Selective retina therapy (SRT) in patients with therapy refractory persistent acute central serous chorioretinopathy (CSC): 3 months functional and morphological results

Abstract Purpose Central serous chorioretinopathy (CSC) is a disease presenting with detachment of the neurosensory retina and characteristic focal leakage on fluorescein angiography. The spontaneous remission rate is 84% within 6 months. In this study, the efficacy of selective retina therapy (SRT) was examined in patients with therapy refractory persistent acute CSC defined by symptoms for at least 6 months and persistent subretinal fluid (SRF) despite eplerenone therapy. Material and methods This is a prospective, monocentric observational study in 17 eyes (16 patients, mean age 42 years, 2 female). SRT was performed with the approved R:GEN laser (Lutronic, South Korea), a micropulsed 527-nm Nd:YLF laser device, with a train of 30 pulses of 1.7 μs at 100-Hz repetition rate at the point of focal leakage determined by fluorescein angiography (FA) at baseline (BSL). Visits on BSL, week 4 (wk4), and week 12 (wk12) included best corrected visual acuity (BCVA, logMar), central retinal thickness (CRT) on spectral domain optical coherence tomography (SD-OCT), and FA. Statistical analysis was performed by pair-by-pair comparisons of multiple observations in each case with Bonferroni correction for multiple testing. (IBM SPSS Statistics 25®). Results Mean CRT at BSL was 387.69 ± 110.4 μm. CRT significantly decreased by 106.31 μm in wk4 (95%-KI: 21.42–191.2; p = 0.01), by 133.63 μm in wk12 (95%-KI: 50.22–217.03; p = 0.001) and by 133.81 μm (95%-KI: 48.88–218.75; p = 0.001) compared to BSL. Treatment success defined as complete resolution of SRF occurred at wk4 in 7/17 eyes (35.3%) and at wk12 in 10/17 eyes (58.8%). Re-SRT was performed in 7/17 eyes (41.2%) after an average of 107.14 ± 96.59 days. Treatment success after Re-SRT was observed in 4/6 eyes (66.6%, 12 weeks after Re-SRT). Mean BCVA did not change significantly from BSL to any later timepoint after adjusting for multiple testing. Notably, eyes with treatment success showed better BCVA at all timepoints and gained more letters compared to failures. Conclusion Single or repetitive SRT may be an effective and safe treatment in 2 of 3 patients suffering from acute persistent CSC after 6 months of symptoms or more. We observed complete resolution of SRF in around 60% of eyes 12 weeks after first SRT treatment and also 12 weeks after Re-SRT treatment in eyes with persistent or recurrent SRF. Results on the long-term course after SRT are still pending.

Download Full-text

Factors Predicting Response to Selective Retina Therapy in Patients with Chronic Central Serous Chorioretinopathy

Journal of Clinical Medicine ◽

10.3390/jcm11020323 ◽

2022 ◽

Vol 11 (2) ◽

pp. 323

Author(s):

Minhee Kim ◽

Seung Hee Jeon ◽

Ji-young Lee ◽

Seung-hoon Lee ◽

Young-jung Roh

Keyword(s):

Central Serous Chorioretinopathy ◽

Subretinal Fluid ◽

Central Macular Thickness ◽

Fundus Fluorescein Angiography ◽

Chronic Central Serous Chorioretinopathy ◽

Safety And Efficacy ◽

Selective Retina Therapy ◽

Corrected Visual Acuity ◽

Anatomical Outcomes ◽

Best Corrected Visual Acuity

This retrospective study aimed to assess the safety and efficacy of selective retina therapy (SRT) with real-time feedback-controlled dosimetry (RFD) for chronic central serous chorioretinopathy (CSC) and to evaluate factors predictive of treatment response. We included 137 eyes of 135 patients with chronic CSC. SRT was performed to cover each of the leakage areas on fundus fluorescein angiography. Changes in mean best-corrected visual acuity (BCVA), central macular thickness (CMT), and subretinal fluid (SRF) height were evaluated at baseline and at 3 and 6 months after treatment. Complete SRF resolution was observed in 52.6% (72/137 eyes) and 90.5% (124/137 eyes) at 3 and 6 months, respectively. Mean BCVA (logMAR) significantly improved from 0.41 ± 0.31 at baseline to 0.33 ± 0.31 at month 6 (p < 0.001). Mean CMT significantly decreased from 347.67 ± 97.38 μm at baseline to 173.42 ± 30.95 μm at month 6 (p < 0.001). Mean SRF height significantly decreased from 187.85 ± 97.56 µm at baseline to 8.60 ± 31.29 µm after 6 months (p < 0.001). Baseline SRF height was a significant predictive factor for retreatment requirement (p = 0.008). In conclusion, SRT showed favorable anatomical outcomes in patients with chronic CSC. A higher baseline SRF height was a risk factor for retreatment.

