Episode Of Central Serous Chorioretinopathy Research Articles

Morphological and Functional Correlations in Acute Central Serous Chorioretinopathy

PurposeWe evaluate morphological and functional correlations in patients with acute central serous chorioretinopathy (CSC).MethodsA prospective study was conducted on 50 patients with an acute CSC episode lasting less than 3 months. At baseline, assessments included optical coherence tomography (OCT), best-corrected visual acuity (BCVA), contrast sensitivity (CS), microperimetry (MP), and multifocal electroretinography (mfERG). A correlation analysis between OCT morphological parameters (maximal subretinal fluid height (SRF), central retinal thickness (CRT), and macular volume (MV)) and functional parameters was conducted on the affected eye for each patient.ResultsAmong the morphological parameters, SRF showed the strongest correlations with functional parameters (r absolute value range = 0.10–0.70). Weak correlations were observed between BCVA and morphological parameters (r absolute value range = 0.14–0.26). Average retinal sensitivity (MP-A) was the functional parameter displaying the most robust negative correlation with morphological parameters (r absolute value range = 0.61–0.70). In contrast, average contrast sensitivity (CS-A) and mfERG average amplitude density in the first (mfERG-A1) and second (mfERG-A2) ring showed weak to moderate (r absolute value range = 0.35–0.56) yet statistically significantly nonzero correlations.ConclusionsSRF and CRT could serve as the most representative morphological proxies for visual function deficit in acute CSC patients. Retinal sensitivity, as measured by MP, may be superior to BCVA in clinical research studies or when an in-depth visual function evaluation is needed.

Biomarkers predicting central serous chorioretinopathy episode persistence.

The purpose of this study was to identify biomarkers at presentation that are associated with a persistent central serous chorioretinopathy (CSC) episode. The prospective study included 35 patients with an acute CSC episode. Potential clinical and imaging biomarkers were evaluated at baseline and 3 months from the episode onset. As biomarkers age, sex, steroid use, episode recurrence, central retinal thickness (CRT), macular volume (MV), choroidal thickness (CT), pigment epithelial detachment (PED) height, and width, number of retinal hyperreflective foci (HF), leakage pattern, and area of retinal pigment epithelial (RPE) alterations were investigated. At 3 months from the CSC episode onset, spontaneous resolution occurred in 19 patients, while 16 patients had a persistent CSC episode. The group of patients with a persistent episode was statistically significantly associated with female sex (p = 0.032), older age (p = 0.015), wider PED (p = 0.005), and higher number of HF (p = 0.02). Moreover, this group of patients had a significant association with thinner choroid and diffuse RPE alterations as a pair (p = 0.008). Older and female CSC patients with wider PED, increased number of HF, thinner choroid, and diffuse RPE alterations at presentation are inclined to episode persistence and could benefit from earlier treatment.

Visual function during and after an acute central serous chorioretinopathy episode.

To evaluate visual function parameters during and after an acute central serous chorioretinopathy (CSC) episode. A prospective study included 19 fovea involving acute CSC patients with episode resolution within 3months from the episode onset. Optical coherence tomography, best corrected visual acuity (BCVA), contrast sensitivity (CS), microperimetry (MP), and multifocal electroretinography (mfERG) were performed at baseline, 3 and 6months from the episode onset. In a sub analysis, patients were divided into groups with greater (gMV, N = 9) and lower (lMV, N = 10) macular volume at presentation, and functional outcomes were observed. BCVA (p < 0.001), average CS (CS-A) (p < 0.001), average retinal sensitivity (MP-A) (p < 0.001), mfERG amplitude densities in the first and second ring (mfERG-A1, p < 0.001; mfERG-A2, p = 0.017), and implicit times in the first, second, and third ring (mfERG-IT1, p = 0.024; mfERG-IT2, p = 0.002; mfERG-IT3, p = 0.018) improved with episode resolution 3months after the episode onset. From 3 to 6months after the episode onset, only CS-A (p = 0.045) continued to improve. Patients in thegMV group had lower mfERG-A1 (p = 0.017) and central retinal sensitivity (MP-C, p = 0.05) 6months from the episode onset. Although all functional parameters mostly improve with CSC episode resolution, only CS continues to improve thereafter. Patients with greater MV at presentation have worse functional outcomes. Visual function impairment in acute CSC patients is confined to the topographical area of subretinal fluid detachment.

