Management of chronic central serous chorioretinopathy

Gender differences in central serous chorioretinopathy based on the new multimodal imaging classification

PURPOSE

To analyse the gender-specific differences in central serous chorioretinopathy (CSCR) based on a new multimodal imaging classification system.

METHOD

This was a retrospective, multicentric, longitudinal, observational study in patients with a diagnosis of unilateral or bilateral CSCR. Visual acuity outcomes and differences based on 'Simple' and 'Complex' CSCR were analysed. The occurrence of choroidal neovascularization (CNVM) and number of recurrences were also compared. Regression analysis was used to evaluate baseline predictors of final visual acuity.

RESULTS

The study included 109 eyes of 58 patients (55 eyes of 28 female patients and 54 eyes of 30 male patients). Simple CSCR was seen in 8 (14.8%) eyes and 21 (38.2%) eyes in male and female groups respectively, while complex CSCR was seen in 46 (85.2%) eyes and 34 (61.8%) eyes in male and female groups respectively (p = 0.005). Recurrence was more commonly seen in males (34 eyes) than in females (23 eyes) (p = 0.03). Males (96.7%) were also significantly more likely to have a bilateral presentation (78.6% in females) (p = 0.03). Conversely, CNVM was more commonly seen in female eyes (8 eyes) than male eyes (4 eyes) (p = 0.23). On multivariable regression analysis, factors affecting reduced need for treatment were history of steroid use, good visual acuity at baseline, and simple CSCR. Factors affecting good final visual acuity were history of steroid use, good visual acuity at baseline, and younger age.

CONCLUSION

Males tended to have complex CSCR and recurrence compared to the female sub-group, while females exhibited CNVM more commonly than males.

TWO-YEAR CLINICAL OUTCOMES AFTER PHOTODYNAMIC ACUTE EXUDATIVE MACULOPATHY IN PATIENTS WITH CHRONIC CENTRAL SEROUS CHORIORETINOPATHY

PURPOSE

To analyze the 2-year clinical outcomes after photodynamic therapy-induced acute exudative maculopathy (PAEM) in patients with chronic central serous chorioretinopathy.

METHODS

Prospective observational study that included 64 eyes of 64 patients with chronic central serous chorioretinopathy who received half-fluence photodynamic therapy and had a 2-year follow-up. Patients were classified into two groups based on whether they had had PAEM at 3 days after treatment (PAEM+, n = 22; ≥50 µ m) increase in subretinal fluid or not (PAEM-, n = 42). Best-corrected visual acuity and subretinal fluid changes evaluated with optical coherence tomography were registered at 3 days, 1 month, 3 months, 1 year, and 2 years after photodynamic therapy. The number of recurrences, the appearance of outer retinal atrophy, and choroidal neovascularization were analyzed.

RESULTS

Best-corrected visual acuity was 75.9 ± 13.6 (20/32) and 82.0 ± 11.0 letters (20/25) at 2 years in the PAEM+ and PAEM- groups, respectively ( P = 0.055). There were no differences in the best-corrected visual acuity change (4.2 ± 7.7 vs. 3.3 ± 7.1 letters; P = 0.654) and the subretinal fluid decrease (-117.3 ± 74.2 vs. -138.5 ± 83.6 µ m; P = 0.323) at 2 years between patients with and without PAEM. No differences in the number of recurrences ( P = 0.267), the appearance of choroidal neovascularization ( P = 0.155), or outer retinal atrophy ( P = 0.273) between both groups were noted.

CONCLUSION

Patients with chronic central serous chorioretinopathy with and without PAEM presented similar results at 2 years in best-corrected visual acuity gain, subretinal fluid reduction, and complication rate.

Comparison of prevalent management options to treat acute central serous chorioretinopathy

Purpose

To study the acute central serous chorioretinopathy (CSC) management strategies practiced at a tertiary eye care center in eastern India.

Methods

In a retrospective chart review study, the clinical outcomes of three different management approaches to treating acute CSC were analyzed. Individuals with follow-ups of fewer than 6 months were excluded. Logistic regression analysis was performed to identify the prognostic markers of CSC resolution.

Results

In the 10-year study period (January 2013-July 2022), 206 eyes were included. Placebo treatment was the preferred practice (48.5%; n = 100 eyes). Watchful observation without placebo was the management strategy in 30.6% (n = 63) of the eyes, and 20.9% (n = 43) of eyes received focal lasers. Risk factor modification was attempted in all. There was no significant difference in the resolution rate (P = 0.819), time to resolution (P = 0.331), and disease recurrence (P = 0.067) among the groups. Univariate logistic regression analysis did not favor any of the treatment strategies predicting resolution and recurrence.

Conclusion

Alternative treatment modes did not score over the natural history of acute CSC regarding disease resolution, vision gain, and disease recurrence. The study reaffirms observation as the standard of care for acute CSC.

