Cases Of Central Serous Chorioretinopathy Research Articles

Sensitivity and specificity of multispectral imaging in detecting central serous chorioretinopathy

Central serous chorioretinopathy (CSCR) is a common and idiopathic retinal disorder that affects young to middle aged adults. The aim of this study was to describe the characteristics of eyes with CSCR using a light-emitting diode (LED)-based multispectral imaging (MSI) system and to evaluate the diagnostic reliability of MSI compared to fluorescein angiography (FA) in detecting CSCR. A total of 56 eyes among 52 patients with 1 or more retinal pigment epithelium (RPE) abnormality were retrospectively enrolled in the study. The patients underwent complete examination, including optical coherence tomography, FA, indocyanine-green angiography, and MSI. MSI images were retrospectively reviewed by experienced masked graders. Diagnoses that were made based on MSI alone were compared with those that were made using FA. Sensitivity and specificity were calculated, and the morphological features on MSI were summarized. Among 56 eyes in 52 patients, MSI detected 22 of 26 true-positive CSCR cases but missed 4 FA-confirmed lesions. Further, it correctly excluded 30 of 30 non-CSCR lesions. The sensitivity and specificity of MSI were 84.6 and 100%, respectively, for identifying CSCR. Using MSI, RPE leakage was observed in 25 (96.2%) of 26 eyes with CSCR, which was comparable to the performance of FA. Dome-shaped areas of signal, which corresponded to fluid accumulation associated with neurosensory retinal detachment or RPE detachment were observed in 23 (88.5%) of 26 eyes. As a non-invasive technique, MSI permitted the visualization of RPE leakage and neurosensory detachment and allowed good detection of CSCR in this selected clinical population. Lasers Surg. Med. 49:498-505, 2017. © 2016 Wiley Periodicals, Inc.

A case of bilateral central serous chorioretinopathy secondary to Cobimetinib treatment

PurposeOn November 2015, Cobimetinib (Cotellic®) was approved for usingin combination with Vemurafenib to treat adult patients with unresectable or metastatic melanoma with a BRAF V600 mutation. We report a case of central serous chorioretinopathy (CSC) associated with Cobimetinib treatment.MethodsA 48‐year‐old male patient complained of a blurred spot in the center of vision in both eyes. The patient was diagnosed with metastatic melanoma and had begun the treatment with 60 mg of Cobimetinib 2 days before the symptoms appeared.ResultsBest‐corrected visual acuity (BCVA) was 20/20 bilaterally, slit‐lamp examination and Goldmann applanation intraocular pressure (IOP) were normal. Funduscopy revealed a bilateral dome‐shaped subretinal macular elevation on both eyes. Spectral‐domain optical coherence tomography (SD‐OCT) showed macular edema with retinal pigment epithelium (RPE) detachment in both eyes. Treatment was suspended and within 5 days macular morphology was normal. He started with a lower dose of Cobimetinib, 40 mg once daily, and a month later he is not presenting any retinal alteration.ConclusionsAlthough CSC is considered an idiopathic disease, it is really important to perform a thorough anamnesis and to look for the etiology, especially when it is a bilateral case like this one. In CSC secondary to Cobimetinib, it is really necessary to adjust the dose of the drug because CSC usually disappears. Leaving this therapy is not an option for many patients with unresectable or metastatic melanoma. SD‐OCT could play an important role in the dose adjustment to avoid CSC in these patients. To the best of our knowledge this is the first case of bilateral CSC secondary to Cobimetinib treatment for metastatic melanoma.

Microsecond yellow laser for subfoveal leaks in central serous chorioretinopathy.

