Tsonaka R, Feenstra HM, Dijkman G, Peters PJ, Diederen RM, Hoyng CB, Schlingemann RO, Boon CJ. Half-Dose Photodynamic Therapy Versus Eplerenone in Chronic Central Serous Chorioretinopathy (SPECTRA): A Randomized Controlled Trial. Am J Ophthalmol 2022; 233:101-110. [PMID: 34214454 DOI: 10.1016/j.ajo.2021.06.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare the efficacy and safety between half-dose photodynamic therapy (PDT) and eplerenone therapy for treating chronic central serous chorioretinopathy (cCSC). DESIGN This was a multicenter, open-label, randomized controlled trial. METHODS This investigator-initiated trial was conducted in 3 academic medical centers in the Netherlands. Eligible patients were randomized at a 1:1 ratio to receive either indocyanine green angiography-guided half-dose PDT or oral eplerenone for 12 weeks. Both anatomical and functional outcomes were evaluated at 3 months after the start of treatment. RESULTS A total of 107 patients were randomly assigned to receive either half-dose PDT (n = 53) or eplerenone treatment (n = 54). Thirteen patients (3 in the PDT group and 10 in the eplerenone group) did not adhere to the study protocol. At the 3-month evaluation visit, 78% of patients in the PDT group had complete resolution of subretinal fluid accumulation compared to only 17% of patients in the eplerenone group (P < .001). Mean best-corrected visual acuity in Early Treatment of Diabetic Retinopathy Study letters at the 3-month evaluation visit was 83.7 ± 10.8 and 82.8 ± 9.0 in the PDT and eplerenone groups, respectively (P = .555). In addition, mean retinal sensitivity on microperimetry was 25.4 ± 3.4 dB and 23.9 ± 4.0 dB in the PDT and eplerenone groups, respectively (P = .041). Finally, mean vision-related quality of life scores were 87.2 ± 8.5 and 83.8 ± 12.1 in the PDT and eplerenone groups, respectively (P = .094). Three patients (6%) in the PDT group experienced adverse events during the study compared to 18 patients (33%) in the eplerenone group. CONCLUSIONS Half-dose PDT is superior to oral eplerenone for cCSC with respect to both short-term safety and efficacy outcomes.
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19
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[Statement of the Professional Association of Ophthalmologists in Germany (BVA), the German Ophthalmological Society (DOG) and the Retinological Society (RG) on central serous chorioretinopathy : Status 18 October 2021]. Ophthalmologe 2021; 119:148-162. [PMID: 34905071 DOI: 10.1007/s00347-021-01549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
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Iqbal F, Iqbal K, Inayat B, Arjumand S, Ghafoor Z, Sattar W, Abbas K. Eplerenone Treatment in Chronic Central Serous Chorioretinopathy. Cureus 2021; 13:e18415. [PMID: 34729255 PMCID: PMC8555938 DOI: 10.7759/cureus.18415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background The study examined the efficacy of eplerenone in the management of chronic central serous chorioretinopathy (CSCR) with the aim of short-term observations. The study also aimed at observing changes in optical coherence tomography (OCT) parameters and visual acuity. Methodology This retrospective study was conducted at Layton Rahmatulla Benevolent Trust (LRBT) Eye Hospital from September 2019 to October 2020. A thorough ocular examination, color fundus photographs, fluorescein angiography, and macular OCT were performed on all patients. We administered one tablet of 50 mg eplerenone on day one and further advised the use of the same dose for 30 days. After the administration of the tablet, the patients were further analyzed on weeks one, two, and four. On every visit, we examined ophthalmic conditions by visual acuity, slit lamp, and dilated fundus examinations along with macular OCT and measured blood pressure. At follow-up, we measured the levels of serum creatinine at weeks one and four. Student's t-test and chi-square test were used for normal distribution and nominal variables. A p-value < 0.05 was considered statistically significant in all the analyses. Results A total of 15 patients were selected for this research, but unfortunately, two of them withdrew amid the study. For the remaining 13 patients, the mean duration of observing symptoms was three months and three weeks. At one-month follow-up, the mean subretinal fluid (SRF) height (94.18 μm) decreased, but we did not find any statistical significance between the SRF height at one-month follow-up and baseline (113.15 μm). In four patients, the SRF height increased up to 3-30 μm after four months of treatment. In our study, we found some negative consequences of eplerenone therapy in terms of hypertension, cramps, nausea, and migraine. Conclusion We concluded that short-term eplerenone treatment assists in the reduction of the choroidal thickness (CT) and central macular thickness (CMT) among patients with central serous chorioretinopathy. However, eplerenone treatment failed to decrease subretinal fluid height and does not bring any significant improvement in the visual acuity of patients. Some mild adverse effects of the treatment include hypertension, abdominal cramps, nausea, and migraine.
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Affiliation(s)
- Faisal Iqbal
- Department of Ophthalmology, Layton Rahmatulla Benevolent Trust (LRBT) Eye Hospital, Lahore, PAK
| | - Kashif Iqbal
- Department of Ophthalmology, Layton Rahmatulla Benevolent Trust (LRBT) Eye Hospital, Lahore, PAK
| | - Bilal Inayat
- Department of Ophthalmology, Layton Rahmatulla Benevolent Trust (LRBT) Eye Hospital, Lahore, PAK
| | - Sabeen Arjumand
- Department of Pharmacology, Sharif Medical and Dental College, Lahore, PAK
| | - Zarish Ghafoor
- Department of Pharmacology, Avicenna Medical College, Lahore, PAK
| | - Werdah Sattar
- Department of Ophthalmology, Lahore General Hospital, Lahore, PAK
| | - Kiran Abbas
- Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Berger L, Bühler V, Yzer S. Central Serous Chorioretinopathy - an Overview. Klin Monbl Augenheilkd 2021; 238:971-979. [PMID: 34416788 DOI: 10.1055/a-1531-5605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Central serous chorioretinopathy (CSCR) is characterised by retinal serous detachment usually localised in the macular region. CSCR predominantly affects men between 30 and 50 years of age. Traditional classification differentiates between acute (duration shorter than 4 to 6 months) and chronic disease (duration longer than 4 to 6 months). The pathogenesis is multifactorial and current thinking assumes the presence of localised choroidal hyperpermeability with subsequent secondary changes in the retinal pigment epithelium (RPE). The symptoms of acute CSCR include central blurred vision, often with deterioration in visual acuity. Optical coherence tomography (OCT) reveals subretinal fluid (SRF) and/or single retinal pigment epithelial detachments. Fluorescein angiography (FA) usually shows a leaking point with absent or only minor RPE changes in the acute phase and indocyanine green angiography (ICG) highlights circumscribed areas of thickened and hyperpermeable choroid. Acute cases may show spontaneous resolution of SRF, but may also recur and/or become chronic. After the initial diagnosis, spontaneous remission is seen in about 70 to 80% of cases, with a recurrence rate of about 50%. Due to the favourable spontaneous course, it is recommended to wait for 4 to 6 months after the first symptoms manifest. Steroid therapy is considered as a major risk factor. Chronic cases are characterised by slow deterioration in visual acuity with reduced contrast and colour perception. There are extensive RPE changes, with secondary degenerative changes of the photoreceptors. The disease can by complicated by choroidal neovascularisation (CNV), especially in elderly patients. The literature lists a number of treatments: The leakage point (visible in the FA) can be treated by focal laser therapy, either micropulse laser or, if sufficiently distant from the fovea, by argon laser coagulation. Randomised trials in chronic CSCR demonstrated good outcomes with photodynamic therapy. With observation periods ranging from 3 to 6 months, several case series reports found improvement after systemic administration of mineralocorticoid receptor antagonists, carbonic anhydrase inhibitors or non-steroidal anti-inflammatory drugs. In the presence of secondary CNV, anti-VEGF treatment should be initiated. It is unclear whether the combination with PDT might be useful.
