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van Dijk EHC, Boon CJF. Serous business: Delineating the broad spectrum of diseases with subretinal fluid in the macula. Prog Retin Eye Res 2021; 84:100955. [PMID: 33716160 DOI: 10.1016/j.preteyeres.2021.100955] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/14/2021] [Accepted: 02/19/2021] [Indexed: 02/08/2023]
Abstract
A wide range of ocular diseases can present with serous subretinal fluid in the macula and therefore clinically mimic central serous chorioretinopathy (CSC). In this manuscript, we categorise the diseases and conditions that are part of the differential diagnosis into 12 main pathogenic subgroups: neovascular diseases, vitelliform lesions, inflammatory diseases, ocular tumours, haematological malignancies, paraneoplastic syndromes, genetic diseases, ocular developmental anomalies, medication-related conditions and toxicity-related diseases, rhegmatogenous retinal detachment and tractional retinal detachment, retinal vascular diseases, and miscellaneous diseases. In addition, we describe 2 new clinical pictures associated with macular subretinal fluid accumulation, namely serous maculopathy with absence of retinal pigment epithelium (SMARPE) and serous maculopathy due to aspecific choroidopathy (SMACH). Differentiating between these various diseases and CSC can be challenging, and obtaining the correct diagnosis can have immediate therapeutic and prognostic consequences. Here, we describe the key differential diagnostic features of each disease within this clinical spectrum, including representative case examples. Moreover, we discuss the pathogenesis of each disease in order to facilitate the differentiation from typical CSC.
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Affiliation(s)
- Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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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: 110] [Impact Index Per Article: 27.5] [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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Lam WS, Creaney J, Chen FK, Chin WL, Muruganandan S, Arunachalam S, Attia MS, Read C, Murray K, Millward M, Spiro J, Chakera A, Gary Lee YC, Nowak AK. A phase II trial of single oral FGF inhibitor, AZD4547, as second or third line therapy in malignant pleural mesothelioma. Lung Cancer 2019; 140:87-92. [PMID: 31901768 DOI: 10.1016/j.lungcan.2019.12.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Currently, there is no optimal salvage therapy for patients with malignant pleural mesothelioma (MPM) who relapse after treatment with first-line chemotherapy. In line with the strong preclinical rationale for targeting fibroblast growth factor receptor (FGFR) signalling in malignant mesothelioma, we conducted a phase II study assessing the efficacy of AZD4547, an oral tyrosine multi-kinase FGFR 1-3 inhibitor, as a second or third-line treatment. MATERIALS AND METHODS We conducted a single-center, open-label, single-arm phase II study of AZD4547 in eligible patients with confirmed, measurable MPM and radiological progression after first or second-line systemic chemotherapy. Patients received continuous, twice-daily oral AZD4547 on a 3-weekly cycle. The primary end point was 6-month progression free survival (PFS6). Response was assessed with CT scan every 6 weeks according to the modified RECIST criteria for mesothelioma (mRECIST) and toxicities were also assessed. The study used a Simon's two-stage design: 26 patients would be recruited to the first stage and more than 7 (27 %) of 26 patients were required to achieve PFS6 to continue to stage two, for a potential total cohort of 55 patients. RESULTS 3 of 24 patients (12 %) were progression-free at 6 months. Hence, the study fulfilled stopping criteria regardless of further recruitment and warranted discontinuation. The most common toxicities (across all grades) were hyperphosphatemia, xerostomia, mucositis, retinopathy, dysgeusia, and fatigue. Maximum toxicities were grade 2 or below for all patients across all cycles. There was no association between tumour BAP1 protein loss and clinical outcomes. CONCLUSIONS The FGFR 1-3 inhibitor AZD4547 did not demonstrate efficacy in patients with MPM who had progressed after first line treatment with platinum-based chemotherapy.
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Affiliation(s)
- Wei-Sen Lam
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia; National Centre for Asbestos Related Diseases, University of Western Australia, Level 5, QQ Block, QEII Medical Centre, Western Australia, 6009, Australia.
| | - Jenette Creaney
- National Centre for Asbestos Related Diseases, University of Western Australia, Level 5, QQ Block, QEII Medical Centre, Western Australia, 6009, Australia; Institute for Respiratory Health, University of Western Australia, Sir Charles Gairdner Hospital Avenue, Nedlands, Western Australia, 6009, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia.
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye institute), The University of Western Australia, Nedlands, Western Australia, 6009, Australia.
| | - Wee Loong Chin
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia; National Centre for Asbestos Related Diseases, University of Western Australia, Level 5, QQ Block, QEII Medical Centre, Western Australia, 6009, Australia; School of Biomedical Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia; Medical School, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia.
| | - Sanjeevan Muruganandan
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia.
| | - Sukanya Arunachalam
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye institute), The University of Western Australia, Nedlands, Western Australia, 6009, Australia.
| | - Mary S Attia
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye institute), The University of Western Australia, Nedlands, Western Australia, 6009, Australia.
| | - Catherine Read
- Institute for Respiratory Health, University of Western Australia, Sir Charles Gairdner Hospital Avenue, Nedlands, Western Australia, 6009, Australia.
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia.
| | - Michael Millward
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia; Medical School, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia.
| | - Jon Spiro
- Department of Cardiology, Royal Perth Hospital, Wellington Street, Perth, Western Australia, 6000, Australia.
| | - Aron Chakera
- Renal Unit, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia.
| | - Y C Gary Lee
- Institute for Respiratory Health, University of Western Australia, Sir Charles Gairdner Hospital Avenue, Nedlands, Western Australia, 6009, Australia; Medical School, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia.
| | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, 6009, Australia; National Centre for Asbestos Related Diseases, University of Western Australia, Level 5, QQ Block, QEII Medical Centre, Western Australia, 6009, Australia; Institute for Respiratory Health, University of Western Australia, Sir Charles Gairdner Hospital Avenue, Nedlands, Western Australia, 6009, Australia; Medical School, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia.
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