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Lange CA, Ohlmeier C, Kiskämper A, von Schwarzkopf C, Hufnagel H, Gruber M, Schworm B, Brocks U, Reinking F, Schreiner L, Miura Y, Grundel M, Lohmann T, Clemens CR, Gamulescu MA, Eter N, Grisanti S, Priglinger S, Spitzer MS, Walter P, Agostini HA, Stahl A, Pauleikhoff LJB. Clinical Landscape of Central Serous Chorioretinopathy in Germany: Retina.net CSC Registry Report Number 1. Ophthalmologica 2024; 247:95-106. [PMID: 38368867 DOI: 10.1159/000535930] [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: 09/12/2023] [Accepted: 12/11/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION The German Registry of central serous chorioretinopathy (CSC) collects data on CSC patients in a nationwide multicenter approach to analyze epidemiology, risk factors, clinical presentations, as well as diagnosis and treatment patterns. METHODS In this multicenter cohort study, patients with CSC were enrolled in nine tertiary referral centers in Germany between January 2022 and June 2023. After consenting to the study, demographic data, risk factors, reported symptoms, best-corrected visual acuity (BCVA), funduscopic findings, disease severity, and diagnostic and treatment decisions were recorded and analyzed. RESULTS A total of 539 eyes of 411 CSC patients were enrolled in this study including 308 males (75%) and 103 females (25%). Patients were predominantly of Caucasian origin and had a mean age of 55.5 years (IQR 41.0-70.0). 28% of eyes were classified as acute (<4 months duration) CSC, 28% as chronic (>4 months duration) CSC, 21% as inactive CSC, 11% as chronic atrophic CSC, and 12% as CSC with secondary CNV. 128 patients (31%) demonstrated bilateral CSC. The most common risk factors reported were psychological stress (52%), smoking (38%), arterial hypertension (38%), and a history of or current use of steroids (30%). Most frequently encountered symptoms included decreased visual acuity (76%), metamorphopsia (49%), relative scotoma (47%), blurred vision (19%), and dyschromatopsia (9%). The mean logMAR BCVA on initial examination was 0.2 (≈20/30, IQR 0.2-0.4) but showed significant variation with a tendency of lower BCVA in chronic cases. At the baseline visit, 74% of the overall cohort received no treatment, while 19% underwent local treatment and only 2% underwent systemic treatment. Of the local therapies, anti-VEGF injections were the most frequently performed procedure (33%, mainly for secondary CNV), followed by micropulse laser (28%), focal nonpulsed laser (23%), verteporfin photodynamic therapy (14%), and nonsteroidal anti-inflammatory eye drops (2%). Among intravitreal anti-VEGF agents, aflibercept was used most frequently, followed by bevacizumab and ranibizumab. CONCLUSION This registry represents one of the largest cohorts of European patients with CSC to date. Patient age and the proportion of women were higher than expected and bilateral active disease was lower than anticipated, highlighting that neither age nor gender should be overemphasized when diagnosing CSC. Therapeutic interventions are heterogeneous and include verteporfin photodynamic therapy, micropulse laser, and anti-VEGF injections in case of secondary CNV.
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Affiliation(s)
- Clemens A Lange
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
- Eye Center, Freiburg Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | | | - Anna Kiskämper
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
| | | | - Hinrich Hufnagel
- Eye Center, Freiburg Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Markus Gruber
- Eye Center, Freiburg Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Benedikt Schworm
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ulrike Brocks
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Reinking
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lisa Schreiner
- Department of Ophthalmology, University Hospital of Regensburg, Regensburg, Germany
| | - Yoko Miura
- Department of Ophthalmology, University of Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Milena Grundel
- Department of Ophthalmology Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Tibor Lohmann
- Department of Ophthalmology, RWTH University Hospital of Aachen, Aachen, Germany
| | - Christoph R Clemens
- Department of Ophthalmology, University of Münster Medical Center, Münster, Germany
| | | | - Nicole Eter
- Department of Ophthalmology, RWTH University Hospital of Aachen, Aachen, Germany
| | - Salvatore Grisanti
- Department of Ophthalmology, University of Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Martin S Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Walter
- Department of Ophthalmology, RWTH University Hospital of Aachen, Aachen, Germany
| | - Hansjürgen A Agostini
- Eye Center, Freiburg Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Andreas Stahl
- Department of Ophthalmology Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Laurenz J B Pauleikhoff
- Eye Center, Freiburg Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Oribio-Quinto C, Herranz-Heras JC, Burgos-Blasco B, Alarcon-Garcia AD, Fernández-Vigo JI. Clinical and multimodal imaging findings in a case of serous maculopathy with absence of retinal pigment epithelium (SMARPE). Eur J Ophthalmol 2024; 34:NP66-NP69. [PMID: 37038336 DOI: 10.1177/11206721231169310] [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] [Indexed: 04/12/2023]
Abstract
INTRODUCTION The differential diagnosis for serous SRF can involve diseases with widely different pathogenic mechanisms that can range from vascular ocular diseases to ocular tumours and paraneoplastic syndromes. Recently, van Dijk et al. have described in three patients a new entity which they have called serous maculopathy with an absence of retinal pigment epithelium (SMARPE). We hereby describe a case of this infrequent macular disease and report its characteristic findings on multimodal imaging. CASE DESCRIPTION We present the case of a 65-year-old hyperopic woman with a three-year history of visual acuity (VA) loss in her left eye. Prior optical coherence tomography (OCT) had revealed the presence of serous subretinal fluid that had shown no response to treatment with intravitreal injections. On swept source OCT angiography scan, no macular alterations in the retinal vascular plexus structure were noted and there was no evidence of choroidal neovascularization. Ultra-widefield fluorescence angiography of the left eye revealed an early hyperfluorescent macular spot corresponding to the area of absent RPE and late fluorescein pooling. On ultra-widefield indocyanine green angiography there were no central or peripheral abnormalities of choroidal vascularization. CONCLUSION This recently described entity should be considered as a differential diagnosis in persistent serous subretinal fluid. Multimodal imaging helps differentiate SMARPE from its main differential diagnoses, and care should be taken to identify and differentiate it from similar conditions to avoid unnecessary treatment with its possible side effects and complications.
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Affiliation(s)
| | - Juan Carlos Herranz-Heras
- Department of ophthalmology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - José Ignacio Fernández-Vigo
- Department of ophthalmology, Hospital Clínico San Carlos, Madrid, Spain
- Centro Internacional de Oftalmologia Avanzada, Madrid, Spain
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Park J, Hwang SH, Nam DH, Lee DY. Changes in Aqueous Concentrations of Various Cytokines after Intravitreal Bevacizumab Injection for Chronic Central Serous Chorioretinopathy. KOREAN JOURNAL OF OPHTHALMOLOGY 2023; 37:453-461. [PMID: 37899289 PMCID: PMC10721406 DOI: 10.3341/kjo.2023.0005] [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: 01/29/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 10/31/2023] Open
Abstract
PURPOSE This study aimed to investigate changes in cytokine levels after intravitreal bevacizumab injection in patients with chronic central serous chorioretinopathy (CSC). METHODS In a prospective interventional trial, 12 eyes from 12 patients with chronic CSC and six eyes from six patients who underwent cataract surgery were included as controls. Patients diagnosed as with CSC received a single intravitreal injection of bevacizumab (1.25 mg/0.05 mL). Aqueous humor samples were collected from the patients and controls. Best-corrected visual acuity and foveal thickness were evaluated, and aqueous samples were obtained before and 4 weeks after injection. The aqueous concentrations of interleukin (IL)-6, IL-8, interferon-induced protein (IP)-10, monocyte chemotactic protein (MCP)-1, platelet-derived growth factor (PDGF)-AA, and vascular endothelial growth factor (VEGF) were measured using a multiplex bead assay. RESULTS After injection, the foveal thickness decreased significantly from 328.08 μm (range, 210-477 μm) to 283.91 μm (range, 168-356 μm; p = 0.048), but the best-corrected visual acuity was not significantly different (p = 0.066). The aqueous levels of IL-8 increased significantly from 3.3 pg/mL (range, 1.5-8.3 pg/mL) to 4.7 pg/mL (range, 2.2-11.6 pg/mL) at 4 weeks after the injection (p = 0.046). The aqueous levels of VEGF decreased significantly from 31.4 pg/mL (range, 17.0-53.3 pg/mL) to 15.2 pg/mL (range, 7.7-21.5 pg/mL; p < 0.01). No significant changes in levels of IL-6 (p = 0.455), IP-10 (p = 0.055), MCP-1 (p = 0.076), and PDGF-AA (p = 0.339) were noted 4 weeks after injection. CONCLUSIONS In this study we found intravitreal bevacizumab injection decreased VEGF and increased IL-8 in the eyes of patients with chronic CSC. This study suggests the possibility that the pathogenesis of CSC may be related to abnormal circulation of the choroidal blood vessels through VEGF and IL-8 cytokine level changes.