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Affiliation(s)
| | - Virginie Bühler
- Department of Ophthalmology, Inselspital, Bern University Hospital
| | - Suzanne Yzer
- Department of Ophthalmology, Radboud Universiteit, Nijmegen, Niederlande
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22
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Daugirdas SP, Bheemidi AR, Singh RP. Should We Stop Treating Patients With Eplerenone for Chronic CSCR? Commentary on the VICI Trial. Ophthalmic Surg Lasers Imaging Retina 2021; 52:308-310. [PMID: 34185584 DOI: 10.3928/23258160-20210528-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The VICI trial reported by Lotery et al. is a recent placebo-controlled, randomized trial that examined the efficacy of eplerenone treatment for chronic central serous chorioretinopathy (CSCR) in 104 patients. The study found no significant difference in best-corrected visual acuity (BCVA) between the eplerenone-treated and placebo groups, prompting the VICI investigators to conclude that eplerenone should not be prescribed to treat CSCR. Limitations of the study include the patients' high baseline BCVA, use of a functional outcome like BCVA as the primary endpoint instead of an anatomical outcome, failure to account for rebound effect, and measuring subretinal fluid (SRF) thickness instead of the more informative SRF volume. Based on these reasons and evidence from multiple case series and prospective studies over the past 7 years, it is the opinion of the authors of this editorial that the VICI investigators' conclusion to stop prescribing eplerenone for CSCR is too severe. Future clinical trials should continue to explore the potential for eplerenone as long-term maintenance treatment in chronic CSCR. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:308-310.].
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Fasler K, Gunzinger JM, Barthelmes D, Zweifel SA. Routine Clinical Practice Treatment Outcomes of Eplerenone in Acute and Chronic Central Serous Chorioretinopathy. Front Pharmacol 2021; 12:675295. [PMID: 34040534 PMCID: PMC8141746 DOI: 10.3389/fphar.2021.675295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose: To evaluate efficacy of eplerenone therapy vs. observation on resolution of subretinal fluid (SRF) in patients with acute and chronic central serous chorioretinopathy (CSCR) in routine clinical practice. Methods: Retrospective comparative case series of eyes diagnosed with CSCR treated with eplerenone or observation. Primary outcome measure was maximum height of SRF at 12 months. Secondary outcome was percentage of eyes with complete resolution of SRF, percentage of eyes with reduction of SRF ≥50%, and best corrected visual acuity (VA) at 12 months. Separate analysis was conducted for eyes with acute and chronic CSCR. Results: Sixty-eight eyes of 60 patients (82% male) were included. Eleven of the 38 eyes with acute CSCR, and seven of the 30 eyes with chronic CSCR, received eplerenone. Subretinal fluid decreased from baseline to 12 months in acute (287 ± 221 to 31 ± 63 µm) and chronic (148 ± 134 to 40 ± 42 µm) CSCR. Kaplan-Meier curves were similar for treated and observed eyes and COX regression analysis did not show a significant difference in SRF resolution in treated vs. observed eyes (p = 0.6 for acute, p = 0.2 for chronic CSCR). Conclusion: This routine clinical practice outcome study did not show evidence of efficacy of eplerenone on resolution of SRF in acute nor chronic CSCR.
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Affiliation(s)
- Katrin Fasler
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Jeanne M Gunzinger
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Sandrine A Zweifel
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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Wu Z, Wang H, An J. Comparison of the efficacy and safety of subthreshold micropulse laser with photodynamic therapy for the treatment of chronic central serous chorioretinopathy: A meta-analysis. Medicine (Baltimore) 2021; 100:e25722. [PMID: 33907163 PMCID: PMC8084005 DOI: 10.1097/md.0000000000025722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/24/2021] [Accepted: 04/10/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This meta-analysis was conducted to compare the therapeutic effect and safety of subthreshold micropulse laser (SML) vs photodynamic therapy (PDT) in treatment of chronic central serous chorioretinopathy (cCSC). METHODS PubMed, EMBASE, and the Cochrane Library were searched for all relevant studies published up to August 17, 2020. Data of interest were analyzed by STATA (version 14.0) software. RESULTS Four randomized clinical trials (RCTs) and 5 retrospective studies with 790 eyes were included in this meta-analysis after study selection. The results showed that SML significantly improved the best-corrected visual acuity (BCVA) compared with PDT at 6 to 8 weeks, 6 months, and 7 to 8 months in patients with cCSC (weighted mean difference (WMD) = -0.15, 95% confidence intervals (CI): -0.23 to -0.07, P < .01; WMD = -2.83, 95% CI: -4.79 to -0.87, P < .01; and WMD = -2.61, 95% CI: -4.23 to -1.24, P = .026, respectively). There was also a statistically significant difference between SML and PDT groups in the differences in the complete resolution of subretinal fluid (SRF) (risk radios = 0.388, 95% CI: 0.307 to 0.491, P < .01). There were no significant differences between the SML and PDT in the overall effect with central macular thickness (CMT), adverse events, complete resolution of SRF and treatment response. CONCLUSIONS Based on the available evidence, this meta-analysis demonstrated that SML may be considered as a competitive alternative to PDT for treating cCSC, and as the first-line treatment of cCSC.
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Manayath G, Verghese S, Ranjan R, Agrawal H, Khanna A, Narendran V, Chhablani J. Long-term outcomes of half-fluence photodynamic therapy and eplerenone in chronic central serous chorioretinopathy: A comparative study. Eur J Ophthalmol 2021; 31:3110-3116. [PMID: 33508971 DOI: 10.1177/1120672121991053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS To compare the long-term outcomes in chronic central serous chorioretinopathy (cCSC) following half-fluence photodynamic therapy (HF-PDT) and oral eplerenone treatment. METHODS This retrospective comparative study included consecutive patients of cCSC treated with either HF-PDT or eplerenone. The treatment outcomes of the two groups were analyzed at 3-month, 6-month, and 12-month post-treatment. RESULTS This study included 20 eyes (20 patients) in HF-PDT group, and 18 eyes (18 patients) in eplerenone group. All baseline parameters in HF-PDT and eplerenone groups were comparable including neurosensory detachment height (217.05 ± 140.25 µm vs 178.05 ± 164.24 µm respectively, p = 0.09), best-corrected visual acuity (BCVA) (logMAR 0.24 ± 0.13 vs logMAR 0.46 ± 0.37 respectively, p = 0.1), and subfoveal choroidal thickness (SFCT) [427.4 ± 117.4 µm vs 456.38 ± 119.25 µm respectively, p = 0.45]. HF-PDT resulted in complete resolution of neurosensory detachment in higher proportion of eyes compared to eplerenone at each follow-up visits (3 months: 90% vs 27.7%, p = 0; 6 months: 100% vs 61.1%, p = 0.003; and 12 months: 100% vs 70%, p = 0.03) with a significantly shorter duration to resolution (3.3 ± 0.9 months vs 5.8 ± 3.3 months respectively, p = 0.02). Intergroup comparison showed no significant difference between mean BCVA (p = 0.38 at 3 months, p = 0.14 at 6 months, and p = 0.19 at 12 months). Mean SFCT at 12 months of the two groups differed significantly (p = 0.003) due to increased choroidal thickness of eplerenone group. CONCLUSION HF-PDT has a superior efficacy to achieve faster, greater and long-lasting resolution of subretinal fluid in cCSC compared to eplerenone therapy.