Randomized controlled trials in central serous chorioretinopathy: A review

Central serous chorioretinopathy (CSCR), a common chorioretinal disease, presents with a myriad of manifestations. Acute CSCR presents with localized neurosensory detachment whereas chronic CSCR may show widespread retinal pigment epithelium (RPE) changes, chronic shallow subretinal fluid, and choroidal neovascularization (CNV) suggestive of a variable natural history leading to suboptimal visual outcomes. Even though multiple treatment options including laser photocoagulation, photodynamic therapy, micropulse laser, anti-vascular endothelial growth factors, and systemic drugs (spironolactone, eplerenone, melatonin, mifepristone) are available, there is an absence of any standardized treatment protocol or gold standard treatment modality. Moreover, their performance compared to observation especially in acute CSCR is still debatable. Compared to other chorioretinal diseases such as age-related macular degeneration, diabetic retinopathy, diabetic macular oedema, and retinal vein occlusion, there is a relative dearth of randomized controlled trials in CSCR. Multiple inconsistencies including reliance on history of disease duration, variable inclusion criteria/disease descriptors/study endpoints, and availability of multiple treatment modalities lead to difficulties in designing RCTs. A consensus-based treatment protocol, therefore, is still elusive. We reviewed the literature and compiled the list of papers published to date, wherein we analyse and compare the inclusion criteria, imaging modalities, study endpoints, study duration, and study results. Correcting these discrepancies and deficiencies will help standardize future study designs, facilitating a next step toward a standardized treatment protocol.

Exploring New Therapeutic Avenues for Ophthalmic Disorders: Glaucoma-Related Molecular Docking Evaluation and Bibliometric Analysis for Improved Management of Ocular Diseases

Ophthalmic disorders consist of a broad spectrum of ailments that impact the structures and functions of the eye. Due to the crucial function of the retina in the vision process, the management of eye ailments is of the utmost importance, but several unmet needs have been identified in terms of the outcome measures in clinical trials, more proven minimally invasive glaucoma surgery, and a lack of comprehensive bibliometric assessments, among others. The current evaluation seeks to fulfill several of these unmet needs via a dual approach consisting of a molecular docking analysis based on the potential of ripasudil and fasudil to inhibit Rho-associated protein kinases (ROCKs), virtual screening of ligands, and pharmacokinetic predictions, emphasizing the identification of new compounds potentially active in the management of glaucoma, and a comprehensive bibliometric analysis of the most recent publications indexed in the Web of Science evaluating the management of several of the most common eye conditions. This method resulted in the finding of ligands (i.e., ZINC000000022706 with the most elevated binding potential for ROCK1 and ZINC000034800307 in the case of ROCK2) that are not presently utilized in any therapeutic regimen but may represent a future option to be successfully applied in the therapeutic scheme of glaucoma following further comprehensive testing validations. In addition, this research also analyzed multiple papers listed in the Web of Science collection of databases via the VOSviewer application to deliver, through descriptive analysis of the results, an in-depth overview of publications contributing to the present level of comprehension in therapeutic approaches to ocular diseases in terms of scientific impact, citation analyses, most productive authors, journals, and countries, as well as collaborative networks. Based on the molecular docking study's preliminary findings, the most promising candidates must be thoroughly studied to determine their efficacy and risk profiles. Bibliometric analysis may also help researchers set targets to improve ocular disease outcomes.

Management of Atypical Central Serous Chorioretinopathy Mimicking Vogt-Koyanagi-Harada Disease

Purpose: To report a case of multifocal central serous chorioretinopathy (CSCR) mimicking Vogt-Koyanagi-Harada (VKH) disease. Methods: A 42-year-old man was evaluated for an exudative retinal detachment (RD) with a presumptive diagnosis of VKH while being treated with corticosteroids. The examination showed subretinal fibrin deposition with a bullous, exudative, macula-involved RD in the left eye and a progressive decline in visual acuity (VA) to hand motions. Multimodal imaging showed multifocal hyperfluorescent leaks bilaterally by angiography, highly suggestive of CSCR exacerbated by corticosteroids. Results: After the multifocal CSCR diagnosis, the systemic corticosteroids were tapered and eventually discontinued. The patient was then managed with focal laser photocoagulation, photodynamic therapy, and acetazolamide. The VA improved to 20/30 with complete resolution of the bullous RD at the 12-month follow-up. Conclusions: Extensive bullous RD with subretinal fibrin deposition is an infrequent manifestation of CSCR commonly associated with corticosteroid use that can mimic VKH. Thus, it is important to distinguish CSCR from VKH and the potential of combination therapy in managing chronic multifocal CSCR with a bullous RD.

Pachychoroid Spectrum Disorders: An Updated Review

Pachychoroid disease spectrum is a recent term that has been associated with an increasing number of phenotypes. This review discusses updated findings for each of the typical pachychoroid entities (central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, peripapillary pachychoroid syndrome, and focal choroidal excavation), as well as two relatively new additions (peripapillary pachychoroid neovasculopathy and peripheral exudative hemorrhagic chorioretinopathy). Here, we discuss the potential pathogenic mechanisms for these diseases and relevant imaging updates. Finally, we argue for a consistent classification scheme for these entities.