PurposeTo evaluate the role of navigated yellow microsecond laser in treating subfoveal leaks in nonresolving central serous chorioretinopathy (CSC).MethodsThis prospective study included ten eyes of ten consecutive patients with nonresolving CSC with subfoveal leaks. All eyes were treated with 577 nm navigated yellow microsecond laser (5% duty cycle). Key inclusion criteria include a vision loss for a duration of minimum 3 months duration due to focal subfoveal leak on fluorescein angiography. Key exclusion criteria include prior treatment for CSC and any signs of chronic CSC. Comprehensive examination, in addition to low-contrast visual acuity assessment, microperimetry, autofluorescence, spectral domain optical coherence tomography, and fundus fluorescein angiography, was done at baseline, 1, 3, and 6 months after treatment. Rescue laser was performed as per predefined criteria at 3 months.ResultsThe average best-corrected visual acuity improved from 73.3±16.1 letters to 75.8±14.0 (P=0.69) at 3 months and 76.9±13.0 (P=0.59) at 6 months, but was not statistically significant. Low-contrast visual acuity assessment (logMAR) improved from 0.41±0.32 to 0.35±0.42 (P=0.50) at 3 months and 0.28±0.33 (P=0.18) at 6 months. Average retinal sensitivity significantly improved from baseline 18.93±7.19 dB to 22.49±6.67 dB (P=0.01) at 3 months and 21.46±8.47 dB (P=0.04) at 6 months. Rescue laser was required only in one eye at 3 months; however, laser was required in three eyes at 6 months.ConclusionMicrosecond laser is a safe and effective modality for treating cases of nonresolving CSC with subfoveal leaks.

Bilateral Central Scotoma Due to CSCR in an Asthmatic Policeman

Central serous chorioretinopathy (CSCR) is a retinal condition characterized by fluid accumulation in the subretinal space, resulting in neurosensory detachment or pigment epithelial detachment. The risk factors associated with this condition include male gender, middle age, smoking, stress and use of corticosteroids. We report a case of CSCR in a 37-year-old policeman with hypertension and bronchial asthma. He presented with sudden onset of bilateral blurring of central vision for 1 day, worse over the left eye. There were no other significant eye complaints. He is an active smoker and has been on long-term corticosteroids for asthma. On examination, the visual acuity was 6/9 bilaterally. The anterior segment of both eyes was normal. Examination of the right fundus revealed a dome-shaped swelling inferior to the fovea, while the left fundus showed circular detachment of the neurosensory retina at the macula. He was diagnosed to have bilateral central serous chorioretinopathy. He was also counseled to stop smoking. The corticosteroids were continued due to the risk of precipitating an asthma attack if they were withheld. Upon his next review two months later, his condition remained stable. CSCR is usually a self-limited condition, with good visual outcome. A thorough medical, social and drug history should be obtained, and patients advised to modify their lifestyle to eliminate or reduce risk factors such as smoking, stress and corticosteroid use.

Effect of a topical nonsteroidal anti-inflammatory agent (0.1% pranoprofen) on acute central serous chorioretinopathy.

To investigate the effects of topical pranoprofen 0.1% on acute central serous chorioretinopathy (CSC). The medical records of 52 cases (52 patients) of CSC were retrospectively reviewed. Twenty-six patients were treated with topical pranoprofen 0.1% (treatment group) and 26 patients did not receive treatment (control group). Baseline and follow-up values for visual acuity, subfoveal choroidal thickness (SCT), subretinal fluid (SRF) maximum height, and central macular thickness (CMT) were examined and compared between groups. In the treatment group, mean SCT decreased from 365.5 ± 52.9μm at baseline to 288.9 ± 36.1μm at 6months after initiation of treatment (p = 0.005). Both SRF maximum height and CMT were also decreased from baseline at 1month (SRF maximum height, baseline: 221.5 ± 108.4, 1month: 97.7 ± 54.3μm, p = 0.002; CMT, baseline: 403.9 ± 114.6, 1month: 270.1 ± 37.9μm, p = 0.003). In the control group, SCT decreased throughout the follow-up period, but the change was not significant. Subretinal fluid maximum height and CMT were significantly decreased after 3months in the control group (SRF, baseline: 265.4 ± 112.4μm, 6months: 64.8 ± 116.9μm, p = 0.005; CMT, baseline: 459.1 ± 104.9μm, 6months: 304.6 ± 92.8μm, p < 0.001). Visual acuity was improved from baseline in both groups after 6months, but the improvement was only significant in the treatment group (p = 0.002). The rate of disease recurrence was lower in the treatment group (23%) than in the control group (38%), but this difference between groups was not statistically significant (p = 0.229, chi-square test). Topical pranoprofen 0.1% was effective in treating acute CSC, as demonstrated by an increase in visual acuity and a decrease in SRF, SCT, and CMT after treatment. These results suggest that topical pranoprofen 0.1% may be useful in treating patients with acute CSC.