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Affiliation(s)
- George Manayath
- Department of Retina and Vitreous Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Shishir Verghese
- Department of Retina and Vitreous Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Ratnesh Ranjan
- Department of Retina and Vitreous Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Hitesh Agrawal
- Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, Hyderabad Eye Research Foundation, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Amishi Khanna
- Department of Retina and Vitreous Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Venkatapathy Narendran
- Department of Retina and Vitreous Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Jay Chhablani
- Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, Hyderabad Eye Research Foundation, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India.,Department of Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Duan J, Zhang Y, Zhang M. Efficacy and safety of the mineralocorticoid receptor antagonist treatment for central serous chorioretinopathy: a systematic review and meta-analysis. Eye (Lond) 2021; 35:1102-1110. [PMID: 33414535 DOI: 10.1038/s41433-020-01338-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/22/2020] [Accepted: 11/24/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES We performed a systematic review and meta-analysis to assess the efficacy and safety of the mineralocorticoid receptor antagonist (MRA) treatment for central serous chorioretinopathy (CSC). METHODS We searched the PubMed, Embase, and the Cochrane Library to identify relevant clinical studies published prior to March 2020. The primary outcome was change in best-corrected visual acuity (BCVA), and the secondary outcomes included the subretinal fluid (SRF), subfoveal choroidal thickness (SFCT), and central macular thickness (CMT). RESULTS Five randomized controlled trials (RCT) and four cohort studies met the inclusion criteria with a total of 352 eyes. The MRA treatment was not superior to placebo in BCVA at 1 month (WMD = -0.06, 95% CI -0.15-0.02, P = 0.15, I2 = 86%), 3 months (WMD = -0.04, 95% CI -0.14-0.06, P = 0.44, I2 = 77%) and 6 months (WMD = -0, 95% CI -0.05-0.05, P = 0.92, I2 = 0%). The MRA treatment resulted in significant reduction than the placebo in the SRF (WMD = -60.64, 95% CI -97.91 to -23.37, P = 0.001, I2 = 49%), SFCT (WMD = -39.15, 95% CI -52.58 to -25.72, P < 0.001, I2 = 0%), and CMT (WMD = -60.75, 95% CI -97.85 to -23.65, P = 0.01, I2 = 53%). CONCLUSIONS Our meta-analysis shows that the MRA treatment can improve anatomical structure in CSC patients, but it is not effective for achieving BCVA gain. The applicant of the MRA is safe and have no severe effect.
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Affiliation(s)
- Jianan Duan
- Macular Disease Research Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yun Zhang
- Macular Disease Research Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Meixia Zhang
- Macular Disease Research Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Liew G, Ho IV, Ong S, Gopinath B, Mitchell P. Efficacy of Topical Carbonic Anhydrase Inhibitors in Reducing Duration of Chronic Central Serous Chorioretinopathy. Transl Vis Sci Technol 2020; 9:6. [PMID: 33344050 PMCID: PMC7718817 DOI: 10.1167/tvst.9.13.6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Topical carbonic anhydrase inhibitors (CAIs) can influence retinal fluid distribution, but their role in treating central serous chorioretinopathy (CSCR) has not been studied. We examined the efficacy of a topical CAI (dorzolamide) in treating chronic CSCR. Methods Prospective, nonrandomized, controlled intervention study of patients with chronic CSCR of at least 3 months duration. Observed controls (n = 15) were recruited consecutively from 2016 to 2017; treated cases (n = 18) were recruited from 2018 to 2019. Controls were observed without active intervention, whereas treated cases were treated with topical dorzolamide for 3 months. The study end points were change in central macular thickness (CMT), change in best corrected visual acuity (BCVA), and proportion of eyes achieving complete resolution of subretinal fluid (SRF). All end points were at 3 months. Results Treated patients who received topical CAI had greater reduction in CMT (−145.6 µm, 95% confidence interval [CI] −170.5 to −120.7) compared to observed controls (−45.1 µm, 95% CI −65.3 to −25.1) at the main study end point of 3 months (P = 0.015). A higher proportion of treated patients achieved complete resolution of SRF compared to observed controls (77.8% vs. 40.0%, P = 0.04) at 3 months. However, change in BCVA at 3 months was similar in both groups (P = 0.12). Conclusions Topical CAI resulted in more rapid reduction of CMT compared to observation. These results, if confirmed in other studies, suggest topical CAI may be a viable treatment option for patients with chronic CSCR. Translational Relevance Topical CAI is used to treat a number of retinal disorders, and may be a novel treatment option for chronic CSCR.
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Affiliation(s)
- Gerald Liew
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), the Westmead Institute for Medical Research, University of Sydney, NSW, Australia.,Retina Associates, Sydney, NSW, Australia
| | - I-Van Ho
- Retina Associates, Sydney, NSW, Australia.,Retina Unit, Sydney Eye Hospital, Sydney, NSW, Australia
| | | | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), the Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), the Westmead Institute for Medical Research, University of Sydney, NSW, Australia.,Sydney West Retina, Sydney, NSW, Australia
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28
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Han JY, Choi EY, Lee CS. Therapeutic Effects and Safety of Spironolactone for Central Serous Chorioretinopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.11.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Stanescu-Segall D, Touhami S, Bodaghi B, LeHoang P. Eplerenone for chronic central serous chorioretinopathy. Lancet 2020; 396:1556-1557. [PMID: 33189169 DOI: 10.1016/s0140-6736(20)32327-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Dinu Stanescu-Segall
- Département d'Ophtlalmologie, Centre Hospitalier Universitaire Piite Salpétrière, Paris 75013, France.
| | - Sara Touhami
- Département d'Ophtlalmologie, Centre Hospitalier Universitaire Piite Salpétrière, Paris 75013, France
| | - Bahram Bodaghi
- Département d'Ophtlalmologie, Centre Hospitalier Universitaire Piite Salpétrière, Paris 75013, France
| | - Phuc LeHoang
- Département d'Ophtlalmologie, Centre Hospitalier Universitaire Piite Salpétrière, Paris 75013, France
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30
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Kaye R, Chandra S, Sheth J, Boon CJF, Sivaprasad S, Lotery A. Central serous chorioretinopathy: An update on risk factors, pathophysiology and imaging modalities. Prog Retin Eye Res 2020; 79:100865. [PMID: 32407978 DOI: 10.1016/j.preteyeres.2020.100865] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/02/2020] [Accepted: 04/27/2020] [Indexed: 02/08/2023]
Abstract
Central serous chorioretinopathy (CSC) is a common form of vision loss, typically seen in working-age men. The pathophysiology behind CSC still eludes us, however significant advances have been made in understanding this disease over the last decade using information from genetic and cell-based studies and imaging modalities. This review aims to give an overview of the current pathophysiology hypotheses surrounding CSC in addition to future directions in cellular work from human induced pluripotent stem cell derived choroidal endothelial cells from CSC patients. Furthermore, this review will provide the reader with an update on the clinical aspects of CSC including risk factors, diagnostic challenges and findings from multimodal imaging.
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Affiliation(s)
- Rebecca Kaye
- Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, SO16 6YD, United Kingdom
| | - Shruti Chandra
- NIHR Moorfields Biomedical Research Centre, 162, City Road, London, EC1V 2PD, United Kingdom
| | - Jay Sheth
- Surya Eye Institute and Research Center, Mumbai, India
| | - Camiel J F Boon
- Leiden University Medical Centre, Department of Ophthalmology, P.O. Box 9600, 2300 RC, Leiden, the Netherlands; Amsterdam University Medical Centers, Department of Ophthalmology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, 162, City Road, London, EC1V 2PD, United Kingdom
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, SO16 6YD, United Kingdom.
