Assessment of central serous chorioretinopathy by optical coherence tomography and multifocal electroretinography

Morphological and Functional Correlations in Acute Central Serous Chorioretinopathy

PURPOSE

We evaluate morphological and functional correlations in patients with acute central serous chorioretinopathy (CSC).

METHODS

A prospective study was conducted on 50 patients with an acute CSC episode lasting less than 3 months. At baseline, assessments included optical coherence tomography (OCT), best-corrected visual acuity (BCVA), contrast sensitivity (CS), microperimetry (MP), and multifocal electroretinography (mfERG). A correlation analysis between OCT morphological parameters (maximal subretinal fluid height (SRF), central retinal thickness (CRT), and macular volume (MV)) and functional parameters was conducted on the affected eye for each patient.

RESULTS

Among the morphological parameters, SRF showed the strongest correlations with functional parameters (r absolute value range = 0.10-0.70). Weak correlations were observed between BCVA and morphological parameters (r absolute value range = 0.14-0.26). Average retinal sensitivity (MP-A) was the functional parameter displaying the most robust negative correlation with morphological parameters (r absolute value range = 0.61-0.70). In contrast, average contrast sensitivity (CS-A) and mfERG average amplitude density in the first (mfERG-A1) and second (mfERG-A2) ring showed weak to moderate (r absolute value range = 0.35-0.56) yet statistically significantly nonzero correlations.

CONCLUSIONS

SRF and CRT could serve as the most representative morphological proxies for visual function deficit in acute CSC patients. Retinal sensitivity, as measured by MP, may be superior to BCVA in clinical research studies or when an in-depth visual function evaluation is needed.

Central Serous Chorioretinopathy: An Update on the Current State of Management

Central serous chorioretinopathy (CSCR) is a relatively common retinal disorder that leads to central vision impairment, often with a high recurrence rate. The exact etiology and pathogenetic mechanisms have not been fully elucidated but are likely to be associated with hyperpermeability of the choroidal capillaries and failure of the retinal pigment epithelium (RPE), leading to serous detachment of the neurosensory retina. Multimodal imaging plays a critical role in the diagnostic approach and monitoring of CSCR. Fortunately, the natural course of the disease is usually self-limiting, with spontaneous resolution and total fluid reabsorption. However, some patients may exhibit recurrences or persistent subretinal fluid (chronic CSCR), leading to progressive and irreversible RPE atrophy or photoreceptor damage. Thus, to prevent permanent visual loss, individualized treatment should be considered. Recent developments in the diagnostic and therapeutic approach have contributed to better outcomes in patients with CSCR. More studies are required to improve our understanding of epidemiology, pathogenesis, diagnosis, and treatment, with a significant impact on the management of this challenging clinical entity. The purpose of this review is to summarize the current knowledge about the clinical features, diagnostic workup, and therapeutic approach of CSCR.

Functional Outcomes and Safety Profile of Trans-Foveal Subthreshold Micropulse Laser in Persistent Central Serous Chorioretinopathy

Our study evaluated visual function changes after subthreshold micropulse laser (SML) treatment in persistent central serous chorioretinopathy (CSC) and SML safety profile. We conducted a prospective study including 31 fovea-involving CSC patients. The natural course was observed for the first 3 months, SML was performed at 3 months, and SML effectiveness was observed at 6 months. At all three clinical visits, optical coherence tomography (OCT), best corrected visual acuity (BCVA), contrast sensitivity (CS) in five spatial frequencies (1.5, 3.0, 6.0, 12.0, and 18.0 cycles per degree (cpd)), microperimetry (MP), and multifocal electroretinography (mfERG) were performed. The SML safety profile was evaluated with functional and morphological parameters. In the cohort of all CSC patients treated with SML, the statistically significant average improvement was observed in BCVA (p = 0.007), CS-1.5 (p = 0.020), CS-3.0 (p = 0.050), CS-12.0 (p < 0.001), CS-18.0 (p = 0.002), CS (CS-A) (p < 0.001), MP in the central ring (MP-C) (p = 0.020), peripheral ring (MP-P) (p = 0.042), and average retinal sensitivity (MP-A) (p = 0.010). After the SML treatment, mean changes in mfERG amplitudes and implicit times in our cohort were not statistically significant. No morphological or functional adverse effects of SML treatment were observed. SML treatment in persistent CSC episodes leads to significant functional improvement and has an excellent safety profile.

