Efficacy of oral rifampicin in chronic central serous chorioretinopathy

Objective: To evaluate the role of oral rifampicin in the management of chronic central serous chorioretinopathy. Methods: Retrospective analysis of patients diagnosed with chronic central serous chorioretinopathy (duration >3 months) and treated with oral rifampicin 600 mg daily for a maximum period of 3 months was carried out. Baseline visual acuity, fundus fluorescein angiography, and optical coherence tomography were recorded and the patients were followed up. Resolution of subretinal fluid and improvement in visual acuity were the main outcome measures. Recurrence of subretinal fluid was noted. Any adverse reaction to the drug was monitored. Results: Nine eyes of eight patients were included in the study. The average age of the patients was 41.90 years (range 32–52 years). Mean duration of symptoms was 16 months (range 3–60 months). Mean duration of follow-up was 10.11 months (range 3–33 months). Fluorescein angiography showed four eyes with subfoveal leaks and five eyes with diffuse retinal pigment epitheliopathy. Complete resolution of subretinal fluid was achieved in four of the nine eyes – two patients at the end of 1 month, one patient each at the end of 2 and 3 months, respectively. Visual acuity improvement was noted in four of the nine eyes. Three patients had one-line improvement and one patient had a two-line visual improvement. None of the patients had severe adverse events for which the drug had to be discontinued. None of the patients had recurrence of subretinal fluid after the discontinuation of the drug. Conclusion: Oral rifampicin could provide a useful, effective, and cost-effective alternative for treatment of patients with chronic central serous choroidopathy and evidence of healthier retinal pigment epithelium, those with focal leakage. It was not effective in eyes with diffuse retinal pigment epitheliopathy.

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Chronic Central Serous Chorioretinopathy; Signs, Diagnosis and Treatment

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0204 ◽

2020 ◽

pp. 104-111

Keyword(s):

Central Serous Chorioretinopathy ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Fluid Accumulation ◽

Fundus Fluorescein Angiography ◽

Blurred Vision ◽

Chronic Central Serous Chorioretinopathy

Central serous chorioretinopathy (CSCR) is a maculopathy characterized by the separation of the neurosensory layer as a result of fluid accumulation between the retinal pigment epithelium (RPE) and the photoreceptor layer. Classically it is classified as acute and chronic forms. When the disease lasts longer than 4-6 months, it is called a chronic form and comprises 15% of all CSCR cases. Although the exact etiology is unknown; studies emphasize changes in choroidal circulation causing choroidal ischemia and vascular hyperpermeability as well as subretinal fluid accumulation due to deterioration pump function of RPEs. Subretinal fluid accumulation can lead to photoreceptor dysfunction and loss of vision. Classical findings in patients are a decrease in visual acuity, blurred vision, metamorphopsia, micropsia, disturbance in color vision and dark adaptation, and scotomas. Diagnosis and follow-up depend on fundoscopy as well as imaging. Optical coherent tomography is the primary method. Fundus autofluorescence (FAF) is useful in defining RPE changes noninvasively. Fundus fluorescein angiography (FFA) shows the source of leakage. In recurrent, unresolved and chronic cases, OCT, FAF, FFA, and indocyanine green angiography can be used all together to manage the disease, to follow-up its extension, and to diagnose possible neovascular as well as polypoidal component. For the treatment of chronic CSCR patients, besides medical treatments such as carbonic anhydrase inhibitors, mineralocorticoid receptor, and glucocorticoid antagonists and intravitreal vascular endothelial growth factor antagonist (Anti-VEGF) injections, half-dose photodynamic therapy and subthreshold micropulse laser treatment are used. Prospective, controlled trials with large series for the treatment of chronic CSCR warranted.