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31
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Moreno-Morillo FJ, Fernández-Vigo JI, Güemes-Villahoz N, Burgos-Blasco B, López-Guajardo L, Donate-López J. Update on the management of chronic central serous chorioretinopathy. ACTA ACUST UNITED AC 2020; 96:251-264. [PMID: 32891458 DOI: 10.1016/j.oftal.2020.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
Central serous chorioretinopathy (CSC) is one of the main causes of impaired visual acuity in patients younger than 60 years. Its pathophysiology remains partially unknown, although it has been postulated that choroidal hyper-permeability may be involved. This typically produces a neurosensory retinal detachment and/or a detachment of the retinal pigment epithelium in the posterior pole. Although acute CSC generally does not require treatment, when chronic it must be treated to avoid visual impairment. With the development of new imaging techniques, there has been an improvement in diagnosis, and different therapeutic strategies have been proposed. Various treatments for the management of chronic CSC have currently been shown to be useful to improve or stabilise visual acuity, the resolution of subretinal fluid, and to prevent recurrences. The most commonly used treatments today are photodynamic therapy, micropulse subthreshold laser, mineralocorticoid antagonists, or anti-vascular endothelial growth factor drugs. There are also other proposals and new treatments being developed, with promising results. This review aims to provide the reader with an overview of the current scientific evidence of the different treatment options available for CSC in order to help decision-making in clinical practice.
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Affiliation(s)
- F J Moreno-Morillo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - J I Fernández-Vigo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España; Centro Internacional de Oftalmología Avanzada, Madrid, España.
| | - N Güemes-Villahoz
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - B Burgos-Blasco
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - L López-Guajardo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - J Donate-López
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
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Fraenkel D, Suffo S, Langenbucher A, Seitz B, Abdin AD. Eplerenone for treatment of chronic central serous chorioretinopathy. Eur J Ophthalmol 2020; 31:1885-1891. [PMID: 32854564 DOI: 10.1177/1120672120952648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the morphological and functional outcome of oral eplerenone for treatment of patients with chronic central serous chorioretinopathy (CSC) in a real life experience. PATIENTS AND METHODS In this retrospective study, we reviewed the clinical files of 30 patients with chronic CSC. All patients were treated with eplerenone for a period of 6 weeks or 3 months depending on the clinical response. Main outcome measures included: best corrected visual acuity (BCVA), central macular thickness (CMT) and height of the subretinal fluid (SRF). Comparisons between responders and non-responders were performed to identify factors that were predictive of the treatment response. RESULTS All patients were treated with eplerenone 18 ± 20 weeks after onset of the first symptoms. BCVA (LogMAR) improved from 0.2 ± 0.2 to 0.13 ± 0.18 at 6 weeks (p = 0.01) and to 0.09 ± 0.15 at 3 months (p = 0.01). Mean CMT decreased from 409 ± 136 to 323 ± 87 µm at 6 weeks (p = 0.001) and to 298 ± 98 µm at 3 months (p = 0.01). Mean height of SRF decreased from 153 ± 126 to 73 ± 79 µm at 6 weeks (p = 0.001) and to 49 ± 88 µm at 3 months (p = 0.005). Complete resolution of SRF was achieved in 20 patients after 3 months (67%). Reported stress in the medical history was the only statistical significant predictive factor associated with a positive treatment response. CONCLUSION This study showed a statistically significant improvement of the best corrected visual acuity and a significant reduction of macular thickness and subretinal fluid in patients with chronic CSC treated with oral eplerenone, especially in patients under stress.
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Affiliation(s)
- Doris Fraenkel
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Germany
| | - Shady Suffo
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Germany
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Germany
| | - Alaa Din Abdin
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Germany
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Vignesh TP, Maitray A, Sen S, Chakrabarti A, Kannan NB, Ramasamy K. Subthreshold Micro-Pulse Yellow Laser and Eplerenone Drug Therapy in Chronic Central Serous Chorio-Retinopathy Patients: A Comparative Study. Semin Ophthalmol 2020; 35:237-245. [PMID: 32853034 DOI: 10.1080/08820538.2020.1809682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To study the outcomes of subthreshold micropulse yellow laser (SML) and eplerenone (EP) therapy in central serous chorio-retinopathy (cCSCR). METHODS Retrospective study of 28 eyes of 27 patients undergoing SML and 20 eyes of 19 patients undergoing EP therapy. RESULTS Median duration of follow-up was 8 months for SML and 4.5 months for EP group. Complete SRF resolution was seen in 12/28 (42.8%) eyes in SML and 4/20 (20%) in EP group. Six eyes in SML group and two eyes in EP group needed additional SML. No EP patients demonstrated hyperkalemia warranting stopping of therapy. Baseline visual acuity (VA) was correlated positively with final VA in both groups. Presence/absence of focal leaks had differing outcomes in both treatment groups in terms of anatomical resolution. CONCLUSION Both treatment modalities were effective in the management of cCSCR showing comparable favorable anatomical outcomes, but visual outcomes were not significant, probably due to chronicity of the pathology.
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Affiliation(s)
- T P Vignesh
- Department of Vitreo-retina, Aravind Eye Hospital , Madurai, India
| | - Aditya Maitray
- Department of Vitreo-retina, Aravind Eye Hospital , Madurai, India
| | - Sagnik Sen
- Department of Vitreo-retina, Aravind Eye Hospital , Madurai, India
| | | | | | - Kim Ramasamy
- Department of Vitreo-retina, Aravind Eye Hospital , Madurai, India
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Venkatesh R, Pereira A, Jayadev C, Prabhu V, Aseem A, Jain K, Bavaharan B, Yadav NK, Chhablani J. Oral Eplerenone Versus Observation in the Management of Acute Central Serous Chorioretinopathy: A Prospective, Randomized Comparative Study. Pharmaceuticals (Basel) 2020; 13:ph13080170. [PMID: 32751370 PMCID: PMC7463844 DOI: 10.3390/ph13080170] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022] Open
Abstract
In this prospective, interventional case-control study, 58 patients with unilateral acute central serous chorioretinopathy (CSCR) were recruited. Patients ≥ 18 years age, presenting with first episodes of acute CSCR, were included. Acute CSCR was defined by the presence of subretinal fluid (SRF) and symptoms for <12 weeks duration with no clinical or imaging features of chronicity. Patients were alternately divided into treatment (Table Eplerenone 50 mg/day for minimum 1 month) and observation groups. Vision, SRF height and subfoveal choroidal thickness (SFCT) were checked at 1-, 2- and 3-months in both eyes of each group. Each group had 29 eyes. Mean age was 40.4 ± 7.1 and 43.3 ± 8.34 years in treatment and observation group, respectively. Mean symptom duration was 6.46 ± 1.45 and 5.87 ± 2.09 weeks, respectively. Vision improvement to 6/6 was seen in 92%, 100% and 100% cases in treatment group and 74%, 86% and 100% in control group at each visit, respectively. Complete SRF resolution in the treatment group was noted in 45%, 55% and 62% cases at each respective monthly visit. In the observation group, complete SRF resolution was noted in 10%, 21% and 31% at 1-, 2- and 3-month visits, respectively. SRF (p < 0.001) and SFCT (p < 0.001) reduction was noted in the affected eye of both groups. SFCT was reduced in the fellow eye after treatment (p = 0.005) compared to the observation group (p = 0.276). In conclusion, oral eplerenone achieves faster SRF resolution and vision improvement in acute CSCR. Additionally, it shows beneficial effects on the fellow eye.
