ObjectiveTo observe the change of retinal microstructures and the association between visual outcome with these microstructures in central serous chorioretinopathy (CSC) after laser treatment.MethodsThis is a retrospective study. From April 2016 to February 2017, a total of 52 eyes from 52 patients who underwent conventional laser treatment (27 eyes) or subthreshold laser treatment (25 eyes) for CSC and the sub-retinal fluid (SRF) absorbed completely were included in this study. The were 46 patients (46 eyes) and 6 males (6 eyes), with the mean age of 43.92±8.62 years. The healthy fellow eyes (49 eyes) were selected as control. All patients were underwent BCVA and SD-OCT examination. According to the OCT images for all patients, the thickness of central foveal (CFT), outer nuclear (ONL), inner segment (IS), outer segment (OS) were measured. The status of ellipsoid zone (EZ), interdigitation zone (IZ) and RPE were also evaluated at fovea. Comparing the change of SD-OCT microstructures in two time points, the first visit after SRF absorbed and the last visit respectively. Spearman correlation analysis was used to analyze the relation between BCVA and ONL, IS, OS.ResultsAt the first visit after SRF absorbed, compared with control eyes, the thickness of CFT (182.55±24.14 μm), ONL (72.86±17.39 μm), IS (41.23±5.14 μm), OS (18.52±10.26 μm) in CSC eyes were decreased (P＜0.001). Meanwhile, the mean BCVA of CSC eyes was 81.27±6.39 letters, which was also significantly decreased comparing with control eyes (P＜0.001). At last visit, the thickness of CFT, ONL, IS, OS were 195.19±22.10, 75.44±16.33, 44.56±4.09, 26.60±11.39 μm, and the mean BCVA was 85.50±5.95 letters. All recovered significantly comparing with first visit (P＜0.05). At first visit, the BCVA of patients with integrate EZ (83.38±5.78 letters) was significantly better than the BCVA of patients with unintegrated EZ (77.90±5.97 letters) (P=0.003). And the BCVA of patients with smooth RPE (82.72±5.95 letter) was also significantly better than the BCVA of patients with rough RPE (78.00±6.31 letters) (P=0.020). The result of Spearman correlation analysis showed that the thickness of OS was positively correlated to BCVA at two time points (r=0.423, 0.416; P=0.002, 0.002).ConclusionsIn CSC, the thickness of ONL, IS, OS were decreased, and the integrality of EZ, IZ, the smooth of RPE were disrupted in different extent. After laser treatment, with retinal reattachment, those microstructures including ONL, IS, OS, EZ, IZ recovered slowly. The thickness of OS, the integrality of EZ and the smooth of RPE were associated with visual acuity.
ObjectiveTo evaluate the efficacy of 30% and 50% dose photodynamic therapy (PDT) for acute central serous chorioretinopathy (CSC). MethodsA retrospective cohort study. Ninety-two eyes of 88 patients with CSC, diagnosed by best corrected visual acuity (BCVA) of logarithm of the minimum angle of resolution (logMAR), indirect ophthalmoscope, fundus colorized photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA)and optical coherence tomography (SD-OCT) treated with 30% and 50% doses of verteporfin respectively between March 2007 and August 2013, were enrolled. The eyes were divided into 50% dose group (49 eyes) and 30% dose group (43 eyes). The differences of age (t=-1.45), gender (χ2=0.011), eyes (χ2=2.140), mean logMAR BCVA (t=-0.40), mean central retinal thickness (CRT) and the maximum thickness of serous retinal detachment (SRD) between two groups were not significant (P > 0.05). The difference of spot size between two groups was significant (t=-2.84, P < 0.05). The follow-up time was ranged from 6 to 68 months, with a mean of (17.16 ±11.30) months. The difference of follow-up between two groups was significant (P > 0.05). The BCVA, cure rate, recurrence rate and the changes of CRT and maximum SRT were observed by SD-OCT. ResultsThe subretinal fluid (SRF) of 31 eyes (72.09%) in the 30% dose group and that of 47 eyes (95.92%) in the 50% dose PDT group was absorbed completely respectively. The cure rates in the 30% dose PDT group was significantly less than that in the 50% dose group (χ2=10.077, P=0.020). There was a significant negative association between the cure rate and spot size by Logistic regression (odds ratio > 1, P=0.040). The difference of changes in the BCVA of logMAR in 50% dose group was better than that in 30% dose group after more than 12 months after PDT (P=0.036). On 3, 6, 12 and more than 12 months after PDT, the difference in CRT in 50% dose group and 30% dose group were not statistically significant (P=0.068, 0.060, 0.082, 0.067). The difference in maximum thickness of SRD was not statically significant (P > 0.05). SRF was appeared in 8 eyes (25.81%) of 31 eyes in the 30% dose group, while SRF was appeared in 1 eye (2.13%) of 47 eyes in the 50% dose group. The recurrence rate of 30% dose group was much higher than that of 50% dose group (P < 0.05). ConclusionsFor acute CSC treated by PDT, the curative effect of 50% dose group is better than the 30% dose group.