Associations of Single-Nucleotide Polymorphisms in Slovenian Patients with Acute Central Serous Chorioretinopathy.

Central serous chorioretinopathy (CSC) is a chorioretinal disease that usually affects the middle-aged population and is characterised by a thickened choroid, retinal pigment epithelium detachment, and subretinal fluid with a tendency towards spontaneous resolution. We investigated 13 single-nucleotide polymorphisms (SNPs) in 50 Slovenian acute CSC patients and 71 healthy controls in Complement Factor H (CFH), Nuclear Receptor Subfamily 3 Group C Member 2 (NR3C2), Cadherin 5 (CDH5) Age-Related Maculopathy Susceptibility 2 (ARMS2), TNF Receptor Superfamily Member 10a (TNFRSF10A), collagen IV alpha 3 (COL4A3) and collagen IV alpha 4 (COL4A4) genes using high-resolution melt analysis. Statistical calculations revealed significant differences in genotype frequencies for CFH rs1329428 (p = 0.042) between investigated groups and an increased risk for CSC in patients with TC (p = 0.040) and TT (p = 0.034) genotype. Genotype–phenotype correlation analysis revealed that CSC patients with CC genotype in CFH rs3753394 showed a higher tendency for spontaneous CSC episode resolution at 3 months from the disease onset (p = 0.0078), which could indicate clinical significance of SNP testing in CSC patients. Bioinformatics analysis of the non-coding polymorphisms showed alterations in transcription factor binding motifs for CFH rs3753394, CDH5 rs7499886 and TNFRSF10A rs13278062. No association of collagen IV polymorphisms with CSC was found in this study.

Posterior choroidal fluid loculation in central serous chorioretinopathy presenting as a choroidal elevation: A rare Pachychoroid phenotype.

To describe an unusual variant of central serous chorioretinopathy (CSC) presenting as a choroidal elevation with subretinal fluid and its response to accepted treatment modalities of CSC. A retrospective case series. Six eyes of three patients, two males and one female, with a mean age of 55.3 years, were included in the study. All of them had Pachychoroid features, solitary choroidal elevation and subretinal fluid on optical coherence tomography (OCT); none of the patients had a previous episode of CSC. Patients were studied with biomicroscopy, ultrasonography, fluorescein angiography and indocyanine green angiography. Systemic evaluation to rule out inflammatory and infective pathologies, and an oncologist referral also was done. Patients were managed in the line of central serous chorioretinopathy, using conservative treatment, focal laser and oral eplerenone. Resolution of subretinal fluid and choroidal elevation. Complete resolution of choroidal elevation and subretinal fluid was noted in all the three patients. There was no recurrence till the end of follow-up. Pachychoroid disease may present as solitary choroidal elevation with subretinal fluid due to exaggerated posterior choroidal fluid loculation and has a favourable outcome. However, it should be considered after exclusion of other differential diagnoses.

Structural OCT Parameters Associated with Treatment Response and Macular Neovascularization Onset in Central Serous Chorioretinopathy.

IntroductionThis study aimed to assess quantitative factors associated with treatment response and macular neovascularization (MNV) onset in central serous chorioretinopathy (CSC) through an artificial intelligence-based approach.MethodsThe study was designed as an interventional, prospective case series with a planned follow-up of 36 months. We included only eyes demonstrating the first episode of CSC. All the patients underwent eplerenone or photodynamic therapy (PDT) treatment. Eyes developing MNV underwent anti-VEGF injections. We developed an artificial intelligence-based model to assess predictive quantitative structural optical coherence tomography (OCT) factors related to treatment response and onset of MNV. Main outcome measures were best-correct visual acuity (BCVA), central macular thickness (CMT), retinal thickness (RT), retinal pigment epithelium (RPE) thickness, choroidal thickness, Sattler’s layer thickness (SLT), Haller’s layer thickness, retinal and choroidal hyperreflective foci (HF), and MNV.ResultsWe included 96 naïve CSC eyes (96 patients). Baseline BCVA was 0.18 ± 0.25 logMAR, which increased to 0.16 ± 0.27 logMAR after 3 years (p > 0.05). Baseline CMT was 337 ± 126 µm, which improved to 229 ± 40 µm after 3 years (p < 0.01). We observed good response to eplerenone in 40/78 (51%) eyes, whereas 38/78 (49%) eyes underwent PDT. The artificial intelligence model showed choroidal HF and age as determining factors of good response to eplerenone or PDT. RPE thickness < 36 µm, RT < 300 µm, and SLT < 50 µm increased probability of 50% of having MNV.ConclusionsCSC response to eplerenone or PDT is influenced by choroidal HF and patient age. RPE and SLT represent relevant factors for onset of MNV.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-021-00336-3.