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Affiliation(s)
- Ramesh Venkatesh
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Arpitha Pereira
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Chaitra Jayadev
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Vishma Prabhu
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Aditya Aseem
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Kushagra Jain
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Bharathi Bavaharan
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Naresh Kumar Yadav
- Narayana Nethralaya, Department of Retina & Vitreous, 121/C, Chord Road, 1st ‘R’ Block, Rajaji Nagar, Bengaluru 560010, India; (R.V.); (A.P.); (C.J.); (V.P.); (A.A.); (K.J.); (B.B.); (N.K.Y.)
| | - Jay Chhablani
- Department of Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA 15213, USA
- Correspondence: or
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Zhang B, Chou Y, Zhao X, Yang J, Chen Y. Efficacy of mineralocorticoid receptor antagonist for central serous chorioretinopathy: a meta-analysis. Int Ophthalmol 2020; 40:2957-2967. [PMID: 32632615 DOI: 10.1007/s10792-020-01479-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the efficacy of mineralocorticoid receptor antagonist (MRA) for patients with central serous chorioretinopathy (CSCR). METHODS The Pubmed, Embase, and the Cochrane Central Register of Controlled Trials were comprehensively searched up to February 2020, to identify the studies comparing the efficacy of MRA with placebo/observation or photodynamic therapy (PDT) for CSCR. The primary outcomes were maximal subretinal fluid height and central macular thickness (CMT). The secondary outcomes included subfoveal choroidal thickness (SFCT) and best-corrected visual acuity (BCVA). Data of interest were extracted and analyzed by R version 3.6.0. The weighted mean difference and their 95% confidence intervals were used to assess the strength of the association. RESULTS Ten studies including 284 affected eyes were involved, with 168 undergoing MRA treatment, 60 taking placebo/observation, and 56 receiving PDT. The pooling results showed that MRA was significantly more effective in resolving maximal subretinal fluid height (P < 0.01) and diminishing CMT (P < 0.01) than placebo/observation, while PDT could achieve significantly better CMT reduction than MRA (P = 0.03). For BCVA improvement and SFCT reduction, no statistical difference was detected among the groups of MRA, observation, placebo, or PDT (P > 0.05). CONCLUSION MRA is an effective therapy for the management of CSCR, which is only slightly inferior to PDT in terms of CMT reduction. For patients who could not afford PDT, MRA could function as an alternative treatment with acceptable efficacy and safety.
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Affiliation(s)
- Bilei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, No.9 Dongdansantiao, Dongcheng District, Beijing, 100730, China
| | - Yuyu Chou
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, No.9 Dongdansantiao, Dongcheng District, Beijing, 100730, China
| | - Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, No.9 Dongdansantiao, Dongcheng District, Beijing, 100730, China
| | - Jingyuan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, No.9 Dongdansantiao, Dongcheng District, Beijing, 100730, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China. .,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, No.9 Dongdansantiao, Dongcheng District, Beijing, 100730, China.
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Venkatesh R, Pereira A, Jain K, Yadav NK. Minoxidil induced central serous Chorioretinopathy treated with oral Eplerenone - a case report. BMC Ophthalmol 2020; 20:219. [PMID: 32503484 PMCID: PMC7275492 DOI: 10.1186/s12886-020-01499-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 06/02/2020] [Indexed: 11/30/2022] Open
Abstract
Background Minoxidil solution has routinely been used for decades for the treatment of androgenic alopecia. Central serous chorioretinopathy (CSCR) is a rare side-effect noted following prolonged topical minoxidil therapy for androgenic alopecia. In this report, we describe a case of a 41-year-old young man who developed CSCR following prolonged therapy with topical Minoxidil solution and was treated with oral eplerenone. Case presentation A 41-year-old male presented to the retina clinic with complaints of seeing a black spot, blurred vision and metamorphopsia involving the right eye for the past 4 months. He was on treatment for androgenic alopecia with topical 5% Minoxidil application on scalp two times a day. He noticed the symptoms 8 months after starting the treatment and had stopped the medication since the past 2 months. On examination, best-corrected visual acuity was 20/20 in both eyes. Fundoscopic examination of the right eye with +78D lens on slit lamp revealed the presence of subretinal fluid and few focal spots of retinal pigment epithelial alterations. Optical coherence tomography scan evaluation showed the presence of subretinal fluid (SRF) and pachychoroid supporting the diagnosis of CSCR. Indocyanine green angiography revealed dilated hyperpermeable choroidal vasculature on the nasal side of the fovea in the early and later phases of the angiogram. The patient was diagnosed with CSCR as a possible consequence of the topical minoxidil solution. Patient was asked to avoid future use of Minoxidil and was started on oral eplerenone therapy 50 mg/day for 4 consecutive weeks. One month later, there was complete resolution of his symptoms and SRF. At the final follow-up visit, 2 months after starting the therapy, there was no recurrence of SRF. Conclusion CSCR is a rare side-effect noted following prolonged topical minoxidil therapy for androgenic alopecia. While we found oral eplerenone to be safe and effective, further studies would be required before it can be routinely used in the population.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina & Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st 'R' Block, Rajaji Nagar, Bengaluru, 560010, India.
| | - Arpitha Pereira
- Department of Retina & Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st 'R' Block, Rajaji Nagar, Bengaluru, 560010, India
| | - Kushagra Jain
- Department of Retina & Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st 'R' Block, Rajaji Nagar, Bengaluru, 560010, India
| | - Naresh Kumar Yadav
- Department of Retina & Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st 'R' Block, Rajaji Nagar, Bengaluru, 560010, India
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Fusi-Rubiano W, Saedon H, Patel V, Yang YC. Oral medications for central serous chorioretinopathy: a literature review. Eye (Lond) 2020; 34:809-824. [PMID: 31527760 PMCID: PMC7182569 DOI: 10.1038/s41433-019-0568-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/04/2019] [Accepted: 07/27/2019] [Indexed: 02/08/2023] Open
Abstract
Central serous chorioretinopathy (CSCR) is characterised by acute or chronic neurosensory detachments of the retina, usually in the posterior pole, with or without associated detachments of retinal pigment epithelium. Although the condition often resolves spontaneously, chronic and recurrent cases can lead to significant visual loss in the working population and it is thus increasingly recognised as an important public health issue. The uncertainty regarding the underlying cause of CSCR has led to a wide range of therapies being tried for this condition including photodynamic therapy, laser photocoagulation, anti-VEGF injections and a multitude of oral agents. This article aims to review the current evidence for oral agents that have been used for treatment of CSCR. A systematic literature search was conducted for articles published between 1980 to July 2018. A total of 73 articles were included. These studied the following oral medications: eplerenone, spironolactone, beta blockers, H. pylori agents, omeprazole, rifampicin, methotrexate, aspirin, acetazolamide, mifepristone, melatonin, finasteride, ketoconazole, antioxidants and curcumin phospholipid. Although none of the studies showed robust evidence of efficacy, the mineralocorticoid receptor antagonists, particularly eplerenone, appear to demonstrate the highest quality evidence for use in this condition. The review aims to give the reader an overview of the current available evidence for oral medications used in the treatment of CSCR in order to provide an evidence-based discussion with the patient and guide through possible options for treatment.
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Affiliation(s)
- William Fusi-Rubiano
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK.
| | - Habiba Saedon
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK
| | - Vijay Patel
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK
| | - Yit C Yang
- Ophthalmology Department, New Cross Hospital, Wednesfield Road, Wolverhampton, WV10 0QP, UK
- School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, UK
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Rabiolo A, Bandello F. Eplerenone is not superior to placebo for chronic central serous chorioretinopathy. Lancet 2020; 395:252-253. [PMID: 31982052 DOI: 10.1016/s0140-6736(19)33132-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 12/05/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Alessandro Rabiolo
- Department of Ophthalmology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan 20132, Italy.