Optical Coherence Tomography Angiography in Central Serous Chorioretinopathy.

Purpose. To analyze optical coherence tomography angiography (OCTA) findings in eyes with central serous chorioretinopathy (CSC) and to compare them with those obtained with multimodal imaging. Methods. A series of consecutive patients diagnosed with CSC, underwent OCTA and multimodal imaging, including spectral domain OCT, fluorescein, and indocyanine green angiography. OCTA images were performed at three main depth intervals: automatically segmented outer retina, manually adjusted outer retina, and automatically segmented choriocapillaris. Results. Thirty-three eyes of 32 consecutive patients were analyzed. OCTA showed 3 main anomalies at the choriocapillaris: the presence of dark areas (19/33 eyes) which were frequently associated with serous retinal detachment, presence of dark spots (7/33 eyes) which were frequently associated with retinal pigment epithelium detachment, and presence of abnormal vessels (12/33 eyes) which were frequently, but not systematically, associated with choroidal neovascularization, as confirmed by multimodal imaging. Conclusions. OCTA revealed dark areas and dark spots, which were commonly observed. An abnormal choroidal pattern was also observed in one-third of cases, even when multimodal imaging did not evidence any choroidal neovascularization. Abnormal choroidal vessels should be interpreted with caution, and we could assume that this pathological choroidal vascular pattern observed in many CSC cases could be distinct from CNV.

Central Serous Chorioretinopathy Misdiagnosed as Posterior Uveitis and the Vicious Circle of Corticosteroid Therapy.

Purpose:To determine the proportion of patients with central serous chorioretinopathy (CSCR) mistaken for posterior uveitis and to identify the deleterious consequences.Methods:Charts of 1,657 patients admitted in the section of inflammatory eye diseases at the Center for Ophthalmic Specialized Care (COS) in Lausanne, Switzerland from 1995 to 2013 were reviewed. CSCR cases misdiagnosed as posterior uveitis or those with superimposed disease due to steroid therapy for uveitis were studied. Delay in diagnosis, specific erroneous uveitis diagnosis and evolution of the disease were also evaluated. Retrospectively, the most useful means for a correct diagnosis of CSCR were the original fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) when available.Results:Out of a total of 1,657 patients, 15 (0.9%) cases with CSCR were identified. These included 12 subjects misdiagnosed as posterior uveitis and 3 uveitis subjects with superimposed CSCR following corticosteroid therapy for uveitis. The presentation of the disease was largely influenced by improper and continued use of corticosteroids.Conclusion:CSCR is a rare but not negligible misdiagnosis in posterior uveitis representing approximately 1% of subjects from a collective series of uveitis cases at a referral center. Investigative measures such as FA, ICGA and OCT are crucial for reaching a correct diagnosis and avoiding disease aggravation due to corticosteroid therapy.

Risk of central serous chorioretinopathy in adults prescribed oral corticosteroids: a population-based study in Taiwan.

To investigate the incidence and risk factors for central serous chorioretinopathy (CSCR) in adults who use oral corticosteroids in Taiwan. This is a population-based nested case-control study between 2000 and 2008. From the Taiwan National Health Insurance Research Database, adults who were repetitively prescribed oral corticosteroids were included as the study cohort. Of those, newly diagnosed CSCR cases were identified and the CSCR incidence was calculated. Subjects matched for age, gender, and the enrollment time were randomly selected as the controls. Corticosteroids use was compared between the cases and controls. Poisson and conditional logistic regressions were used to analyze the potential risk factors for CSCR. Among 142,035 oral corticosteroids users, 320 cases of CSCR were identified, and 1,554 matched controls were randomly selected. The incidence rate of CSCR was 44.4 (95% confidence interval, 39.5-49.3) cases per 100,000 person-years. Multivariate Poisson regression showed that male patients and those aged 35 years to 44 years had significantly higher incidence rates of CSCR. There were no differences in either median dosage or mean duration of systemic corticosteroid treatment between the cases and controls. After adjusting for other confounders, current use of oral corticosteroids was found to be significantly associated with the risk of CSCR (odds ratio, 2.40; 95% confidence interval, 1.49-3.89). Male gender, middle age, and current use of oral corticosteroids were found to be the risk factors for CSCR. However, oral corticosteroids dosage and treatment duration were not associated with the CSCR risk.