Wide-field OCT-angiography assessment of choroidal thickness and choriocapillaris in eyes with central serous chorioretinopathy

Purpose: To assess wide-field changes in choroidal thickness and choriocapillaris in eyes with central serous chorioretinopathy (CSC) compared with the fellow eyes and eyes from healthy individuals using wide-field swept-source (SS) OCT-Angiography (OCTA).

Methods: A cross-sectional study in which 68 eyes from 34 individual patients affected by unilateral CSC and 32 eyes of 32 age- and sex-matched healthy subjects were evaluated. All subjects underwent wide-field SS-OCTA examination to quantify choroidal thickness and vascular density of the choriocapillaris. To assess the wide-field changes, we developed five 4-by-4 mm square regions located in the posterior pole and in the four quadrants of the peripheral retina (superotemporal, inferotemporal, superonasal, and inferonasal subfields, respectively).

Results: The choroidal thickness of eyes with CSC was greater than that of the fellow eyes in the central and inferonasal subfields (p < 0.001 for the central subfield and p = 0.006 for the inferonasal subfield, respectively). Compared with the choroidal thickness of healthy eyes, that of patients with CSC were significantly greater in all the subfields (p < 0.05 for the fellow eyes and p < 0.05 for eyes with CSC, respectively). Compared with that of healthy eyes, the vascular density of choriocapillaris in eyes of patients with CSC were significantly greater in the central and superotemporal subfields (p < 0.05 for the fellow eyes and p < 0.05 for eyes with CSC, respectively). In the central region, the vascular density of choriocapillaris of the fellow eyes was greater than eyes with CSC (p = 0.023).

Conclusion: CSC appears to be a bilateral disease with asymmetric manifestations. Local factors of the diseased eyes may play an important role in the development of CSC, during which dynamic and regional changes in the choriocapillaris may have happened. Wide-field swept-source OCTA provided a useful tool to study the pathogenesis of CSC.

The Temporal Topography of Central Serous Chorioretinopathy in the Chinchilla Rabbits Induced by Intravenous Injection of Adrenaline: An in vivo Study

Purpose

To explore the temporal topography of the chorioretinopathy in an animal model of central serous chorioretinopathy (CSC) induced by intravenous injection of adrenalin in the Chinchilla rabbits.

Methods

Ten Chinchilla rabbits received a daily intravenous injection of adrenaline at 0.04 mg/kg for 8 weeks. Fluorescence fundus angiography (FFA) and electroretinogram (ERG) were performed every week afterwards to see whether there was fluorescence leakage in the fundus and to evaluate the retinal function. Indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were also conducted to detect the change of choroidal vessels. Finally, the eyes of the rabbits were enucleated to make the retinal sections for histological examination with hematoxylin–eosin (HE) staining.

Results

Within 8 weeks of the adrenalin administration, 7 out of the 10 rabbits showed different degrees of fluorescence leakage on FFA. The leakage was more obvious during 2–3 weeks after the adrenalin administration. With the progress of disease, the leakage subsided gradually and a scar-like lesion formed. ICGA revealed the local choroidal ischemia and the dilated choroidal vessels. An obvious detachment of retina and an increased thickness of the choroid were found on OCT, which was most obvious 2 weeks after the adrenalin administration (P<0.01). ERG revealed no obvious decline of the b-wave amplitude before and after the adrenalin administration (P>0.05). A circumscribed retinal detachment, the depigmentation of retinal pigment epithelium and enlarged choroidal vessels were shown by the histological examination.