Short Term Presence of Subretinal Fluid in Central Serous Chorioretinopathy Affects Retinal Thickness and Function.

Background: Acute central serous chorioretinopathy (CSCR), with subretinal fluid (SRF) resolving spontaneously within a few months from disease onset, has been considered as a benign and self-limiting disease for many years. This study sought to discover if a short presence of SRF can result in morphological and functional damage to the retina. Materials and methods: The study included patients treated by subthreshold diode micropulse laser (SDM) application for acute CSCR at the Dobry Wzrok Ophthalmological Clinic between January 2018 and November 2019. Inclusion criteria were: first episode of CSCR; duration of symptoms of two months or less; complete resolution of subretinal fluid (SRF) after a single session of SDM; and a lack of any retinal pathology, previous CSCR episode, significant anisometropia or amblyopia in the collateral eye. Fifteen patients fulfilled the inclusion criteria, including 13 males and two females aged 42.3 ± 9.5 years. The mean duration of symptoms before treatment was 4.7 ± 1.3 weeks on average. Baseline and follow-up examinations were performed in both the affected and collateral eyes and included best-corrected visual acuity (BCVA); spectral-domain optical coherent tomography measurements such as central retinal thickness (CRT) and minimal foveal thickness (MFT) (at the follow-up visit only); fluorescein angiography (at presentation only) and fundus autofluorescence. The first follow-up visit, when the total resolution of SRF was noted, was conducted between 8 and 12 weeks after SDM. Results: Resolved CSCR eyes had significantly poorer BCVA, CRT, and MFT findings in comparison with healthy collateral eyes (respectively, 0.11 +/− 0.1 vs. 0.01 +/− 0.04 logMAR; 238.80 +/− 23.39 vs. 264.87 +/− 21.22 µm and 178.93 +/− 16.88 vs. 199.47 +/− 17.87 µm) despite the short period of CSCR duration (maximum of 14 ± 2.15 weeks on average). Conclusion: Short presence of SRF typical for acute CSCR can affect retinal function and morphology resulting in poorer visual outcome.

Risk Factors and Outcomes of Choroidal Neovascularization Secondary to Central Serous Chorioretinopathy

We identified clinical characteristics and risk factors of choroidal neovascularization (CNV) in eyes with prior episode of central serous chorioretinopathy (CSC). This retrospective case-control study included those initially diagnosed with CSC and developed CNV secondarily (Group 1, n = 16), those diagnosed with CNV in eyes of previous putative CSC (Group 2, n = 14), and those initially diagnosed with CSC, and did not develop CNV secondarily, as a control group for Group 1 (Group 3, n = 250). Clinical characteristics including treatment outcomes were assessed. Demographics and multimodal imaging at the time of CSC diagnosis of secondary CNV were compared between the groups to identify risk factors. Duration from diagnosis of CSC to development of CNV in Group 1 was 40.2 ± 42.0 months. Classic CNV was noted in 23 (76.7%) eyes. After treatment with intravitreal antiangiogenics with average of 4.9 times, visual acuity improved in Group 1 and Group 2 (p = 0.002). Multivariate analysis revealed that systemic hypertension, pigmentary changes, and double layer sign were associated with development of CNV secondary to CSC (p < 0.05). Hypertension, pigmentary changes, and double layer sign were independent risk factors for CNV secondary to CSC. The CNV’s responded well to treatment, resulting in improved vision.

Serous Retinal Detachment Causes a Transient Reduction on Spectral Domain OCT Estimates of Ganglion Cell Layer Thickness.

