Idiopathic Central Serous Chorioretinopathy Research Articles

Foveal atrophy in patients with active central serous chorioretinopathy at first presentation: characteristics and treatment outcomes

Background/aimsThis study aimed to investigate the clinical characteristics and treatment outcomes of patients with active central serous chorioretinopathy (CSC) and foveal atrophy.MethodsPatients diagnosed with active idiopathic CSC using multimodal imaging...

Micropulse laser therapy in chronic idiopathic central serous chorioretinopathy in right eye of 38-year-old patient – case report

<b>WSTĘP:</b> Centralna chorioretinopatia surowicza (<i>central serous chorioretinopathy</i> – CSC) jest schorzeniem charakteryzującym się idiopatycznym surowiczym uniesieniem sensorycznej warstwy siatkówki w okolicy plamki, które najczęściej występuje jednostronnie, głównie u młodych mężczyzn ze zwiększoną podatnością na stres. Definiowanie optymalnego leczenia CSC jest skomplikowane ze względu na szeroki zakres objawów choroby, zmienny przebieg kliniczny, słabo poznaną patofizjologię CSC oraz brak konsensusu co do systemu klasyfikacji. W leczeniu CSC coraz częściej znajduje zastosowanie laser mikropulsowy, który działając selektywnie na nabłonek barwnikowy siatkówki, nie powoduje uszkodzeń fotoreceptorów. Celem pracy była ocena zastosowania terapii laserem mikropulsowym w leczeniu przewlekłego CSC. <b>OPIS I WYNIKI:</b> Pacjent 38-letni leczony od kilkunastu miesięcy z powodu nawracającego CSC w oku prawym, leczony miejscowo kroplami oraz lekami doustnymi. Ostrość wzroku pacjenta w chwili rozpoznania wynosiła 0,63, ciśnienie wewnątrzgałkowe 19 mmHg. Centralna grubość siatkówki w optycznej koherentnej tomografii (<i>optical coherence tomography</i> – OCT) wynosiła 530 µm. U pacjenta wykonano angiografię fluoresceinową (<i>fluorescein angiography</i> – FA) potwierdzającą rozpoznanie oraz zakwalifikowano go do laseroterapii siatkówki z użyciem mikropulsów. Podczas kontroli w badaniu FA uzyskano poprawę stanu klinicznego. Ostrość wzroku pacjenta wynosiła 1,0, ciśnienie wewnątrzgałkowe 17 mmHg. Uzyskano spadek centralnej grubość siatkówki w badaniu OCT do poziomu 299 µm. <b>WNIOSKI:</b> Zastosowanie lasera mikropulsowego umożliwia uzyskanie trwałego efektu klinicznego u pacjenta z przewlekłym nawracającym CSC.

Quantification of Metamorphopsia in Resolved Idiopathic Central Serous Chorioretinopathy: An Analysis Using M-CHARTS, Amsler Grid, and Optical Coherence Tomography.

To quantify metamorphopsia in patients with resolved idiopathic Central Serous Chorioretinopathy (CSCR) using M-CHARTS and compare the results with the traditional Amsler grid and optical coherence tomography (OCT). For the purpose of this study, all consecutive cases of patients with resolved CSCR were evaluated for metamorphopsia (using the standard Amsler grid and M-CHARTS) and spectral domain OCT. The OCT images were analyzed for the following five parameters: central macular thickness, pigment epithelial detachment, retinal pigment epithelial bumps, discontinuation in the inner segment/outer segment junction or the external limiting membrane, fibrinous exudates in the subretinal space, and hyperreflective dots in the intraretinal and/or subretinal layer. Binary logistic regression was used to find the association between metamorphopsia and foveal morphology. Cohen's Kappa was used to determine the agreement between the M-CHARTS and Amsler grid for diagnosing metamorphopsia. The sensitivity, specificity, and accuracy in the diagnosis of metamorphopsia were calculated against the Amsler grid. Of 41 eyes, Amsler Grid detected metamorphopsia in 39.02%, and M-CHARTS detected metamorphopsia in 53.66%. The agreement rate of detection between the two tests was moderate (Kappa=0.52). M-CHARTS had a sensitivity of 87.50%, a specificity of 68.00%, a positive predictive value of 63.64%; and a negative predictive value of 89.47% for the diagnosis of metamorphopsia compared to the Amsler grid. The presence of PED in OCT was significantly associated with metamorphopsia. M-CHARTS can be a useful ancillary test to detect and quantify metamorphopsia even after fluid resolution in CSCR. Structural changes in macular morphology as observed with OCT can predict the likelihood of metamorphopsia.