Conclusion

The temporal topography of the chorioretinopathy in the Chinchilla rabbits by intravenous injection of adrenaline somewhat mimicked that of the human CSC, which could enhance its application in the exploration for the pathogenesis and the therapeutic measures for human CSC.

Longitudinal multimodal functional macular analysis after half-dose photodynamic therapy for central serous chorioretinopathy

BACKGROUND

Half-dose photodynamic therapy (HD-PDT) has been widely used for central serous chorioretinopathy (CSC) with good anatomical results. However, long-term functional outcomes after this treatment remain uncertain. This study aimed a longitudinal multimodal macular assessment, correlating functional and anatomical outcomes.

METHODS

This is a retrospective study performed in a tertiary referral center including 111 eyes from 95 CSC patients. Data on best corrected visual acuity (BCVA), central macular thickness (CMT), central retinal sensitivity (CRS) using microperimetry (MP) and multifocal electroretinography (mfERG) at baseline and 3, 6, 12, 18, 24, 36, 48 and 60 months after treatment were registered. A correlation analysis was performed.

RESULTS

Mean follow-up was 34.5 ± 26.3 months. A significant improvement in BCVA and CMT was registered in all the visits. CRS significantly improved until 24 months (p<0.001 at 12 months, p<0.05 at 24 months), worsening afterwards. The mfERG amplitude of N1 and P1 waves significantly improved in the first 12 months, aggravating afterwards. The implicit time improved until 24 months, deteriorating after 48 months. This long-term decline was also described in some inactive untreated fellow eyes CONCLUSIONS: : A multimodal longitudinal analysis of CSC patients after HD-PDT shows that, after the first 12 to 24 months, the significant sustained improvement in BCVA and CMT is not paired by a sustained improvement in macular sensitivity or electrical response. This long-term functional deterioration might result from the disease itself and not directly from the treatment.

Multifocal electroretinography-assisted anatomical and functional evaluation of subthreshold green laser in acute central serous chorioretinopathy

Purpose:

To compare observation versus subthreshold green laser (STL) in acute central serous chorioretinopathy (CSC) in terms of anatomical and functional outcomes.

Methods:

Prospective randomized interventional study. 30 eyes with the first episode of acute CSC underwent complete ophthalmologic examination, measurement of best-corrected Snellen visual acuity (BCVA), contrast sensitivity (CS), fundus fluorescein angiography (FFA), spectral-domain optical coherence tomography (SD-OCT), and multifocal electroretinography (mfERG) at baseline. Patients were randomized equally to group A (observation) or group B (STL using 532 nm wavelength applied to the leakage point). Outcome measures included BCVA, CS, central foveal thickness (CFT), and mean macular thickness (MMT) on SD-OCT and P1 amplitude and implicit time (IT) on mfERG. Patients were followed up for 6 months.

Results:

Mean BCVA was comparable between the two groups on follow up; however, mean CS was significantly higher in group B at 6 months (P = 0.032). CFT was significantly lower in group B at 1 month (P = 0.001) and 3 months (P = 0.049); however, this difference was not maintained at 6 months (P = 0.265). P1 amplitude and IT in all 5 rings were comparable between the two groups at baseline. On follow up, P1 amplitude of ring 1 became significantly higher in group B at 3 months (P = 0.036) and 6 months (P = 0.022).

Conclusion:

Immediate treatment of acute CSC with STL, as compared to conservative management, leads to more rapid resolution on SD-OCT and superior functional outcomes as evidenced by CS and mfERG.

Pattern electroretinography in patients with unilateral acute central serous chorioretinopathy

BACKGROUND

To evaluate the pattern electroretinography (PERG) in patients with acute central serous chorioretinopathy (CSCR) at baseline and after spontaneous resolution.