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Affiliation(s)
- Jooye Park
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung Ha Hwang
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Heun Nam
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
| | - Dae Yeong Lee
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
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Oribio-Quinto C, Alarcón-García AD, Fuentes JE, Fernández-Vigo JI. Evaluation of the changes in choroidal macular anastomoses after photodynamic therapy and in the follow-up of central serous chorioretinopathy by en face optical coherence tomography. Photodiagnosis Photodyn Ther 2023; 43:103719. [PMID: 37487812 DOI: 10.1016/j.pdpdt.2023.103719] [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: 06/26/2023] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE To evaluate the changes in the choroidal macular anastomoses after photodynamic therapy (PDT) and in the follow-up of patients with central serous chorioretinopathy (CSCR) by en face optical coherence tomography (EF-OCT). METHODS Prospective study using EF-OCT images of patients with chronic CSCR treated by PDT with a minimum follow-up of 12 months and with the presence of at least two prominent anastomoses in the macula. Scans of 6 × 6 mm and 12 × 12 mm were made to assess the changes in choroidal macular anastomoses (defined as a diameter ≥150 µm) crossing the medial raphe. EF-OCT was performed before PDT and 3 days, 3 months and at the end of the follow-up after PDT. RESULTS The mean follow-up time was 23.6 ± 12.1 months. The mean number of anastomoses was 2.5 ± 1.1 in the baseline examination, being 2.3 ± 1.2 in the final examination, with no differences being observed (p = 0.110). A sub-analysis was performed to assess differences in the evolution of the anastomoses between active chronic CSCR and those in which the subretinal fluid (SRF) had been resolved, with no differences being observed in the number or caliber of anastomoses (p = 0.642 and p = 0.306). A significant decrease in the size of anastomoses was found at the 3-day (p<0.01) and 3-month (p = 0.032) visits, but not at the last follow-up visit (p = 0.156). CONCLUSIONS There was an early decrease in the size of the major macular choroidal anastomotic vessels after PDT treatment. Long-term studies are required to assess its evolution and its possible role in the etiopathogenesis of this disease.
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Affiliation(s)
- Carlos Oribio-Quinto
- Ophthalmology Department, Hospital Clínico San Carlos, Institute of Health Research (IdISSC), Profesor Martin Lagos s/n, Madrid 28040, Spain.
| | - Antonio Domingo Alarcón-García
- Ophthalmology Department, Hospital Clínico San Carlos, Institute of Health Research (IdISSC), Profesor Martin Lagos s/n, Madrid 28040, Spain
| | - Jacobo Enríquez Fuentes
- Ophthalmology Department, Hospital Clínico San Carlos, Institute of Health Research (IdISSC), Profesor Martin Lagos s/n, Madrid 28040, Spain
| | - José Ignacio Fernández-Vigo
- Ophthalmology Department, Hospital Clínico San Carlos, Institute of Health Research (IdISSC), Profesor Martin Lagos s/n, Madrid 28040, Spain; Centro Internacional de Oftalmología Avanzada, Madrid 28010, Spain
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Fikriyah L, Hidayati HB, Ardhi MS. Concomitant cavernous sinus thrombosis and central serous chorioretinopathy in a patient with total ophthalmoplegia and monocular blindness: a case report. Ann Med Surg (Lond) 2023; 85:946-950. [PMID: 37113961 PMCID: PMC10129092 DOI: 10.1097/ms9.0000000000000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/22/2022] [Indexed: 04/29/2023] Open
Abstract
Cavernous sinus thrombosis (CST) is an unusual condition that can result in high mortality and morbidity rate if not treated immediately. Case presentation An Indonesian male, 47 years old, presented with total right ocular ophthalmoplegia followed by blindness, headache, ptosis, periorbital swelling, and hypoesthesia over the left V1 region. MRI of the brain showed suitable cavernous thickening until the right orbital apex, which in contrast showed enhancement suggestive of right Tolosa-Hunt syndrome. The patient was treated with a high dose of steroids, but the patient's complaints did not improve. The patient underwent digital subtraction angiography and found CST. The optical coherence tomography was found to be central serous chorioretinopathy. He was treated with an antibiotic, anticoagulant, and extraction of the right maxillary molar was performed to remove the source of the infection. After 3 weeks, visual acuity and optical coherence tomography examination were improved. Discussion A comprehensive examination, such as digital subtraction angiography, is essential to confirm CST diagnosis for the patient to obtain the right therapy. This report highlighted the value of the prompt diagnosis of CST through neuroimaging and the importance of proper therapy in patient management. Conclusions Early diagnosis, comprehensive examination, and proper treatment of CST will increase good prognosis.
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Affiliation(s)
| | - Hanik Badriyah Hidayati
- Corresponding author: Department of Neurology, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Jalan Mayjend Prof. Dr. Moestopo No. 6-8, Airlangga, Gubeng, Surabaya, East Java, 60286, Indonesia. Tel.: +6231-5501670; fax: +6231-5022472. E-mail address: (H.B. Hidayati)
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Iovino C, Iodice CM, Pisani D, Rosolia A, Testa F, Giannaccare G, Chhablani J, Simonelli F. Yellow Subthreshold Micropulse Laser in Retinal Diseases: An In-Depth Analysis and Review of the Literature. Ophthalmol Ther 2023; 12:1479-1500. [PMID: 36933125 PMCID: PMC10164197 DOI: 10.1007/s40123-023-00698-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
Yellow subthreshold micropulse laser (YSML) is a retinal laser capable of inducing a biologic response without causing thermal damage to the targeted tissue. The 577-nm YSML is delivered to the retina abiding by different protocols in which wavelength, power, duration, spot size and number of spots can be properly set to achieve the most effective and safe treatment response in various chorioretinal disorders. The ultrashort trains of power modulate the activation of the retinal pigment epithelium cells and intraretinal cells, such as Müller cells, causing no visible retinal scars. Subthreshold energy delivered by YSML stimulates the production of the heat-shock proteins, highly conserved molecules that protect cells against any sort of stress by blocking apoptotic and inflammatory pathways that cause cell damage. YSML treatment allows resorption of the subretinal fluid in central serous chorioretinopathy and intraretinal fluid in various conditions including diabetic macular edema, postoperative cystoid macular edema and other miscellaneous conditions. YSML also seems to modulate the development and progression of reticular pseudodrusen in dry age-related macular degeneration. The aim of this review is to discuss and summarize the safety and efficacy of YSML treatment in retinal diseases.
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Affiliation(s)
- Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Clemente Maria Iodice
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Danila Pisani
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andrea Rosolia
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Testa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Jay Chhablani
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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Oribio-Quinto C, Fernández-Vigo JI, Bilbao-Malavé V, Pérez-García P, Burgos-Blasco B, Arias-Barquet L, Donate-López J. Anatomical and functional impact of verteporfin shortage in patients with chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2023; 42:103501. [PMID: 36893954 DOI: 10.1016/j.pdpdt.2023.103501] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND To describe the functional and anatomical impact that the worldwide shortage of verteporfin has had on patients diagnosed with chronic central serous chorioretinopathy (cCSCR) whose treatment with photodynamic therapy (PDT) had to be delayed. METHODS Prospective observational study. Patients were divided into two groups based on the time interval since PDT had been indicated: groups 1 and 2, with waiting times of less and more than 9 months respectively. Best corrected visual acuity (BCVA), the maximum height of the subretinal fluid (MSRF) and subfoveal choroidal thickness (SFCT) at the baseline visit and the last visit were compared. RESULTS 49 eyes of 48 patients with cCSCR were included. The mean waiting time for PDT was 9.0 ±3.8 months. The mean BCVA was 69.0 ±17.1 letters and 68.9 ±16.4 letters for the baseline and last visit respectively, showing no difference (p= 0.958). Although there was no difference in the mean global BCVA, 15 eyes (30.5%) showed a deterioration of ≥5 letters, including 7 eyes (14%) with a decrease of ≥10 letters. Mean MSRF height was 151.4 ±97.2 μm and 98.2 ±83.1 μm for the baseline and last visit respectively (p= 0.005), persisting in 74.5% of the eyes. CONCLUSION No significant impact was observed in the BCVA in cCSCR due to the shortage of verteporfin. However, one-third of patients had BCVA loss. There was a significant spontaneous decrease in MSRF, but it persisted in the majority of the patients, still susceptible to PDT.
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Affiliation(s)
- Carlos Oribio-Quinto
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain.
| | - José Ignacio Fernández-Vigo
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Madrid, Spain
| | - Valentina Bilbao-Malavé
- Department of Ophthalmology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pilar Pérez-García
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain
| | - Barbara Burgos-Blasco
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain
| | - Luis Arias-Barquet
- Department of Ophthalmology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Donate-López
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain
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Dursun E, Dursun GA. The quantitative evaluation of retinal layers after resolution of subretinal fluid in acute central serous chorioretinopathy. Eur J Ophthalmol 2022; 33:11206721221136989. [PMID: 36325684 DOI: 10.1177/11206721221136989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE To evaluate the average retinal layer thicknesses in eyes with unilateral acute central serous chorioretinopathy (CSC) (with subretinal fluid (SRF)) and after complete resolution of SRF in these eyes and to compare the results with those obtained in healthy eyes. METHODS Fifty-four eyes of 27 patients with unilateral acute CSC (CSC in active phase) who had complete resolution of SRF and 25 eyes of 25 healthy control subjects enrolled in this retrospective study. The average thicknesses of the retinal layers were measured by segmentation analysis of optical coherence tomography at baseline and 6 months after complete resolution of SRF. RESULTS The mean outer nuclear layer (ONL) thickness was significantly lower in eyes with CSC than in fellow eyes (p < 0.001). The mean ONL thickness was increased after resolution of SRF, but still low compared to unaffected fellow eye and the increment was not statistically significant (p > 0.05). There were significant strong inverse correlations between visual acuity and ONL thicknesses at baseline and 6 months after complete resolution of SRF (p < 0.001, r = - 0.810; p < 0.001, r = - 0.705, respectively). CONCLUSION ONL thickness was thinned in cases with acute CSC, and although there was some increment in ONL thickness 6 months after complete resolution of SRF, it was still thinner compared to unaffected fellow eyes.
