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Bousquet E, Provost J, Torres-Villaros H, Behar-Cohen F. [Central serous chorioretinopathy: A review]. J Fr Ophtalmol 2023; 46:791-802. [PMID: 37277234 DOI: 10.1016/j.jfo.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/12/2023] [Indexed: 06/07/2023]
Abstract
The central serous chorioretinopathy (CSCR) is characterized by serous retinal detachments SRD associated with one or several retinal pigment epithelium detachments/irregularities (PEDs). The choroid is thickened with dilated choroidal veins and choroidal hyperpermeability suggesting an underlying choroidopathy. CSCR belongs to the pachychoroid spectrum. CSCR affects mostly middle-aged men and the main risk factor is the corticosteroid intake. In most cases, the subretinal detachment resolves spontaneously with a good visual prognosis. However, recurrent or chronic form of the disease can lead to irreversible retinal damage and decreased visual acuity. Laser on an extra foveal leak point or half dose/half fluence photodynamic therapy are the first-line treatment options.
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Affiliation(s)
- E Bousquet
- Départment d'ophtalmologie, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris (AP-HP), université de Paris Cité, Paris, France.
| | - J Provost
- Départment d'ophtalmologie, ophtalmopôle, hôpital Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), université de Paris Cité, Paris, France
| | - H Torres-Villaros
- Départment d'ophtalmologie, ophtalmopôle, hôpital Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), université de Paris Cité, Paris, France
| | - F Behar-Cohen
- Départment d'ophtalmologie, ophtalmopôle, hôpital Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), université de Paris Cité, Paris, France; Centre de recherche des cordeliers, université de Paris Cité, Inserm, From physiopathology of retinal diseases to clinical advances, 75006 Paris, France
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Burgos-Blasco B, Güemes-Villahoz N, Hernández-Ruiz S, Donate-Lopez J, López-Guajardo L. Dexamethasone implant prior to anti-VEGF therapy in pigment epithelium detachments with high-risk rupture characteristics secondary to neovascular age-related macular degeneration. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:676-683. [PMID: 35879177 DOI: 10.1016/j.oftale.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Evaluate the incidence of pigment epithelial tear when intravitreal delayed-release dexamethasone implant is administered (off-label use) prior to antiangiogenic treatment in pigment epithelium detachments (PED) secondary to neovascular age-related macular degeneration (nAMD) with high-risk rupture characteristics and investigate if it causes a decrease in the PED size. METHODS Patients with nAMD, PED height >500 microns and Ozurdex implant prior to the antiangiogenic therapy were included. The presence of pigment epithelium rupture in optical coherence tomography scans, best-corrected visual acuity (BCVA) and PED measurements (maximum height and diameter) were registered. RESULTS The study included 14 eyes of 14 patients: mean age 77 ± 7 years, 11 (79%) females. 25 ± 13 days after the Ozurdex, patients started with at least 3 anti-VEGF monthly injections. BCVA improved from 64 ± 14-69 ± 11 letters after anti-VEGF therapy (p > 0.05). Mean baseline PED height was 817 ± 269 µm, being 639 ± 268 µm after Ozurdex and 370 ± 260 µm after anti-VEGF injections (p = 0.035 and p = 0.009). One retinal pigment epithelium tear occurred (7%). No other adverse effects were reported. CONCLUSIONS Dexamethasone implant prior to anti-VEGF therapy may represent a promising therapeutic modality for large PED in nAMD, reducing PED dimensions and the risk of pigment epithelium tears prior to anti VEGF therapy.