Download Full-text

Selective Retina Therapy with Real-Time Feedback-Controlled Dosimetry for Treating Acute Idiopathic Central Serous Chorioretinopathy in Korean Patients

Journal of Ophthalmology ◽

10.1155/2018/6027871 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Ye Ji Kim ◽

Youn Gon Lee ◽

Dong Won Lee ◽

Jae Hui Kim

Keyword(s):

Real Time ◽

Central Serous Chorioretinopathy ◽

Therapeutic Option ◽

Subretinal Fluid ◽

Symptom Duration ◽

Short Term Treatment ◽

Foveal Thickness ◽

Clinical Trial Registration ◽

Korean Patients ◽

Selective Retina Therapy

Purpose. To evaluate short-term treatment outcomes following selective retina therapy (SRT) with real-time feedback-controlled dosimetry in Korean patients with acute idiopathic central serous chorioretinopathy (CSC). Methods. Sixteen eyes (16 patients) with acute idiopathic CSC (symptom duration < 3 months) were included in this retrospective study. All patients underwent a single session of SRT with real-time feedback-controlled dosimetry. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) before and 3 months after treatment were examined and compared. Results. The logarithm of minimal angle of resolution BCVA was significantly better 3 months after treatment (0.16 ± 0.18) than at the time of diagnosis (0.27 ± 0.18, P=0.002). Additionally, subretinal fluid had resolved in all 16 eyes 3 months after treatment and CFT was significantly lower 3 months after treatment (215.6 ± 17.9 μm) than at baseline (441.4 ± 124.8 μm, P<0.001). No notable SRT-related complications were observed during the study period. Conclusion. The results of the present study suggest that SRT is a useful therapeutic option for patients with acute idiopathic CSC. Further studies are required to better understand the long-term efficacy of this treatment. This trial is registered with clinical trial registration number NCT03339856.

Download Full-text

Central Serous Chorioretinopathy And Selective Serotonin Reuptake Inhibitors

10.21203/rs.3.rs-41809/v1 ◽

2020 ◽

Author(s):

Ahmet ALTUN ◽

Fatih Atmaca ◽

Ahmet Icagasioglu ◽

Selcuk Cekmeceli

Keyword(s):

Central Serous Chorioretinopathy ◽

Serotonin Reuptake ◽

Complete Resolution ◽

Selective Serotonin Reuptake Inhibitors ◽

Antidepressant Drug ◽

Subretinal Fluid ◽

Selective Serotonin ◽

Group 3 ◽

Group 2 ◽

Group 1

Abstract Aim: To investigate the relationship between central serous chorioretinopathy (CSC) and selective serotonin reuptake inhibitor (SSRI) antidepressant drugs.Methods: The files of patients diagnosed with CSC who applied to our clinics were analyzed retrospectively. Group 1 was formed from patients who had never used any antidepressant drug. Group 2 and Group 3 were composed of patients who did not stop and stopped using SSRI after the third month, respectively. Ophthalmological examinations, optical coherence tomography and fundus fluorescein angiography images of the patients were analyzed and the groups were compared with each other. Results: Group 1, Group 2 and Group 3 had 122, 8, 12 eyes, respectively. The time for complete resolution of subretinal fluid (SRF) in Group 3 was statistically significantly shorter than Group 1 and Group 2 (p ˂ 0.01). In Group 2, the time for complete resolution of SRF was significantly longer than Group 1 (p ˂ 0.05). Conclusion: SSRI group antidepressant drugs might be an important factor in CSC etiology and prognosis. Discontinuation of these drugs may accelerate subretinal fluid resolution.