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Affiliation(s)
- Erdem Dursun
- Ophthalmology Department, Kırıkkale High Speciliazation Hospital, Kırıkkale, Turkey
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Toto L, D'Aloisio R, De Nicola C, Evangelista F, Ruggeri ML, Cerino L, Simonelli MB, Aharrh-Gnama A, Di Nicola M, Porreca A, Mastropasqua R. Short-term comparison between navigated subthreshold microsecond pulse laser and oral eplerenone for chronic central serous chorioretinopathy. Sci Rep 2022; 12:4727. [PMID: 35304566 PMCID: PMC8933552 DOI: 10.1038/s41598-022-08764-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
To compare the anatomical/functional changes after navigated subthreshold pulse laser (SML) and oral eplerenone therapy for chronic central serous chorioretinopathy (cCSC). A total of 36 eyes of 36 patients suffering from cCSC treated with navigated SML (Navilas® 577s; OD-OS GmbH, near Berlin, Germany) (18 eyes, SML group) and oral eplerenone (18 eyes, eplerenone group) were enrolled in this retrospective study. Main outcome measures during a 3-month follow up period included changes of best corrected visual acuity (BCVA), central macular thickness (CMT), foveal subretinal fluid thickness (FSRFT), and subfoveal choroidal thickness (SFCT). At baseline average duration of symptoms was 6.8 ± 0.6 months in SML group and 6.4 ± 0.9 months in eplerenone group (p = 0.127). Mean BCVA, CMT and FSRFT changed significantly over time (p < 0.001). From baseline to 90 days the BCVA improved from 0.3 ± 0.1 to 0.1 ± 0.1 logMAR in SML group and from 0.3 ± 0. to 0.2 ± 0.1 logMAR in eplerenone group, CMT reduced from 357.1 ± 104.3 to 210.6 ± 46.7 μm and from 428.7 ± 107.7 to 332.5 ± 27.5 μm in SML group and eplerenone group respectively, FSRFT reduced from 144.4 ± 108.2 to 22.6 ± 37.2 μm and from 217.1 ± 105.9 to 54.4 ± 86.2 μm in SML group and eplerenone group. 55.6% of patients in SML group and 66.7% in eplerenone group showed a complete resolution of FSRFT during follow up. The interaction between group and time was statistically significant with greater absolute variation for CMT and FSRFT in SML group compared to eplerenone group (p < 0.001 and p = 0.043). SFCT did not change significantly during follow up (p = 0.083) for both groups. Both navigated SML and oral eplerenone were effective treatments showing recovery of retinal morphology and related visual acuity improvement in cCSC.
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Affiliation(s)
- Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Rossella D'Aloisio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy.
| | - Chiara De Nicola
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Federica Evangelista
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Maria Ludovica Ruggeri
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Luca Cerino
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Maria Beatrice Simonelli
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Agbéanda Aharrh-Gnama
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Marta Di Nicola
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Annamaria Porreca
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
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Long H, Liu M, Hu Q, Li X. 577 nm subthreshold micropulse laser treatment for acute central serous chorioretinopathy: a comparative study. BMC Ophthalmol 2022; 22:105. [PMID: 35248003 PMCID: PMC8898420 DOI: 10.1186/s12886-022-02330-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background To assess the efficacy of 577 nm subthreshold micropulse laser (SML) treatment for acute central serous chorioretinopathy (CSC). Methods This retrospective comparative case-series included 34 eyes of 34 patients with acute CSC who received either 577 nm SML treatment (SML group, n = 16 eyes) or were only monitored (observation group, n = 18 eyes). Acute CSC was defined as disease course < 3 months. Eyes with any history of treatment in the past were excluded. Data were collected over a period of 6 months. The best corrected visual acuity (BCVA), central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were observed. Results SML group showed significantly greater improvement in the BCVA (logMAR) compared to observation group at 1 month (0.20 ± 0.10 vs 0.30 ± 0.12, P < 0.01), 3 months (0.13 ± 0.06 vs 0.21 ± 0.06, P < 0.01) and 6 months (0.01 ± 0.06 vs 0.09 ± 0.66, P < 0.01). The CMT reduction was significantly greater in the SML group at 1 month (337.19 ± 62.96 µm vs 395.11 ± 91.30 µm, P < 0.05), 3 months (312.94 ± 49.50 µm vs 364.50 ± 70.30 µm, P < 0.05) and 6 months (291.38 ± 26.46 µm vs 348.56 ± 54.65 µm, P < 0.05). In the SML group, the SFCT did not show a significant decrease at 1 month (468.88 ± 42.19 µm, P > 0.05) but showed a significant reduction at 3 months (451.75 ± 39.36 µm, P < 0.05) and 6 months (450.50 ± 34.24 µm, P < 0.05) from baseline (489.94 ± 45.86 µm). In the observation group, there was no significant change in SFCF during follow-up. No adverse events occurred in the SML group. Conclusions Although some patients with acute CSC show spontaneous healing, timely intervention with 577 nm SML can shorten the disease course, improve visual acuity, and reduce the risk of chronic transformation without adverse events.
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11
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Xu F, Wan C, Zhao L, You Q, Xiang Y, Zhou L, Li Z, Gong S, Zhu Y, Chen C, Li C, Zhang L, Guo C, Li L, Gong Y, Zhang X, Lai K, Huang C, Zhao H, Ting D, Jin C, Lin H. Predicting Central Serous Chorioretinopathy Recurrence Using Machine Learning. Front Physiol 2021; 12:649316. [PMID: 34899363 PMCID: PMC8656454 DOI: 10.3389/fphys.2021.649316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/14/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose: To predict central serous chorioretinopathy (CSC) recurrence 3 and 6 months after laser treatment by using machine learning. Methods: Clinical and imaging features of 461 patients (480 eyes) with CSC were collected at Zhongshan Ophthalmic Center (ZOC) and Xiamen Eye Center (XEC). The ZOC data (416 eyes of 401 patients) were used as the training dataset and the internal test dataset, while the XEC data (64 eyes of 60 patients) were used as the external test dataset. Six different machine learning algorithms and an ensemble model were trained to predict recurrence in patients with CSC. After completing the initial detailed investigation, we designed a simplified model using only clinical data and OCT features. Results: The ensemble model exhibited the best performance among the six algorithms, with accuracies of 0.941 (internal test dataset) and 0.970 (external test dataset) at 3 months and 0.903 (internal test dataset) and 1.000 (external test dataset) at 6 months. The simplified model showed a comparable level of predictive power. Conclusion: Machine learning achieves high accuracies in predicting the recurrence of CSC patients. The application of an intelligent recurrence prediction model for patients with CSC can potentially facilitate recurrence factor identification and precise individualized interventions.
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Affiliation(s)
- Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Cheng Wan
- Department of Electronical and Information Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Qijing You
- Department of Electronical and Information Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Yifan Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhongwen Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Songjian Gong
- Xiamen Eye Center, Affiliated to Xiamen University, Xiamen, China
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Chuan Chen
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Cong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Li Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Department of Ophthalmology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
| | - Chong Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Longhui Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yajun Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Kunbei Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hongkun Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Daniel Ting
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Department of Ophthalmology, Singapore National Eye Center, Singapore, Singapore
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Center of Precision Medicine, Sun Yat-sen University, Guangzhou, China
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12
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Xu F, Wan C, Zhao L, Liu S, Hong J, Xiang Y, You Q, Zhou L, Li Z, Gong S, Zhu Y, Chen C, Zhang L, Gong Y, Li L, Li C, Zhang X, Guo C, Lai K, Huang C, Ting D, Lin H, Jin C. Predicting Post-Therapeutic Visual Acuity and OCT Images in Patients With Central Serous Chorioretinopathy by Artificial Intelligence. Front Bioeng Biotechnol 2021; 9:649221. [PMID: 34888298 PMCID: PMC8650495 DOI: 10.3389/fbioe.2021.649221] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 10/28/2021] [Indexed: 12/02/2022] Open
Abstract
To predict visual acuity (VA) and post-therapeutic optical coherence tomography (OCT) images 1, 3, and 6 months after laser treatment in patients with central serous chorioretinopathy (CSC) by artificial intelligence (AI). Real-world clinical and imaging data were collected at Zhongshan Ophthalmic Center (ZOC) and Xiamen Eye Center (XEC). The data obtained from ZOC (416 eyes of 401 patients) were used as the training set; the data obtained from XEC (64 eyes of 60 patients) were used as the test set. Six different machine learning algorithms and a blending algorithm were used to predict VA, and a pix2pixHD method was adopted to predict post-therapeutic OCT images in patients after laser treatment. The data for VA predictions included clinical features obtained from electronic medical records (20 features) and measured features obtained from fundus fluorescein angiography, indocyanine green angiography, and OCT (145 features). The data for OCT predictions included 480 pairs of pre- and post-therapeutic OCT images. The VA and OCT images predicted by AI were compared with the ground truth. In the VA predictions of XEC dataset, the mean absolute errors (MAEs) were 0.074–0.098 logMAR (within four to five letters), and the root mean square errors were 0.096–0.127 logMAR (within five to seven letters) for the 1-, 3-, and 6-month predictions, respectively; in the post-therapeutic OCT predictions, only about 5.15% (5 of 97) of synthetic OCT images could be accurately identified as synthetic images. The MAEs of central macular thickness of synthetic OCT images were 30.15 ± 13.28 μm and 22.46 ± 9.71 μm for the 1- and 3-month predictions, respectively. This is the first study to apply AI to predict VA and post-therapeutic OCT of patients with CSC. This work establishes a reliable method of predicting prognosis 6 months in advance; the application of AI has the potential to help reduce patient anxiety and serve as a reference for ophthalmologists when choosing optimal laser treatments.