DISTINCT CHARACTERISTICS OF SIMPLE VERSUS COMPLEX CENTRAL SEROUS CHORIORETINOPATHY.

To compare the clinical and genetic characteristics of simple and complex central serous chorioretinopathy using central serous chorioretinopathy international group criteria. Patients with idiopathic central serous chorioretinopathy were included. Depending on the presence or absence of retinal pigment alterations greater than 2-disc areas in either eye, patients were classified into complex or simple types. Demographic factors and clinical findings were compared between groups. CFH variants, including rs800292 and rs1329428, were genotyped using TaqMan technology. A total of 319 consecutive patients were evaluated at the initial presentation. Of them, 53 (16.6%) had the complex type. The complex type was exclusively seen in men (100% vs. 79.0%, P = 2.0 × 10 -4 ) and demonstrated a significantly higher proportion of bilateral involvement (75.5% vs. 17.7%, P = 6.2 × 10 -18 ) and descending tract(s) (83.0% vs. 0%, P = 1.2 × 10 -57 ) than the simple type. Increased choroidal thickness (425 ± 131 vs. 382 ± 110, P = 0.02) and decreased central retinal thickness (274 ± 151 vs. 337 ± 136, P = 2.9 × 10 -4 ) were observed for the complex versus simple type. The risk allele frequencies of both variants were significantly higher in the complex versus simple type (rs800292: 61.3% vs. 48.7%, P = 0.018; rs1329428: 65.1% vs. 54.3%, P = 0.04). In this new classification system, the complex type has distinct genetic and clinical characteristics compared with the simple type.

Efficacy and Safety of Laser Photocoagulation in Persistent Idiopathic Central Serous Chorioretinopathy: A Prospective Interventional Study

Introduction: Central Serous Chorioretinopathy (CSCR) encompasses the macular area, secondary to the accumulation of subretinal fluid and increased permeability from the choriocapillaris resulting in focal or diffuse dysfunction of the retinal pigment epithelium. Diagnosis of CSCR is done by several procedures like clinical examination, Amsler grid testing, fluorescein angiography, ocular coherence tomography. There are several treatment options including photodynamic therapy, laser photocoagulation, etc., for CSCR. Aim: To study the efficacy and safety of laser photocoagulation in persistent idiopathic CSCR. Materials and Methods: The present prospective interventional study was conducted in the Department of Ophthalmology, BJ Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India, from August 2019 to January 2021. A total of 30 patients (30 eyes) with idiopathic CSCR, persistent for duration of three months or more with worsening of visual symptoms, active leakage on Fundus Fluoresceine Angiography (FFA) were subjected to 532 nm subthreshold green laser photocoagulation treatment after routine investigations. Statistical analysis was done on International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) software version 20.0. Results: In the present study, there was male preponderance (86.7%) for the CSCR cases. The mean±Standard Deviation (SD) age of in the study was 37.7±0.07 years. All the eyes studied had unilateral involvement with 53.35% right eye involvement and 46.7% left eye involvement. The duration of current episode of CSCR in months showed a mean+SD of 5.86±1.40. The distribution of visual acuity in affected eye (before laser treatment) depicts the mean prelaser Best Corrected Visual Acuity (BCVA) of 30 patients at baseline was (0.68±0.20) in LogMAR. About 67% patients experienced central scotoma and 33% patients had metamorphopsia on Amsler chart. Distribution of active leakage site on FFA showed that 43% cases had active leakage in superonasal quadrant, 30% had active leakage in superotemporal, 17% had active leak in inferonasal quadrant and 10% had active leak in inferotemporal quadrant. CSCR associated with or without Retinal Pigment Epithelium (RPE) atrophy showed that 63.3% patients had RPE atrophy suggesting long-standing course of disease with NSD and subretinal fluid collection affecting RPE. Prelaser mean CMT on OCT of affected eye was 445.83±54.79 µm which was reduced to mean CMT of 303.57±48.49 µm at four weeks follow up, which further reduced to mean CMT of 224.9±20 µm at end of 12 weeks was statistically significant with p-value<0.001. The statistical analysis for the macular thickness at four weeks and 12 weeks showed significant probability with paired t-test with p-value<0.001. Conclusion: It can be concluded from the present study that early treatment with laser photocoagulation is efficient in the restoration of vision within a period of 12 weeks.