During the acute stage of central serous chorioretinopathy (CSC) with retinal elevation, the spectral domain optical coherence tomography (SD-OCT) estimate of ganglion cell layer complex thickness is reduced. Thickness returns to normal after resolution of the event. Measurement error is at least partially responsible for this effect. The reduction in ganglion cell layer complex thickness does not represent atrophy and is not predictive of a poor outcome. We investigated the effects of serous retinal detachment on the ganglion cell layer complex analysis (GCA) by SD-OCT in CSC patients during the acute episodes and after resolution of fluid. We retrospectively reviewed medical records of 30 patients who visited the hospital with a first episode of CSC. We analyzed GCA maps using SD-OCT (Cirrus; Carl Zeiss Meditec, Dublin, CA) at the initial visit with serous retinal elevation and after the absorption of subretinal fluid. For repeatability analysis, we used the intraclass correlation and repeatability coefficient from two consecutive measurements 5 minutes apart in 12 patients. At the initial visit, an average thickness of ganglion cell layer complex was thinner than that measured in the fellow eye (67.4 ± 27.4 μm), but after the absorption of subretinal fluid, it normalized to 87.0 ± 6.7 μm; the difference was statistically significant. The intraclass correlation and repeatability coefficient were low during the period of serous elevation but normalized after fluid resorption. Abnormalities of GCA resulted from the segmentation error of ganglion cell layer and inner plexiform layer during the acute phase of CSC. Serous retinal detachment can affect the GCA and repeatability measurements of the GCA. Clinicians should consider this finding when using the GCA measurement in the diagnosis and management of the patients with retinal contour changes such as retinal elevation including CSC.

Correlation between morphological characteristics in spectral‐domain‐optical coherence tomography, different functional tests and a patient's subjective handicap in acute central serous chorioretinopathy

The purpose of this study was to identify quantitatively measurable morphologic optical coherence tomography (OCT) characteristics in patients with an acute episode of central serous chorioretinopathy (CSC) and evaluate their correlation to functional and psychological variables for their use in daily clinical practice. Retinal thickness (RT), the height, area and volume of subretinal fluid (SRF)/pigment epithelium detachments were evaluated using the standardized procedures of the Vienna Reading Center. These morphologic characteristics were compared with functional variables [best-corrected visual acuity (BCVA), contrast sensitivity (CS), retinal sensitivity/microperimetry, fixation stability], and patients' subjective handicap from CSC using the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25). Data from 39 CSC patients were included in this analysis. Three different SRF height measures showed a high negative correlation (r=-0.7) to retinal sensitivity within the central 9°, which was also negatively correlated with SRF area and volume (r=-0.6). The CS score and fixation stability (fixation points within 2°) showed a moderate negative correlation (r=-0.4) with SRF height variables. Comparison of the subjective handicap with morphological characteristics in spectral-domain (SD)-OCT showed SRF height had the highest correlation (r=-0.4) with the subjective problems reported and overall NEI VFQ-25 score. In conclusion, SRF height measured in SD-OCT showed the best correlation with functional variables and patients' subjective handicap caused by the disease and therefore seems to be the best variable to look at in daily clinical routine. Even though area and volume also show a correlation, these cannot be so easily measured as height and are therefore not suggested for daily clinical routine.

Susceptibility to a Dexamethasone Intraocular Implant with and Without Concomitant Oral Steroid Intake: A Case Report

Introduction: This case report addresses the possible and controversial influence of a concomitant oral steroid intake on the efficacy of a dexamethasone intravitreal implant (Ozurdex) in treating macular edema (ME), mostly when related to inflammatory ocular diseases. Case Presentation: A 34-year-old Caucasian male with Behcet's disease (BD) presented with central retinal vein occlusion (CRVO), first in one eye and then in the other. The eye affected first showed a favorable course. The eye next affected, instead, developed chronic ME poorly responsive to systemic and local treatments. In this eye, two Ozurdex implants were finally performed with a 6-month interval. During the uneventful follow up to the first injection, an episode of central serous chorioretinopathy occurred in the fellow non-implanted eye. This caused the end of the long-lasting oral steroidal regimen, due to the well known negative effect of steroids on

Acute central serous chorioretinopathy: a correlation study between fundus autofluorescence and spectral-domain OCT.