Imaging characteristics of bilateral CSCR cases:12 months follow up

PURPOSE

To report the disease pattern, progression and imaging characteristics in eyes with bilateral central serous chorioretinopathy (CSCR).

METHODS

This was a retrospective case review of bilateral CSCR patients with active disease in at least one eye. Multimodal imaging including fundus photography, fundus autofluorescence, optical coherence tomography (OCT), fluorescein and indocyanine angiography (FA/ICGA) was done at baseline and follow-up visits. Disease classification was done using recently described classification criteria. The degree of asymmetry in the disease distribution pattern at baseline and disease progression during follow-up visit with a minimum duration of 12 months was studied.

RESULTS

Among 103 CSCR patients, 36 patients (34.95%) with mean age of 53.6 ± 10.5 years had bilateral CSCR at baseline. Five patients (13.9%) had asymmetrical disease i.e. simple in one eye and complex in fellow eye. The remaining 31 patients had symmetric disease (simple, 2; complex 29). Mean duration of follow up was 17.58 ± 13.84 months. There was no significant difference between both eye parameters at last follow up (best corrected visual acuity, BCVA; central macular thickness, CMT; and subfoveal choroidal thickness, SFCT) (all p > 0.05). At last follow up, 22 eyes (2 simple and 20 complex) remained active whereas none of the eyes converted from simple to complex CSCR.

CONCLUSION

Bilateral disease was more commonly seen with complex CSCR in contrast to simple CSCR. Moreover, disease distribution in complex CSCR had symmetric pattern if bilateral disease was present. None of the simple CSCR eyes converted to complex type.

Morphometric analyses in patients treated with subthreshold laser photocoagulation for central serous chorioretinopathy

BACKGROUND AND OBJECTIVE

To analyze changes in selected parameters in optical coherence tomography (OCT) after subthreshold laser coagulation (ST-LP) in patients with central serous chorioretinopathy (CSCR).

MATERIALS AND METHODS

Fifty-four eyes of 49 patients with CSCR were included in the study. Each patient underwent therapy with ST-LP with a frequency-doubled Neodym-YAG Laser and OCT imaging. In OCT the thickness of the central subfield, cube volume, average cube thickness, volume under the ETDRS grid, and average thickness under the ETDRS grid were collected.

RESULTS

Decreases in total OCT volume and central retinal subfield thickness were statistically significant (p < 0.05). Possible correlations were observed between visual acuity at V3 (3 months after ST-LP) and Baseline and between central retinal subfield thickness at V1 (4 weeks after ST-LP) and visual acuity at BL.

CONCLUSION

A decrease in retinal thickness and retinal volume could be shown after ST-LP. Central retinal subfield thickness measured by OCT could be a more sensitive measure than mean retinal thickness or macular volume for early detection of disease recurrence occurring in some patients 3 months after ST-LP.

Choroidal arteriovenous anastomoses: a hypothesis for the pathogenesis of central serous chorioretinopathy and other pachychoroid disease spectrum abnormalities

The pachychoroid disease spectrum (PDS) includes several chorioretinal diseases that share specific choroidal abnormalities. Although their pathophysiological basis is poorly understood, diseases that are part of the PDS have been hypothesized to be the result of venous congestion. Within the PDS, central serous chorioretinopathy is the most common condition associated with vision loss, due to an accumulation of subretinal fluid in the macula. Central serous chorioretinopathy is characterized by distinct risk factors, most notably a high prevalence in males and exposure to corticosteroids. Interestingly, sex differences and corticosteroids are also strongly associated with specific types of arteriovenous anastomoses in the human body, including dural arteriovenous fistula and surgically created arteriovenous shunts. In this manuscript, we assess the potential of such arteriovenous anastomoses in the choroid as a causal mechanism of the PDS. We propose how this may provide a novel unifying concept on the pathophysiological basis of the PDS, and present cases in which this mechanism may play a role.

Focal Laser Photocoagulation for Central Serous Chorioretinopathy in Under-Represented Populations: A Retrospective Case Series