Scleral Thickness in Steroid-Induced Central Serous Chorioretinopathy.

PurposeTo evaluate and compare the scleral thickness of patients with idiopathic central serous chorioretinopathy (iCSC) and steroid-induced central serous chorioretinopathy (sCSC) using anterior-segment OCT.DesignRetrospective, comparative study.ParticipantsOne hundred ten eyes of 110 patients with central serous chorioretinopathy.MethodsWe classified the patients into iCSC and sCSC groups and compared age, sex, spherical equivalent, axial length, subfoveal choroidal thickness (SCT), and scleral thickness. We measured scleral thickness 6 mm posterior to the scleral spur in 4 directions.Main Outcome MeasureScleral thickness in sCSC eyes.ResultsWe enrolled 96 and 14 eyes in the iCSC and sCSC groups, respectively. The sCSC group included a greater proportion of women than the iCSC group (42.9% and 13.5%, respectively; P = 0.020). We observed no between-group differences in age, spherical equivalent, axial length, or SCT. Univariate analysis revealed that the sCSC group had a significantly thinner sclera at the superior (423.4 μm vs. 346.6 μm; P < 0.001), temporal (440.1 μm vs. 399.4 μm; P = 0.020), inferior (450.1 μm vs. 395.3 μm; P = 0.001), and nasal (436.6 μm vs. 391.9 μm; P = 0.002) points than the iCSC group. Multivariate analyses revealed that female sex (odds ratio, 4.322; 95% confidence interval, 1.025–18.224; P = 0.046) and mean scleral thickness (odds ratio, 0.972; 95% confidence interval, 0.955–0.990; P = 0.002) were significantly associated with sCSC.ConclusionsThe scleral thickness of eyes in the sCSC group was significantly thinner than that in the iCSC group. This suggests that the sclera has less involvement in the pathogenesis of sCSC than in that of iCSC.

Short-Term Outcomes of Cataract Surgery in Patients with a History of Central Serous Chorioretinopathy.

Purpose This study aimed to evaluate the short-term outcomes of cataract surgery in patients with a history of idiopathic central serous chorioretinopathy (CSC). Methods This retrospective study included 26 patients with a history of CSC who underwent uncomplicated phacoemulsification and intraocular lens implantation. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) measured before the surgery were compared with those obtained at mean 3.6 months after the surgery. BCVA outcome was also analyzed in eyes with and without subretinal fluid (SRF). Results The mean logarithm of the minimal angle of resolution BCVA significantly improved from 0.52 ± 0.40 before the surgery to 0.21 ± 0.30 one month after the surgery and 0.20 ± 0.31 at 3.6 months after the surgery (P < 0.001). The mean CFT was 281.2 ± 84.2 μm before the surgery, 301.5 ± 90.7 μm one month after the surgery, and 279.9 ± 83.6 μm at 3.6 months after the surgery. The CFT before surgery was not different from those measured at 3 months (P=0.253). Significant improvement in BCVA at 3.6 months was noted in the SRF group (N = 12, P=0.003) and the non-SRF group (N = 14, P=0.001). CSC recurrence was noted in 2 patients in the non-SRF group. Conclusions Significant improvement in visual acuity was noted after cataract surgery in patients with a history of idiopathic CSC, without a risk of aggravation of CSC in most patients.

Evaluation of the Safety and Efficacy of Selective Retina Therapy Laser Treatment in Patients with Central Serous Chorioretinopathy.