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Affiliation(s)
- Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Cheng Wan
- College of Electronic Information Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shaopeng Liu
- School of Computer Science, Guangdong Polytechnic Normal University, Guangzhou, China
| | - Jiaming Hong
- School of Medical Information Engineering, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yifan Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Qijing You
- College of Electronic Information Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhongwen Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Songjian Gong
- Xiamen Eye Center, Affiliated with Xiamen University, Xiamen, China
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School, Miami, FL, United States
| | - Chuan Chen
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School, Miami, FL, United States
| | - Li Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Department of Ophthalmology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yajun Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Longhui Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Cong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chong Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Kunbei Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Daniel Ting
- Singapore National Eye Center, Department of Ophthalmology, Singapore, Singapore
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Center of Precision Medicine, Sun Yat-sen University, Guangzhou, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Arrigo A, Aragona E, Bordato A, Calamuneri A, Moretti AG, Mercuri S, Bandello F, Parodi MB. Acute Central Serous Chorioretinopathy Subtypes as Assessed by Multimodal Imaging. Transl Vis Sci Technol 2021; 10:6. [PMID: 34739039 PMCID: PMC8572513 DOI: 10.1167/tvst.10.13.6] [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] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/10/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To differentiate acute central serous chorioretinopathy (CSC) subtypes by multimodal imaging. Methods The research was designed as a prospective, interventional study. Naive patients with acute CSC were followed for 24 months. Overall, 96 CSC patients (96 eyes) and 210 controls (210 eyes) were included. Multimodal imaging allowed the study to classify CSC into retinal pigment epithelium-related CSC (RPE-CSC) and choroidal-related CSC (choroidal-CSC) subtypes. The RPE-CSC type was characterized by normal choroidal thickness (CT) in association with disseminated RPE alterations. The choroidal-CSC type was distinguished by identifying a pachychoroid. All the patients underwent eplerenone or verteporfin photodynamic therapy (PDT). Patients developing macular neovascularization (MNV) underwent anti-VEGF injections. Quantitative measurements included central macular thickness (CMT), choroidal thickness (CT), Sattler layer thickness (SLT) and Haller layer thickness (HLT). Results Considering the CSC patients as a whole, baseline BCVA was 0.18 ± 0.25 LogMAR, increasing to 0.13 ± 0.21 LogMAR after 24 months (P < 0.01), whereas baseline CMT improved from 337 ± 126 µm to 244 ± 84 µm after 24 months (P < 0.01). We found the following subdivision of CSC eyes: RPE-CSC type (45%) and choroidal-CSC type (55%). Overall, MNV were detected in 18 eyes (19%), 13 eyes (72%) in the RPE-CSC subgroup and five eyes (28%) in the choroidal-CSC subgroup. Forty eyes responded to eplerenone (57% of RPE-CSC and 47% of choroidal-CSC), whereas 38 eyes required PDT (43% of RPE-CSC and 53% of choroidal-CSC). Conclusions Acute CSC includes two main clinical manifestations, displaying differing features concerning retinal and choroidal involvement. Translational Relevance This study identified two clinically different acute CSC subtypes on the basis of quantitative pachychoroid cutoff values.
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Affiliation(s)
- Alessandro Arrigo
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Emanuela Aragona
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Alessandro Bordato
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | | | | | - Stefano Mercuri
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
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14
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Lu H, Wang Z, Xin Z, Yang J. To evaluate the microcirculation of retinochoroid capillary between acute and chronic central serous chorioretinopathy with OCTA. Medicine (Baltimore) 2021; 100:e27069. [PMID: 34477141 PMCID: PMC8415977 DOI: 10.1097/md.0000000000027069] [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: 08/08/2020] [Accepted: 08/08/2021] [Indexed: 11/25/2022] Open
Abstract
To investigate the difference in chorioretinal microcirculation between acute central serous chorioretinopathy (aCSC) and chronic central serous chorioretinopathy (cCSC) using optical coherence tomography angiography.In total, 65 patients previously diagnosed with central serous chorioretinopathy (33 aCSC and 32 cCSC) were included in our cross-sectional study. All patients underwent complete ophthalmologic assessment including logarithm of the minimum angle of resolution best-corrected visual acuity, fundus fluorescein angiography, and optical coherence tomography angiography. Sixty eyes of 60 refractive error and age matched healthy people were selected as control.The vessel density of inner retina in patients with aCSC were higher than that in patients with cCSC (51.32 ± 2.01 vs 49.15 ± 3.68, P = .004), however, the vessel density of superficial choroid layer in aCSC were significantly lower than that in cCSC (49.83 ± 6.96 vs 53.42 ± 6.28, P = .033). Further analysis of the data reveals the presence of a distinct choroidal neovascularization (CNV) in 8 patients (25%) with cCSC while there was no evidence of CNV in patients with aCSC.Our study can contribute to a better understanding of the difference in retinochoroid microcirculation between aCSC and cCSC. The vessel density of inner retina was lower and the vessel density of superficial choroid was higher in cCSC, and patients with cCSC were more susceptible to CNV than patients with aCSC.
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Affiliation(s)
- Huawen Lu
- Wuzhou Gongren Hospital, Guangxi, China
| | - Zuofen Wang
- Zibo Central Hospital, Binzhou Medical University, Zibo, Shandong Province, China
| | - Zhaoting Xin
- Zibo Central Hospital, Binzhou Medical University, Zibo, Shandong Province, China
| | - Jun Yang
- Wuzhou Gongren Hospital, Guangxi, China
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15
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The impact of vascular risk factors on the thickness and volume of the choroid in AMD patients. Sci Rep 2021; 11:15106. [PMID: 34302055 PMCID: PMC8302717 DOI: 10.1038/s41598-021-94676-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/29/2021] [Indexed: 11/08/2022] Open
Abstract
Disturbances in choroidal microcirculation may lead to the onset and progression of age-related macular degeneration (AMD). We aimed to assess changes in the choroidal volume and thickness in the macular region in AMD eyes and to investigate whether coexisting vascular risk factors alter choroidal status. We enrolled 354 AMD patients (175 dry, 179 wet AMD) and 121 healthy controls. All participants underwent a complete ophthalmologic examination and assessment of choroidal thickness and volume. A multivariate analysis adjusted for age, sex, and smoking status revealed that wet AMD was an independent factor associated with higher average thickness of the central ring area (ATC) and average volume of the central ring area (AVC) and lower choroidal vascularity index (CVI) compared to controls (β = + 0.18, p = 0.0007, β = + 0.18, p = 0.0008, respectively) and to dry AMD (β = + 0.17, p = 0.00003 for both ATC and AVC and β = - 0.30 p < 0.0001 for CVI). ATC, AVC and average volume (AV) were lower in AMD patients with hypertension and ischaemic heart disease (IHD). The duration of hypertension was inversely correlated with ATC, AVC and AV (Rs = - 0.13, p < 0.05; Rs = - 0.12; p < 0.05, Rs = - 0.12; p < 0.05, respectively) while IHD duration negatively correlated with AV (Rs = - 0.15, p < 0.05). No such associations were observed in the control group. Our findings show that the choroidal vascular system in eyes with AMD is much more susceptible to damage in the presence than in the absence of systemic vascular disease.
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Zhou L, Lai K, Jin L, Huang C, Xu F, Gong Y, Li L, Zhu Z, Lu L, Jin C. Subthreshold Micropulse Laser vs. Conventional Laser for Central Serous Chorioretinopathy: A Randomized Controlled Clinical Trial. Front Med (Lausanne) 2021; 8:682264. [PMID: 34336888 PMCID: PMC8322653 DOI: 10.3389/fmed.2021.682264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate the effectiveness and safety of 577-nm subthreshold micropulse laser (SML) on acute central serous chorioretinopathy (CSC). Methods: One hundred and ten patients with acute CSC were randomized to receive SML or 577-nm conventional laser (CL) treatment. Optical coherence tomography and best-corrected visual acuity (BCVA) were performed before and after treatment. Results: At 3 months, the complete resolution of subretinal fluid (SRF) in 577-nm SML group (72.7%) was lower than that in CL group (89.1%) (Unadjusted RR, 0.82; P = 0.029), but it was 85.5 vs. 92.7% at 6 months (unadjusted RR, 0.92; P = 0.221). The mean LogMAR BCVA significantly improved, and the mean central foveal thickness (CFT) significantly decreased in the SML group and CL group (all P < 0.001) at 6 months. But there was no statistical difference between the two groups (all P > 0.05). In the SML group, obvious retinal pigment epithelium (RPE) damage was shown only in 3.64% at 1 month but 92.7% in the CL group (P < 0.001). Conclusions: Although 577-nm SML has a lower complete absorption of SRF compared with 577-nm CL for acute CSC at 3 months, it is similarly effective as 577-nm CL on improving retinal anatomy and function at 6 months. Importantly, 577-nm SML causes less damage to the retina.