To evaluate the correlation between fundus autofluorescence (FAF) and spectral-domain OCT (SD-OCT) morphological analysis in eyes with acute central serous chorioretinopathy (CSCR). Thirty-one patients with a first episode of CSCR and symptom duration of less than 6 weeks were prospectively enrolled. FAF and SD-OCT examination were performed at baseline and at 2-month intervals. Main outcome measure was the correlation between FAF and SD-OCT retinal morphology. At baseline, 30/31 and 29/31 eyes showed a macular hypo-AF, corresponding to the neurosensory retinal detachment (SRD), on shortwave-FAF (SW-FAF) and near-infrared-FAF (NIR-FAF), respectively. While the SRD resolved, both FAF techniques showed a granular hyper-AF in 31 eyes. At first examination, SD-OCT confirmed the SRD with a photoreceptor outer-segment (OS) elongation in all cases. During SRD resolution, the photoreceptor layer appeared thicker and fragmented. Multiple hyper-reflective precipitates were detected in the outer plexiform and nuclear layer and between the photoreceptors and appeared colocalized with the hyper-AF dots composing the granular hyper-AF. After SRD resolution, the hypo-AF area reverted to a normal pattern on SW-FAF in all eyes and in 25/31 on NIR-FAF. Examination at 12 months showed that the granular hyper-AF was still detectable in 54 % eyes, whereas 6/31 eyes showed hypo-AF dots on NIR-FAF. On SD-OCT, the junction IS/OS was identifiable in 11/31 eyes soon after the SRD resolution and appeared completely restored in all patients at the final visit. The simultaneous acquisition of FAF and SD-OCT provides detailed findings of retinal abnormalities of CSCR and may help to understand the evolving process linked to CSCR.

Central Serous Chorioretinopathy Produces Macular Pigment Profile Changes

Macular pigment (MP) is the collective name for three isomeric carotenoids: lutein, zeaxanthin, and meso-zeaxanthin. Macular pigment density is greatest in the central retina, peaking at the fovea and falling to negligible levels at 7 degrees of eccentricity from the fovea. Several studies have documented the interocular symmetry of MP optical density (MPOD) spatial distribution. The ongoing University of Missouri-St. Louis study uses a novel, customized heterochromatic flicker photometer to map the spatial distribution of MPOD up to 8 degrees of eccentricity relative to the fovea. Here, we report the MPOD measurements in a subject with resolved central serous chorioretinopathy (CSC) in the right eye. Two subjects performed the full MPOD spatial mapping. The test subject (WK) had a history of central serous CSC of the right eye. The control subject (CP) had an unremarkable ocular health history. Comprehensive exams were performed on each subject including Cirrus optical coherence tomography imaging and fundus photographs. Subject CP showed highly symmetric interocular MPOD profiles at the fovea and 2, 4, and 6 degrees of eccentricity. Subject WK showed interocular asymmetry at the fovea and at 2 degrees with relative symmetry at 4 and 6 degrees. A paired sample t test identified nonsignificant interocular values for subject CP and statistically significant differences of at 2 degrees for subject WK. We hypothesize that subject WK's interocular MPOD spatial distribution asymmetry resulted from his history of resolved CSC. This asymmetry is statistically significant at 2 degrees of retinal eccentricity and corresponds to the extent of retinal pigment epithelium changes observed on the fundus photographs. These findings suggest that MP and retinal pigment epithelium changes after a CSC episode are comparable in the area of the retina affected. These disruptions may also be measureable in other macular conditions in which the sensory retina is affected (e.g., cystoid macular edema and clinically significant macular edema).

Recurrent central serous chorioretinopathy with dexamethasone eye drop used nasally for rhinitis

Central serous chorioretinopathy (CSC) is characterized by serous retinal detachment at the posterior pole. Several factors have been implicated in the pathogenesis, and endogenous or exogenous corticosteroids are thought to play a major role. Here we present a case of a 35-year-old male with complaints of a dark circle in front of his right eye. Fundus examination, optical coherence tomography and fundus fluorescein angiography were performed. The patient was diagnosed with CSC. CSC resolved completely within seven weeks. Four weeks later the CSC recurred and spontaneously resolved over eight weeks. Overall, the patient had three additional recurrences of CSC in the same eye over the next year. A detailed history taking revealed the patient was using 0.1% dexamethasone eye drops nasally for recurrent rhinitis for few days prior to each episode of CSC. This indicates the strong correlation between steroids given by any route and the pathogenesis of CSC.