METHODS

A total of 32 patients (mean ± SD age: 38.8 ± 8.2 years, 71.9 per cent female) with unilateral acute CSCR and spontaneous resolution during follow-up period were included. The unaffected eyes of the study patients comprised the control group. The best-corrected visual acuity, PERG and optical coherence tomography findings were recorded both at baseline and following spontaneous resolution at two to four months.

RESULTS

The P50 and N95 amplitudes of the affected eyes were significantly lower than the control group both at baseline and after CSCR resolution (p < 0.001 for each). A significant increase was noted in both P50 and N95 amplitudes of the affected eyes from baseline to post-resolution (p < 0.001 for each). Subfoveal choroidal thickness was significantly higher in the affected eyes as compared with control eyes both at the baseline and after CSCR resolution along with a significant decrease in the affected eyes from baseline to post-resolution (p < 0.001 for each). The central retinal thickness was higher in the affected eyes as compared with the control eyes at baseline (p = 0.009), along with a significant decrease in the affected eyes from baseline to post-resolution (p < 0.001). Between the baseline P50 amplitude and the visual acuities of the affected eyes, a strong correlation was noted at baseline (r = -0.691, p < 0.001) and a moderate correlation was noted after CSCR resolution (r = -0.422, p = 0.031).

CONCLUSIONS

In conclusion, our findings revealed an association of CSCR with impaired P50 and N95 amplitudes and a significant improvement but not a complete recovery in both parameters after CSCR resolution. Our findings emphasise potential utility of PERG in the electrophysiological evaluation of functional impairment in CSCR patients and the likelihood of P50 amplitude to have a prognostic value in CSCR.

Combined Technique and Its Clinical and Pathogenetic Evaluation in Treatment of Central Serous Chorioretinopathy Using Subthreshold Microimpulse Laser Irradiation with a Wavelength of 577 nm in Combination with Injections of Platelet Autoplasma

Background. Lack of a holistic understanding of the etiology and pathogenesis of central serous chorioretinopathy (CSH), which determines the conduct of pathogenetic therapy, as well as the lack of effectiveness of treatment methods aimed at developing new pathology methods.

Aims. To conduct a comparative therapeutic potential of a combination of subthreshold micropulse laser irradiation (SMILV) with a course of injection of autologous plasma enriched with platelets (TP) in CSH. To evaluate the effectiveness of SMILV with a wavelength of 577 nm with wing-injection injections of TP compared with SMIV monotherapy in the treatment of CSH. Consider issues of modern treatment of CSH, as well as determine the levels of cytokines in the tear fluid of patients with CSH before and after SMILV and SMILV + TP treatment.

Methods and methods. The study was conducted on 60 patients (60 eyes) with CSH. Patients were divided into 2 groups: in the comparison group, patients received treatment only SMILV wavelength 577 nm, and in the experimental group – SMILV followed by the introduction of TP. TP was prescribed after 72 hours, 3 injections in the region of the pterygomaxillary fossa on the side of damage to the eyes, with an interval between injections of 72 hours.

SMILV was performed on a Supra 577 nm laser machine (Quantel Medical, France) over the entire area of macular edema. Conclusion. Comparative analysis of clinical and functional results of treatment of central serous chorioretinopathy SMILV with a wavelength of 577 nm and a combination of SMILV with injections of autologous plasma enriched with platelets and the outcome of the disease revealed a greater effectiveness of combining SMILV with a course of injections of autologous plasma enriched with platelets.

What is new in central serous chorioretinopathy?