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Bullous central serous chorioretinopathy and retinal pigment epithelium sequelae postblunt trauma

BMJ Case Reports ◽

10.1136/bcr-2020-235882 ◽

2020 ◽

Vol 13 (9) ◽

pp. e235882

Author(s):

Nithin Teja Gunna ◽

Deepika C Parameswarappa ◽

Padmaja Kumari Rani

Keyword(s):

Visual Acuity ◽

Retinal Pigment Epithelium ◽

Central Serous Chorioretinopathy ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Specific Treatment ◽

Subretinal Fluid ◽

Fundus Fluorescein Angiography ◽

Near Vision ◽

The Right

A 68-year-old man presented with diminution of distance and near vision in the right eye for a duration of 1 month postblunt trauma with a stick. On examination, his visual acuity in the right eye was 20/320 and near vision was <N36. Right eye fundus showed bullous neurosensory retinal detachment at posterior pole and retinal pigment epithelium (RPE) atrophic area temporal to fovea. Optical coherence tomography showed subretinal fluid with pigment epithelial detachment and an area of RPE and photoreceptor loss temporal to fovea. Fundus fluorescein angiography and indocyanine green angiography showed focal leaks and transmitted hyperfluorescence corresponding to the area of RPE loss. Left eye examination was unremarkable except for senile cataract of nuclear opalescence grade 3. A diagnosis of right eye bullous central serous chorioretinopathy (CSCR) and RPE sequelae postblunt trauma was made. Our patient was managed conservatively with no specific treatment for CSCR. One month later, there was improvement in vision with decrease in neurosensory detachment. The area of RPE loss remained the same with photoreceptor loss. Since this area of RPE and photoreceptor loss were temporal to fovea, our patient’s visual acuity was not affected significantly.

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Diagnosis and Monitoring of Choroidal Osteoma through Multimodal Imaging

Case Reports in Medicine ◽

10.1155/2014/393804 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Theodoros Empeslidis ◽

Usman Imrani ◽

Vasileios Konidaris ◽

Fizza Mushtaq ◽

Pandelis Fotiou ◽

...

Keyword(s):

Visual Acuity ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Interesting Case ◽

Choroidal Neovascularisation ◽

Optical Biopsy ◽

Fundus Fluorescein Angiography ◽

Choroidal Osteoma ◽

History Of

A 16-year-old Caucasian female with a 6-month history of decreased visual acuity and metamorphopsia in the left eye is reported. The fundus of the left eye revealed a well defined lesion in the macula region. Diagnosis of choroidal osteoma was established using spectral domain optical coherence tomography (OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICG), and B-scan ultrasonography. Subretinal fluid (SRF) and retinal pigment epithelium (RPE) detachment were noted in the absence of obvious classic choroidal neovascularisation (CNV). The patient was followed up for over 13 months without any treatment in the interim and the lesion was noted to have enlarged but visual acuity and SRF had remained stable. We report an interesting case where subretinal fluid was noted in the absence of evident choroidal neovascularisation and provide an example of the imaging modalities application in the era of “optical biopsy.”

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Photodynamic Therapy with Verteporfin for Chronic Central Serous Chorioretinopathy: A Review of Data and Efficacy

Pharmaceuticals ◽

10.3390/ph13110349 ◽

2020 ◽

Vol 13 (11) ◽

pp. 349

Author(s):

Pierluigi Iacono ◽

Stefano Da Pozzo ◽

Monica Varano ◽

Mariacristina Parravano

Keyword(s):

Photodynamic Therapy ◽

Central Serous Chorioretinopathy ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Serous Retinal Detachment ◽

Subretinal Fluid ◽

Chronic Central Serous Chorioretinopathy ◽

Long Time ◽

Potential Damage ◽

Retinal Disorder

Central serous chorioretinopathy represents the fourth most frequent retinal disorder, occurring especially in young age. Central serous chorioretinopathy is mainly characterized by macular serous retinal detachment and although the clinical course moves frequently toward a spontaneous resolution, the subretinal fluid may persist for a long time, thus evolving to the chronic form, and leading to a potential damage of the retinal pigment epithelium and to photoreceptors. The photodynamic therapy with verteporfin plays an important role in the armamentarium among the many therapeutic options employed in this complex retinal disorder. In this review, the authors aim to summarize data of efficacy and safety of PDT focusing especially on mechanisms of action of the PDT and providing comparative outcomes with the alternative therapeutic approaches, including especially the subthreshold laser treatment.