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan 20132, Italy
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Lotery A, Sivaprasad S, O'Connell A, Harris RA, Culliford L, Ellis L, Cree A, Madhusudhan S, Behar-Cohen F, Chakravarthy U, Peto T, Rogers CA, Reeves BC. Eplerenone for chronic central serous chorioretinopathy in patients with active, previously untreated disease for more than 4 months (VICI): a randomised, double-blind, placebo-controlled trial. Lancet 2020; 395:294-303. [PMID: 31982075 DOI: 10.1016/s0140-6736(19)32981-2] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/07/2019] [Accepted: 11/15/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND In chronic central serous chorioretinopathy (CSCR), fluid accumulates in the subretinal space. CSCR is a common visually disabling condition that develops in individuals up to 60 years of age, and there is no definitive treatment. Previous research suggests the mineralocorticoid receptor antagonist, eplerenone, is effective for treating CSCR; however, this drug is not licensed for the treatment of patients with CSCR. We aimed to evaluate whether eplerenone was superior to placebo in terms of improving visual acuity in patients with chronic CSCR. METHODS This randomised, double-blind, parallel-group, multicentre placebo-controlled trial was done at 22 hospitals in the UK. Participants were eligible if they were aged 18-60 years and had had treatment-naive CSCR for 4 months or more. Patients were randomly assigned (1:1) to either the eplerenone or the placebo group by a trial statistician through a password-protected system online. Allocation was stratified by best-corrected visual acuity (BCVA) and hospital. Patients were given either oral eplerenone (25 mg/day for 1 week, increasing to 50 mg/day for up to 12 months) plus usual care or placebo plus usual care for up to 12 months. All participants, care teams, outcome assessors, pharmacists, and members of the trial management group were masked to the treatment allocation. The primary outcome was BCVA, measured as letters read, at 12 months. All outcomes apart from safety were analysed on a modified intention-to-treat basis (participants who withdrew consent without contributing a post-randomisation BCVA measurement were excluded from the primary analysis population and from most secondary analysis populations). The trial is registered with ISRCTN, ISRCTN92746680, and is completed. FINDINGS Between Jan 11, 2017, and Feb 22, 2018, we enrolled and randomly assigned 114 patients to receive either eplerenone (n=57) or placebo (n=57). Three participants in the placebo group withdrew consent without contributing a post-randomisation BCVA measurement and were excluded from the primary outcome analysis population. All patients from the eplerenone group and 54 patients from the placebo group were included in the primary outcome. Modelled mean BCVA at 12 months was 79·5 letters (SD 4·5) in the placebo group and 80·4 letters (4·6) in the eplerenone group, with an adjusted estimated mean difference of 1·73 letters (95% CI -1·12 to 4·57; p=0·24) at 12 months. Hyperkalaemia occurred in eight (14%) patients in each group. No serious adverse events were reported in the eplerenone group and three unrelated serious adverse events were reported in the placebo group (myocardial infarction [anticipated], diverticulitis [unanticipated], and metabolic surgery [unanticipated]). INTERPRETATION Eplerenone was not superior to placebo for improving BCVA in people with chronic CSCR after 12 months of treatment. Ophthalmologists who currently prescribe eplerenone for CSCR should discontinue this practice. FUNDING Efficacy and Mechanism Evaluation Programme, and National Institute for Health Research and Social Care.
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Affiliation(s)
- Andrew Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Abby O'Connell
- Bristol Trials Centre, Clinical Trials and Evaluation Unit, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Rosie A Harris
- Bristol Trials Centre, Clinical Trials and Evaluation Unit, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Lucy Culliford
- Bristol Trials Centre, Clinical Trials and Evaluation Unit, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Lucy Ellis
- Bristol Trials Centre, Clinical Trials and Evaluation Unit, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Angela Cree
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Savita Madhusudhan
- Liverpool Ophthalmic Reading Centre, St Paul's Eye Unit, Royal Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Francine Behar-Cohen
- P-HP Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Ophtalmopole, Université de Paris, Paris, France; Centre de Recherche des Cordeliers, INSERM UMR 1138, Université de Paris, Sorbonne Université, Paris, France
| | - Usha Chakravarthy
- Centre for Vision Sciences, The Queen's University of Belfast, Belfast, UK
| | - Tunde Peto
- Centre for Vision Sciences, The Queen's University of Belfast, Belfast, UK
| | - Chris A Rogers
- Bristol Trials Centre, Clinical Trials and Evaluation Unit, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Barnaby C Reeves
- Bristol Trials Centre, Clinical Trials and Evaluation Unit, University of Bristol, Bristol Royal Infirmary, Bristol, UK
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40
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Kumari E, Baidya K, Khan R. Efficacy of Drug Eplerenone in the Management of Chronic Central Serous Chorioretinopathy. ACTA ACUST UNITED AC 2019. [DOI: 10.18410/jebmh/2019/687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Farooq O, Habib A, Shah MA, Ahmed N. Effect of oral eplerenone in anatomical and functional improvement in patients with chronic central serous chorioretinopathy. Pak J Med Sci 2019; 35:1544-1547. [PMID: 31777490 PMCID: PMC6861486 DOI: 10.12669/pjms.35.6.896] [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] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the efficacy of oral eplerenone in anatomical and functional improvement in patients with chronic central serous chorioretinopathy (CSCR). Methods: This quasi experimental study was performed at PNS Shifa Hospital Karachi from September 2018 to February 2019. Study included 23 patients. Patients were included using consecutive sampling technique and informed consent was taken from all patients before staring treatment. 50 mg of oral eplerenone per day was given for three months. Subretinal fluid (SRF) height and visual acuity (VA) were noted at baseline, one month and three month follow-up. Structured Study performa was used for data collection. Data was analysed and assessed with SPSS version 23. P value of <0.05 was considered statistically significant. Results: Mean age of patients was 40.7±7 years and mean duration of disease before treatment was 3.7±0.76 months. Mean baseline BCVA and SRF height was 0.39±0.02 logMAR and 123±12.5 µm respectively. Sixty-five percent patients responded at one month and 80% at three months with reduction in SRF height. Improvement in visual acuity was also statistically significant at 3 months (p<0.05). Conclusion: Use of eplerenone in chronic CSCR resulted in significant improvement in vision and decrease in mean SRF height.