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Affiliation(s)
- Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Kunbei Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yajun Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Longhui Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhe Zhu
- Department of Medicine, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, United States
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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17
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Arrigo A, Calamuneri A, Aragona E, Bordato A, Grazioli Moretti A, Amato A, Bandello F, Battaglia Parodi M. Structural OCT Parameters Associated with Treatment Response and Macular Neovascularization Onset in Central Serous Chorioretinopathy. Ophthalmol Ther 2021; 10:289-298. [PMID: 33606200 PMCID: PMC8079563 DOI: 10.1007/s40123-021-00336-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/29/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION This study aimed to assess quantitative factors associated with treatment response and macular neovascularization (MNV) onset in central serous chorioretinopathy (CSC) through an artificial intelligence-based approach. METHODS The study was designed as an interventional, prospective case series with a planned follow-up of 36 months. We included only eyes demonstrating the first episode of CSC. All the patients underwent eplerenone or photodynamic therapy (PDT) treatment. Eyes developing MNV underwent anti-VEGF injections. We developed an artificial intelligence-based model to assess predictive quantitative structural optical coherence tomography (OCT) factors related to treatment response and onset of MNV. Main outcome measures were best-correct visual acuity (BCVA), central macular thickness (CMT), retinal thickness (RT), retinal pigment epithelium (RPE) thickness, choroidal thickness, Sattler's layer thickness (SLT), Haller's layer thickness, retinal and choroidal hyperreflective foci (HF), and MNV. RESULTS We included 96 naïve CSC eyes (96 patients). Baseline BCVA was 0.18 ± 0.25 logMAR, which increased to 0.16 ± 0.27 logMAR after 3 years (p > 0.05). Baseline CMT was 337 ± 126 µm, which improved to 229 ± 40 µm after 3 years (p < 0.01). We observed good response to eplerenone in 40/78 (51%) eyes, whereas 38/78 (49%) eyes underwent PDT. The artificial intelligence model showed choroidal HF and age as determining factors of good response to eplerenone or PDT. RPE thickness < 36 µm, RT < 300 µm, and SLT < 50 µm increased probability of 50% of having MNV. CONCLUSIONS CSC response to eplerenone or PDT is influenced by choroidal HF and patient age. RPE and SLT represent relevant factors for onset of MNV.
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Affiliation(s)
- Alessandro Arrigo
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy.
| | | | - Emanuela Aragona
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Alessandro Bordato
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | | | - Alessia Amato
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
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18
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Sesar AP, Sesar A, Bucan K, Sesar I, Cvitkovic K, Cavar I. Personality Traits, Stress, and Emotional Intelligence Associated with Central Serous Chorioretinopathy. Med Sci Monit 2021; 27:e928677. [PMID: 33423036 PMCID: PMC7805417 DOI: 10.12659/msm.928677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the relationship between personality traits, stress, emotional intelligence, and central serous chorioretinopathy (CSCR). MATERIAL AND METHODS This prospective case-control study included 57 patients with acute CSCR and 57 age- and sex-matched controls with refractive errors. Inclusion criteria for CSCR group were acute unilateral onset of visual disturbances within 2 weeks until the first visit to the ophthalmologist and ophthalmoscopic finding of a round or oval macular detachment confirmed by optical coherence tomography as a dome-shaped serous neuroretinal elevation. RESULTS Using the Sixteen Personality Factor Questionnaire (16 PF), patients with CSCR achieved slightly higher scores on primary characteristics such as warmth (P=0.612) and perfectionism (P=0.137) when compared to the control subjects. Mean scores measured with the Social Readjustment Rating Scale (SRRS) were significantly higher in patients with CSCR (P=0.004), which means that these patients had notably elevated average reactivity to stressful life events. In addition, the number of patients with a high stress level was higher in the CSCR group than in the control group. Considering the level of emotional intelligence measured with the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), patients with CSCR achieved significantly lower scores on well-being (P=0.003) and sociability (P=0.011) factors, as well as on total score (P=0.014). CONCLUSIONS A higher level of perceived stress is the most important psychological risk factor for CSCR. According to our results, a low level of emotional intelligence may be an additional factor that contributes to the occurrence of CSCR.
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Affiliation(s)
- Anita Pusic Sesar
- Department of Ophthalmology, University Clinical Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - Antonio Sesar
- Department of Ophthalmology, University Clinical Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - Kajo Bucan
- Department of Ophthalmology, University Hospital of Split, Split, Croatia
| | - Irena Sesar
- Department of Ophthalmology, University Clinical Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - Katarina Cvitkovic
- Department of Ophthalmology, University Clinical Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - Ivan Cavar
- Department of Physiology, School of Medicine University of Mostar, Mostar, Bosnia and Herzegovina
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Hu J, Qu J, Li M, Sun G, Piao Z, Liang Z, Yao Y, Sadda S, Zhao M. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY-GUIDED PHOTODYNAMIC THERAPY FOR ACUTE CENTRAL SEROUS CHORIORETINOPATHY. Retina 2021; 41:189-198. [PMID: 32343102 DOI: 10.1097/iae.0000000000002795] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the anatomic results of optical coherence tomography angiography (OCTA)-guided half-dose photodynamic therapy (PDT) versus indocyanine green angiography (ICGA)-guided PDT in eyes with acute central serous chorioretinopathy. METHODS This study is a prospective, single-center, noninferiority, double-masked, randomized, controlled clinical trial. Fifty-one eyes of 45 patients with acute central serous chorioretinopathy were recruited, and randomized to an ICGA-guided group and an OCTA-guided group. The primary outcome measures were the rates of complete subretinal fluid (SRF) resolution at 1 month and 3 months. RESULTS Forty-six eyes of 40 patients finished the follow-up and were analyzed. In the OCTA-guided group, the SRF was completely resolved in 13 (56.5%) eyes within 1 month and in 21 (91.3%) eyes within 3 months. In the ICGA-guided group, the SRF was resolved in 16 (69.6%) of the eyes within 1 month and in 22 (95.7%) of the eyes by 3 months. Optical coherence tomography angiography-guided PDT was demonstrated noninferior to ICGA-guided PDT for SRF resolution rate at 3 months (P = 0.016), but not at 1 month (P = 0.311) for acute central serous chorioretinopathy patients. Subretinal fluid did not recur in any of the eyes in the OCTA-guided group, but did recur in 2 eyes (8.7%) of the ICGA-guided group during the 3-month follow-up period. CONCLUSION Optical coherence tomography angiography-guided PDT seemed to be noninferior to ICGA-guided PDT for resolution of SRF at 3 months in eyes with acute central serous chorioretinopathy.
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Affiliation(s)
- Jie Hu
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Peking University People's Hospital, Beijing, China
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Battaglia Parodi M, Arrigo A, Iacono P, Falcomatà B, Bandello F. Central Serous Chorioretinopathy: Treatment with Laser. Pharmaceuticals (Basel) 2020; 13:ph13110359. [PMID: 33147718 PMCID: PMC7692124 DOI: 10.3390/ph13110359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 01/11/2023] Open
Abstract
Currently, no general consensus exists regarding the management of central serous chorioretinopathy (CSC). Laser treatments include three different therapeutic approaches: conventional laser, subthreshold laser and photodynamic therapy. Conventional focal laser, addressed to seal the leaking points, as evidenced on fluorescein angiography, was largely used in the past, but now, it is almost completely abandoned, owing to the potential complications. Several studies confirmed the positive effects achieved by subthreshold laser treatment in CSC, even though its improper application in the PLACE trial has questioned the effectiveness.
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Affiliation(s)
- Maurizio Battaglia Parodi
- Department of Ophthalmology, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.P.); (A.A.); (F.B.)
- TSRetina, 34123 Trieste, Italy
| | - Alessandro Arrigo
- Department of Ophthalmology, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.P.); (A.A.); (F.B.)
| | - Pierluigi Iacono
- IRCCS-Fondazione Bietti, Via Livenza 3, 00198 Rome, Italy
- Correspondence: ; Tel.: +39-06-77052834; Fax: +39-06-77052833
| | - Bruno Falcomatà
- Department of Ophthalmology, Ospedale Bianchi-Malacrino-Gabrielli, 89100 Reggio Calabria, Italy;
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.P.); (A.A.); (F.B.)
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Chen XW, Han FY, Su G, Pan L, Cai SJ. Improved thickness measurement method for choroidal hyperpermeability in central serous chorioretinopathy. Int J Ophthalmol 2020; 13:1397-1403. [PMID: 32953578 DOI: 10.18240/ijo.2020.09.10] [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: 11/21/2019] [Accepted: 05/08/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To observe choroidal thickness changes in the choroidal hyperpermeability area (CHA) in patients with central serous chorioretinopathy (CSC) after photodynamic therapy (PDT) using indocyanine green angiography (ICGA) combined with optical coherence tomography (OCT). METHODS This was a cohort study of 17 eyes (17 patients) with CSC. In all patients, the range of CHA was determined by ICGA. The patients were divided into two groups based on CHA covered the fovea (group A) or not (group B). All patients received half-dose verteporfin PDT over CHA in ICGA. Choroidal thickness was measured by OCT before, 1, and 3mo after treatment. The choroidal thickness values of the fovea and CHAs were obtained for each measurement. Secondary outcomes were changes in the best-corrected visual acuity (BCVA) and amount of subretinal fluid (SRF). RESULTS The differences in center choroidal thickness at baseline and at 1 and 3mo post-PDT were statistically significant in group A and all patients (both P<0.001). There was no significant difference in group B (P=0.059). The differences of thickness of CHA and BCVA at baseline and 1 and 3mo post-PDT were statistically significant in group A, group B, and all patients (all P<0.01). All patients showed complete SRF absorption at 3mo post-PDT. CONCLUSION Center choroidal thickness does not accurately reflect changes in CHA of patients whose CHA does not covered the fovea center. Using CHA as the observation target can make up for this limitation, expand the scope of application, and reduce bias.
