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 analyze the associations between the choroidal vasculature and submacular fluid (SMF) in central serous chorioretinopathy (CSC). MethodsA retrospective study. A total of 29 CSC patients (31 eyes) with complete records who visited the Department of Ophthalmology in Peking University People's Hospital from August 1, 2021 to March 1, 2023 were included in this study. The patients were divided into complete absorption and incomplete absorption groups according to the status of SMF in the last visit. All the patients underwent ultra-widefield swept-source optical coherence tomography angiography (UWF SS-OCTA) with a scanning range of 24 mm × 20 mm. The UWF SS-OCTA images were automatically analyzed in 9 regions (superotemporal, superior, superonasal, temporal, central, nasal, inferotemporal, inferior, and inferonasal). Alterations of choroidal vasculature in the nine subfields after SMF absorption were described, including choroidal thickness (CT), flow density of choriocapillaris layer, vessel density of large choroidal vessel layer, three-dimensional choroidal vascularity index (CVI), the mean choroidal vessel volume (mCVV), and the mean choroidal stroma volume (mCSV). The relevant factors affecting the complete absorption of SMF were additionally evaluated. ResultsAt baseline, CT (Z=2.859, P=0.004), mCVV (t=2.514, P=0.018), and mCSV (Z=2.958, P=0.003) in the superotemporal region of the affected eyes in the incomplete absorption group were significantly higher than those in the complete absorption group. Compared with baseline, at the last visit, the proportion of asymmetric vortex veins in the complete absorption group was significantly decreased (χ2=6.000, P=0.014), CVI in the superotemporal, superonasal, temporal, central, nasal, inferotemporal, and inferonasal regions (t=－4.125, t=－3.247, Z=－3.213, t=－2.994, t=－3.417, t=－3.733, t=－3.795; P=0.001, 0.006, 0.001, 0.010, 0.005, 0.003, 0.002), the mCVV of 9 regions (t=－2.959, t=－2.537, t=－2.235, t=－3.260, t=－3.022, t=－2.796, t=－2.747, Z=－2.107, t=－2.935; P=0.011, 0.025, 0.044, 0.006, 0.010, 0.015, 0.017, 0.035, 0.012) were significantly decreased. Compared to the complete absorption group, the choroidal blood flow changes in the non-complete absorption group were more limited, and CT in the upper region increased significantly at the last follow-up (t=2.272, P=0.037). Multivariate logistic regression analysis revealed that baseline CT in the superotemporal region may be an independent risk factor affecting the complete absorption of SMF (odds ratio=0.981, 95% confidential interval 0.965-0.997, P=0.021). ConclusionsIn the process of SMF absorption in CSC, significant reductions of choroidal blood flow were found in the large choroidal vessel layer, and there may be a locally compensatory increase in CT. In addition, baseline CT in superotemporal region is an independent risk factor affecting SMF absorption.
ObjectiveTo compare the choriocapillaris flow density and choroidal vessel volume (CVV) of acute and chronic central serous chorioretinopathy (CSC).MethodsA cross-sectional observational clinical study. A total of 64 eyes of 64 patients (CSC group) diagnosed with CSC at Department of Ophthalmology of West China Hospital of Sichuan University from May 2019 to October 2020, and a total of 64 eyes of 64 age and gender matched healthy volunteers (control group) during the same period were included in this study. In the CSC group, there were 34 patients with acute CSC (acute CSC group) and 30 patients with chronic CSC (chronic CSC group). There was no significant difference in age (t=－0.041) and sex composition ratio (χ2=0.191) between CSC group and control group (P＞0.05). There were statistically significant differences in age (t=－1.872) and sex composition ratio (χ2=8.778) between acute CSC group and chronic CSC group (P＜0.05). Swept source optical coherence tomography angiography (SS-OCTA) was performed using VG200D. The scanning mode was 512×512 and scannig range was 12 mm × 12 mm. The choriocapillaris flow density of the 3 mm, 6 mm, 12 mm circular area and 1-3 mm ring, 3-6 mm ring, and 6-12 mm ring, and the CVV of the of the 3 mm, 6 mm, 12 mm circular area was automatically generated by the built-in software (v1.28.6). The age, choriocapillaris flow density and CVV were compared between two groups using independent sample t test.ResultsCompared with the control group, the choriocapillaris flow density decreased in the CSC group, and there were statistically significant differences in the 3 mm, 6 mm circular area (t=－7.210, －4.040; P＜0.001). There were statistically significant differences between CSC group and control group in the 3 mm, 6 mm, 12 mm circular area (t=1.460, 12.270, 11.250; P＜0.05). Compared with the acute CSC group, the choriocapillaris flow density decreased in the chronic CSC group, and there were statistically significant differences (P＜0.05) in the 3 mm, 6 mm circular area (t=3.230, 2.330), the total and four quadrants of 1-3 mm ring (t=2.780, 2.060, 2.140, 2.620, 3.770), the superior quadrants of the 3-6 mm ring (t=2.550), and the superior and temporal of 6-12 mm ring (t=3.070, 2.610). There was no significant difference of CVV in the 3 mm, 6 mm and 12 mm circular area between the acute CSC group and the chronic CSC group (t=0.250, 0.070, －0.110; P＞0.05).ConclusionCompared with acute CSC, chronic CSC exhibits significant decreased choriocapillaris flow density and no change in CVV.