This case series examines visual and anatomic outcomes of focal laser photocoagulation in the treatment of central serous chorioretinopathy (CSCR) with subretinal fluid (SRF) in under-represented populations. We reviewed records of 25 eyes with CSCR and SRF that underwent focal laser photocoagulation. Visual acuity (VA) and central macular thickness (CMT) were recorded prior to laser, after laser treatment, and at final follow-up and were all compared using Wilcox signed-rank tests after using Shapiro-Wilk tests to determine normality. The racial and ethnic breakdown of our cohort (n = 25) includes 64% Hispanic (n = 16), 20% black (n = 5), 12% Asian (n = 3), 4% other (n = 1). Patients were followed for a median of 15.5 months (range: 5.75-87 months) after treatment. The VA prior to laser compared to best-available VA significantly improved (p = 0.0003). Pre-laser CMT to post-laser CMT (p < 0.0001) and pre-laser CMT to final CMT (p < 0.0001) significantly improved. Excluding the one eye that developed a choroidal neovascular membrane, the pre-laser VA to final VA improved significantly (p = 0.0047) as well as the pre-laser CMT to final CMT (p < 0.0001). Of the 25 eyes, 4 had persistent SRF following laser, and of the 21 eyes with complete resolution of SRF, 2 developed recurrent SRF. Focal laser photocoagulation can significantly improve VA and CMT in CSCR with active SRF in patients who have been under-represented in prior clinical studies.

Evaluation of clinical and functional sequels of central serous chorioretinopathy. A case series analysis

OBJECTIVE

To evaluate the clinical and functional sequelae of patients with a diagnosis of resolved CSC, through macular OCT, contrast sensitivity test, visual field 10-2 and Farnsworth D-15 color test.

METHODS

27 eyes of 26 individuals with CSC resolved by macular OCT were included and evaluated; the patients underwent a contrast sensitivity test with the Optec 6500 equipment, a 10-2 visual field with an Octopus 900 Haag-Streit, and a Farnsworth D-15 color test.

RESULTS

Sequelae were observed in 20 eyes (74.1%) by macular OCT and in 21 (77.8%) in contrast sensitivity, predominantly type 2 defect. Also 27 (100%) had a visual field 10-2 altered corresponding to reduced foveal sensitivity, 11 eyes (40.7%) corresponded to central and paracentral scotomas. The color test showed alteration in 11 (40.7%) of the total eyes evaluated, finding tritanomaly in 9 of them (81.8%). No significant differences were observed in the studies between observation group vs the treatment group.

CONCLUSIONS

CSC can leave sequelae in the visual quality of patients despite treatment in the acute phase. Visual acuity before and after treatment in the intervention group had no significant difference.

ACUTE EXUDATIVE MACULOPATHY AND BACILLARY LAYER DETACHMENT IN CENTRAL SEROUS CHORIORETINOPATHY PATIENTS AFTER PHOTODYNAMIC THERAPY

PURPOSE

To describe the incidence and characteristics of photodynamic therapy (PDT)-induced acute exudative maculopathy (PAEM) and bacillary layer detachment (BALAD) in patients with chronic central serous chorioretinopathy (CSCR).

METHODS

Prospective observational case series including 92 eyes of 75 patients that underwent PDT. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT) and OCT angiography were performed before, 3 days, 1 month and 3 months after half-fluence PDT. Two groups were established depending on the presence or absence (N=28 and N=64 respectively) of PAEM. Choriocapillaris flow voids increase, subfoveal choroidal thickness (SFCT) and the presence of choroidal neovascularization (CNV) were collected.

RESULTS

The incidence of PAEM was 28/92 (30.4%). There was no difference in the age, gender, baseline subretinal fluid (SRF), SFCT or the presence of CNV between groups (p≥0.094). No differences emerged in the SRF at one and three months after PDT between groups (p≥0.524), nor in the mean BCVA gain at three months (4.1±7.6 versus 3.6±6.4 letters; p=0.773). A BALAD was observed in 13 patients with PAEM (46.4%).

CONCLUSION

PAEM is frequent in patients with chronic CSCR but has a favorable prognosis. There was no association between PAEM and age, gender, SFCT or CNV, however, it was related to choriocapillaris flow voids increase.

Bilateral multifocal and recurrent chorioretinopathy - case report

Objective: The aim of this report is to highlight a rare condition that raises serious diagnosis and treatment difficulties. Case presentation: A 34-year-old male patient presented at the Department of Ophthalmology accusing reduced visual acuity (VA), dyschromatopsia and slight photophobia in his left eye (OS). Posterior pole examination revealed serous retinal detachment superior to the optic nerve head in his right eye (OD) and a well-defined macular oedema in the OS. Optical coherence tomography (OCT) confirmed the presence of subretinal fluid accumulations, fundus fluorescein angiography (FFA) revealed punctate hyperfluorescent pinpoint foci in the macular region of both eyes in the early venous phase and dye pooling in the late phase. The first diagnosis was Probable Vogt-Koyanagi-Harada (VKH) syndrome, but the evolution under corticosteroid therapy and shifting of the position of the serous retinal detachments in time, changed the diagnosis to multifocal, recurrent central serous choroidopathy. The patient received treatment with anti-vascular endothelial growth factor (VEGF) agents and presented multiple episodes of partial remission and shift of the subretinal fluid. Conclusions: The persistent, recurrent, multifocal and bilateral exudative retinal detachments raised significant diagnosis difficulties. In the absence of a well-established treatment, the current prognosis is unfavorable. Abbreviations: MARC = multifocal and recurrent choroidopathy, CSCR = Central Serous Chorioretinopathy, RPE = retinal pigment epithelium, CFH = complement factor H, VA = visual acuity, OD = right eye, OS = left eye, OCT = ocular coherence tomography, VEGF = vascular endothelial growth factor, FFA = Fundus fluorescein angiography, p-ANCA = Perinuclear anti-neutrophil cytoplasmic antibodies, PR3 = IgG antibodies against proteinase 3, ANA = antinuclear antibodies, CIC = Circulating immune complexes, CMV = Cytomegalovirus, VKH = Vogt-Koyanagi-Harada.