Download Full-text

Fingolimod-associated central serous chorioretinopathy in a young girl

BMJ Case Reports ◽

10.1136/bcr-2021-243207 ◽

2021 ◽

Vol 14 (8) ◽

pp. e243207

Author(s):

Gajanan Chavhan Pratima ◽

Doris Benita ◽

Sandip Sarkar ◽

Amit Kumar Deb

Keyword(s):

Central Serous Chorioretinopathy ◽

Complete Resolution ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Corrected Visual Acuity ◽

Sphingosine 1 Phosphate ◽

Eye Examination ◽

The Right

Fingolimod is a sphingosine-1-phosphate analogue used for the treatment of multiple sclerosis. We, hereby, report a rare case of fingolimod-associated central serous chorioretinopathy (CSCR) in a 21-year-old woman who presented with blurring of vision in the right eye 3 weeks after initiation of oral fingolimod. On examination, best-corrected visual acuity was 20/20 in both the eyes. Fundus examination revealed shallow, serous macular neurosensory detachment in the right eye, and it was confirmed with spectral domain optical coherence tomography. Left eye fundus was normal. Fluorescein angiography showed focal retinal pigment epithelium leak inferior to the fovea. A diagnosis of fingolimod-associated CSCR was made. Oral fingolimod was discontinued. Subsequent follow-up visits showed partial resolution of CSCR at 2 weeks and at 1 month and complete resolution of the subretinal fluid at 2 months. CSCR is, therefore, a rare adverse effect of oral fingolimod treatment. Baseline eye examination and subsequent follow-up at regular intervals are recommended for patients on fingolimod.

Download Full-text

Spironolactone versus observation in the treatment of acute central serous chorioretinopathy

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311096 ◽

2017 ◽

Vol 102 (8) ◽

pp. 1060-1065 ◽

Cited By ~ 13

Author(s):

Xinghong Sun ◽

Yuanlu Shuai ◽

Wangyi Fang ◽

Jia Li ◽

Weizhong Ge ◽

...

Keyword(s):

Treatment Group ◽

Central Serous Chorioretinopathy ◽

Complete Resolution ◽

Subretinal Fluid ◽

Control Group ◽

Significant Difference ◽

Registration Number ◽

Acute Central Serous Chorioretinopathy ◽

The Mean ◽

Randomised Controlled

PurposeTo evaluate the efficacy of oral spironolactone in patients with acute central serous chorioretinopathy (CSC).MethodsThis is a prospective, randomised controlled clinical study. Thirty patients with acute CSC were the participants, including 18 patients who were treated with spironolactone (40 mg orally, twice daily) for 2 months in the experimental group and 12 patients who received observation in the control group. Main outcome measures included the proportion of eyes achieving complete resolution of subretinal fluid (SRF), changes in central macular thickness (CMT), the height of SRF (SRFH), best corrected visual acuity (BCVA) and subfoveal choroidal thickness (SFCT). The follow-up period was 2 months.ResultsComplete resolution of SRF was achieved in 55.6% (10/18) and 8.3% (1/12) of the eyes in the treatment group and the control group, respectively, at 2 months (p=0.018). The mean CMT and SRFH decreased significantly at each visit in both groups (p<0.05), and there was significant difference between the two groups at 2 months (p<0.05 and p<0.05, respectively). BCVA (in logarithm of the minimum angle of resolution; mean) improved in both groups at 2 months (p<0.05). In the treatment group, the mean baseline SFCT significantly decreased from 502.50±87.38 µm to 427.44±74.37 µm at 2 months (p<0.01), while the change from baseline (from 480.33±102.38 µm to 463.75±100.63 µm) was not significant in the control group (p=0.195). But the differences between the two groups in BCVA and SFCT were not significant.ConclusionsOral spironolactone is more effective with a faster absorption of SRF than observations. It is a promising treatment for acute CSC.Trial registration numberChiCTR-IPR-16008428, Results.