ObjectiveTo observe the clinical efficacy of half-dose photodynamic therapy (PDT) in the treatment of acute central serous chorioretinopathy (CSC) by enhanced deep imaging-OCT (EDI-OCT).MethodsA retrospective case study. From September 2015 to November 2018, 100 patients with acute CSC who received half-dose PDT in Hangzhou Branch of the Eye Optometry Hospital of Wenzhou Medical University were included in the study. Among 100 patients, 69 patients were males and 31 patients were females; the average age was 49.63±7.97 years; the average duration of disease was 2.19±0.71 months. All patients underwent BCVA, EDI-OCT, FFA, ICGA and other examinations. BCVA was used on the international standard visual acuity chart and converted to logMAR visual acuity records. Before treatment, the average logMAR BCVA was 0.29±0.19, the average macular foveal retinal thickness (CMT) was 370.59±134.98 μm, and the average macular subfoveal choroidal thickness (SFCT) was 366.93±86.95 μm. All patients were treated with half-dose PDT. We compared the changes of BCVA, CMT, SFCT, and subretinal fluid (SRF) of the eye before treatment and 2 weeks after treatment and 1, 3, and 6 months. Pearson correlation analysis method was used to analyze the correlation between BCVA and baseline BCVA, CMT, SFCT after 6 months of treatment.ResultsSix months after treatment, SRF was completely absorbed in 98 eyes, with an effective rate of 98.0%. Compared with before treatment, 2 weeks and 1, 3, and 6 months after treatment, the BCVA of the eye significantly increased (F=66.493, P＜0.001), and CMT and SFCT significantly decreased (F=134.625, 30.394; P＜0.001,＜0.001). The results of Pearson correlation analysis showed that BCVA was positively correlated with baseline BCVA 6 months after treatment (r=0.529, P＜0.001), and there was no significant correlation with CMT and SFCT. There were no serious complications related to treatment during the follow-up period.ConclusionsHalf-dose PDT can effectively increase BCVA in a short period of time for acute CSC. EDI-OCT can observe that CMT, SFCT and SRF absorption are significantly reduced after 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.
As most patients of central serous retinopathy (CSC), the symptoms of acute onset will alleviate by oneself after 4-6 months. About 30%-50% of patients with CSC experience chronic or recurrent cases. Resulting in persistent neurosensory detachments and subretinal fluid, causing significant vision loss. Mineralocorticoid receptor (MR) is a kind of nuclear hormone receptors, plays a role in theregulation of water and electrolyte balance. Excessive MR signaling is associated with many diseases. Study found that MR antagonists decreased the thickness of the retina and improved in vision, there was no serious adverse reactions during the period of treatment for chronic CSC. Initial dose of MR antagonists was 25 mg per day, 1 week later, dosage was increased to 50 mg per day, and treatment for about 3 months. There is no conclusive effective treatment and the dosage are still unknown. MR antagonists may be a safe and effective way to treat chronic CSC, though evidence is scant. Prospective, multicenter, large-scale trials is required.
Pachychoroid spectrum diseases includes central serous chorioretinopathy (CSC), pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, and polypoidal choroidal vasculopathy, which share common characteristics, including focal or diffused increased choroidal thickness, choroidal hyper-permeability, and dilated choroidal vessels. These diseases are likely to represent a continuum of the same pathogenic process. Similar features and association among them suggest that they may have similar etiology. It is of great clinical significance to understand the composition and typical morphological changes of pachychoroid-related diseases and to explore its possible pathogenesis.