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Intravitreal Ziv-Aflibercept in Treatment of Naïve Chronic Central Serous Chorioretinopathy Related Choroidal Neovascular Membrane

Case Reports in Ophthalmological Medicine ◽

10.1155/2017/5036248 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5

Author(s):

Nishant Radke ◽

Charudutt Kalamkar ◽

Amrita Mukherjee ◽

Snehal Radke

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Case Report ◽

Fluorescein Angiography ◽

Male Patient ◽

Visual Function ◽

Central Serous Chorioretinopathy ◽

Choroidal Neovascular Membrane ◽

Fundus Fluorescein Angiography ◽

Chronic Central Serous Chorioretinopathy

Purpose. To study the effect and outcome of intravitreal Ziv-Aflibercept (IVZ) in treatment of Chronic Central Serous Chorioretinopathy (CSCR) related Choroidal Neovascular Membrane (CNVM). Methods. A case report of 48-year-old male patient treated with 1.25 mg/0.05 ml IVZ (total 3 doses at monthly intervals) in CSCR related CNVM. Pre- and posttreatment fundus fluorescein angiography (FFA) and Optical Coherence Tomography (OCT) were done to document response along with improvement in visual acuity. Patients. Single eye of a 48-year-old male patient. Results. Regression of CNVM was noted with improvement of macular contour and thickness on OCT and cessation of leakage on FFA. Visual acuity improved from 3/60, <N36 to 6/12, N12. Discussion. Anti-VEGF injections have shown benefit in treatment of CNVM. There is very little information about benefit of IVZ in CSCR related CNVM. Conclusion. IVZ is effective in regression of CSCR related CNVM and is associated with better macular anatomy and improved visual function.

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The morphology of choroidal neovascularization in chronic central serous chorioretinopathy presenting with flat, irregular pigment epithelium detachment

International Ophthalmology ◽

10.1007/s10792-021-01768-3 ◽

2021 ◽

Author(s):

Claudio Azzolini ◽

Jennifer Cattaneo ◽

Laura Premoli ◽

Cristian Metrangolo ◽

Maurizio Chiaravalli ◽

...

Keyword(s):

Choroidal Neovascularization ◽

Central Serous Chorioretinopathy ◽

Multimodal Imaging ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Morphological Characteristics ◽

Subretinal Fluid ◽

Chronic Central Serous Chorioretinopathy ◽

Cross Sectional ◽

Pigment Epithelium Detachment

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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Central Serous Chorioretinopathy – an Overview

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-1531-5605 ◽

2021 ◽

Author(s):

Lieselotte Berger ◽

Virginie Bühler ◽

Suzanne Yzer

Keyword(s):

Visual Acuity ◽

Central Serous Chorioretinopathy ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Case Series ◽

Subretinal Fluid ◽

Laser Coagulation ◽

Blurred Vision ◽

Colour Perception ◽

Spontaneous Course

AbstractCentral serous chorioretinopathy (CSCR) is characterised by retinal serous detachment usually localised in the macular region. CSCR predominantly affects men between 30 and 50 years of age. Traditional classification differentiates between acute (duration shorter than 4 to 6 months) and chronic disease (duration longer than 4 to 6 months). The pathogenesis is multifactorial and current thinking assumes the presence of localised choroidal hyperpermeability with subsequent secondary changes in the retinal pigment epithelium (RPE). The symptoms of acute CSCR include central blurred vision, often with deterioration in visual acuity. Optical coherence tomography (OCT) reveals subretinal fluid (SRF) and/or single retinal pigment epithelial detachments. Fluorescein angiography (FA) usually shows a leaking point with absent or only minor RPE changes in the acute phase and indocyanine green angiography (ICG) highlights circumscribed areas of thickened and hyperpermeable choroid. Acute cases may show spontaneous resolution of SRF, but may also recur and/or become chronic. After the initial diagnosis, spontaneous remission is seen in about 70 to 80% of cases, with a recurrence rate of about 50%. Due to the favourable spontaneous course, it is recommended to wait for 4 to 6 months after the first symptoms manifest. Steroid therapy is considered as a major risk factor. Chronic cases are characterised by slow deterioration in visual acuity with reduced contrast and colour perception. There are extensive RPE changes, with secondary degenerative changes of the photoreceptors. The disease can by complicated by choroidal neovascularisation (CNV), especially in elderly patients. The literature lists a number of treatments: The leakage point (visible in the FA) can be treated by focal laser therapy, either micropulse laser or, if sufficiently distant from the fovea, by argon laser coagulation. Randomised trials in chronic CSCR demonstrated good outcomes with photodynamic therapy. With observation periods ranging from 3 to 6 months, several case series reports found improvement after systemic administration of mineralocorticoid receptor antagonists, carbonic anhydrase inhibitors or non-steroidal anti-inflammatory drugs. In the presence of secondary CNV, anti-VEGF treatment should be initiated. It is unclear whether the combination with PDT might be useful.