Central Serous Chorioretinopathy after Caesarean Section

Background: We report a case of central serous chorioretinopathy (CSCR) after caesarean section of a 37-year-old Caucasian woman. Four days after an uneventful delivery of twins, the patient noticed blurry vision, metamorphopsia and central scotoma of her right eye. Methods: At presentation, the visual acuity of the right eye was 8/20 and funduscopy revealed a central serous detachment of the retina. Optical coherence tomography displayed an increase of macular thickness to 558μm and fluorescein angiography showed pinpoint leakage at the foveolar avascular zone. Non-steroidal, anti- inflammatory eye drops and acetazolamide tablets were administered. Results: Five months later, macular morphology returned to normal, with a macular thickness of 276μm and a visual acuity of 20/20. Although CSCR has been reported during pregnancy, this is, to the best of our knowledge, the first report of a CSCR following an uneventful caesarean section. Conclusions: CSCR should be taken into account in the differential diagnosis of impaired vision following caesarean section. Women giving birth via caesarean should be informed of the possibility of a postpartum CSCR.

Contribution of "en face" SD‐OCT in retinal and choroidal vascular abnormalities

AbstractPURPOSE : To evaluate the retinal and choroidal aspect in retinal or choroidal vascular abnormalities using « en face » OCT images. METHODS : All the study patients underwent a complete ophthalmologic examination including biomicroscopic fundus examination, color photography, fundus autofluorescence, fluorescein angiography, indocyanin green angiography , B‐scan and « en face » SD‐OCT. RESULTS : A total of 11 patients with choroidal or retinal vascular abnormalities, 4 cases diagnosed with submacular choroidal varix, 2 cases of central serous chorioretinopathy with choroidal cavitations, 2 cases of retinal vein occlusion (RVO) with perivenular whitening and retinal ischemia, 3 cases of retinal arterial macroaneurysm were analysed. The B scan findings were correlated with the angiography findings as well as with the « en face » OCT scans. In all the cases the « en face » OCT providing a layer‐by layer view of the involved retina and choroid (with EDI mode: enhanced‐depth imaging). CONCLUSIONS : « En face » OCT imaging enables an easy analyse of the structural retinal and choroidal vascular abnormalities which are correlated with B scan OCT and angiography findings.

Cadherin 5 is Regulated by Corticosteroids and Associated with Central Serous Chorioretinopathy

Central serous chorioretinopathy (CSC) is characterized by leakage of fluid from the choroid into the subretinal space and, consequently, loss of central vision. The disease is triggered by endogenous and exogenous corticosteroid imbalance and psychosocial stress and is much more prevalent in men. We studied the association of genetic variation in 44 genes from stress response and corticosteroid metabolism pathways with the CSC phenotype in two independent cohorts of 400 CSC cases and 1,400 matched controls. The expression of cadherin 5 (CDH5), the major cell–cell adhesion molecule in vascular endothelium, was downregulated by corticosteroids which may increase permeability of choroidal vasculature, leading to fluid leakage under the retina. We found a significant association of four common CDH5 SNPs with CSC in male patients in both cohorts. Two common intronic variants, rs7499886:A>G and rs1073584:C>T, exhibit strongly significant associations with CSC; P = 0.00012; odds ratio (OR) = 1.5; 95%CI [1.2;1.8], and P = 0.0014; OR = 0.70; 95%CI [0.57;0.87], respectively. A common haplotype was present in 25.4% male CSC cases and in 35.8% controls (P = 0.0002; OR = 0.61, 95% CI [0.47–0.79]). We propose that genetically predetermined variation in CDH5, when combined with triggering events such as corticosteroid treatment or severe hormonal imbalance, underlie a substantial proportion of CSC in the male population.