Objective To observe the characteristics of spectral-domain optical coherence tomography (SD-OCT) for leakage point in acute central serous chorioretinopathy (CSC). Methods A total of 21 acute CSC patients (21 eyes) were enrolled in this retrospective study, including 17 men (17 eyes) and 4 women (5 eyes). The mean age was (47.3±8.8) years (range 35 - 66 years). The mean duration was (1.6±0.8) months (range 0.5 - 3.0 months). All patients were underwent mydriatic fundus photography, SD-OCT examination and fluorescein fundus angiography (FFA). SD-OCT and FFA images were carefully compared to observe the SD-OCT examination characteristics of fluorescence leakage point. Results 21/21 eyes had one fluorescein leakage point. In addition to serous retinal detachment, leakage point in the SD-OCT examination showed retinal pigment epithelium (RPE) protrusion in 10 eyes (47.6％), RPE detachment in 7 eyes (33.3％), highly reflective areas suggesting fibrinous exudate in the subretinal space in 3 eyes (14.3％), and RPE defect in 1 eye (4.8％). Conclusion The SD-OCT characteristics of acute CSC include RPE protrusion, RPE detachment, highly reflective areas suggesting fibrinous exudate in the subretinal space and RPE defect.
ObjectiveTo compare the differences of optic nerve head (ONH) parameters and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) between acute Vogt-Koyanagi-Harada syndrome (VKH) and acute central serous chorioretinopathy (CSC) patients.MethodsRetrospective clinical case control analysis. This study included 38 eyes of 20 acute VKH patients (VKH group) and 37 eyes of 37 acute CSC patients (CSC group). Seventy five eyes of 57 normal healthy subjects, matching patients with age and gender, were collected as control group. The disc RPE angle, the thickness of average CP-RNFL, the nasal, superior, temporal and inferior quadrant CP-RNFL thickness, and ONH parameters including optic disc area, cup area, rim area, C/D area ratio, linear CD ratio (CDR), vertical CDR were measured by 3D-OCT. Analysis of variance was performed for comparison among three groups. Minimum significant difference t test was performed for comparison between two groups.ResultsThe differences of ONH parameters between VKH group and CSC group: 29 eyes of VKH group appeared retinal detachment next to disc, only 12 eyes appeared in CSC group. Twenty one eyes of VKH group appeared optic disc hyperemia while none in CSC group. The three groups’ disc RPE angles were (138.62±11.96)°, (154.09±5.85)° and (153.41±5.77)°. VKH group were significantly smaller than CSC group (t=－2.05, P=0.00) and control group (t=－1.68, P=0.00), while there was no significant difference between CSC group and control group (t=－1.88, P=0.72). The optic cup area and rim area were significantly bigger in VKH group than in CSC group (t=4.61, 2.71; P=0.00, 0.01), and the thickness of mean CP-RNFL, all quadrants of CP-RNFL were significantly thicker in VKH group than in CSC group (t=6.25, 4.40, 3.53, 5.48, 2.69; P=0.00, 0.00, 0.00, 0.00, 0.01).ConclusionCompared with the acute CSC, VKH patients are likely to appear retinal detachment next to disc, their disc RPE angles are smaller, their optic cup area and rim area are bigger, and their CP-RNFL thickness are thicker.