PurposeTo assess the safety and efficacy of selective retina therapy (SRT) using a Q-switched neodymium-doped yttrium lithium fluoride laser with feedback systems in patients with idiopathic central serous chorioretinopathy (CSC).MethodsThis randomized clinical trial enrolled patients having at least 3-month symptom of CSC. From month 3 visit, all subjects in both groups were eligible for SRT retreatment if they showed persistent or recurrent subretinal fluid (SRF). The primary outcome was complete resolution of SRF by optical coherence tomography at 3 months after treatment. The secondary outcomes were changes in SRF, central macular thickness (CMT) and best-corrected visual acuity at the 1-, 3-, and 6-month examinations.ResultsSixty-eight CSC patients were included (SRT, 31; control, 37). After 1 and 3 months, complete resolution of SRF was achieved in 25.8% and 54.8% of SRT group and 17.6% and 35.1% of controls. The differences were not statistically significant (p = 0.424 and p = 0.142, respectively). However, mixed model for repeated measures analyses showed that the reduction of SRF and CMT were observed earlier in SRT group than in the sham group (least squares mean difference, −59.7 μm; 95% confidence interval, −98.2 to −21.2; p = 0.0029; least squares mean difference −67.0 μm; 95% confidence interval, −104.8 to −29.2; p = 0.0007, respectively). Significant reduction of SRF (≥50% reduction from baseline) was more frequently observed in SRT group (80.6%) than the sham group (44.1%) at month 1 (p = 0.007). Early reduction of SRF and CMT was more abundant in SRT group with symptom duration less than 6 months. Treatment related serious adverse events were not observed.ConclusionsSRT using a Q-switched neodymium-doped yttrium lithium fluoride laser with feedback system was safe in this trial and effective for early resolution of SRF in the CSC patients. Early intervention with SRT can be a safe alternative for patients with acute symptomatic CSC.

Serum cortisol and serum testosterone levels in idiopathic central serous chorioretinopathy

Aim: To analyse the serum cortisol and serum testosterone levels in idiopathic central serous chorioretinopathy. Material and methods: The prospective interventional study was conducted in the central laboratory associated with the Department of Ophthalmology, Subharti Medical College, Meerut. A study was conducted in 30 cases of CSR. The patients were divided into two groups i.e. Group A (15 patients with unilateral sudden painless loss of vision of less than one month of duration serving as cases and Group B (15 patients with no signs and symptoms serving as control). Evaluation of Macular thickness was done using OPTOVUE RTvue 100 OCT procedure. After pupil dilation, the patient is seated at the machine, asked to fixate at the internal fixation point and scan is obtained. The macular thickness map was taken to measure the thickness of macula. Fundus Fluorescein Angiography (FFA) was done, if required. Patients of both the groups underwent investigations such as dilated fundus examination, serum cortisol and serum testosterone levels. Results: Mean serum cortisol (μg/dL) among the case group was higher as compared to the control group with statistically significant difference as p

Factors influencing the episode duration and the anatomical and functional outcome in cases of acute central serous chorioretinopathy

ObjectiveTo investigate the factors affecting the duration of subretinal fluid (SRF) resolution and their correlation with the final anatomical and functional outcome in cases of treatment naïve acute central serous...

ANGIOGRAPHIC SMOKESTACK LEAKAGE NOT ASSOCIATED WITH CENTRAL SEROUS CHORIORETINOPATHY.

To report a series of cases with smokestack leakage on fundus fluorescein angiography outside the clinical setting of central serous chorioretinopathy. A multicenter, observational retrospective case series evaluating fundus fluorescein angiography on Topcon and Optos systems. Seven patients with neovascularization due to ischemic retinopathy demonstrated a unique smokestack pattern of angiographic leakage. The patients' ages ranged between 44 and 71 years and were seen at 3 academic teaching hospitals in the Washington-Baltimore metropolitan area. Five patients had been diagnosed with proliferative diabetic retinopathy, one with sickle cell ischemic retinopathy, and one with branch retinal artery occlusion; none of the patients had a known history or clinical signs of current or past central serous chorioretinopathy. This is the first published case series to the author's knowledge of ischemic retinopathy displaying a smokestack leakage pattern on fundus fluorescein angiography that is classically described with idiopathic central serous chorioretinopathy.

Secondary Stress Induced Central Serous Chorioretinopathy in Bamako: Report of Two Cases

Introduction: Idiopathic central serous chorioretinopathy (ICSC) is characterized by the buildup of fluid leading to circumscribed elevation of the retina within the posterior pole. This condition affects young people between the ages of 20 - 50 years. The disease is seen predominantly in men as compared to women. We report the cases of two (02) patients received in consultation at IOTA-Teaching Hospital between July 2019 and February 2020. Case Presentation: We report two cases of Idiopathic stress central serous chorioretinopathy. The first case is a 37-year-old man that we received in consultation for visual acuity decrease from a sudden installation for 1 hour. The clinical and paraclinical arguments permitted us to retain the diagnosis of Idiopathic stress central serous chorioretinopathy. The patient benefited from laser treatment and the clinical evolution was good. The second case is a 42-year-old man, who consulted for a sudden reduction of visual acuity that had been evolving for 3 weeks. The clinical and paraclinical contexts were in favour of the diagnosis of Idiopathic stress central serous chorioretinopathy. The patient was treated with spironolactone. The clinical evolution was favourable. Conclusion: Our study confirms the existence of central serous chorioretinopathy (CSC) in Black African patients. Studies show the connection between CSC and stress.