Download Full-text

Mineralocorticoid Receptor Antagonist Treatment for Steroid-Induced Central Serous Chorioretinopathy Patients with Continuous Systemic Steroid Treatment

Journal of Ophthalmology ◽

10.1155/2018/4258763 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Jin Young Kim ◽

Ju Byung Chae ◽

Jisoo Kim ◽

Dong Yoon Kim

Keyword(s):

Central Serous Chorioretinopathy ◽

Complete Resolution ◽

Mineralocorticoid Receptor ◽

Therapeutic Option ◽

Subretinal Fluid ◽

Primary Outcome Measure ◽

Electrolyte Imbalance ◽

Systemic Steroid ◽

Symptom Duration ◽

Mineralocorticoid Receptor Antagonist

Purpose. To investigate the effectiveness of mineralocorticoid receptor (MR) antagonist in patients with steroid-induced central serous chorioretinopathy (CSC). Methods. A retrospective review was conducted of steroid-induced CSC patients who were treated with the MR antagonist spironolactone 50 mg once per day for at least 1 month. The primary outcome measure was complete resolution rate of subretinal fluid (SRF) after spironolactone treatment. Secondary outcomes included central subfield thickness (CST), subfoveal choroidal thickness (SFCT), and best-corrected visual acuity (BCVA) changes after spironolactone treatment. Results. Seventeen eyes from 15 patients were included in this study. Conditions warranting chronic systemic steroid use were myasthenia gravis (6/15, 40%), glomerulonephritis (5/15, 33.3%), and organ transplantation (4/15, 26.7%). Mean symptom duration of CSC was 4.00 ± 3.04 months. After spironolactone treatment, 14 eyes (82.4%) showed complete resolution of SRF (P<0.001) without discontinuation of systemic steroid. CST and BCVA were significantly improved after spironolactone treatment. SFCT was significantly decreased after spironolactone treatment. No patients experienced electrolyte imbalance after spironolactone treatment. Conclusion. MR antagonist treatment may be a therapeutic option for steroid-induced CSC patients. This treatment modality may be especially beneficial for steroid-induced CSC patients who cannot discontinue steroid medication due to systemic conditions.

Download Full-text

The Effect of Selective Retina Therapy with Automatic Real-Time Feedback-Controlled Dosimetry for Chronic Central Serous Chorioretinopathy: A Randomized, Open-Label, Controlled Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm10194295 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4295

Author(s):

Ji-young Lee ◽

Min-hee Kim ◽

Seung-hee Jeon ◽

Seung-hoon Lee ◽

Young-jung Roh

Keyword(s):

Real Time ◽

Central Serous Chorioretinopathy ◽

Controlled Trial ◽

Subretinal Fluid ◽

Post Treatment ◽

Control Group ◽

Controlled Clinical Trial ◽

Chronic Central Serous Chorioretinopathy ◽

Selective Retina Therapy

This prospective randomized controlled trial evaluated the safety and efficacy of real-time feedback-controlled dosimetry (RFD)-guided selective retina therapy (SRT) in chronic central serous chorioretinopathy (CSC). Forty-four participants with chronic CSC were included and randomly assigned to the control group or SRT group. The SRT laser system with RFD-guidance was applied to cover the entire leakage area. If SRF remained at the 6-week follow-up visit, re-treatment and rescue SRT was performed for the SRT group and crossover group, respectively. The rate of complete resolution of subretinal fluid (SRF), mean SRF height, and mean retinal sensitivity were compared between the two groups at 6-weeks post-treatment. The complete SRF resolution rate in all SRT-treated eyes was evaluated at 12-weeks post-treatment. The rate of complete SRF resolution was significantly higher in the SRT group (63.6%) than in the control group (23.8%) at 6-weeks post-treatment (p = 0.020). The mean SRF height at 6 weeks after SRT was significantly lower in the SRT group (p = 0.041). Overall, SRT-treated eyes showed complete SRF resolution in 70.3% of eyes at 12-weeks post-treatment. RFD-guided SRT was safe and effective to remove SRF in chronic CSC patients during the 3-month follow-up period.

Download Full-text

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

European Journal of Ophthalmology ◽

10.1177/11206721211064021 ◽

2021 ◽

pp. 112067212110640

Author(s):

Francesca Amoroso ◽

Alexandre Pedinielli ◽

Salomon Yves Cohen ◽

Camille Jung ◽

Jay Chhablani ◽

...