Recurrent Central Serous Chorioretinopathy after Peripheral Retinal Laser Photocoagulation: A Case Report

To report a case of recurrent central serous chorioretinopathy (CSC) after performing peripheral laser photocoagulation for retinal degenerations. A 44-year-old woman with ocular history of CSC presented to the emergency room of our department complaining of heavy photopsia due to retinal tuft and lattice degenerations, and underwent laser photocoagulation to prevent retinal detachment. Two days after laser treatment, the visual acuity dropped, and optical coherence tomography scan showed the onset of CSC. The serous detachment completely resolved in 20 days with no therapy. A new CSC episode occurred in the same eye after another analogous laser treatment and, similarly, quickly resolved spontaneously. We reviewed the literature and discuss the possibility that laser-induced inflammation could rouse an inflammatory cascade mediated by proinflammatory cytokines and PAI-1, leading to the exacerbation of retinal serous detachment in susceptible patients.

Choroidal thickness following extrafoveal photodynamic treatment with verteporfin in patients with central serous chorioretinopathy

To evaluate the effect of verteporfin photodynamic treatment (PDT) on choroidal thickness in patients with central serous chorioretinopathy (CSC). Choroidal thickness was measured with enhanced depth imaging- optical coherence tomography (EDI-OCT) before and after verteporfin PDT (full-dose verteporfin, half-light dose) in 16 eyes in 16 patients with serous detachment of the fovea secondary to extrafoveal angiographic fluorescein leakage. Treatment was confined to the area of leakage, whereas choroidal thickness before and after treatment was assessed over a larger area of the fundus using OCT. Complete resolution of the serous detachment was seen in all 16 eyes within 1 month of extrafoveal PDT, while choroidal thickness in the area where PDT was applied decreased from 407 μm [mean; 95% confidence interval (CI(95) ) 356-458 μm] to 349 μm (mean; CI(95) 300-399 μm; p < 0.0001), and subfoveal choroidal thickness was reduced from 421 μm (mean; CI(95) 352-489 μm) to 346 μm (mean; CI(95) 278-414 μm; p = 0.0001). Initially, subfoveal choroidal thickness was significantly increased in the treated eye compared with the healthy fellow eye (mean 324 μm; CI(95) 273-376 μm; p = 0.0003), but after treatment, the difference was not significant. Photodynamic therapy of active CSC was followed by choroidal thickness reduction, not only locally but also at considerable distance from the treated area. Thus, the process that causes choroidal thickening in CSC appears to spread laterally within the choroid.

FLUORESCEIN ANGIOGRAPHY-GUIDED PHOTODYNAMIC THERAPY WITH HALF-DOSE VERTEPORFIN FOR CHRONIC CENTRAL SEROUS CHORIORETINOPATHY

The purpose of this study was to evaluate the results of fluorescein angiography-guided photodynamic therapy with half-dose verteporfin in the treatment of chronic central serous chorioretinopathy with focal leakage areas. Eight cases with a history of central serous chorioretinopathy of ≥6 months were included. All eyes had one or more focal areas of active retinal pigment epithelial leak. Photodynamic therapy was applied with half-dose verteporfin (3 mg/m²), and the spot size was set limited to the area of active leakage shown on fluorescein angiography. The mean duration of the last central serous chorioretinopathy episode was 12.50 months. The mean best-corrected visual acuity improved from 20/122 to 20/60 the first month (P = 0.017) and to 20/55 the first year after treatment (P = 0.018). Seven eyes (87.5%) had improved vision 1 year after treatment, and 1 eye (12.5%) had stable vision with a mean number of 3.61 gained lines. The mean central macular thickness was reduced from 366 ± 95 μm to 217 ± 32 μm the first month (P = 0.006). Fluorescein angiography-guided photodynamic therapy with half-dose verteporfin seems to be a rational and effective alternative to other methods in the treatment of chronic central serous chorioretinopathy with focal leakage on fluorescein angiography.