Case Report of Tadalafil-Induced Central Serous Chorioretinopathy

We aimed to report a case of central serous chorioretinopathy (CSC) in a 47 year-old man who used tadalafil 20 mg, three times on alternate days for erectile dysfunction. Since the patient’s incidental ophthalmologic examination two weeks before the drug intake was entirely normal, our case report strongly supported that the tadalafil had caused CSC.

Chronic alcoholism and central serous chorioretinopathy

A 36-year-old alcoholic male suffered from central serous chorioretinopathy (CSCR). Morning serum cortisol was 293.3 ng/ml (normal range: 50-250 ng/ml), which was elevated. After 1-week of treatment with mineralo-corticoid antagonist eplerenone at 25 mg/day, patients witnessed visual acuity in the left eye increased to 6/12, which corroborated with optical coherence tomography showing substantial decrease of sub-retinal fluid. It is first documented case of CSCR associated with chronic use of alcohol that exhibited response to mineralo-corticoid antagonist eplerenone. In this study, though the exact role of alcohol intake in the pathogenesis could not be established, a disturbed the hypothalamic-pituitary-adrenal axis as a connecting link between the two conditions are observed. This will pave the way for larger, controlled studies directed to establish an association between alcohol intake and CSCR.

The Impact of Financial Crisis on Central Serous Chorioretinopathy in Greece: Is There Any Correlation?

To investigate the impact of economic crisis on central serous chorioretinopathy (CSCR) incidence in Greece, analyzing data by 3 different ophthalmology units during the period 2005-2012. Between January 1, 2005, and December 31, 2012, all patients at 3 separate ophthalmology units, i.e., 2 public university clinics and 1 private center, presenting with the diagnosis of acute CSCR, either new cases or recurrent ones, were consecutively enrolled in the study. Patients' data, including age and sex, as well as the date of presentation, were recorded and analyzed. Recurrent cases were also recorded. The study sample included 580 new cases of CSCR (463 male, 117 female) and 97 recurrent cases (84 male, 13 female). The mean age was 48.8 ± 10.3 years (range 25-90). The number of incident as well as recurrent cases increased with more recent years. As expected, the increasing trend of cases and recurrences was reproducible upon the sex-specific analyses. Moreover, the increasing trend of cases and recurrences was reproducible upon the majority of analyses stratified by age. Our study suggests a potential impact of financial crisis on CSCR. Our results demonstrated that CSCR incidence, in both new and recurrent cases, has increased during the years of economic crisis in Greece, especially in 2010-2011, implying that CSCR is likely to be associated with stress or other emotional stimuli caused by financial crisis. It is also important to note that the results were similar in public and private units.

Thermography in ocular inflammation

The purpose of this study was to evaluate ocular inflammatory and non-inflammatory conditions using commercially available thermal camera. A non-contact thermographic camera (FLIR P 620) was used to take thermal pictures of seven cases of ocular inflammation, two cases of non-inflammatory ocular pathology, and one healthy subject with mild refractive error only. Ocular inflammatory cases included five cases of scleritis, one case of postoperative anterior uveitis, and a case of meibomian gland dysfunction with keratitis (MGD-keratitis). Non-inflammatory conditions included a case of conjunctival benign reactive lymphoid hyperplasia (BRLH) and a case of central serous chorio-retinopathy. Thermal and non-thermal photographs were taken, and using analyzing software, the ocular surface temperature was calculated. Patient with fresh episode of scleritis revealed high temperature. Eyes with MGD-keratitis depicted lower temperature in clinically more affected eye. Conjunctival BRLH showed a cold lesion on thermography at the site of involvement, in contrast to cases of scleritis with similar clinical presentation. Ocular thermal imaging is an underutilized diagnostic tool which can be used to distinguish inflammatory ocular conditions from non-inflammatory conditions. It can also be utilized in the evaluation of tear film in dry eye syndrome. Its applications should be further explored in uveitis and other ocular disorders. Dedicated "ocular thermographic" camera is today's need of the hour.