Central serous chorioretinopathy (CSCR) is considered a benign, self-limiting disease. However, as many as third of the patients have recurrent episodes or chronic disease that may cause significant functional impairment. New diagnostic tools and new treatment modalities are emerging in order to improve the functional outcomes of these patients. Spectral domain optical coherence tomography (SD-OCT) has the ability to image individual layers of the retina and choroid. SD-OCT images in CSCR patients have demonstrated increased subfoveal thickness measurements, high reflective deposits in areas of subretinal precipitates and changes in the Retinal pigment epithelium layers of the asymptomatic eyes of patients with supposedly unilateral CSCR. A positive correlation was found between the level of distribution to the layer of inner segment/outer segment junction of the photoreceptors and the visual impairment. Fundus autoflouresence images show a wide variety during different stages of the disease in CSCR patients. Minimal abnormalities during the early stages are followed by hyperautofluoresence in the detached area in later stages, often in a manner of inferior gravitation and at the borders of the detachments. The chronic phase is characterized by varying degrees of atrophy and areas of decreased autofluorescence surrounding areas of chronic leaks. These changes help differentiate an active disease from an inactive state. Multifocal electroretinography (mfERG) has the ability to demonstrate a persistent depression despite the resolution of subretinal detachments. It is therefore being investigated as a follow up tool for patients with chronic CSCR. An excellent correlation was found between changes in mfERG and visual function. Macular microperimetry, measuring retinal sensitivity within the central visual field, is intended to compensate for the underestimation of visual impairment in patients with macular diseases. Reduced retinal sensitivity was found in areas of previous subretinal fluids in CSCR patients. The device can also serve as a follow up tool in these patients. Regarding treatment in CSCR patients, focal argon laser photocoagulation treatment may be applied to small extrafoveal leaks. However, the main purpose of this treatment is to shorten disease duration, with no advantage over observation regarding final visual outcome, rate of progression to chronic CSCR or number of recurrences. Photodynamic therapy (PDT) with verteporfin has been shown to completely resolve serous detachment in 60%-80% of patients and to have a partial affect in the remaining patients. Reduced-fluence treatment is replacing full-fluence therapy in order to minimize side effects with no accompanying reduced effectiveness. Visual acuity is also improved following reduced-fluence PDT compared to placebo. It has also been found that patients with intense hyperfluorescence are more likely to show resolution of accumulating fluid compared to patients with mild or no leakage observed on indocyanine-green angiography prior to treatment. Regarding newer treatment modalities, intravitreal injections of anti-vascular endothelial growth factor agents have a limited effect in patients with CSCR. Recent reports have not demonstrated an advantage for this treatment in regards to anatomic and functional outcome. Micropulse diode laser was not proven to be safer or more effective than argon laser or PDT. Corticosteroid antagonists, not tested in controlled trials, may have a beneficial effect in patients with CSCR. Aspirin may also play a role in treating these patients, with rapid recovery of visual acuity and reduced number of recurrences observed. In conclusion, imaging is evolving rapidly while the clinical implications of these new imaging modalities are less clear. Large randomized trials investigating different treatment modalities are still lacking.

Angiographic characteristics of central serous chorioretinopathy in an Egyptian population

AIM

To describe and analyze the demographic characteristics and to determine the angiographic features of acute central serous chorioretinopathy(CSCR) in an Egyptian population.

METHODS

A series of consecutive patients presenting with acute idiopathic CSCR to Mansoura Ophthalmology Center Mansoura University who underwent fluorescein angiography (FA) within a 3-year-period (between January 1, 2007 and December 31, 2009) was retrospectively studied. Patient demographics and angiographic features were studied. Results were compared to those of other Western and Asian populations.

RESULTS

Fluorescein angiograms of 86 patients were analyzed. 91% were males. The age range of patients was 24 - 49 years, with a mean age of (38±6) years. The right eye was the presenting eye in 47% of patients. Eighty-seven percent of eyes showed delayed choroidal filling. Thirty-five percent of patients had more than one point of leakage. The macula was the most common site of fluorescein leakage seen in 79% of patients. Peripheral leakage was seen in 14% of patients while peripapillary leakage was seen in 12% of patients. The inkblot leakage pattern was found in 53% of patients. The presenting eye had RPE atrophic changes in 84% of cases. The other eye was assessed in 44 patients (51%). Fifty-five percent of them had signs of RPE atrophic changes.