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Affiliation(s)
- B Burgos-Blasco
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - N Güemes-Villahoz
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - S Hernández-Ruiz
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - J Donate-Lopez
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - L López-Guajardo
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Finzi A, Valsecchi N, Tassi F, Cellini M, Fontana L. Chronic Central Serous Chorioretinopathy with Pigment Epithelium Detachment Treated with Sildenafil: A Case Report. Case Rep Ophthalmol 2022; 13:692-699. [PMID: 36845460 PMCID: PMC9944586 DOI: 10.1159/000524992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/09/2022] [Indexed: 11/19/2022] Open
Abstract
Central serous chorioretinopathy (CSCR) is a retinal disease that may be complicated by the development of serous retinal pigment epithelial detachment (PED). The exact molecular mechanisms of CSCR have remained uncertain as well as there is no effective medical therapy. Herein, we describe a case of a 43-year-old male suffering from chronic CSCR with PED and visual acuity reduction (20/40) that showed improvement in visual acuity (20/25) and metamorphopsia 2 weeks after daily intake of 20 mg sildenafil tablets. Optical coherence tomography (OCT) scan showed resolution of PED with residual degeneration of the photoreceptor inner and outer segment layer and retinal pigmented epithelium. The patient continued treatment with sildenafil 20 mg for 2 months. Six months after the discontinuation of therapy, visual acuity was maintained, with absence of PED at OCT. Our case supports the hypothesis that phosphodiesterase type 5 (PDE-5) inhibitors may be an alternative in the treatment of patients with CSCR, alone or combined with other medications.
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Affiliation(s)
- Alessandro Finzi
- aOphthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy,*Alessandro Finzi,
| | - Nicola Valsecchi
- aOphthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Filippo Tassi
- bOphthalmology Unit, Policlinico di Monza, University of Milano Bicocca, Monza, Italy
| | - Mauro Cellini
- aOphthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Fontana
- aOphthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Azzolini C, Cattaneo J, Premoli L, Metrangolo C, Chiaravalli M, Donati S. The morphology of choroidal neovascularization in chronic central serous chorioretinopathy presenting with flat, irregular pigment epithelium detachment. Int Ophthalmol 2021; 41:2109-2116. [PMID: 33748901 PMCID: PMC8172501 DOI: 10.1007/s10792-021-01768-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
Purpose To evaluate morphological characteristics of choroidal neovascularization in chronic central serous chorioretinopathy (CSC) presenting with flat and irregular pigment epithelium detachment (FIPED) by means of innovative multimodal imaging. Methods In this observational cross-sectional study, we examined 10 consecutive patients affected by chronic CSC and FIPED using fluorescein angiography (FA), indocyanine-green angiography (ICGA) and optical coherence tomography angiography (OCTA). A qualitative analysis of the nature and characteristics of neovascular membrane was performed, combining available multimodal imaging and literature data. Results Multiple areas of retinal pigment epithelium alterations, macular hypo- and hyperpigmentation and atrophic areas were identified. Spectral domain OCT (SD-OCT) showed subretinal fluid in 80% of eyes and the ‘double layer sign’ in all patients. Late FA phases showed staining areas without leakage in all eyes; ICGA showed a hyperfluorescent plaque with surrounding hypofluorescence in 80% of patients. OCTA detected characteristic neovascular networks in the outer retina within the FIPEDs, classified as filamentous vessels with a pruned tree-like pattern in five eyes and a tangled pattern in three eyes. The choriocapillaris network showed dark areas in 80% of eyes and diffuse dark spots in all eyes. Conclusion Multimodal imaging completes clinical characterization of FIPEDs in chronic CSC. This study using OCTA technology describes the phenotype of hidden neovascular lesions in shape and morphology.
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Affiliation(s)
- Claudio Azzolini
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Jennifer Cattaneo
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Laura Premoli
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Cristian Metrangolo
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Maurizio Chiaravalli
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Simone Donati
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy.