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 investigate the value of pattern reversal visual evoked potential (PRVEP) and sweep pattern visual evoked potential (SPVEP) in evaluating the visual function of patients with central serous chorioretinopathy (CSC).MethodsA retrospective clinical trial. A total of 38 monocular CSC patients were enrolled from March 2016 to December2018 in Heping Hospital Affiliated Changzhi Medical College. There were 34 males and 4 females with the mean age of 40.0±5.2 years. All patients undergo PRVEP detection in both the acute phase (disease course ≤ 3 months) and the clinical cure phase (disease course ≤ 6 months) using the German Roland electrophysiological RETIport system.The stimulation pattern adopted a checkerboard with 1.00° and 0.25° stimulation angles. The P100 peak amplitude and peak time were observed. SPVEP inspection equipment and methods were the same as PRVEP, and the spatial frequency was 1, 2, 4, 6, 8, 12, 16, 22 cpd. The difference between SPVEP vision and subjective vision were compared. The PRVEP peak amplitude, peak time and SPVEP amplitude and phase of the affected eye and the contralateral eye were compared by paired t test; the subjective vision and SPVEP visual acuity of the affected eye and the contralateral eye were compared by Wilcoxon paired rank test; Pearson product-moment correlation analysis was performed on SPVEP vision.ResultsIn the acute phase, the peak amplitude of P100 in the affected eye was lower than that in the contralateral eye (t=30.26, 13.59), and the peak time was prolonged (t=－19.89, －29.41). The difference was statistically significant (P＜0.01); in clinically cured period, the P100 peak amplitude (t=1.49, －0.57) and peak time (t=－1.22, －1.84) of the affected eye and the contralateral eye showed no significant difference (P＞0.05). In the acute phase, the difference in SPVEP amplitude between the affected eye and the contralateral eye with different spatial frequencies was statistically significant (P＜0.01); the phase of the affected eye and the contralateral eye were compared about the spatial frequency 1, 2, 4, 6, 8, 12 cpd, the difference was statistically significant (P＜0.01). During the clinical cure period, the spatial frequency of 6, 8, 12, 16 cpd, the SPVEP amplitude of the affected eye and the contralateral eye, the difference was statistically significant (P＜0.01); on the spatial frequency of 6, 8, 12 cpd, the phase of SPVEP was compared between the affected eye and the contralateral eye, the difference was statistically significant (P＜0.01). During the acute phase and the clinical cure phase, the SPVEP visual acuity of the affected eye was lower than that of the contralateral eye, and the difference was statistically significant (P＜0.01); during the acute phase and clinical cure phase, the SPVEP visual acuity of the affected eye and the contralateral eye were lower than the subjective vision. The difference was statistically significant (acute phase: Z =－5.38, －3.00; P＜0.001, 0.003; clinical cure phase: Z=－5.36, －5.38; P＜0.001,＜0.001). In the acute phase, the subjective visual acuity of the affected eye was positively correlated with SPVEP visual acuity (r=0.847, P＜0.001).ConclusionsPRVEP and SPVEP are useful for objectively assessing the visual function of the patients with CSC. Especially, the slight and potential visual impairment in CSC can been detected by SPVEP.
Objective To observe the degree of choriocapillary ectasia (CCE) and sub-foveal choroidal thickness (SFCT) in central serous chorioretinopathy (CSC) with different activity and discuss their relations. Methods Forty eyes of 40 CSC patients were recruited. The activity of CSC was determinate by fundus fluorescein angiography (FFA). There were 23 eyes with active CSC (active-CSC group), and 17 eyes with inactive CSC (inactive-CSC group). All eyes in both groups were examined with optical coherence tomography angiography(OCTA), and the CCE area of the choriocapillary layer was measured within a 3 mm×3 mm zone centered on the central fovea of macula. Ectasia was classified based on CCE area, more than 66% of examination area was high ectasia, and 33%-66% as medium ectasia, below 33% as low ectasia. SFCT was measured with frequency domain optical coherence tomography. The relationship between CCE degree, SFCT and CSC group was analyzed. Results Among the 23 eyes of active-CSC group, there were 5 eyes of low ectasia, 12 eyes of medium ectasia, 6 eyes of high ectasia. Among 17 eyes of inactive-CSC group, there were 11, 4, 2 eyes of low, medium and high ectasia respectively. Active-CSC group had more advanced degree of ectasia than that in inactive-CSC group(Z=-2.472, P=0.013).SFCT of active-CSC group and inactive-CSC group were (418.13±126.15), (429.76±105.80) μm respectively, the difference was not significant (t=-0.308, P=0.760). SFCT in eyes with low ectasia, medium ectasia, high ectasia were (419.13±105.60), (381.00±125.12), (515.13±67.68) μm respectively. The difference among the three group was statistical significant (F=4.106, P=0.025). SFCT in eyes of high ectasia was obviously thicker than low ectasia and medium ectasia, the difference was statistical significant (P=0.007, 0.048);the SFCT difference between low ectasia and medium ectasia did not appear statistical significance (P=0.326). There was no linear relation between SFCT and CCE degree (r=0.247, P=0.124). Conclusions Active-CSC eyes has more advanced CCE degree than inactive-CSC eyes, but SFCT is the same between the two groups. High ectasia eyes have thicker SFCT.