Central serous chorioretinopathy associated with narcolepsy

Bidirectional Mendelian randomization to explore the causal relationships between schizophrenia and narcolepsy

INTRODUCTION

This study employs the Mendelian Randomization (MR) approach to explore the potential causal relationship between schizophrenia and the risk of developing narcolepsy.

METHODS

Genome-Wide Association Studies (GWAS) data from European populations were used to identify independent genetic variants associated with schizophrenia and narcolepsy, which were then used as instrumental variables in the analysis. The inverse variance weighting (IVW) method was performed to validate the findings. Effect sizes were presented as odds ratios (OR) and beta coefficients (β).

RESULTS

The IVW analysis showed no significant causal relationship between schizophrenia and narcolepsy (OR: 1.002, 95 % CI: 0.996-1.007, P = 0.531). Likewise, the reverse analysis did not find any significant causal association (OR: 1.059, 95 % CI: 0.717-1.567, P = 0.421). Sensitivity analyses further confirmed the robustness of these findings.

CONCLUSION

The MR analysis does not provide evidence for a bidirectional causal relationship between schizophrenia and narcolepsy. Further research is needed to elucidate the underlying mechanisms and to identify potential targets for intervention.

Central Serous Chorioretinopathy in a Case of Regressed Familial Retinoblastoma

Purpose

To present a case of central serous chorioretinopathy (CSC) in association with regressed familial retinoblastoma.

Case Report

A 23-year-old man with regressed unilateral familial retinoblastoma in his left eye presented with decreased vision of the left eye since two months ago. The patient had undergone chemotherapy and cryotherapy for the treatment of retinoblastoma 20 years ago. In the left eye, funduscopy disclosed regressed mass of retinoblastoma, inferonasal to the optic disc, and focal subfoveal neurosensory detachment. Optical coherence tomography (OCT) and fluorescein angiography revealed CSC. As there was no sign of recurrence of retinoblastoma and retinal findings did not show late-onset chemotherapy-related retinopathy, the patient was diagnosed with CSC and followed up. After two months, visual acuity of the left eye improved, and repeated macular OCT revealed absorption of the subretinal fluid.

Conclusion

Subretinal fluid accumulation in a patient with regressed retinoblastoma is not always a sign of tumor recurrence or a treatment-related retinopathy.

An Update on the Diagnosis and Management of Central Serous Chorioretinopathy

Central serous chorioretinopathy (CSC) is a complicated disease with still unclear causes, pathogenesis and management strategy despite active research. CSC has been traditionally considered as a self-limiting disease where spontaneous recovery occurs in 90% of the patients within a few months. This proclaimed "benign" nature of CSC, however, has been queried by increasing scientific evidence that permanent photoreceptors damage and neurosensory-cystoid degeneration of macula occur in the event of chronic CSC. CSC is probably not a benign disease. Treatments for CSC are still evolving. It is very difficult to define the proper timing for active treatment of CSC because it is not easy to define a universally accepted cut-off time point for active intervention. There is a recent suggestion that active CSC treatment should be considered if symptoms last longer than 3 months as atrophy of photoreceptors may occur as early as 4 months after initial presentation. The CSC patients may be stratified into two groups based on the initial presenting visual acuity and duration of symptom: the good visual prognosis group and the dubious visual prognosis group. The management may then be tailor-made based on the visual prognosis group. "Safety-enhanced'" photodynamic therapy (PDT) using lower doses and reduced fluence is still the mainstay of treatment. Newer treatment modalities like intravitreal anti-VEGF therapy, micropulsed diode laser treatment, and the use of corticosteroid antagonists do warrant further investigation. Combination therapies involving two or more of the above modalities of treatments may have a role to play in this actively researched area.