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Affiliation(s)
- Xing-Wang Chen
- Department of Ophthalmology, Guizhou Eye Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Fang-Yuan Han
- Department of Ophthalmology, the Third Affiliated Hospital of Zunyi Medical University (the First People's Hospital of Zunyi), Zunyi 563000, Guizhou Province, China
| | - Gang Su
- Department of Ophthalmology, Guizhou Eye Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Le Pan
- Department of Ophthalmology, Guizhou Eye Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Shan-Jun Cai
- Zunyi Medical University, Zunyi 563000, Guizhou Province, China
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Central Serous Chorioretinopathy: Multimodal Imaging and Management Options. Case Rep Ophthalmol Med 2020; 2020:8890404. [PMID: 32855831 PMCID: PMC7443246 DOI: 10.1155/2020/8890404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 01/27/2023] Open
Abstract
Central serous chorioretinopathy (CSCR) is an idiopathic maculopathy characterized by thickened choroid, retinal pigment epithelial detachment, and variable subretinal fluid. CSCR predominantly affects young men, with risk factors including corticosteroid use, the type A behavior pattern, and psychological stress. While usually self-limited with a good visual prognosis, recurrent and persistent CSCR can lead to outer retinal and/or retinal pigment epithelial atrophy, choroidal neovascularization, and visual loss. This article reviews current multimodal imaging and treatment options, which include observation, mineralocorticoid receptor antagonists, thermal laser photocoagulation, and off-label photodynamic therapy with verteporfin.
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Azad AD, Zhou M, Afshar AR, Bakri SJ, Pershing S. Systemic Corticosteroid Use after Central Serous Chorioretinopathy Diagnosis. Ophthalmology 2020; 128:121-129. [PMID: 32619546 DOI: 10.1016/j.ophtha.2020.06.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To analyze the frequency of systemic corticosteroid prescriptions before and after central serous chorioretinopathy (CSC) diagnosis. DESIGN Retrospective claims-based analysis. PARTICIPANTS A nationally representative sample of commercial insurance beneficiaries who received care between 2007 and 2015. METHODS We limited the study population to beneficiaries with incident CSC diagnosed by an eye care provider, excluding those with other major ophthalmologic comorbidities. We developed a non-CSC comparison cohort matched to CSC patients by age, sex, general health (Charlson Comorbidity Index), and geographic region. We compared systemic corticosteroid prescriptions before and after CSC diagnosis and by diagnosing provider (optometrist vs. ophthalmologist) and evaluated likelihood of steroids treatment among CSC versus matched control patients using logistic and Cox proportional hazard regression models. MAIN OUTCOME MEASURES Systemic corticosteroid prescription frequency among CSC patients within 12 months pre-diagnosis and at 6, 12, and 24 months post-diagnosis, median time to steroid initiation and discontinuation, and odds of receiving steroids post-diagnosis among CSC and control patients. RESULTS We identified 3418 CSC patients. Nearly 39% (n = 1326) were prescribed systemic steroids at some point during the analysis period, versus 23% of controls (4033 of 17 178 patients). Over 12% of CSC patients (n = 430) within 1 year pre-diagnosis, and nearly 12% (n = 404) within 1 year post-diagnosis. Most patients who received steroids after diagnosis were steroid naive (n = 231). Among those receiving steroids, CSC patients demonstrated longer median time to first post-diagnosis steroid prescription (1.82 years vs. 0.50 years for non-CSC patients) and longer time to last steroid prescription (1.62 years vs. 0.35 years for non-CSC patients). Although CSC patients were significantly less likely to receive steroids within 6 months post-diagnosis compared with non-CSC patients (odds ratio, 0.72; 95% confidence interval, 0.59-0.89), they were significantly more likely to receive steroids by 2 years post-diagnosis. Prescribing patterns were similar for patients diagnosed by an ophthalmologist versus optometrist. CONCLUSIONS Despite evidence showing that steroids contribute to CSC development, many patients continue to be prescribed systemic corticosteroids after CSC diagnosis. Our results suggest a need for greater communication and collaboration among providers to ensure that clinical practice reflects evidence-based recommendations.
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Affiliation(s)
- Amee D Azad
- Stanford University School of Medicine, Palo Alto, California
| | - Maggie Zhou
- Stanford University School of Medicine, Palo Alto, California
| | - Armin R Afshar
- Retina Service, Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Sophie J Bakri
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Suzann Pershing
- Byers Eye Institute, Stanford University, Palo Alto, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
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Impact of Carotid Endarterectomy on Choroidal Thickness and Volume in Enhanced Depth Optical Coherence Tomography Imaging. J Ophthalmol 2020; 2020:8326207. [PMID: 32280535 PMCID: PMC7125458 DOI: 10.1155/2020/8326207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/23/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose Carotid endarterectomy (CEA) is considered an effective therapeutic method for improving ocular circulation. The choroid is a predominantly vascular tissue; thus, systemic and local vascular alterations may influence its morphology and function. The aim of the current study was to analyse changes in choroidal thickness and volume in patients with significant internal carotid artery stenosis (ICAS) before and after unilateral CEA. Methods The 42 eyes of the 21 asymptomatic patients included in the study were divided into two groups: those ipsilateral (EIE) and those contralateral (ECE) to CEA. All participants underwent a complete ophthalmologic examination, including enhanced depth imaging-optical coherence tomography (EDI-OCT). A comparative analysis of subfoveal thickness (CT) and choroidal volume (CV) measured in nine Early Treatment of Diabetic Retinopathy Study (ETDRS) subfields at baseline, on the 2nd day after CEA, and in the 3rd month after CEA was performed. Results In the EIE and ECE groups, no significant differences in either CT or CV values before and on the 2nd day after the CEA were observed. In the EIE group, a significant increase in CT and CV in the 3rd month after CEA compared to baseline was noted in the specific ETDRS region. Changes in CT and CV after surgery were positively correlated with the participants' physical activity status and diastolic blood pressure and negatively correlated with the participants' age and smoking status. Additionally, the analysis of changes in CV after CEA showed a positive correlation between the EIE and ECE groups. Conclusions CT and CV fluctuations in the central and perifoveal areas visualized with EDI-OCT enabled the observation of the processes of tissue adaptation to variable blood flow conditions.
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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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Bahadorani S, Maclean K, Wannamaker K, Chu ER, Gresores N, Sohn JH, Diaz-Rohena R, Singer MA. Treatment of central serous chorioretinopathy with topical NSAIDs. Clin Ophthalmol 2019; 13:1543-1548. [PMID: 31616132 PMCID: PMC6699520 DOI: 10.2147/opth.s202047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/04/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Central serous chorioretinopathy (CSCR) is a common retinopathy that is often observed until resolution. The purpose of this study is to evaluate the effects of topical nonsteroidal anti-inflammatory drugs (NSAIDs) on timing of CSCR recovery. Methods An IRB-approved retrospective review was conducted on patients that had been diagnosed with a new-onset, symptomatic case of CSCR. Patients were either observed only (13 untreated eyes) or treated with topical bromfenac or nepafenac (14 eyes) over an average of about a 4-5 week follow-up period. Results There was no statistical significance between central macular thickness (CMT) and visual acuity of treatment and control groups at the initial presentation. However, at the follow-up visit, CMT reductions in the treatment group were significantly higher than in the control group (p<0.006). Conclusion Use of topical NSAIDs in the treatment of acute CSCR leads to a faster rate of reduction in the subretinal fluid volume over a follow-up period of a few weeks.
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Affiliation(s)
- Sepehr Bahadorani
- Department of Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kyle Maclean
- Department of Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kendall Wannamaker
- Department of Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Edward Rickie Chu
- Department of Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Nathan Gresores
- Medical Center Ophthalmology Associates, San Antonio, TX, USA
| | - Jeong-Hyeon Sohn
- Department of Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Roberto Diaz-Rohena
- Department of Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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The Efficacy of Intravitreal Conbercept for Chronic Central Serous Chorioretinopathy. J Ophthalmol 2019; 2019:7409426. [PMID: 31205784 PMCID: PMC6530212 DOI: 10.1155/2019/7409426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/10/2019] [Accepted: 04/25/2019] [Indexed: 02/02/2023] Open
Abstract
Purpose To evaluate the efficacy and safety of conbercept for patients with chronic central serous chorioretinopathy (CSC). Methods A retrospective clinical study. Thirty-one patients (35 eyes) with chronic CSC were given intravitreal injections of conbercept and followed up for at least 6 months. Observed indicators included best-corrected visual acuity (BCVA), central macular thickness (CMT), and resolution of subretinal fluid (SRF). Serial changes in BCVA and CMT were analyzed by using repeated measures analysis of variance. Results During the 6-month follow-up, the mean number of injections required and performed was 1.77 ± 0.60. The logMAR BCVA was 0.48 ± 0.26 at the baseline, 0.34 ± 0.26, 0.30 ± 0.26, 0.27 ± 0.26, 0.24 ± 0.26, and 0.23 ± 0.26 at 2-week and 1-, 2-, 3-, and 6-month follow-ups, respectively (F = 27.173, P < 0.05). CMT was 313.74 ± 144.51 μm at the baseline and decreased to 263.49 ± 120.44 μm, 225.91 ± 91.98 μm, 195.77 ± 66.69 μm, 189.74 ± 65.41 μm, and 199.49 ± 81.50 μm at 2-week and 1-, 2-, 3-, and 6-month follow-ups, respectively (F = 18.093, P < 0.05). Full resolution of SRF was achieved in 8 (22.9%) eyes at 1 month, 16 (45.7%) eyes at 2 months, 22 (62.9%) eyes at 3 months, and 27 (77.1%) eyes at 6 months after the initial treatment of anti-VEGF injection. No severe adverse event was noted relevant to the therapy. Conclusions Intravitreal injection of conbercept may effectively reduce the CMT and improve the BCVA in chronic CSC in a short term of 6 months.