Navigated micropulse laser for central serous chorioretinopathy: Efficacy, safety, and predictive factors of treatment response

PURPOSE

There is no widely accepted treatment for persistent/chronic central serous chorioretinopathy. The present study aimed to evaluate the efficacy, safety, and factors associated to treatment response to navigated micropulse laser in chorioretinopathy.

METHODS

Retrospective observational case series including consecutive patients presenting with symptomatic persistent and chronic chorioretinopathy. All patients were treated with 5% navigated micropulse laser with the Navilas system (Navilas®, OD-OS GmBH, Teltwo, Germany), by overlying fluorescein angiography, indocyanine green angiography and/or spectral domain-optical coherence tomography images of visible leaking points and/or choroidal hyperpermeability/subretinal fluid to plan the laser treatment.

RESULTS

Thirty-nine eyes of 36 consecutive patients (29 men and 7 women, with a mean age of 51.87 years) were included. Logarithm of the minimum angle of resolution (LogMar) best-corrected visual acuity increased from 0.39 ± 0.24 at baseline to 0.24 ± 0.22 at 3 months (p < 0.0001) and to 0.20 ± 0.07 at 6 months (p < 0.0001). Subretinal fluid decreased from 166.82 ± 111.11 micron at baseline to 52.33 ± 78.97 micron (p < 0.0001) at 3 months and 34.12 ± 67.56 micron at 6 months (p < 0.0001). The presence of a hot spot on fluorescein angiography and a focal choroidal hyperpermeability on indocyanine green angiography, but not the duration of symptoms correlated significantly with the resolution of subretinal fluid at month 3 (p = 0.023 and p = 0.001).

CONCLUSION

Navigated micropulse laser laser treatment was found to be effective and safe for the treatment of chorioretinopathy, with significant improvement in visual and anatomical outcomes, unaccompanied by any adverse event at 3 and 6 months follow-up. Factors associated to subretinal fluid resolution may allow a better selection of likely responders to navigated micropulse laser treatment.

Central Serous Chorioretinopathy: Morphological and Functional Outcome after Subthreshold Thermal Laser Coagulation with a Frequency-Doubled Nd:YAG Continuous-Wave Laser

PURPOSE

Central serous chorioretinopathy (CSCR) presents itself as a serous detachment of the central neurosensory retina (NR), which may be accompanied by focal detachment of the retinal pigment epithelium (RPE) and changes in the RPE itself. It is often self-limiting; however, if the macular region is affected, visual impairment can be serious. If spontaneous remission does not occur, data on the effectiveness of further treatment options are sparse. We therefore decided to examine the effectiveness of subthreshold laser photocoagulation (ST-LP) on best-corrected visual acuity (BCVA) and subretinal fluid (SRF) resorption. We conducted a retrospective analysis of all patients who underwent ST-LP based on the diagnosis of CSCR in a German university eye hospital from 2009 to 2014.

METHODS

The diagnosis of CSCR was based on the following criteria: detachment of the NR and possibly the RPE visible on ophthalmoscopy, evidence of SRF on optical coherence tomography (OCT), visualization of one or more source points typical for CSCR in fluorescein angiography, and exclusion of differential diagnoses. The time between the anamnestic onset of symptomatic complaints and ST-LP was determined as well as BCVA and OCT before ST-LP. ST-LP was performed as a subthreshold thermal laser coagulation with a frequency-doubled Nd:YAG continuous-wave laser. Follow-up examinations were scheduled at 4, 8, and 12 weeks after ST-LP.

RESULTS

Fifty-four eyes of 49 patients were included in the study. The median age of patients was 47 years. Eighty-nine percent of the included patients were male. Twenty percent of patients had a first manifestation of CSCR, 69% had a recurrence, and 11% had persistent SRF for >6 months. The median visual acuity rose from 0.30 at baseline (BL) to 0.10 at 4 weeks and 0.00 at 8 weeks, before dropping slightly to 0.05 at 12 weeks. Changes of visual acuity in comparison to BL were statistically significant (p < 0.05). The initial median retinal thickness of 397 μm at BL decreased to 264 μm at 4 weeks, to 236 μm at 8 weeks, and to 239 μm at 12 weeks (decreases to BL all statistically significant p < 0.05).