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Affiliation(s)
- Omer Farooq
- Dr. Omer Farooq, MBBS, FCPS, FRCS. Department of Ophthalmology, PNS Shifa Hospital, BUMDC, Karachi, Pakistan
| | - Asad Habib
- Dr. Asad Habib, MBBS. Department of Ophthalmology, PNS Shifa Hospital, BUMDC, Karachi, Pakistan
| | - Masood Alam Shah
- Dr. Masood Alam Shah, FCPS. Department of Ophthalmology, PAF Hospital Faisal, Karachi, Pakistan
| | - Najia Ahmed
- Dr. Najia Ahmed, MBBS, FCPS. Department of Dermatology, PNS Shifa Hospital, BUMDC, Karachi, Pakistan
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Iacono P, Toto L, Costanzo E, Varano M, Parravano MC. Pharmacotherapy of Central Serous Chorioretinopathy: A Review of the Current Treatments. Curr Pharm Des 2019; 24:4864-4873. [PMID: 30674250 DOI: 10.2174/1381612825666190123165914] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/18/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Central serous chorioretinopathy (CSC) is the fourth most frequent retinal disorder in terms of prevalence. It typically occurs in young subjects and affects men more often than women. CSC is characterized by serous retinal detachment (SRD) involving mainly the macular area. The clinical course is usually selflimited, with spontaneous resolution within 3 months. The persistence of SRD or multiple relapse may result in a chronic form of CSC distinguished by permanent retinal pigment epithelium (RPE) and photoreceptor damage. As the pathogenetic mechanism of CSC primarily involves RPE and choroidal vascularization, the current therapeutic approaches aim to restore the normal functions of RPE and normal choroidal vascular permeability. In this review, the authors aim to summarize the current therapeutic approach to CSC. METHODS A comprehensive review of the literature was conducted in PubMed by searching for relevant studies on the current therapeutic options for CSC, including simple observation, conventional laser treatment, subthreshold laser treatment (SLT), photodynamic therapy (PDT) with verteporfin, treatment with mineralocorticoid receptor (MR) antagonists and treatment with anti-vascular endothelial growth factor drugs. RESULTS Since most cases resolve spontaneously, the most common initial CSC treatment is observation. Current evidence suggests that PDT and SLT are valuable in improving visual acuity, reducing subretinal fluid and maintaining long-term effectiveness. No clear evidence of efficacy has been achieved for anti-VEGF. MR antagonists might be a viable choice for the treatment of chronic CSC. CONCLUSION The pathophysiology of CSC remains poorly understood and as a consequence, the gold standard of care for CSC is yet to be defined. To date, PDT and SLT continue to offer good clinical outcomes. Positive preliminary results seem to emerge from the studies of MR antagonists.
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Affiliation(s)
| | - Lisa Toto
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University G. d'Annunzio Chieti-Pescara, Chieti, Italy
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van Rijssen TJ, van Dijk EHC, Yzer S, Ohno-Matsui K, Keunen JEE, Schlingemann RO, Sivaprasad S, Querques G, Downes SM, Fauser S, Hoyng CB, Piccolino FC, Chhablani JK, Lai TYY, Lotery AJ, Larsen M, Holz FG, Freund KB, Yannuzzi LA, Boon CJF. Central serous chorioretinopathy: Towards an evidence-based treatment guideline. Prog Retin Eye Res 2019; 73:100770. [PMID: 31319157 DOI: 10.1016/j.preteyeres.2019.07.003] [Citation(s) in RCA: 255] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 12/17/2022]
Abstract
Central serous chorioretinopathy (CSC) is a common cause of central vision loss, primarily affecting men 20-60 years of age. To date, no consensus has been reached regarding the classification of CSC, and a wide variety of interventions have been proposed, reflecting the controversy associated with treating this disease. The recent publication of appropriately powered randomised controlled trials such as the PLACE trial, as well as large retrospective, non-randomised treatment studies regarding the treatment of CSC suggest the feasibility of a more evidence-based approach when considering treatment options. The aim of this review is to provide a comprehensive overview of the current rationale and evidence with respect to the variety of interventions available for treating CSC, including pharmacology, laser treatment, and photodynamic therapy. In addition, we describe the complexity of CSC, the challenges associated with treating CSC, and currently ongoing studies. Many treatment strategies such as photodynamic therapy using verteporfin, oral mineralocorticoid antagonists, and micropulse laser treatment have been reported as being effective. Currently, however, the available evidence suggests that half-dose (or half-fluence) photodynamic therapy should be the treatment of choice in chronic CSC, whereas observation may be the preferred approach in acute CSC. Nevertheless, exceptions can be considered based upon patient-specific characteristics.
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Affiliation(s)
- Thomas J van Rijssen
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Suzanne Yzer
- Department of Ophthalmology, Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Graduate School, Tokyo, Japan
| | - Jan E E Keunen
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre 162, London, United Kingdom
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, West Wing, Oxford, United Kingdom
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Jay K Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, India
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong; 2010 Retina & Macula Centre, Tsim Sha Tsui, Kowloon, Hong Kong
| | - Andrew J Lotery
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands.
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Funk S, Fulga R, Klabe K, Breyer D, Seitz B, Langenbucher A, Kaymak H. [Nanosecond Laser Treatment in Chorioretinopathia Centralis Serosa without RPE Defects: A Retrospective Case Series]. Klin Monbl Augenheilkd 2019; 238:60-66. [PMID: 31600817 DOI: 10.1055/a-0999-5542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chorioretinopathia centralis serosa (CCS) is a uni- or bilateral disease of the macula which is characterized by detachment of the neuro-sensory retina. The spontaneous resolution rate is 68% after four months and 84% after six months. PURPOSE To investigate the efficacy of subthreshold nanopulse laser treatment for central serous chorioretinopathy (CCS) in the absence of any atrophy in the retinal pigment epithelium (RPE). METHODS This retrospective study comprised 23 eyes of 23 patients without previous treatment. Patients were followed up to 12 months. Laser treatment was performed with the 2RT® nanolaser using a grid stimulation. Changes in corrected visual acuity (VA), microperimetry and subretinal fluid height in optical coherence tomographic images were measured. Saliences in autofluorescence images and angiographic images were observed. All results were documented 1, 3, 6 and 12 months after the first treatment. Patients did not receive any supplementary treatment. RESULTS Two months after the first treatment, 74% of the patients showed complete SRF resolution and 91% of the patients within 6 months had complete resorption of the SRF. Central visual acuity and macula sensitivity significantly improved from 0.18 ± 0.16 logMAR to 0.09 ± 0.17 logMAR and 24.19 ± 3.96 dB to 27.59 ± 2.89 dB. The SRF decreased within one month significantly. No CNV was documented during the observation time. The baseline subretinal fluid height is a predictive factor of faster resolution. CONCLUSION The evaluation of our treatment results shows that the therapy is a safe and promising method. Patients with a CCS without existing RPE defects benefit from the treatment with the 2RT® nanolaser, which is associated with an improvement of the macula function.
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Affiliation(s)
- Saskia Funk
- I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf
| | - Roxana Fulga
- I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf
| | - Karsten Klabe
- I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf
| | - Detlev Breyer
- I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg/Saar
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar
| | - Hakan Kaymak
- I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf
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Bousquet E, Zhao M, Daruich A, Behar-Cohen F. Mineralocorticoid antagonists in the treatment of central serous chorioetinopathy: Review of the pre-clinical and clinical evidence. Exp Eye Res 2019; 187:107754. [DOI: 10.1016/j.exer.2019.107754] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/12/2022]
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Barrera-Chimal J, Jaisser F. Vascular mineralocorticoid receptor activation and disease. Exp Eye Res 2019; 188:107796. [PMID: 31521629 DOI: 10.1016/j.exer.2019.107796] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 12/11/2022]
Abstract
Mineralocorticoid receptor activation in endothelial and smooth muscle cells can promote vascular disease by increasing oxidative stress, promoting inflammation, accelerating vascular stiffness, remodeling, and calcification, altering vessel responsiveness to various vasoactive factors, thus altering vascular tone and blood pressure, and by altering angiogenesis. Here, we review the recent evidence highlighting the impact of vascular mineralocorticoid receptor activation in pathological situations, including kidney injury, vascular injury associated with metabolic diseases, atherosclerosis, cerebral vascular injury during hypertension, vascular stiffening and aging, pulmonary hypertension, vascular calcification, cardiac remodeling, wound healing, inflammation, thrombosis, and disorders related to angiogenic defects in the eye. The possible mechanisms implicating mineralocorticoid receptor activation in various vascular disorders are discussed. Altogether, recent evidence points towards pharmacological mineralocorticoid receptor inhibition as a strategy to treat diseases in which overactivation of the mineralocorticoid receptor in endothelial and/or smooth muscle cells may play a pivotal role.