Central serous chorioretinopathy (CSC) is one of the main causes of impaired visual function in middle-aged men. CSC is characterized by a thickening of the choroid and hyperpermeability of the choroidal vessels, resulting in serous subretinal fluid. The pathogenesis of CSC is not fully understood. Since the introduction of indocyanine green angiography, the detection of the influence of the vortex veins in CSC, it has been established that the presence of a thick choroid may be caused by congestion of the vortex vein, resulting in new choroidal drainage through a vortex vein anastomosis. The study of vortex venous blood hemodynamics has elucidated the new concept of the pathogenesis of CSC, deepened our understanding of the disease, and provided a theoretical basis for new treatment methods. With a better understanding of the pathogenesis of CSC, we expect to be able to stratify patients at risk in the clinic and evaluate optimized treatment options for patients with CSC
ObjectiveTo observe the characteristics of optical coherence tomography (OCT) in central serous chorioretinopathy (CSC) patients with different symptom duration before and after photodynamic therapy (PDT), and investigate its relationship with vision prognosis. Methods93 CSC patients (103 eyes) who had undergone the treatment of PDT were enrolled in this study. The eyes were divided into 3 groups according to symptom duration including group A (< 4 months, 28 eyes), group B (4-6 months, 42 eyes), group C (> 6 months, 33 eyes). The best corrected visual acuity (BCVA) and OCT were performed before and after treatment. Before the treatment, the percentage of patients with regular retinal pigment epithelium (RPE), irregular bump or detachment of RPE and disordered RPE were 63.0%, 37.0%, 0.0% in group A; 41.9%, 53.5%, 4.7% in group B and 24.2%, 57.6%, 18.2% in group C, respectively. The difference of percentage of RPE structure was no significance among the three groups (χ2=19.88, P=0.001). The outer nuclear layer (ONL) thickness was (220.42±49.88), (145.81±19.65), (98.15±33.02) μm in group A, B, C respectively, the difference between three groups was significant (P=0.000). The BCVA differences in different RPE structure and the relationship between ONL thickness and vision prognosis were recorded and analyzed. ResultsThe difference of ONL thickness in eyes with regular RPE and irregular bump or detachment of RPE in group A, B and C were not significant (P=0.599, 0.151, 0.789). The ONL thickness in eyes with disordered RPE were decreased significantly compared to eyes with irregular bump or detachment of RPE in group B and C (P=0.025, 0.036). The ONL thickness were (139.14±26.23), (119.14±21.09), (97.61±29.92) μm after PDT, respectively. Compared with ONL thickness before PDT, there was statistically significant decreasing after PDT in group A and B (P=0.000, 0.010), but there was no statistically significant difference after PDT in group C (P=0.192). After PDT, BCVA was negatively related to ONL thickness before PDT in group A (r=-0.684, P=0.000), and was positively related to ONL thickness after PDT in group C (r=0.413, P=0.017), but was neither related to ONL thickness before nor after PDT in group C (r=0.278, 0.117; P=0.074, 0.462). ConclusionsWith the duration of symptom being longer, the rate of irregular bump or detachment of RPE and disordered RPE are increased gradually, ONL thickness is getting thinner. After PDT, the ONL thickness became thinner in eyes with symptom duration less than 6 months and has no difference in eyes with symptom duration more than 6 months. The difference of BCVA in eyes with different RPE structure is significant. The vision prognosis of CSC with duration less than 4 months or more than 6 months are related to ONL thickness.
ObjectiveTo observe the characteristics of blue light(BLAF) versus near infrared wavelength (IRAF) fundus autofluorescence in central serous chorioretinopathy (CSC) patients. MethodsSeventy-seven eyes of 81 patients diagnosed with CSC were enrolled in this study. According to the duration of disease, patients were divided into acute CSC group and chronic or recurrent CSC group. All patients were examined with fundus fluorescein angiography, including BLAF and IRAF. There were forty-six patients (47 eyes) with acute, thirty-one patients (34 eyes) with chronic or recurrent CSC. The characteristics of BLAF and IRAF in CSC were compared. ResultsIn acute CSC, there were nineteen eyes (40.4%) showed scattered hyper-fluorescence corresponding to the leaking points, eleven eyes (23.4%) showed mottled hypo-fluorescence in BLAF; while 17 eyes (36.2%) showed normal change corresponding to the leaking points. There were 35 eyes can be observed serous retinal detachments in the BLAF images, 21 eyes (60.0%) showed hypo-fluorescence and 14 eyes (40.0%) showed hyper-fluorescence. In the IRAF images, 25 eyes (53.2%) showed mottled fluorescence corresponding to the leaking points, 11 eyes (23.4%) presented with scattered hyper-fluorescent spots and normal fluorescence. The serous retinal detachments of 26 eyes exhibited hypo-fluorescence in the IRAF images. In chronic or recurrent CSC, 19 eyes (55.9%) showed scattered hyper-fluorescence corresponding to the leakage points; followed by no abnormal change in 10 eyes, accounting for 29.4%; few showed mottled hypo-fluorescence (5 eyes 14.7%). There were 35 eyes (41.2%) can be observed serous retinal detachments in the BLAF images. IRAF mainly displayed mottled hypo-fluorescence (22 eyes, 64.7%), ten eyes (29.4%) presented with scattered hyper-fluorescence and 2 eyes (5.8%) presented without abnormal change. The serous retinal detachments of 3 eyes (8.8%) exhibited hypo-fluorescence in the IRAF images. ConclusionsFor acute CSC, a variety of fluorescence were showed in BLAF images and the proportion of the various fluorescences was similar; hypo-fluorescence was showed in the IRAF images. For chronic CSC, hyper-fluorescence was showed in BLAF while hypo-fluorescence in the IRAF images.