CONCLUSION

In our cohort, we were able to achieve substantial and significant clinical benefit through ST-LP measured by improvement in BCVA. Furthermore, we were also able to demonstrate measurable, significant morphological improvements as decreased retinal thickness and increased resorption of SRF as probable mechanisms explaining clinical improvement of CSCR with ST-LP. The advantage of ST-LP over other methods is the low risk of adverse events and its high availability. Controlled, randomized studies are necessary to confirm the data and demonstrate the effect over a longer period of time.

Characteristics of Central Serous Chorioretinopathy without Leakage

Purpose:

To describe optical coherence tomography (OCT) characteristics of central serous chorioretinopathy (CSCR) without any hyperfluorescent leakage on fundus fluorescein angiography (FFA).

Methods:

This was a multicentric, retrospective, observational study of ten eyes of ten patients with CSCR without any hyperfluorescence leakage on FFA. Baseline patient characteristics, best corrected visual acuity, and OCT parameters like relative retinal pigment epithelium (RPE) reflectivity at the presumed leak site and control site were measured.

Results:

Increased macular thickness, neurosensory detachment, and choroidal thickness were seen at the site of maximum subretinal fluid (SRF). Out of ten eyes, nine had photoreceptor outer segment (PROS) disruption (46% ± 26.33%) at the site of SRF pocket, and five had presumed former leak site characterized by PROS thinning. The presumed leak site demonstrated higher RPE reflectivity compared to the control site (0.92 ± 0.04 vs. 0.87 ± 0.04; P = 0.0058).

Conclusion:

CSCR without hyperfluorescent leakage on FFA may have PROS damage and changes in RPE hyperreflectivity.

Comparison of the efficacy and safety of subthreshold micropulse laser with photodynamic therapy for the treatment of chronic central serous chorioretinopathy: A meta-analysis

BACKGROUND

This meta-analysis was conducted to compare the therapeutic effect and safety of subthreshold micropulse laser (SML) vs photodynamic therapy (PDT) in treatment of chronic central serous chorioretinopathy (cCSC).

METHODS

PubMed, EMBASE, and the Cochrane Library were searched for all relevant studies published up to August 17, 2020. Data of interest were analyzed by STATA (version 14.0) software.

RESULTS

Four randomized clinical trials (RCTs) and 5 retrospective studies with 790 eyes were included in this meta-analysis after study selection. The results showed that SML significantly improved the best-corrected visual acuity (BCVA) compared with PDT at 6 to 8 weeks, 6 months, and 7 to 8 months in patients with cCSC (weighted mean difference (WMD) = -0.15, 95% confidence intervals (CI): -0.23 to -0.07, P < .01; WMD = -2.83, 95% CI: -4.79 to -0.87, P < .01; and WMD = -2.61, 95% CI: -4.23 to -1.24, P = .026, respectively). There was also a statistically significant difference between SML and PDT groups in the differences in the complete resolution of subretinal fluid (SRF) (risk radios = 0.388, 95% CI: 0.307 to 0.491, P < .01). There were no significant differences between the SML and PDT in the overall effect with central macular thickness (CMT), adverse events, complete resolution of SRF and treatment response.

CONCLUSIONS

Based on the available evidence, this meta-analysis demonstrated that SML may be considered as a competitive alternative to PDT for treating cCSC, and as the first-line treatment of cCSC.

Long-term outcomes of half-fluence photodynamic therapy and eplerenone in chronic central serous chorioretinopathy: A comparative study

AIMS

To compare the long-term outcomes in chronic central serous chorioretinopathy (cCSC) following half-fluence photodynamic therapy (HF-PDT) and oral eplerenone treatment.

METHODS

This retrospective comparative study included consecutive patients of cCSC treated with either HF-PDT or eplerenone. The treatment outcomes of the two groups were analyzed at 3-month, 6-month, and 12-month post-treatment.

RESULTS

This study included 20 eyes (20 patients) in HF-PDT group, and 18 eyes (18 patients) in eplerenone group. All baseline parameters in HF-PDT and eplerenone groups were comparable including neurosensory detachment height (217.05 ± 140.25 µm vs 178.05 ± 164.24 µm respectively, p = 0.09), best-corrected visual acuity (BCVA) (logMAR 0.24 ± 0.13 vs logMAR 0.46 ± 0.37 respectively, p = 0.1), and subfoveal choroidal thickness (SFCT) [427.4 ± 117.4 µm vs 456.38 ± 119.25 µm respectively, p = 0.45]. HF-PDT resulted in complete resolution of neurosensory detachment in higher proportion of eyes compared to eplerenone at each follow-up visits (3 months: 90% vs 27.7%, p = 0; 6 months: 100% vs 61.1%, p = 0.003; and 12 months: 100% vs 70%, p = 0.03) with a significantly shorter duration to resolution (3.3 ± 0.9 months vs 5.8 ± 3.3 months respectively, p = 0.02). Intergroup comparison showed no significant difference between mean BCVA (p = 0.38 at 3 months, p = 0.14 at 6 months, and p = 0.19 at 12 months). Mean SFCT at 12 months of the two groups differed significantly (p = 0.003) due to increased choroidal thickness of eplerenone group.