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Clemens CR, Alten F, Termühlen J, Mihailovic N, Rosenberger F, Heiduschka P, Eter N. Prospective PED-study of intravitreal aflibercept for refractory vascularized pigment epithelium detachment due to age-related macular degeneration: morphologic characteristics of non-responders in optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2020; 258:1411-1417. [PMID: 32306096 PMCID: PMC7306025 DOI: 10.1007/s00417-020-04675-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose The aim of this study was to investigate the outcomes of a fixed intravitreal aflibercept regimen in patients with vascular pigment epithelium detachment (vPED) secondary to age-related macular degeneration with refractory subretinal fluid. Methods A prospective, interventional case series involved 20 eyes of 20 patients with refractory subretinal fluid and vPED treated with at least three injections of intravitreal anti-VEGF prior to study inclusion. After study inclusion, patients were treated with three injections of intravitreal aflibercept 2 mg/0.05 mL monthly followed by injections every 8 weeks. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) were evaluated at all visits. Fluorescein angiography and indocyanine green angiography were performed at baseline and quarterly. Primary outcomes were effectivity of a fixed treatment as measured in change in BCVA, PED greatest linear diameter (GLD), and PED height from baseline to month 12. In an additional post hoc analysis, vPED patients were differentiated into two groups: (1) vPED lesions that showed persistence of subretinal fluid throughout 1 year of treatment and (2) vPED lesions that showed complete resolution of subretinal fluid at least at one of the monthly performed OCT volume scans. Reflectivity values were determined in the subretinal pigment epithelium (RPE) compartment in OCT scans at baseline, month 6 and 12. Results A total of 18 patients completed the study protocol. The mean age was 74.8 ± 10.6 years, and six patients were female. The median BCVA of all patients was 72.0 ± 8.0 EDTRS letters at baseline and 72.5 ± 9.5 EDTRS letters at 12-month follow-up (p = 0.7420). The median PED height in all patients as measured in the OCT images significantly decreased from 372.0 ± 140.0 μm to 149.0 ± 142.0 μm after 12 months of treatment (p = 0.0020). Persistent subretinal fluid was present at every OCT control in six patients (group 1). Twelve patients showed resolution of subretinal fluid at least at one OCT control (group 2). Reflectivity values in the sub-RPE compartment in OCT scans were 41.48 ± 4.48 (group 1) and 42.62 ± 12.34 (group 2) at baseline (p = 0.854) and 65.88 ± 6.74 and 50.87 ± 14.11 at month 12 (p = 0.038). Conclusions Intravitreal aflibercept in refractory vPED leads to a significant reduction in PED height and disease activity as well as preservation of BCVA over 1 year. Persistent subretinal fluid was present in PED lesions with high values of reflectivity under the RPE, suggesting both a diffusion barrier and an increasing fibrovascular maturization of the choroidal neovascularization. Trial registration ClinicalTrials.gov Identifier: NCT03370380
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Affiliation(s)
- C R Clemens
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstrasse 15, 48149, Muenster, Germany.
| | - F Alten
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstrasse 15, 48149, Muenster, Germany
| | - J Termühlen
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstrasse 15, 48149, Muenster, Germany
| | - N Mihailovic
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstrasse 15, 48149, Muenster, Germany
| | - F Rosenberger
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstrasse 15, 48149, Muenster, Germany
| | - P Heiduschka
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstrasse 15, 48149, Muenster, Germany
| | - N Eter
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstrasse 15, 48149, Muenster, Germany
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Schworm B, Luft N, Keidel LF, Hagenau F, Kern C, Herold T, Kortuem KU, Priglinger SG, Siedlecki J. Response of neovascular central serous chorioretinopathy to an extended upload of anti-VEGF agents. Graefes Arch Clin Exp Ophthalmol 2020; 258:1013-21. [PMID: 32112141 DOI: 10.1007/s00417-020-04623-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/22/2020] [Accepted: 02/10/2020] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To determine the anatomical and functional outcomes of an extended 6-month intravitreal anti-vascular endothelial growth factor (anti-VEGF) upload in choroidal neovascularization (CNV) secondary to chronic central serous chorioretinopathy (CSCR). METHODS A retrospective database analysis was performed applying the following inclusion criteria: (1) diagnosis of CSCR, (2) diagnosis of secondary CNV, and (3) treatment of at least six consecutive injections of anti-VEGF. Outcome measures included the change of central retinal subfield thickness, remodeling of the pigment epithelium detachments, and change in visual function. RESULTS Twenty-one eyes of 21 patients were included. Mean patient age was 65 ± 8.3 years, and 35% of the patients (n = 8) were female. Mean disease duration before diagnosis of CNV was 48 ± 25.3 months. Mean central retinal thickness decreased from 346 ± 61 to 257 ± 57 μm (p < 0.01) after the sixth injection while mean visual acuity improved from 0.65 ± 0.35 to 0.49 ± 0.29 (logMAR; p < 0.01). Of note, an extended upload of six as opposed to three injections yielded an additional mean central retinal thickness reduction (280 ± 46 μm vs. 257 ± 57 μm, p = 0.038). Significant CNV remodeling was observed as a decrease in pigment epithelium detachment (PED) vertical (p = 0.021) and horizontal diameter (p = 0.024) as well as PED height (p < 0.01). CONCLUSION An extended anti-VEGF upload of six consecutive injections seems to be effective in inducing CNV remodeling and fluid resorption in CNV complicating chronic CSCR.