Serum renalase and cerebellin levels in acute central serous chorioretinopathy

Aim: To compare the blood renalase and cerebellin-1 levels of acute central serous chorioretinopathy (CSC) patients with healthy subjects. Method: A total of 33 eyes with acute naive CSC (less than 2 months duration) and 31 healthy subjects were enrolled in this study. Idiopathic CSC was diagnosed based on the presence of a serous detachment of the neurosensory retina involving the macula that was confirmed using optical coherence tomography and leakage at the retinal pigment epithelium level using fluorescein angiography. Blood samples were collected and centrifuged at 4000 g for 10 minutes. The serum samples were collected and stored at -80 °C until required for analysis. Serum renalase and cerebellin-1 levels were measured using an ELISA kit. Results: In CSC group 11 patients were female and 22 patients were male. In control group 10 participants were female and 20 were male. The sex was similar between groups. Mean age in CSC group was 41, 04±5, 94, in control group was 40, 67±6, 53. Mean ages were similar between groups. Mean renalase levels in CSC group was 27, 19±14, 01 ng/ml and in control group was 19, 12±15, 57 ng/mL. Mean renalase level was higher in CSC group. Mean cerebellin levels were 57, 76±29, 72 pg/mL and 52, 50±29, 25 pg/mL in CSC and in control groups, respectively. Mean cerebellin levels were similar in groups. Conclusion: Comparing with healthy subjects serum renalase levels were higher and cerebellin-1 levels were similar in CSC patients.

Baseline Predictive Factors of Visual Outcome and Persistence of Subretinal Fluid Based on Morphologic Changes in Spectral Domain Optical Coherence Tomography in Patients with Idiopathic Central Serous Chorioretinopathy.

BackgroundTo determine the influence of spectral domain optical coherence tomography (OCT) changes on visual outcome and persistence of subretinal fluid (SRF) in patients with idiopathic central serous chorioretinopathy (CSCR).Materials and methodsIn a retrospective study done in 48 eyes of 45 patients diagnosed as CSCR, all eyes were subjected to fundus photography, spectral domain OCT, and fluorescein angiography (FA) in selected cases.ResultsRetinal pigment epithelium detachment was present in 22.91% of the cases at presentation. The logMar best corrected visual acuity improved from 0.46±0.29 at presentation to 0.18±0.22 at 3 months (P-value<0.01). The mean foveal thickness was 486.81±146.06 µm at presentation and 259±94.5 µm at 3 months (P-value<0.01) (paired T-test). OCT factors that were associated with poor visual outcome (BCVA>0.3 logMar) were disruption in the inner segment (IS)/outer segment (OS) junction or external limiting membrane (ELM) line and hyper-reflective dots in the intra/subretinal layer (P-value<0.05) (Fischer’s Exact test). Out of the total 48 eyes, 26 had persistent SRF at 3 months. The presence of discontinuation in IS/OS junction and hyper-reflective dots in the intra/subretinal layer were the only two OCT factors that were associated with the persistence of SRF (P-value<0.01) (Pearson’s Chi-square test).ConclusionVisual outcome and persistence of subretinal fluid at 3 months can be predicted on the basis of early morphologic changes in OCT. This will aid in counseling patients regarding its course and may guide us in its management.

Effect of Serous Retinal Detachment on the Measurement of Axial Length in Central Serous Chorioretinopathy.