CONCLUSION

HF-PDT has a superior efficacy to achieve faster, greater and long-lasting resolution of subretinal fluid in cCSC compared to eplerenone therapy.

Central serous chorioretinopathy imaging biomarkers

PURPOSE

To identify the factors predicting the visual and anatomical outcomes in eyes with central serous chorioretinopathy (CSCR) through 12 months.

METHODS

Patients with diagnosis of CSCR, either acute or chronic, were included in this multicentric, retrospective study. Demographic factors; systemic risk factors; central macular thickness (CMT), subfoveal choroidal thickness (SFCT), linear extent of ellipsoid zone (EZ) and interdigitation zone damage on optical coherence tomography; details of leak on fluorescein angiography and indocyanine green angiography were included as predictors of anatomical and visual outcomes. Regression analysis was performed to correlate the changes in best corrected visual acuity (BCVA) and resolution of disease activity.

RESULTS

A total of 231 eyes of 201 patients with a mean age (49.7±11.8 years) were analysed. A total of 97 and 134 eyes were classified as acute and chronic CSCR. BCVA (0.35±0.31 to 0.24±0.34; p<0.001), baseline optical coherence tomography (OCT) parameters including CMT (p<0.001), subretinal fluid (SRF) height (p<0.001) and SFCT (p=0.05) showed a significant change through 12 months. Multivariate regression analysis showed change in CMT (p≤0.01) and SRF height at baseline (p=0.05) as factors predictive of good visual outcome. Logistic regression analysis revealed changes in both CMT (p=0.009) and SFCT (p=0.01) through 12 months to correlate with the resolution of disease.

CONCLUSION

OCT parameters such as changes in both CMT and SFCT along with subfoveal EZ damage can be predictive of disease resolution whereas changes in CMT and baseline SRF height correlate well with changes in BCVA through 12 months.

Oral Treatment of Central Serous Chorioretinopathy Patients Using Propranolol Tablets

Purpose: To evaluate the pharmacological effects of propranolol treatment of patients with central serous chorioretinopathy (CSCR) over 4 months. Results: Among the 89 male and 31 female patients, the mean BCVA decreased to 0.42 ± 0.08 logMAR during CSCR attacks. Oral propranolol showed good effectiveness in reducing CSCR signs after at least 4 months of treatment. The final BCVA of the patients in groups 1 and 2 was 0.09 ± 0.01 and 0.19 ± 0.03 logMAR, respectively (p < 0.05). Moreover, the mean complete remission time in groups 1 and 2 was 1.9 and 3.5 months, respectively (p < 0.05), while the “success” rate in groups 1 and 2 was 95.0% (57/60) and 78.3% (47/60), respectively (p < 0.05). The recurrence rate in groups 1 and 2 was 5.3% (3/57) and 25.5% (12/47) after a further 5 months of follow-up, respectively (p < 0.05). Materials and Methods: One hundred and twenty patients were enrolled and randomly divided into two groups that both underwent a visual acuity test and optical coherence tomography (OCT) scanning, between April and December 2017. The 60 patients in group 1 were requested to take propranolol for 4 months, while the other 60 subjects (group 2) received placebo therapy during the same period. The best-corrected visual acuity (BCVA) of every volunteer and an OCT image of each patient were checked and recorded at the beginning of the study and each week thereafter. If the signs of CSCR disappeared completely from the OCT scans, the case was considered a “success” and treatment stopped at once. However, the “success” subjects were further evaluated in follow-ups throughout the next 5 months to determine the rate of recurrence in groups 1 and 2. The time of total complete remission of CSCR from the OCT scans was also measured in groups 1 and 2. Conclusion: CSCR patients revealed an excellent prognosis and success rate of 95.0% after taking propranolol. The treatment was able to enhance subretinal fluid (SRF) absorption, shorten the time to total complete remission, and significantly decrease CSCR recurrence. As such, we suggest that taking propranolol may be an alternative and viable choice for CSCR patients, given that the new method was shown to be safe, cheap, effective, well tolerated and convenient.