CONCLUSION

In the Egyptian population, CSCR is seen at younger age with higher male-to-female ratio and more frequent smokestack leaks than other populations. Despite younger age group, this series of patient showed higher frequency of bilateral and multifocal disease compared to other studies. Roles of psychological stress and choroidal ischemia in pathogenesis of CSCR need further evaluation.

Central serous chorioretinopathy: update on pathophysiology and treatment

Recent technological advances--new pathophysiological insights, new imaging techniques for diagnosis and management, and new treatments--have led to an improved understanding of central serous chorioretinopathy (CSC). The primary role of the choroid has become more widely accepted with widespread use of indocyanine green angiography. Optical coherence tomography (OCT), and particularly enhanced depth imaging OCT, demonstrate a thickened and engorged choroid. Adaptive optics, fundus autofluorescence, multifocal electroretinography, microperimetry, and contrast sensitivity testing reveal that patients with even a mild course suffer previously undetected anatomic and functional loss. Although focal laser and photodynamic therapy are the current standard of care for persistent subretinal fluid in CSC, they are not appropriate in all cases, and the optimal timing of intervention remains unclear.

Correlation of spectral domain optical coherence tomography findings in acute central serous chorioretinopathy with visual acuity

Purpose

To evaluate the structural changes in the acute phase of central serous chorioretinopathy and after its resolution, using spectral domain optical coherence tomography, to correlate these tomographic changes with visual acuity (VA).

Method

This was a prospective study of 100 consecutive patients with acute central serous chorioretinopathy. It was based on presenting the best-corrected VA, divided into three groups (Group 1, n = 36, VA 6/6; Group 2, n = 49, VA 6/9–6/18; Group 3, n = 15, VA > 6/18). All patients underwent fundus evaluation followed by fluorescein angiography and spectral domain optical coherence tomography.

Results

The mean age of the patients was 40 ± 7.17 years. The mean log MAR VA was 0.176 ± 0.0185. Single pigment epithelial detachment (PED), and multiple discrete and multiple confluent PEDs were seen in 21%, 17%, and 32% of the eyes, respectively. The location of the PED was subfoveal in 35% of the eyes. The presence of subretinal fibrin and a rough undersurface of the neurosensory retina were noted in 61% and 64% of the eyes, respectively. On en-face scanning, a break in the walls of the PED and overlying fibrin were seen in 32.8% and 45% of the eyes, respectively. The mean subretinal fluid height at the fovea was 279.11 ± 148.78 μ. The mean outer nuclear layer thickness during the active stage was 95.10 μ and during the resolved stage, it was 77.69 μ (P = 0.012). The average photoreceptor lengths were 73.1 μ, 84.6 μ, and 94.9 μ in groups 1, 2, and 3, respectively, in the acute phase; and 69.5 μ, 70.8 μ, and 61.6 μ, respectively, after resolution (P = 0.013, P = 0.010, and P = 0.011).

Conclusion

In the acute phase of the disease, poorer VA showed statistically significant association with greater dimensions of subretinal fluid – particularly, greater subretinal fluid height and thinning of the outer nuclear layer at the fovea. The presence of fibrin, subretinal precipitates, subfoveal location, or type of PED did not have any association with poor VA. In resolved central serous chorioretinopathy, poorer VA was associated with a persistently thinner outer nuclear layer, shorter photoreceptor lengths, and inner and outer segment junction atrophy.