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Affiliation(s)
- Jonatan Barrera-Chimal
- Laboratorio de Fisiología Cardiovascular y Trasplante Renal, Unidad de Medicina Traslacional, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México and Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Frederic Jaisser
- INSERM U1116, Clinical Investigation Centre, Lorraine University, Vandoeuvre-lès-Nancy, France; INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France; Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006, Paris, France.
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Moein HR, Bierman LW, Novais EA, Moreira-Neto C, Baumal CR, Rogers A, Duker JS, Witkin AJ. Short-term eplerenone for treatment of chronic central serous chorioretinopathy; a prospective study. Int J Retina Vitreous 2019; 5:39. [PMID: 31516734 PMCID: PMC6734298 DOI: 10.1186/s40942-019-0190-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/28/2019] [Indexed: 12/18/2022] Open
Abstract
Background Increased mineralocorticoid activity is one of the plausible causes of chronic central serous chorioretinopathy (CSCR) and mineralocorticoid inhibitors such as eplerenone have been investigated as its potential therapy. This study investigates the short-term safety and efficacy of oral eplerenone in patients with chronic CSCR. Patients and methods Prospective study of 13 eyes of 13 patients with the diagnosis of chronic CSCR. All patients received eplerenone 50 mg/day for 4 weeks. Enhanced depth imaging optical coherence tomography (OCT) was obtained. Best corrected visual acuity (BCVA), and OCT parameters including sub retinal fluid (SRF), choroidal thickness (CT) and central macular thickness (CMT), were measured manually. Results The mean SRF height decreased slightly at 1-month follow-up as compared to baseline, but the change was not statistically significant (94.18 ± 17.53 vs. 113.15 ± 18.69; p = 0.08). Subfoveal CT and CMT was significantly reduced as compared to baseline (6.6% [p = 0.002] and 7.05% [p = 0.04], respectively). The BCVA did not change significantly (20/28 vs. 20/30 [p = 0.16]). Conclusion This study suggests that oral eplerenone may be used as a safe and potentially effective treatment in chronic CSCR, however there are minimal short-term effects on subretinal fluid or visual acuity therefore therapeutic trials longer than one month are necessary to test its benefits.Trial registration Clinicaltrials.gov identification number: NCT01822561. Registered 3/25/13, https://clinicaltrials.gov/ct2/show/study/NCT01822561.
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Affiliation(s)
- Hamid-Reza Moein
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Lauren W Bierman
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Eduardo A Novais
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,2School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Carlos Moreira-Neto
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,Hospital de Olhos do Parana, Curitiba, Brazil
| | - Caroline R Baumal
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Adam Rogers
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Jay S Duker
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - André J Witkin
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
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Transfoveal Micropulse Laser Treatment of Central Serous Chorioretinopathy within Six Months of Disease Onset. J Clin Med 2019; 8:jcm8091398. [PMID: 31500100 PMCID: PMC6780961 DOI: 10.3390/jcm8091398] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 01/04/2023] Open
Abstract
Background: It has been recommended that any invasive treatment performed in patients with central serous chorioretinopathy (CSCR) not be initiated earlier than four months after disease onset due to the potential for spontaneous remission of symptoms. The goal of this study was to examine the outcome of transfoveal subthreshold micropulse laser treatment (SMPLT) of CSCR performed at six months or less after disease onset. Materials and methods: The study included 32 cases of CSCR lasting between three weeks and six months (mean: 3.4 ± 2.3 months). All patients had transfoveal SMPLT applied and were followed for at least three months after each session of SMPLT. Two sessions of SMPLT in total were planned in case of an insufficient response to the first instance of treatment. Evaluation parameters included any change in best-corrected visual acuity (BCVA) and retinal morphology. Results: Total resolution of subretinal fluid (SRF) was noted in 26 cases (81.25%). Final BCVA improved significantly from 0.37 ± 0.22 logMAR to 0.22 ± 0.20 logMAR after treatment. Overall, early SMPLT correlated with better final BCVA (p = 0.0005, Spearman rank correlation). For eyes achieving a total resolution of SRF, BCVA improved from 0.33 ± 0.21 logMAR to 0.17 ± 0.14 logMAR (p = 0.004, Spearman rank correlation). The analysis of SMPLT nonresponders revealed a tendency for poorer baseline visual acuity. Conclusions: Patients with CSCR lasting six months or less treated with transfoveal SMPLT achieve better functional results with early application of this procedure. As baseline BCVA predicts final visual acuity, earlier treatment, permitted by the safety of SMPLT, may improve final visual outcomes.
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Risk Factors for Persistent or Recurrent Central Serous Chorioretinopathy. J Ophthalmol 2019; 2019:5970659. [PMID: 31485346 PMCID: PMC6710733 DOI: 10.1155/2019/5970659] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 05/23/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose To investigate the risk factors for persistent or recurrent central serous chorioretinopathy (CSC). Materials and Methods Consecutive treatment-naïve CSC patients were included from January 2017 to October 2018. All patients were asked to complete questionnaires, addressing previously described risk factors for the development of CSC. Patients were divided into two groups: those with acute CSC, who were in the first episode, with spontaneous resolution of subretinal fluid within 3 months, and with no recurrence within 1 year; and those with persistent or recurrent CSC, the remaining patients. Results In total, 138 patients were enrolled: 20 (14.5%) with acute CSC and 118 (85.5%) with persistent or recurrent CSC. Using multivariate analysis, male sex (odds ratio (OR), 95% confidence interval: 5.63 [1.02–31.02]; p=0.047), older age (OR: 1.14 [1.03–1.25]; p=0.008), and higher Insomnia Severity Index score (OR: 1.30 [1.05–1.60]; p=0.015) were found to be independently associated with persistent or recurrent CSC. Conclusions Male sex, age, and sleep disorders are risk factors for persistent or recurrent CSC in the natural history. These patients may require early photodynamic therapy. Treatment for sleep disorders is strongly recommended. All CSC patients may require careful and periodic follow-up.
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Cakir B, Agostini H, Lange C. [Treatment of central serous chorioretinopathy with mineralocorticoid receptor antagonists]. Ophthalmologe 2019; 116:189-200. [PMID: 30255262 DOI: 10.1007/s00347-018-0785-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Over 3 years have passed since the last publication on the therapeutic principle "Mineralocorticoid receptor antagonists as treatment option for acute and chronic central serous chorioretinopathy" by Maier et al., and numerous new studies have been published on the topic. The aim of this work is to provide an update on the current literature and reevaluate the role of mineralocorticoid receptor antagonists in the treatment of central serous chorioretinopathy (CSC). METHODS AND RESULTS A computer-based literature search in PubMed yielded a total of 20 relevant articles published from 2013 to 2017, which were evaluated in terms of the effect of mineralocorticoid receptor antagonists in CSC treatment. Due to study protocol variability with different primary endpoints and follow-up periods, an in-depth comparison of the selected studies could not be performed. Moreover, the small study populations further limit their validity in this per se heterogeneous disease spectrum. Despite these limitations, current data indicate that aldosterone antagonists are effective in decreasing subretinal fluid and improving visual acuity in patients with CSC. The selective aldosterone antagonist eplerenone with a low side effect profile is a treatment option in patients with non-resolving CSC. CONCLUSION Prospective, randomized studies with uniform disease definition and study criteria are necessary to validate the therapeutic effect and to determine the ideal time of intervention and treatment duration.
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Affiliation(s)
- B Cakir
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - H Agostini
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - C Lange
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland.
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