Biomarkers for central serous chorioretinopathy

Central serous chorioretinopathy (CSCR) is a common chorioretinal disease characterized by serous retinal detachment that most commonly involves the macular region. Although the natural history of the acute form shows a self-limiting course, a significant number of patients suffer from recurrent episodes leading to chronic disease, often leaving patients with residual visual impairment. Visual morbidity is often worsened by a delay in the diagnosis due to the incorrect understanding of the particular biomarkers of the disease. The aim of this review is to provide clinical understanding of the biomarkers of CSCR with an emphasis on the most recent findings in patient demographics, risk factors, clinical imaging findings, and management options. Patients with these biomarkers, age 30–44 years, male gender, increased stress levels, hypercortisolism (endogenous and exogenous exposures), sleep disturbance, pregnancy, and genetic predisposition have increased susceptibility to CSCR. Also, biomarkers on optical coherence tomography (OCT) such as choroidal thickness (CT) and choroidal vascularity index (CVI) showed good diagnostic and prognostic significance in the management of CSCR. There are nonspecific features of CSCR on OCT and OCT angiography such as choroidal neovascularization, photoreceptor alteration/cone density loss, and flat irregular pigment epithelium detachment. We described rare complications of CSCR such as cystoid macular edema (CME) and cystoid macular degeneration (CMD). Patients with CME recovered some vision when treated with anti-vascular endothelial growth factors (anti-VEGFs). Patients with CMD had irreversible macular damage even after treatment with anti-VEGFs.

Correlation in acute CSCR between hyperreflectivity on the infrared image in optical coherence tomography and fluorescein angiography

BACKGROUND

To determine the association between hyperreflective area identified on the reference image (en-face image) in spectral domain optical coherence tomography (SD-OCT) scan and the leak on fluorescein angiography in patients with acute treatment naive central serous chorioretinopathy (CSCR).

METHODS

Retrospective, observational chart review. The reference image (en-face) image on SD OCT raster scan was examined for the presence of a hyperreflective spot and an attempt was made to correlate its location on the actual leak seen on FFA using anatomical landmarks as reference. Follow up was 6 months after CSCR resolution. Appropriate statistical analysis was made.

RESULTS

Sixty-two patients (65 eyes; 49 males) with CSCR were identified of which 62/65 eyes (95.38%) showed the said correlation. The mean age was 31.24 years. The mean follow-up was 17.25 months. The mean BCVA at baseline was 0.28 logMAR. The mean final BCVA was 0.08. The hyperreflective spot noted on the infrared (reference) image correlated the most with the classic ink-blot leakage as well as the minimally enhancing/ill-defined leakage pattern. In 37/41 eyes, the area of hyperreflectivitiy correlated with the pigment epithelial detachment. The hyperreflective spot resolved in most patients who received photodynamic therapy but persisted in most patients who received eplerenone therapy. Persistent hyperreflectivity after subretinal fluid resolution appeared to correlate with persistent metamorphopsia and reduced contrast sensitivity in eyes with no subretinal fluid.

CONCLUSION

We demonstrate an interesting correlation between the area of leak and the OCT reference image (en face) used to determine the level of the scan.

SYNOPSIS

The study looks at the potential applicability of a correlation between leaking areas on fundus fluorescein angiography and a hyperreflective area on the infrared image in optical coherence tomography (OCT) in patients with central serous chorioretinopathy (CSCR).

Retinal neovascularization in a patient with chronic central serous chorioretinopathy

A 45-year-old male presented with diminution of vision in both eyes since the last 2 years. The best-corrected visual acuity was 20/200 in his right eye and 20/600 in left eye. BE fundi had changes of chronic CSCR with PED and NSD in the RE and subretinal fibrosis in the left eye. Both eyes had peripheral pigmentary changes. Multimodal imaging showed peripheral avascular retina in both eyes with neovascularization at disc in the right eye which promptly resolved with a single injection of anti-VEGF. Retinal neovascularization is an unusual finding in the setting of CSCR and has not been reported in the literature.

Intravitreal bevacizumab administration for the treatment of chronic central serous chorioretinopathy

Purpose

To evaluate the effects of intravitreal bevacizumab (IVB) injection on chronic central serous chorioretinopathy (CSC).

Methods

In this prospective interventional case series, a total of 22 eyes of 22 patients, diagnosed with unresolved CSC for three months or longer, received 1.25 mg IVB injection. Also, in case of failure to achieve success parameters, double dose IVB injections continued in order to reach the complete subretinal fluid (SRF) absorption. A complete ophthalmic assessment was carried out one day, one week, and one-month post-injection, and then a monthly visit was performed, and re-injection was done if needed. Visual acuity, subretinal space volume (SSV), central macular thickness (CMT), and contrast sensitivity were measured and compared among baseline values and final post-treatment values.

Results

The mean best corrected visual acuity increased significantly from 0.70 ± 0.22 to 0.17 ± 0.15 logMAR (P <0.001), and the CMT showed a significant reduction from 557.36 ± 129.12 to 259.50 ± 116.73 μm (P <0.001 ). In addition, SSV decreased significantly from 10.53 ± 2.03 to 6.63 ± 1.80 (P = 0.001), and contrast sensitivity improved significantly from 13.8182 ± 2.64820 dB to 17.6818 ± 1.80967 dB (P <0.001).

Conclusion

In this series, SRF absorption occurred and visual acuity improved after IVB injections, however, further comparative studies are needed to show the effect of IVB in chronic CSC.