PurposeTo evaluate the changes of axial length (AXL) in eyes with unilateral idiopathic central serous chorioretinopathy (CSC) after resolution of serous retinal detachment.MethodsA total of 31 patients diagnosed with idiopathic unilateral CSC were included in this study. The changes of AXL according to serous retinal detachment were examined. The keratometric value and AXL were measured using partial coherence interferometry. Serous retinal detachment and central macular thickness (CMT) were measured by spectral domain optical coherence tomography.ResultsThe mean age of the 31 CSC patients, including 19 males, was 42.7 years. The AXL was significantly increased from 23.41 to 23.58 mm after resolution of serous retinal detachment (p < 0.001). The CMT was significantly decreased from 413.4 to 226.8 µm after resolution of serous retinal detachment (p < 0.001). The differences in AXL correlated with CMT differences and subretinal fluid height (r = −0.616, p < 0.001 and r = −0.637, p < 0.001, respectively), and the best-corrected visual acuity was significantly different after resolution of serous retinal detachment (p < 0.001).ConclusionsIn unilateral idiopathic CSC with serous retinal detachment, a shortened AXL in the acute phase was restored after resolution of serous retinal detachment.

OCULAR PERFUSION PRESSURE AND CHOROIDAL THICKNESS IN CENTRAL SEROUS CHORIORETINOPATHY AND PIGMENT EPITHELIOPATHY.

To investigate ocular perfusion pressure (OPP) in patients with central serous chorioretinopathy (CSC) and pigment epitheliopathy (PE). In this retrospective study, we included patients with acute idiopathic unilateral CSC and age- and sex-matched normal controls. The patients with CSC were classified into two groups according to the PE presence on their fellow eyes. We compared OPP among CSC patients with or without PE and normal controls. Among a total of 47 patients with CSC, 21 were classified into the PE group and 26 into the non-PE group. The mean OPP (±SD) of CSC and fellow eyes in the PE group (50.02 ± 4.98 and 50.83 ± 4.12 mmHg, respectively) was greater than that in the non-PE group (43.69 ± 6.88 and 44.0 ± 6.57 mmHg, respectively) and normal controls (45.64 ± 8.73 mmHg) (all, P < 0.05). The mean macular choroidal thickness of CSC and fellow eyes in the PE group (344.4 ± 31.8 and 310.1 ± 37.0 μm, respectively) was thicker than that in the non-PE group (318.5 ± 43.8 and 282.8 ± 36.1 μm, respectively) (all, P < 0.05). Greater macular choroidal thickness and higher OPP were associated with PE (P = 0.002 and P = 0.003). Forty-five percent of the patients with acute unilateral CSC had PE in their fellow eyes. Increased OPP may influence the development of bilateral CSC characteristics.

Differences in Choroidal Structures Between Idiopathic and Steroid-Induced Central Serous Chorioretinopathy

Purpose: The purpose of this article is to investigate the differences in intrachoroidal structures between eyes with idiopathic central serous chorioretinopathy (CSC) and those with steroid-induced CSC. Methods: Thirty eyes of 30 patients with idiopathic CSC and 17 eyes of 15 patients with steroid-induced CSC were studied. Cross-sectional swept-source optical coherence tomography images of eyes with idiopathic and steroid-induced CSC were retrospectively analyzed by the manual layer delineation technique and by the binarization technique. Results: The mean subfoveal choroidal thickness (SCT) was not significantly different between the eyes with idiopathic CSC (408.0 ± 106.6 µm) and those with steroid-induced (389.9 ± 105.4 µm; P = .67) CSC. Manual layer delineation showed that the mean ratio of the large choroidal vessel layer thickness to the SCT was significantly higher in eyes with idiopathic CSC (0.874 ± 0.070) than in eyes with steroid-induced CSC (0.828 ± 0.083; P = .02). The binarization method showed that the mean ratio of the luminal areas to the choroidal areas centered at the fovea was significantly higher in eyes with idiopathic CSC (0.747 ± 0.064) than in eyes with steroid-induced CSC (0.701 ± 0.046; P = .01). Conclusion: The intrachoroidal structures in steroid-induced CSC were different from those in idiopathic CSC. These findings suggest different pathophysiologic mechanisms may be involved in the pathogenesis of these 2 entities.

Central serous chorioretinopathy in elderly subjects: angiographic and tomographic characteristics.