Fundus Autofluorescence and Spectral Domain OCT in Central Serous Chorioretinopathy

Background. To describe the standard autofluorescence (FAF), the near infrared autofluorescence (NIA) and optical coherence tomography (OCT) patterns in central serous chorioretinopathy, correlating them with fluorescein angiography. Methods. Cross-sectional observational study, in which patients with at least seven months of CSC underwent ophthalmologic examination, fundus photography, FAF, NIA, fluorescein angiography (FA), and spectral-domain OCT. Results. Seventeen eyes of thirteen patients were included. The presentation features were a mottled hyperFAF in the detached area and areas with pigment mottling. NIA images showed areas of hyperNIA similar to FAF and localized areas of hypoNIA, which correlated with the points of leakage in the FA. OCT showed pigment epithelium detachment at the location of these hypoNIA spots. Discussion. FAF showed increased presence of fluorophores in the area of retinal detachment, which is believed to appear secondary to lipofuscin accumulation in the RPE or the presence of debris in the subretinal fluid. NIA has been related to the choroidal melanin content and there were areas of both increased and decreased NIA, which could be explained by damage ahead the retina, basically RPE and choroid. These findings, along with the PEDs found in the areas of hypoNIA, support the notion of a primary choroidal disease in CSC.

Visual functions after laser photocoagulation in central serous chorioretinopathy

The authors evalute the visual functions of patients with unilateral central serous chorioretinopathy (CSC) and compare them with their non-affected eye and with a control group. Fourteen patients with CSC treated with direct laser-photocoagulation were examined preoperatively and followed-up, up to 2 years postoperatively. Baseline best corrected visual acuity (BCVA) and contrast sensitivity (CS) of both eyes of patients was significantly lower in comparison with the controls. BCVA and CS in affected eyes were significantly lower compared to the fellow eye of patients. The final BCVA and CS of patients did not differ significantly from the controls, except CS of affected eyes in the spatial frequency of 3.69 c/deg. Two years after laser treatment, there were only nonsignificant differences of both photopic full-field electroretinography (phERG) and multifocal electroretinography (mfERG) responses between the treated, the nonaffected eye of the patients and the control group with exception of a significantly longer P1 implicit time in the parafoveolar region in affected eyes. Colour discrimination was normal in 85.8% of affected eyes of the patients. Despite a significant improvement of macular function in CSC eyes, functional examination methods do not prove complete resolution of function 2 years after laser-treatment.

Electroretinographic findings in transplant chorioretinopathy

Aim:

Transplant chorioretinopathy is a rare complication following solid organ or bone marrow transplantation and can result in severe vision loss. This series presents electroretinogram (ERG) results in patients with this condition.

Methods:

Patients who presented with bilateral vision loss following bone marrow or solid organ transplantation were identified. A complete ophthalmologic examination, fundus photography, and fluorescein angiography (FA) were performed. Full-field ERG was obtained in all patients and a multifocal ERG (mfERG) was obtained in two patients.

Results:

Four patients were identified. All patients had bilateral vision loss and displayed a characteristic pattern of mottled hyperfluorescence on FA. Three patients developed progressive vision loss ranging from 20/60 to hand motions whereas one retained 20/40 vision. All patients exhibited moderate to severe cone dysfunction, while the degree of rod abnormalities was varied. Two patients with severe cone dysfunction showed mild clinical changes initially, but later developed progressive vision loss and chorioretinal atrophy.

Conclusion:

Transplant chorioretinopathy patients undergoing ERG testing show cone dysfunction with a variable degree of rod dysfunction. ERG abnormalities preceded the visual acuity and clinical changes in two patients, suggesting that ERG may be a helpful predictor of the clinical course in this rare disease.

Correlation between functional and anatomical assessments by multifocal electroretinography and optical coherence tomography in central serous chorioretinopathy