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Toto L, D'Aloisio R, Mastropasqua R, Di Antonio L, Di Nicola M, Di Martino G, Evangelista F, Erroi E, Doronzo E, Mariotti C. Anatomical and Functional Changes of the Retina and the Choroid after Resolved Chronic CSCR. J Clin Med 2019; 8:jcm8040474. [PMID: 30959979 PMCID: PMC6517936 DOI: 10.3390/jcm8040474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 03/28/2019] [Accepted: 04/04/2019] [Indexed: 11/22/2022] Open
Abstract
Background: To investigate anatomical/functional changes after oral eplerenone therapy for chronic central serous chorioretinopathy (CCSC) in successfully treated eyes and fellow eyes and assess timing of foveal subretinal fluid (SRF) resolution. Methods: Twenty-one eyes of 21 patients suffering from CCSC with monolateral foveal SRF successfully treated with oral eplerenone were enrolled in this retrospective study (group 1). The fellow eyes (21 eyes; group 2), healthy or affected by CCSC, without foveal SRF were considered in the analysis. A control healthy group was enrolled as well (healthy controls; n = 21). Main outcome measures during follow-up included changes of best corrected visual acuity (BCVA, logMAR), central macular thickness (CMT; µm), SRF (µm), subfoveal choroidal thickness (SFCT; µm), superficial capillary plexus density (SCPD, %), deep capillary plexus density (DCPD, %), and choriocapillaris density (CCD, %) and percentage of eyes showing foveal SRF resolution at different time points. Results: Functional and anatomical parameters significantly improved during the study in group 1. BCVA increased significantly (p < 0.001), while CMT, SFCT, and SRF decreased significantly (p < 0.001; p < 0.001, and p = 0.037, respectively). SCPD, DCPD, and CCD did not show any statistically significant difference during follow-up. In 71.4% of eyes, resolution of SRF was observed within 60 days and in the remaining 28.6%, at 120 days. In fellow eyes, SFCT decreased significantly (p < 0.001), whilst all other parameters did not modify. Conclusions: Eplerenone treatment in chronic CSCR potentially improves recovery of retinal and choroidal morphology as well as visual acuity gain. A complete resolution of foveal SRF was observed in all eyes during a 4-month follow-up, with most eyes healing at 2 months.
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Affiliation(s)
- Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara, 66100 Chieti, Italy.
| | - Rossella D'Aloisio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara, 66100 Chieti, Italy.
| | - Rodolfo Mastropasqua
- Vitreoretinal Unit, Bristol Eye Hospital, University of Bristol, Bristol, BS1 4TB, UK.
- Eye Clinic, Polytechnic University of Marche, 60126 Ancona, Italy.
| | - Luca Di Antonio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara, 66100 Chieti, Italy.
| | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University "G. d'Annunzio" Chieti-Pescara, 66100 Chieti, Italy.
| | - Giuseppe Di Martino
- Department of Medicine and Science of Ageing, School of Hygiene and Preventive Medicine, University G. d'Annunzio Chieti-Pescara, 66100 Chieti, Italy.
| | - Federica Evangelista
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara, 66100 Chieti, Italy.
| | - Emanuele Erroi
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara, 66100 Chieti, Italy.
| | - Emanuele Doronzo
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara, 66100 Chieti, Italy.
| | - Cesare Mariotti
- Eye Clinic, Polytechnic University of Marche, 60126 Ancona, Italy.
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Zhou L, Chong V, Lai K, Huang C, Xu F, Gong Y, Youlidaxi M, Li T, Lu L, Jin C. A pilot prospective study of 577-nm yellow subthreshold micropulse laser treatment with two different power settings for acute central serous chorioretinopathy. Lasers Med Sci 2019; 34:1345-1351. [PMID: 30710172 DOI: 10.1007/s10103-019-02721-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/14/2019] [Indexed: 02/02/2023]
Abstract
To compare the efficacy of 50% threshold power with 25% threshold power of 577-nm subthreshold micropulse laser (SMPL) for acute central serous chorioretinopathy (CSC). Prospective, interventional, non-randomized, comparative case series. A total of 54 patients (54 eyes) with acute CSC were enrolled. Twenty-four eyes received 25% threshold power and 30 eyes received 50% threshold power of 577-nm SMPL. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and complete absorption of subretinal fluid (SRF) were evaluated at 1 month and 3 months. The complete absorption rate of SRF in the 50% power group was significantly greater than that in the 25% power group at 1 month (70.0% vs 25.0%, p < 0.001) and at 3 months (83.3% vs 54.2%, p < 0.001). Mean BCVA improved from 0.34 ± 0.20 LogMAR to 0.02 ± 0.13 LogMAR in the 50% power group and from 0.27 ± 0.15 LogMAR to 0.14 ± 0.21 LogMAR in the 25% power group with a significant difference between the two groups after 3 months (p = 0.027). In the 50% power group, the CMT decreased from 491.6 ± 154.8 μm at baseline to 231.3 ± 92.3 μm at 1 month and 228.2 ± 88.1 μm at 3 months, and in the 25% power group, the CMT decreased from 444.9 ± 164.1 to 306.8 ± 102.6 μm at 1 month and 254.5 ± 101.7 μm at 3 months. There was statistical difference of CMT at 1 month (p = 0.009) but no significant difference at 3 months between the two groups (p = 0.232). SMPL with 50% threshold power may be more effective than 25% threshold power for acute CSC.
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Affiliation(s)
- Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | | | - Kunbei Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | - Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | - Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | - Yajun Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | | | - Tao Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China.
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Sauer L, Andersen KM, Dysli C, Zinkernagel MS, Bernstein PS, Hammer M. Review of clinical approaches in fluorescence lifetime imaging ophthalmoscopy. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-20. [PMID: 30182580 PMCID: PMC8357196 DOI: 10.1117/1.jbo.23.9.091415] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 07/24/2018] [Indexed: 05/04/2023]
Abstract
Autofluorescence-based imaging techniques have become very important in the ophthalmological field. Being noninvasive and very sensitive, they are broadly used in clinical routines. Conventional autofluorescence intensity imaging is largely influenced by the strong fluorescence of lipofuscin, a fluorophore that can be found at the level of the retinal pigment epithelium. However, different endogenous retinal fluorophores can be altered in various diseases. Fluorescence lifetime imaging ophthalmoscopy (FLIO) is an imaging modality to investigate the autofluorescence of the human fundus in vivo. It expands the level of information, as an addition to investigating the fluorescence intensity, and autofluorescence lifetimes are captured. The Heidelberg Engineering Spectralis-based fluorescence lifetime imaging ophthalmoscope is used to investigate a 30-deg retinal field centered at the fovea. It detects FAF decays in short [498 to 560 nm, short spectral channel (SSC) and long (560 to 720 nm, long spectral channel (LSC)] spectral channels, the mean fluorescence lifetimes (τm) are calculated using bi- or triexponential approaches. These are meant to be relatively independent of the fluorophore's intensity; therefore, fluorophores with less intense fluorescence can be detected. As an example, FLIO detects the fluorescence of macular pigment, retinal carotenoids that help protect the human fundus from light damages. Furthermore, FLIO is able to detect changes related to various retinal diseases, such as age-related macular degeneration, albinism, Alzheimer's disease, diabetic retinopathy, macular telangiectasia type 2, retinitis pigmentosa, and Stargardt disease. Some of these changes can already be found in healthy eyes and may indicate a risk to developing such diseases. Other changes in already affected eyes seem to indicate disease progression. This review article focuses on providing detailed information on the clinical findings of FLIO. This technique detects not only structural changes at very early stages but also metabolic and disease-related alterations. Therefore, it is a very promising tool that might soon be used for early diagnostics.
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Affiliation(s)
- Lydia Sauer
- University Hospital Jena, Jena, Thuringia, Germany
- University of Utah, John A. Moran Eye Center, Salt Lake City, Utah, United States
| | - Karl M. Andersen
- University of Utah, John A. Moran Eye Center, Salt Lake City, Utah, United States
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States
| | - Chantal Dysli
- Bern University Hospital, Inselspital, Department of Ophthalmology, Bern, Switzerland
| | - Martin S. Zinkernagel
- Bern University Hospital, Inselspital, Department of Ophthalmology, Bern, Switzerland
| | - Paul S. Bernstein
- University of Utah, John A. Moran Eye Center, Salt Lake City, Utah, United States
| | - Martin Hammer
- University Hospital Jena, Jena, Thuringia, Germany
- University of Jena, Center for Biomedical Optics and Photonics, Jena, Germany
- Address all correspondence to: Martin Hammer, E-mail:
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Kida T, Kobayashi T, Sato T, Fukumoto M, Ikeda T. Seasonal Variation in Japanese Central Serous Chorioretinopathy. Ophthalmologica 2018; 240:150-156. [DOI: 10.1159/000492136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/16/2018] [Indexed: 11/19/2022]
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Tekin K, Cakar Ozdal P, Gulpamuk B, Yasin Teke M. Intravitreal aflibercept therapy in eyes with chronic central serous chorioretihopathy: Short term results. ACTA ACUST UNITED AC 2018; 93:315-323. [PMID: 29735320 DOI: 10.1016/j.oftal.2018.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the short term efficacy and tolerability results of intravitreal aflibercept injection as a treatment option for eyes with chronic central serous chorioretinopathy (CSCR). MATERIAL AND METHODS A prospective longitudinal study. Ten eyes of 10 patients with chronic CSCR who had been followed for >6months after the first intravitreal injection of aflibercept were recruited for the study. The best corrected visual acuity (BCVA) and central macular thickness (CMT) values obtained by spectral-domain optical coherence tomography were recorded at baseline and the first, third, and sixth months after the injection. RESULTS The mean logMAR BCVA was 0.70±0.25 at baseline. At the first, third, and sixth months after the injection, the mean logMAR BCVA were 0.39±0.36, 0.32±0.39, and 0.29±0.34, respectively. The mean and median BCVA over the entire follow-up period was significantly improved compared with baseline BCVA (P<.05 for each one). The mean CMT was 449.30±142.53μm at baseline. It was measured as 302.60±72.28μm on the first month, 294.30±72.85μm on the third month, and 294.60±83.84μm on the sixth month after the injection. The mean and median CMT during the entire follow-up period was significantly decreased compared with baseline CMT (P<.05 for each one). None of the patients had any serious ocular or systemic side effects over the course of the study. CONCLUSIONS Short term results of this study demonstrate that intravitreal aflibercept may be used as a treatment option to improve the BCVA and reduce the CMT in chronic CSCR.