Keyword(s):

Indocyanine Green ◽

Fluorescein Angiography ◽

Treatment Response ◽

Laser Treatment ◽

Central Serous Chorioretinopathy ◽

Indocyanine Green Angiography ◽

Subretinal Fluid ◽

Factors Associated ◽

Micropulse Laser ◽

Choroidal Hyperpermeability

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.

Download Full-text

Fundus Autofluorescence and Spectral Domain OCT in Central Serous Chorioretinopathy

Journal of Ophthalmology ◽

10.1155/2011/706849 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 11

Author(s):

Luiz Roisman ◽

Daniel Lavinsky ◽

Fernanda Magalhaes ◽

Fabio Bom Aggio ◽

Nilva Moraes ◽

...

Keyword(s):

Fluorescein Angiography ◽

Central Serous Chorioretinopathy ◽

Near Infrared ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Subretinal Fluid ◽

Spectral Domain ◽

Fundus Photography ◽

Cross Sectional ◽

Spectral Domain Oct

Background. To describe the standard autofluorescence (FAF), the near infrared autofluorescence (NIA) and optical coherence tomography (OCT) patterns in central serous chorioretinopathy, correlating them with fluorescein angiography.Methods. Cross-sectional observational study, in which patients with at least seven months of CSC underwent ophthalmologic examination, fundus photography, FAF, NIA, fluorescein angiography (FA), and spectral-domain OCT.Results. Seventeen eyes of thirteen patients were included. The presentation features were a mottled hyperFAF in the detached area and areas with pigment mottling. NIA images showed areas of hyperNIA similar to FAF and localized areas of hypoNIA, which correlated with the points of leakage in the FA. OCT showed pigment epithelium detachment at the location of these hypoNIA spots.Discussion. FAF showed increased presence of fluorophores in the area of retinal detachment, which is believed to appear secondary to lipofuscin accumulation in the RPE or the presence of debris in the subretinal fluid. NIA has been related to the choroidal melanin content and there were areas of both increased and decreased NIA, which could be explained by damage ahead the retina, basically RPE and choroid. These findings, along with the PEDs found in the areas of hypoNIA, support the notion of a primary choroidal disease in CSC.

Download Full-text

Central serous chorioretinopathy in active endogenous Cushing’s syndrome

Scientific Reports ◽

10.1038/s41598-021-82536-2 ◽

2021 ◽

Vol 11 (1) ◽

Cited By ~ 1

Author(s):

Joost Brinks ◽

Femke M. van Haalen ◽

Thomas J. van Rijssen ◽

Nienke R. Biermasz ◽

Onno C. Meijer ◽

...

Keyword(s):

Fluorescein Angiography ◽

Cushing’S Syndrome ◽

Central Serous Chorioretinopathy ◽

Vision Loss ◽

De Novo ◽

Case Series ◽

Subretinal Fluid ◽

Cushing's Syndrome ◽

Enhanced Depth Imaging ◽

Ophthalmological Examination

AbstractMultiple case series have provided evidence for a relatively high incidence of central serous chorioretinopathy (CSC) in patients with active Cushing’s syndrome (CS). We describe the ophthalmological status in detail of consecutive patients with active endogenous CS (either de novo or recurrent active endogenous CS) in this prospective cohort study. All patients underwent complete ophthalmological examination, including multimodal imaging, which was performed shortly after establishing the diagnosis of active CS in hypercortisolemic state. Eleven CS patients (4 men, 7 women) with active hypercortisolism were included. Abnormalities reminiscent of (subclinical) CSC were found in 3 patients. Optical coherence tomography (OCT) revealed macular subretinal fluid in 1 patient, who was diagnosed as having active CSC and was successfully treated with half-dose photodynamic therapy. Two other patients showed CSC-like abnormalities: an unilateral pseudovitelliform lesion on OCT and hyperfluorescent changes on fluorescein angiography in one patient, and unilateral leakage on fluorescein angiography in the other patient. Mean subfoveal choroidal thickness on enhanced depth imaging OCT was 270 ± 40 μm (range, 178 – 357 μm). Retinal abnormalities resembling (subclinical) CSC may be more common than previously thought in patients with active CS, and may exist even in patients without visual complaints. Clinicians should have a low threshold for ophthalmological evaluation in case of a CS patient with visual symptoms since there may be therapeutic opportunities to prevent vision loss.

Download Full-text