The mineralocorticoid receptor (MR) belongs to the nuclear receptor superfamily and is expressed in the retina and choroid. MR antagonist (MRA) has a long history of application in non-ophthalmic clinical practice. Various cellular and animal models indicated that inappropriate activation of MR participated in pathological angiogenesis, oxidative stress, inflammation, disturbance of ion/water homeostasis and neurodegenerative changes, while the application of MRA can reduce or reverse these pathological processes. After using MRA in central serous chorioretinopathy (CSC) patients, improved visual function, less subretinal fluid and reduced sub-foveal choroidal thickness were observed. Single nucleotide polymorphisms in MR and plasma aldosterone levels were significantly different between chronic CSC patients and CSC patients with spontaneous remission. Novel formulation for sustained-release MRA and the mechanisms involving inflammation may become the new focus of MR study. This review summarizes the research status of MR and MRA in order to provide a reference for future basic research and clinical treatment.
ObjectiveTo compare the efficacy among 30% and 50% dose of verteporfin photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) in the treatment of chronic central serous chorioretinopathy (CSC). Methods138 eyes of 125 patients with chronic CSC, who were treated in our hospital from March 2006 to May 2014, were enrolled in this retrospective study. All patients were confirmed by spectral domain optical coherence tomography (SD-OCT) and best corrected visual acuity (BCVA), which was recorded with logMAR BCVA. And all the patients were divided into three groups by different treatments: 30% dose group (42 eyes of 39 patients); 50% dose group (77 eyes of 67 patients); anti-VEGF group (19 eyes of 19 patients). The differences of age, gender, eyes, courses, mean logMAR BCVA among three groups were not significant. Disappearing of fluid under retina in SD-OCT was considered to be cured and fluid remaining was not cured. If fluid appeared again the eyes were relapsed. We comparatively analyzed the cure rate, relapse rate and changing of BCVA, central macular thickness (CMT) among 3 groups of patients after 1, 3, 6 months. ResultsThe cure rate among 3 groups after 1 month was statistically different (χ2=6.926, P=0.031). The cure rates of 50% dose PDT treatment group after 3 months and 6 months were better than 30% dose PDT treatment group, but the differences were not significant (χ2=2.218, 1.682; P=0.136, 0.195). The relapse rate between 30% dose and 50% dose PDT treatment groups after 3 months and 6 months were not significant (χ2=2.133, 3.366; P=0.144, 0.067). The improvement of BCVA in 50% dose PDT treatment group was the best, but comparing with the other two groups, the differences were not significant in statistics (P > 0.05). The improvement of CMT in 50% dose PDT treatment group was the best. Comparing with anti-VEGF group, the differences was significant (P < 0.05). But comparing with 30% dose PDT treatment group, the differences was not significant (P > 0.05). Logistic regression analysis showed that after treatment, the cure rates after 1 month and 6 months were negatively correlated with the age (regression coefficient=-0.942, -0.979; odds ratio=0.390, 0.375; P < 0.05) and the cure rates after 3 months was positively correlated with the dose of verteporfin (regression coefficient=0.855, odds ratio=2.351, P < 0.05). Conclusion50% dose verteporfin PDT is recommend for chronic CSC treatment.
Central serous chorioretinitis (CSC) is a kind of choroidal retinopathy characterized by choroidal vasodilatation and hyperpermeability, retinal pigment epithelial cell lesions and serous retinal detachment. Various imaging examinations and imaging techniques have been used to describe the characteristics of the retina and choroid. Fundus manifestations of different types of CSC has both generality, and have their respective characteristic. The classification of CSC and its differentiation from other diseases including the choroidal neovascularization and pachychoroidopathy spectrum depending on varieties of fundus imaging techniques. The current study aims to review the various performance characteristics of CSC especially for chronic CSC with multimodal imaging and the current research progress, so as to provide reference for ophthalmologists to more comprehensively and intuitively understand the clinical characteristics and potential pathogenesis of CSC, and also to provide basis for multimodal imaging assisted diagnosis and treatment.