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Affiliation(s)
- K Tekin
- Ophthalmology Department, Ercis State Hospital, Van, Turquía.
| | - P Cakar Ozdal
- Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Turquía
| | - B Gulpamuk
- Ophthalmology Department, Konya Beyhekim State Hospital, Konya, Turquía
| | - M Yasin Teke
- Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Turquía
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Ashraf H, Jamshidian M, Khalili MR, Zare M, Shamsi A. Subthreshold Continuous Wave Autofluorescence-controlled Laser Treatment of Chronic Central Serous Chorioretinopathy. J Ophthalmic Vis Res 2018; 13:236-240. [PMID: 30090178 PMCID: PMC6058563 DOI: 10.4103/jovr.jovr_9_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose To investigate the therapeutic effect of clinically invisible subthreshold continuous wave autofluorescence-controlled laser treatment on visual acuity and macular status of patients with chronic central serous chorioretinopathy (CSCR). Methods In this prospective case series, patients with clinical and fluorescein angiographic (FA) findings of CSCR and chronic visual loss (>6 months) were included. Complete ocular examination, FA, and optical coherence tomography (OCT) tests were performed. Each eye was subjected to a direct laser treatment of leakage points by 532 nm continuous wave low energy laser pulses, which were kept invisible by reducing the power to 70% of the threshold test spot. Considering the lack of visible effect on the retinal pigment epithelium (RPE), the laser effect was monitored by pre- and post -treatment infrared and autofluorescence images. Results A total of 20 patients were included in this study, of whom 12 patients (9 male and 3 female patients) with an average age of 38 years had complete follow-up (Average: 3.5 months). The mean preoperative visual acuity was 20/80, which improved to 20/40 at the final visit. The mean preoperative central macular thickness (CMT) was 330 μm and the average final CMT in the last OCT test was 188 μm (P = 0.001). Conclusion Subthreshold continuous wave autofluorescence-controlled laser treatment may be a good treatment for chronic CSCR to avoid the risks of retinal damage by clinically suprathreshold laser therapy.
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Affiliation(s)
- Hossein Ashraf
- Poostchi Eye Research Center, Ophthalmology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansooreh Jamshidian
- Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Khalili
- Poostchi Eye Research Center, Ophthalmology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mousa Zare
- Department of Ophthalmology, Jahrom University of Medical Sciences, Shiraz, Iran
| | - Anis Shamsi
- Department of Ophthalmology, Kerman University of Medical Sciences, Kerman, Iran
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Asahi MG, Chon AT, Gallemore E, Gallemore RP. Photodynamic therapy combined with antivascular endothelial growth factor treatment for recalcitrant chronic central serous chorioretinopathy. Clin Ophthalmol 2017; 11:2051-2056. [PMID: 29200818 PMCID: PMC5701552 DOI: 10.2147/opth.s135461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine whether combination photodynamic therapy (PDT) and antivascular endothelial growth factor (VEGF) therapy is effective in the management of chronic central serous chorioretinopathy (CSC) recalcitrant to conventional therapy. Methods This was a retrospective analysis of eight patients with chronic CSC unresponsive to topical nonsteroidal anti-inflammatory drugs, focal photocoagulation, anti-VEGF alone, or PDT alone. All patients were evaluated with a full ophthalmic examination, spectral-domain optical coherence tomography (OCT), fluorescein angiography (FA), and most with indocyanine green angiography (ICGA) followed by treatment with half-fluence PDT and intravitreal anti-VEGF injection (seven bevacizumab, one aflibercept). Patients were seen in follow-up 1 month after treatment. Results All eight patients achieved complete resolution in subretinal fluid following combination treatment. Average duration of CSC prior to initiation of combination therapy was 7.5 months. Mean central macular thickness on OCT decreased significantly from 401.2±52.7 µm to 297.9±18.2 µm (p=0.0010) by 4 months after treatment (1.63±1.18 months). Seven of eight patients were followed up for an average of 13 months with no recurrence during that time. One case recurred at 8 months and was treated with repeat combination at that time. Frank choroidal neovascularization (CNV) was not identified in these cases on FA or ICGA studies. Eight of eight patients showed significant improvement in vision from a logMAR of 0.1125±0.099 to 0.0125±0.064 (p=0.019). Conclusion Combination PDT and anti-VEGF is effective for chronic CSC which has failed conventional therapy. Associated CNV and/or inflammation may be reasons for greater success in patients treated with combination therapy.
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Affiliation(s)
- Masumi G Asahi
- Clinical Research Department, Retina Macula Institute, Torrance, CA, USA
| | - Andrew T Chon
- Clinical Research Department, Retina Macula Institute, Torrance, CA, USA
| | | | - Ron P Gallemore
- Clinical Research Department, Retina Macula Institute, Torrance, CA, USA.,Jules Stein Eye Institute, University of California, Los Angeles, CA, USA
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Exudative retinal detachment. Surv Ophthalmol 2017; 62:723-769. [DOI: 10.1016/j.survophthal.2017.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 12/11/2022]
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Clinical efficacy of anti-VEGF medications for central serous chorioretinopathy: a meta-analysis. Int J Clin Pharm 2017; 39:514-521. [DOI: 10.1007/s11096-017-0460-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
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Manayath GJ, Karandikar SS, Narendran S, Kumarswamy KA, Saravanan VR, Morris RJ, Venkatapathy N. Low Fluence Photodynamic Therapy Versus Graded Subthreshold Transpupillary Thermotherapy for Chronic Central Serous Chorioretinopathy: Results From a Prospective Study. Ophthalmic Surg Lasers Imaging Retina 2017; 48:334-338. [DOI: 10.3928/23258160-20170329-08] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 02/22/2017] [Indexed: 11/20/2022]
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Tekin K, Sekeroglu MA, Cankaya AB, Teke MY, Doguizi S, Yilmazbas P. Intravitreal Bevacizumab and Ranibizumab in the Treatment of Acute Central Serous Chorioretihopathy: A Single Center Retrospective Study. Semin Ophthalmol 2016; 33:265-270. [PMID: 27841949 DOI: 10.1080/08820538.2016.1228985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate and compare the anatomical and functional outcomes of patients with acute central serous chorioretinopathy (CSC) who did not receive any intervention or treatment with intravitreal bevacizumab or ranibizumab. METHODS A single-center retrospective comparative study. Seventy eyes of 70 patients were recruited for the study; 27 patients were only observed without any medication or intervention (observation group), 23 were treated with intravitreal bevacizumab (IVB group), and the remaining 20 were treated with intavitreal ranibizumab (IVR group). The best-corrected visual acuity (BCVA) and central macular thickness (CMT) obtained by spectral-domain optical coherence tomography were compared between the groups. RESULTS There were no significant differences between the groups with regard to age, sex, and follow-up periods (p>0.05). The mean time from baseline to initial complete resolution of subretinal fluid was 3.52±1.64 months in the observation group, 1.19±0.60 months in the IVB group, and 1.11±0.47 months in the IVR group; the resolution time was significantly longer in the observation group (p<0.001). While the CMT was significantly thicker in the observation group when compared to the IVB and IVR groups in the first month (p=0.001), it was similar between the groups in the third, sixth, and twelfth months (p>0.05). Additionally, pairwise comparisons of the IVB and IVR groups revealed that there were no significant differences between these groups regarding CMT at any follow-up time (p>0.05). CONCLUSIONS Compared with observation alone, neither IVB nor IVR had a positive effect in terms of anatomical and functional outcomes for acute CSC. Although the resolution time of SRF is shorter by using ranibizumab, both the ranibizumab and bevacizumab could be effective in achieving rapid resolution of serous detachment in patients with acute CSC.
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Affiliation(s)
- Kemal Tekin
- a Ankara Ulucanlar Eye Training and Research Hospital , Ankara , Turkey
| | | | | | - Mehmet Yasin Teke
- a Ankara Ulucanlar Eye Training and Research Hospital , Ankara , Turkey
| | - Sibel Doguizi
- a Ankara Ulucanlar Eye Training and Research Hospital , Ankara , Turkey
| | - Pelin Yilmazbas
- a Ankara Ulucanlar Eye Training and Research Hospital , Ankara , Turkey
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