To investigate the angiographic, tomographic, and clinical characteristics of idiopathic central serous chorioretinopathy (CSC) in elderly patients. The patients were divided into two groups according to a cutoff age of 60years at baseline. Patients underwent spectral domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography. Angiographic and tomographic features were compared between the two groups (young vs. elderly group). Of 176 patients, 26 patients (15.1%) were 60years or older. Complete resolution of subretinal fluid after treatment was noted in 72.0% of the elderly group and 90.8% of the young group (P = 0.021). The elderly group showed worse baseline and final vision, more bilateral involvement, and lower male preponderance than the young group (P < 0.05, respectively). The elderly group was also associated with a higher frequency of retinal pigment epithelium depigmentation, foveal thinning, and double-layer sign compared with the young group (P < 0.05, respectively). CSC in elderly patients was associated with a lower resolution of serous detachment, increased impairment of retinal pigment epithelial layers, foveal thinning, and worse visual outcome, suggesting a chronic insult to the choroidal vessels involving more severe damage to the outer retinal layers.

Genome-Wide Association Study to Identify a New Susceptibility Locus for Central Serous Chorioretinopathy in the Japanese Population.

Central serous chorioretinopathy (CSC) is a retinal disorder that often affects the vision of middle-aged people yet the molecular mechanisms of CSC remain unknown. This study was conducted to identify genetic factors influencing individual differences in susceptibility to CSC. A two-stage genome-wide association study (GWAS) was conducted with a total of 320 unrelated Japanese idiopathic CSC cases and 3245 population-based controls. In a discovery stage, 137 unrelated Japanese idiopathic CSC cases and 1174 population-based controls were subjected to GWAS, followed by a replication study using an additional 183 individuals with idiopathic CSC and 2071 population-based volunteers. The results of the discovery and replication stages were combined to conduct a meta-analysis. In the two-stage GWAS, rs11865049 located at SLC7A5 in chromosome 16q24.2 was identified as a novel disease susceptibility locus for CSC, as evident from the discovery and replication results using meta-analysis (combined P = 9.71 × 10-9, odds ratio = 2.10). The results of the present study demonstrated that SLC7A5 might be the potential candidate gene associated with CSC, indicating a previously unidentified molecular mechanism of CSC.

Choroidal vascularity changes in idiopathic central serous chorioretinopathy after half-fluence photodynamic therapy.

PurposeThis study evaluated changes in choroidal vascularity after half-fluence photodynamic therapy (HF-PDT) in patients with central serous chorioretinopathy (CSC) using swept-source optical coherence tomography (SS-OCT) en face imaging.MethodsThis retrospective comparative case series included 50 eyes of 25 patients with unilateral CSC who underwent HF-PDT and 50 age-and sex-matched normal healthy control eyes. En face SS-OCT images of the choriocapillaris, Sattler’s layer, and Haller’s layer were converted into binary images. The vascular proportions were defined as the percentage of the area of vascular lumen against the area of the 3.0-mm-diameter circular area. The main outcome measures were the vascular proportions before HF-PDT and at 6 weeks, 6 months, and 12 months after HF-PDT.ResultsAt baseline, the vascular proportions in the CSC eyes were significantly greater than those in the control eyes in all layers (choriocapillaris: 51.8% ± 15.5% vs. 41.3 ± 18.7%, P = 0.018; Sattler’s: 58.6% ± 13.4% vs. 49.7% ± 15.7%, P = 0.017; Haller’s: 65.3% ± 15.3% vs. 53.0% ± 13.4%, P = 0.001). In the CSC eyes, the vascular proportion in the choriocapillaris significantly decreased at 6 weeks (36.6% ± 16.9%, P < 0.001), 6 months (34.0% ± 12.3%, P < 0.001), and 12 months (34.8% ± 17.6%, P < 0.001) after HF-PDT compared with baseline. The vascular proportions in Sattler’s and Haller’s layers did not show a significant decrease at 6 weeks (Sattler’s: 49.7% ± 17.3%, P = 0.052 and Haller’s: 58.3% ± 12.9%, P = 0.558) but decreased significantly at 6 months (Sattler’s: 48.9% ± 12.4%, P < 0.001 and Haller’s: 57.7% ± 15.7%, P = 0.027) and 12 months after HF-PDT from the baseline values (Sattler’s: 45.8% ± 10.4%, P < 0.001 and Haller’s: 56.8% ± 15.7%, P < 0.001).ConclusionAfter HF-PDT, the choriocapillaris showed the earliest decrease in vascular proportion of en face images, Sattler’s and Haller’s layers showed later decreases. The temporal differences in the response of each layer may reflect the pathophysiology of CSC and the therapeutic mechanism of HF-PDT.