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The Role of Imaging in Planning Treatment for Central Serous Chorioretinopathy

Pharmaceuticals ◽

10.3390/ph14020105 ◽

2021 ◽

Vol 14 (2) ◽

pp. 105

Author(s):

Stefano Da Pozzo ◽

Pierluigi Iacono ◽

Alessandro Arrigo ◽

Maurizio Battaglia Parodi

Keyword(s):

Central Serous Chorioretinopathy ◽

Therapeutic Strategy ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Subretinal Space ◽

Planning Treatment ◽

Multiple Biomarkers ◽

Effective Procedures

Central serous chorioretinopathy (CSC) is a controversial disease both in terms of clinical classification and choice of therapeutic strategy. Choroidal layers, retinal pigment epithelium (RPE), photoreceptors, and retina are involved to varying degrees. Beyond well-known symptoms raising the clinical suspect of CSC and slit-lamp fundus examination, multimodal imaging plays a key role in assessing the extent of chorioretinal structural involvement. Subretinal fluid (SRF) originating from the choroid leaks through one or multiple RPE defects and spreads into the subretinal space. Spontaneous fluid reabsorption is quite common, but in some eyes, resolution can be obtained only after treatment. Multiple therapeutic strategies are available, and extensive research identified the most effective procedures. Imaging has carved a significant role in guiding the choice of the most appropriate strategy for each single CSC eye. Multiple biomarkers have been identified, and all of them represent a diagnostic and prognostic reference point. This review aims to provide an updated and comprehensive analysis of the current scientific knowledge about the role of imaging in planning the treatment in eyes affected by CSC.

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Spectral OCT-Angiography in En Face Mode for Detection of Morphological Changes in the Retinal Pigment Epithelium before and after Selective Micro-Pulse Laser Exposure in Patients with Central Serous Chorioretinopathy

Ophthalmology in Russia ◽

10.18008/1816-5095-2019-2-192-201 ◽

2019 ◽

Vol 16 (2) ◽

pp. 192-201

Author(s):

P. L. Volodin ◽

E. V. Ivanova ◽

E. Iu. Polyakova ◽

A. V. Fomin

Keyword(s):

Retinal Pigment Epithelium ◽

Central Serous Chorioretinopathy ◽

Morphological Changes ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Laser System ◽

Subretinal Fluid ◽

Micropulse Laser ◽

En Face ◽

Before And After

Purpose — to study the morphological changes of the retinal pigment epithelium (RPE) by optical coherence tomography-angiography (OCT-A) in En Face mode before and after selective micropulse laser irradiation in patients with central serous chorioretinopathy (CSC), determine the correspondence between the topographic location of RPE defects and detachment on the OCT-angiogram in En Face mode and points of leakage on the FAG.Patients and methods. There were 20 patients (21 eyes) with CSC before and after laser treatment under the observation. All patients underwent high-resolution FAG and OCT-A using Angio Retina 2×2 or 3×3 mm protocol and Angio Retina HD 6×6 mm. The treatment was carried out in a selective micropulse mode with individual selection of parameters using the Navilas 577s navigation laser system (OD-OS, Germany) or the IQ 577 laser system (IRIDEX, USA).Results were evaluated at 2 weeks and 1 month after treatment. Results. In all cases, the leaking points of the subretinal fluid on FAG corresponded to the topographic location of defects and detachments of RPE detachment on OKT-A En Face. According to OCT-A En Face, the following morphological changes were revealed: in 5 cases — single defects of RPE, in 7 cases — multiple defects of RPE, in 9 cases of slit-like detachment of RPE, in 3 patients a combination of slit-like detachment and defect RPE. The sizes of RPE defects varied in the range from 21 to 159 microns, while their rounded shape prevailed. 1 month after the selective micropulse laser effect on OCT-A in the En Face mode, the defects were closed and the RPE detachments fit in all patients, which resulted in resorption of the subretinal fluid and the neurosensory retina attachment.Findings. OCT-A in En Face mode is a highly informative diagnostic method that allows noninvasive detection of morphological changes in RPE with a clear topographic localization relative to the retinal vascular network, as well as evaluating the effectiveness of selective micropulse laser treatment in patients with CSC.

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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.

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