Hypercortisolism induced atypical central serous chorioretinopathy in pregnancy

Pregnancy can cause changes in the functioning of the eye in health and in disease, just as it modifies other non-reproductive systems of the body. Central serous chorioretinopathy (CSCR) is a relatively common retinal disease characterized by the accumulation of sub retinal fluid at the posterior pole of the fundus, creating a circumscribed area of serous retinal detachment. It typically affects young and middle-aged men with no previous medical and family history, and no systemic symptoms or signs. However, pregnancy, predisposed by endogenous hypercortisolism, probably represents a risk factor for central serous chorioretinopathy.1 Many cases of central serous chorioretinopathy have been described during or following treatment with glucocorticoids, administrated by any route, for various systemic or ocular conditions, when the CSCR is generally atypical, bilateral and has less male prelidiction.2 We present here the nuances of a case of a concomitant endogenous hypercortisolism (pregnancy) and exogenous hypercortisolism (treatment with oral corticosteroids) leading to a unilateral, atypical CSCR with sub retinal exudates in a 26 year old second gravida.

The dexamethasone suppression test for the diagnosis of Cushing syndrome in a patient with central serous chorioretinopathy.

To describe a case whereby the dexamethasone suppression test was used to diagnose Cushing syndrome in a patient presenting with central serous chorioretinopathy. A 60-year-old woman presented with central serous chorioretinopathy and was investigated with the dexamethasone suppression test; the result was positive and lead to a diagnosis of an adrenal tumor. The adrenal tumor was removed and her central serous chorioretinopathy resolved. The dexamethasone suppression test can be used safely in an outpatient procedure to investigate cases of central serous chorioretinopathy, and it may be a useful screening tool in these patients.

Bilateral central serous chorioretinopathy with retinal pigment epithelium tears following epidural steroid injection

The cause of central serous chorioretinopathy (CSC) is mostly idiopathic. Other cause such as stressful event or use of corticosteroid has been associated with severe form of CSC. Atypical presentation of CSC has widespread degeneration of retinal pigment epithelium (RPE) or bullous retinal detachment. In this report, we describe a case of bilateral CSC with RPE tear after epidural steroid injection.

Diagnosis and interventions for central serous chorioretinopathy: review and update

Most acute cases of central serous chorioretinopathy resolve spontaneously with minimal visual impairment. The small percentage of eyes developing chronic or recurrent disease that do warrant treatment is often difficult to control. Emergent investigations and treatments have added to the established options available to manage these cases. Optical coherence tomography has proved valuable for both imaging subtle fundoscopic findings and monitoring disease progression. Fluorescein angiography aids identification of pigment epithelial leaks and targets the use of argon laser treatment if outside the fovea. Fluorescein angiography also assists differentiation from other choroidal pathologies such as choroidal neovascularization and polypoidal choroidal vasculopathy. Where the diagnosis is uncertain, indocyanine green angiography can demonstrate classic midphase hyperpermeability. This is also useful to guide the application of photodynamic therapy. Newer treatments such as intravitreal anti-vascular endothelial growth factor are as yet unproven.

Central serous chorioretinopathy: a review of epidemiology and pathophysiology

Central serous chorioretinopathy (CSCR) is a common retinal cause of vision loss. This review surveys the epidemiology, risk factors, clinical presentation, natural history and pathophysiology of CSCR. Studies suggest an annual incidence rate of 10 per 100 000 in men, with CSCR occurring six times more commonly in men compared with women. Most acute CSCR cases resolve spontaneously within 2-3 months. Prognosis is highly dependent on presenting visual acuity; patients with initial visual acuities of 6/6 remain at that level, while patients with initial visual acuities of less than 6/9 recover on average two to three Snellen lines over the next few years. The main risk factors for CSCR are systemic corticosteroid use, type A personality, pregnancy and endogenous Cushing's syndrome. The pathophysiology of CSCR remains obscure, although disorders in both the choroidal circulation and retinal pigment epithelium are implicated.