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Asensio-Sánchez VM, Haro-Álvarez B, Herreras J, Martín-Prieto A. Unusual ocular clinical manifestation of leptospirosis. ACTA ACUST UNITED AC 2018; 93:342-346. [PMID: 29398239 DOI: 10.1016/j.oftal.2017.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/09/2017] [Accepted: 12/15/2017] [Indexed: 11/19/2022]
Abstract
CLINICAL CASE An uncommon case is presented of a 15 year-old girl with bilateral, multiple serous detachments of retina and retinal pigment epithelium. With clinical and laboratory (IgG 1/160 and IgM 1/160, using an indirect immunofluorescence assay) diagnoses of leptospirosis, a complete ophthalmic examination, fluorescein angiography, autofluorescence and optical coherence tomography were performed, and the patient was followed for two years. DISCUSSION Bilateral, multiple serous detachments of retina and retinal pigment epithelium can be a complication of systemic leptospirosis, a zoonotic disease caused by Leptospira. Without a detailed medical history it may be underdiagnosed, mainly because it can mimic other more common diseases. It may be prudent to ask patients regarding contact with pets.
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Affiliation(s)
- V M Asensio-Sánchez
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España.
| | - B Haro-Álvarez
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España
| | - J Herreras
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España
| | - A Martín-Prieto
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España
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Rouvas A, Chatziralli I, Androu A, Mpougatsou P, Alonistiotis D, Douvali M, Kabanarou SA, Theodossiadis P. Ranibizumab versus aflibercept for the treatment of vascularized pigment epithelium detachment due to age-related macular degeneration. Int Ophthalmol 2019; 39:431-40. [PMID: 29404860 DOI: 10.1007/s10792-018-0833-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 01/20/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE To compare the efficacy and safety of two intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents, ranibizumab and aflibercept, for the treatment of vascularized pigment epithelium detachment (vPED) due to age-related macular degeneration (AMD) in a follow-up time of 12 months. METHODS Participants in this study were 71 patients (71 eyes) with vPED due to AMD, who were treated with intravitreal 0.5 mg ranibizumab (n = 38) or 2.0 mg aflibercept (n = 33) and had at least 12-month follow-up. All patients underwent best-corrected visual acuity (BCVA) measurement and optical coherence tomography at baseline and at every visit. The PED height, the presence of subretinal fluid (SRF), intraretinal fluid and diffuse macular edema (DME) were recorded at each visit. RESULTS There was a statistically significant difference in BCVA between the two groups at month 12 in favor of aflibercept. However, both agents were found to improve or stabilize BCVA in the majority of patients at the end of the follow-up. The change in PED height did not differ significantly between the two groups at the end of the follow-up with similar number of injections. At month 12, there was a significant improvement in SRF presence in both groups compared to baseline. CONCLUSIONS Although aflibercept was found to be superior to ranibizumab regarding BCVA improvement, both agents showed anatomical effectiveness with significant reduction in PED height and SRF absorption in patients with vPED due to AMD.
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