Abstract
To study and compare the efficacy of different therapeutic options for the treatment of central serous chorioretinopathy (CSCR). This is a nonrandomized, international multicentre study on 1719 patients (1861 eyes) diagnosed with CSCR, from 63 centres (24 countries). Reported data included different methods of treatment and both results of diagnostic examinations [fluorescein angiography and/or optical coherent tomography (OCT)] and best-corrected visual acuity (BCVA) before and after therapy. The duration of observation had a mean of 11months but was extended in a minority of cases up to 7years. The aim of this study is to evaluate the efficacy of the different therapeutic options of CSCR in terms of both visual (BCVA) and anatomic (OCT) improvement. One thousand seven hundred nineteen patients (1861 eyes) diagnosed with CSCR were included. Treatments performed were nonsteroidal anti-inflammatory eye drops, laser photocoagulation, micropulse diode laser photocoagulation, photodynamic therapy (PDT; Standard PDT, Reduced-dose PDT, Reduced-fluence PDT), intravitreal (IVT) antivascular endothelial growth factor injection (VEGF), observation and other treatments. The list of the OTHERS included both combinations of the main proposed treatments or a variety of other treatments such as eplerenone, spironolactone, acetazolamide, beta-blockers, anti-anxiety drugs, aspirin, folic acid, methotrexate, statins, vitis vinifera extract medication and pars plana vitrectomy. The majority of the patients were men with a prevalence of 77%. The odds ratio (OR) showed a partial or complete resolution of fluid on OCT with any treatment as compared with observation. In univariate analysis, the anatomical result (improvement in subretinal fluid using OCT at 1month) was favoured by age <60years (p<0.005), no previous observation (p<0.0002), duration less than 3months (p<0.0001), absence of CSCR in the fellow eye (p=0.04), leakage outside of the arcade (p=0.05) and fluid height >500μm (p=0.03). The OR for obtaining partial or complete resolution showed that anti-VEGF and eyedrops were not statistically significant; whereas PDT (8.5), thermal laser (11.3) and micropulse laser (8.9) lead to better anatomical results with less variability. In univariate analysis, the functional result at 1month was favoured by first episode (p=0.04), height of subretinal fluid >500μm (p<0.0001) and short duration of observation (p=0.02). Finally, there was no statistically significant difference among the treatments at 12months. Spontaneous resolution has been described in a high percentage of patients. Laser (micropulse and thermal) and PDT seem to lead to significant early anatomical improvement; however, there is little change beyond the first month of treatment. The real visual benefit needs further clarification.
Highlights
Central serous chorioretinopathy (CSCR) is an acquired chorioretinal disorder that was first described by Von Graefe in 1866 as recurrent central syphilitic retinitis. (Kitzmann et al 2008) It is characterized by serous detachment of the neurosensory retina, usually at the posterior pole
The current hypothesis of the pathophysiology of CSCR is that choroidal vascular hyperpermeability is the principal cause of the increased tissue hydrostatic pressure beneath the retinal pigment epithelium (RPE) that eventually leads to disintegration of the RPE (Uyama et al 1999)
Visual acuity (VA) was statistically significantly lower at 1, 3 and 12 months, and at the final follow-up compared with baseline
Summary
Central serous chorioretinopathy (CSCR) is an acquired chorioretinal disorder that was first described by Von Graefe in 1866 as recurrent central syphilitic retinitis. (Kitzmann et al 2008) It is characterized by serous detachment of the neurosensory retina, usually at the posterior pole. Central serous chorioretinopathy (CSCR) is an acquired chorioretinal disorder that was first described by Von Graefe in 1866 as recurrent central syphilitic retinitis. (Kitzmann et al 2008) It is characterized by serous detachment of the neurosensory retina, usually at the posterior pole. The aetiology of CSCR is unknown, but the pathogenesis seems to involve dysfunction of the choroid (the major blood vessel complex feeding the outer portion of the retina) and retinal pigment epithelium (RPE) (Pru€nte & Flammer 1996). The location and amount of subretinal fluid determine what symptoms are experienced. Central serous chorioretinopathy (CSCR) is commonly associated with fluid accumulation under the macula as well as the detachment of the neurosensory retina (Wang et al 2008). There may be no symptoms when the fluid is located outside the macula
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