Central serous chorioretinopathy: an update on pathogenesis and treatment

Central serous chorioretinopathy (CSC) is a chorioretinal disease, incompletely understood with systemic associations, a multifactorial aetiology, and a complex pathogenesis. Increased permeability from the choriocapillaris leads to focal or diffuse dysfunction of the retinal pigment epithelium causing a detachment of the neurosensory retina. CSC has been described in patients with endogenously high levels of corticosteroids as well as in patients with hypercortisolism due to the treatment of ocular or systemic diseases. It is therefore the only 'inflammatory' choroiditis, not proven to be associated with infection that is precipitated or worsened by glucocorticoids. Foveal attenuation, chronic macular oedema, and damage of the foveal photoreceptor layer have been reported as causes of visual loss in CSC. Photoreceptor atrophy in the fovea, despite successful retinal reattachment, typically occurs after a duration of symptoms of approximately 4 months. Treatment should therefore be considered after 3 months if there is angiographic evidence of ongoing foveal leakage in recurrent chronic CSC or in a single CSC episode accompanied by signs of chronic CSC alterations. Based on results of trials conducted so far, it appears that photodynamic therapy with verteporfin is effective and safer than argon laser treatment and should be considered as the treatment of choice, whereas micropulse diode laser photocoagulation seems to be an effective alternative. Glucocorticoid inhibitors are an interesting alternative treatment. Clinical trials are ongoing to test their efficacy. In addition, it is important, where possible, to discontinue any corticosteroid treatment. The possible association of CSC with stress should also be discussed with patients.

Diffuse Retinal Pigment Epitheliopathy among the Inhabitants of Brahmaputra Valley of India

To analyze the patient demography and the various fluorescein angiography (FA) features of diffuse retinal pigment epitheliopathy (DRPE) cases among the inhabitants of the Brahmaputra Valley of India and to see if there is any ethnic variation in its clinical presentation and risk factors. This is a retrospective study in a clinical practice setting with study population of Aryan and Mongoloid races. Data analysis of 30 cases (40 eyes) of DRPE of 262 consecutive cases of central serous chorioretinopathy (CSC) was done. The various features of these cases were compared and statistically evaluated with the findings of CSC cases with symptom duration of 6 months or more and cases with recurrent episodes. A total of 11.45% had DRPE that had average symptom duration of 3.50 years. Logistic regression showed high risk for DRPE if sensory retinal detachment (SRD) persists for more than 18 months. Systemic hypertension was another significant risk factor, whereas multiple RPE leaks appeared to be weakly significant. DRPE was predominant in eyes of patients having first acute episode of CSC in later age and fairly large retinal pigment epithelial detachments (PEDs) contributed to its development. Role of exogenous corticosteroid, retinotoxic drugs, and tobacco consumption could not be assessed properly due to inadequate sample size. The main factor for the development of DRPE is the persistence of SRD for more than 1.50 years. Fairly large leaking PED and onset of primary CSC in later age appear to contribute towards its development. Except for these, no major variation from Western studies was observed.

Serous central chorioretinopathy and endogenous hypercortisolemia

The exact pathogenic mechanism of the accumulation of subretinal fluid at the posterior pole of the fundus in cases of central serous chorioretinopathy (CSC) is not well established. Recently, it was reported that CSC is more frequent among patients with endogenous Cushing's syndrome. Thus, it has been suggested that glucocorticoids might be involved in the pathogenesis of CSC. Subsequently, additional observations, have confirmed the relationship between glucocorticoids and CSC. We present preliminary data on the endogenous cortisol secretion in patients with CSC. Sixteen patients (14 men and 2 women, 35-65 years of age) suffering from CSC, not exposed to exogenous glucocorticoids and without clinical and/or biological stigmata of endogenous Cushing's syndrome, have been examined. Twenty four hour urinary free cortisol (24 h-UFC) secretion was measured within one week of their CSC episode. Twenty four hour urinary free cortisol of age and sex matched controls were also measured. Twenty four hour urinary free cortisol was 188.20 nmol/l +/- 34.1 for the patients suffering from CSC and 115.3 nmol/l +/- 63.4 for the control group (p < 0.05). These results give additional evidence that glucocorticoids may play a role in the pathogenesis of CSC. However, given the substantial variability of urinary free cortisol levels, as indicated by the increased SD, additional number of patients should be examined.