To evaluate the correlation between functional and anatomical assessments with multifocal electroretinography (mfERG) and optical coherence tomography (OCT) in patients with acute central serous chorioretinopathy (CSC). Thirty-four eyes of 34 patients with acute CSC underwent mfERG and OCT examinations. First-order mfERG N1 and P1 response amplitudes and latencies were analyzed.OCT parameters measured included central subretinal fluid (SRF) thickness, central retinal thickness, total central foveal thickness, vertical, and horizontal diameters of SRF, and macular volume. Correlation analyses were performed between best-corrected visual acuity (BCVA), mfERG parameters, and OCT measurements. Correlation analysis showed that logMAR BCVA was significantly correlated with mfERG N1 amplitudes of rings 1 and 2 (P = 0.006), N1 latency of ring 4 (P = 0.012), and P1 latency of ring 1 (P = 0.036). No significant correlation was observed between logMAR BCVA and any of the OCT measurements. For the correlation between mfERG parameters and OCT measurements, mfERG N1 and P1 latencies of the paracentral rings were significantly correlated with the central SRF thickness (P < or = 0.024), diameters of the SRF (P < or = 0.018), and macular volume (P < or = 0.030). MfERG responses but not OCT measurements correlated with logMAR BCVA in patients with acute CSC. The amount of SRF nonetheless correlated with the mfERG N1 and P1 latencies of the paracentral rings, suggesting that impairment in the conduction of electrical responses in the paracentral macula is proportional to the severity of serous macular detachment in CSC. MfERG and OCT can complement each other in the functional and anatomical assessments in CSC.

Detection of retinal metabolic stress resulting from central serous retinopathy

PURPOSE

To test whether eyes with central serous retinopathy have elevated retinal flavoprotein fluorescence (FPF) using a novel clinical imaging method.

METHODS

Three male patients with unilateral central serous retinopathy were examined for FPF at 535 nm induced by 1-msec flashes of 467 nm light. FPF was captured with an electron multiplying charged-coupled device camera with a 512 x 512 pixel chip. Average intensity of retinal FPF for each affected eye was compared with the contralateral, unaffected eye and with six age-matched control eyes by analyzing histograms of pixel intensities plotted for each eye.

RESULTS

For each patient, the central serous retinopathy-affected eye had a significantly greater retinal FPF when compared with the retinal FPF of the unaffected eye. Eyes affected with central serous retinopathy had retinal FPF values that averaged 98% greater than the retinal FPF of age-matched control eyes.

CONCLUSION

Flavoprotein fluorescence analysis may be useful for rapidly and noninvasively identifying metabolic tissue stress of central serous retinopathy.

Smokestack leak in central serous chorioretinopathy

BACKGROUND

To study the demography, various morphological patterns and fluid dynamics of the smokestack leak by fluorescein angiography (FA) in central serous chorioretinopathy (CSC).

METHODS

Part I (clinical): review of the medical records and angiographic documents of 69 consecutive cases of CSC with smokestack leak. Part II (experimental): documentation of the movement of various concentrations of fluorescein dye due to convection currents in a laboratory model that roughly represents a closed chamber similar to that of CSC in human eyes.

RESULTS

The clinical study (Part I) revealed that 14.40% of 479 consecutive cases had smokestack leak, of which 70% occurred in first acute episode (p-value: <0.001), 27.14% in acute recurrent episodes (50% fresh leak) and 2.85% in chronic stage. Patients were predominantly male (84.05%) with a median age of 34.00 +/- 8.14 years. The median symptom duration excluding the chronic cases was 15 +/- 34.28 days. This type of leak was mostly (48.57%) seen in medium-sized CSC, and the majority were in the parafoveal superonasal quadrant (31.42%). The ascending type of leak was predominant (94.28%). In four eyes, an atypical pattern and in two eyes more than one smokestack leak were seen within the same detached area. The experimental study (Part II) demonstrated that fluid containing a low concentration of fluorescein ascended due to convection currents, whereas highly concentrated dye descended.

CONCLUSIONS

The clinical study revealed smokestack leaks to be significantly more common in a primary acute episode, and they usually develop in the early part of the acute phase of the disease (average duration 15 +/- 34.28 days). Rarely, this type of leak can occur in the chronic stage, and multiple leaks may develop in the same detached space. The various patterns of dye movement due to convection currents in the experimental model resembled the dye movement in certain cases of CSC of the present series. The experimental study also hinted at the probability of drainage of unbound fluorescein molecules along with protein-laden heavy fluid in downward spread of the leak.