Idiopathic Central Serous Chorioretinopathy Research Articles

Three-Dimensional Configuration of Subretinal Fluid in Central Serous Chorioretinopathy

The purpose of this study was to characterize the 3-dimensional (3D) configuration of subretinal fluid (SRF) in idiopathic central serous chorioretinopathy (CSC) using spectral-domain optical coherence tomography (SDOCT). The OCT images of patients with CSC were reviewed retrospectively. The 3D configurations of SRF were assessed using a modified segmentation algorithm of SDOCT. The differences of the configurations between acute and chronic CSC were compared. For the patients with acute CSC, we investigated a possible relationship between early change in 3D configuration and disease prognosis. We included 69 eyes of 68 patients in this study. The mean volume, the greatest basal diameter (GBD), and the area of SRF were not different between acute and chronic CSC. The mean peak height (PH) of SRF and the ratio of PH to GBD in acute CSC (298.13 ± 92.67 μm, 9.44 ± 2.57%) were significantly greater than those in chronic CSC (192.97 ± 71.05 μm, 5.97 ± 1.90%; P < 0.001, P < 0.001, respectively). In patients with acute CSC, the early changing pattern of 3D configurations was significantly different according to the SRF prognosis (P = 0.003). In situ decrease of SRF was observed in 94.7% of the spontaneously resolving group. However, downward elongation of SRF was observed more frequently in the persistent group (58.3%) than in the spontaneously resolving group (6.3%). The 3D configurations of SRF were different between acute and chronic CSC. In patients with acute onset, the early change of 3D configuration was different and varied according to the SRF prognosis.

Epidemiology of Idiopathic Central Serous Chorioretinopathy in Taiwan, 2001–2006: A Population-based Study

ObjectivesThe epidemiology of idiopathic central serous chorioretinopathy (CSCR) is not well understood in an Asian population. The present study aimed to investigate the incidence and risk factors for corticosteroid-unrelated CSCR using Taiwan’s National Health Insurance Research Database.Methods and ResultsFrom 2001 to 2006, a total of 786 patients (500 [63.6%] males) who were newly diagnosed with CSCR, aged from 20 to 64 years and had no history of corticosteroid prescription were identified as incident cases of idiopathic CSCR. 3606 age-, gender-, and enrollment time-matched subjects were randomly selected as the control group. The mean annual incidence was 0.21‰ (0.27‰ for males, and 0.15‰ for females; P<0.001), with a male/female ratio of 1.74. The peak incidence was in the 35- to 39-year-old age group (0.30‰), followed by the 40- to 44-year-old age group (0.26‰). Males had a significantly higher mean annual incidence than female only in the middle age groups. Conditional logistic regression was used to estimate the odds ratios (ORs) for potential risk factors of idiopathic CSCR. Only exposure to anti-anxiety drugs (OR, 1.63; 95% confidence interval, 1.09–2.44) was found to be independently associated with idiopathic CSCR among males. No risk factors of idiopathic CSCR were found for females.ConclusionsThis study provides the nationwide, population-based data on the incidence of idiopathic CSCR in adult Asians, and suggests that exposure to anti-anxiety drugs is an independent risk factor for idiopathic CSCR among males.

Angiographic characteristics of central serous chorioretinopathy in an Egyptian population.

To describe and analyze the demographic characteristics and to determine the angiographic features of acute central serous chorioretinopathy(CSCR) in an Egyptian population. A series of consecutive patients presenting with acute idiopathic CSCR to Mansoura Ophthalmology Center Mansoura University who underwent fluorescein angiography (FA) within a 3-year-period (between January 1, 2007 and December 31, 2009) was retrospectively studied. Patient demographics and angiographic features were studied. Results were compared to those of other Western and Asian populations. Fluorescein angiograms of 86 patients were analyzed. 91% were males. The age range of patients was 24 - 49 years, with a mean age of (38±6) years. The right eye was the presenting eye in 47% of patients. Eighty-seven percent of eyes showed delayed choroidal filling. Thirty-five percent of patients had more than one point of leakage. The macula was the most common site of fluorescein leakage seen in 79% of patients. Peripheral leakage was seen in 14% of patients while peripapillary leakage was seen in 12% of patients. The inkblot leakage pattern was found in 53% of patients. The presenting eye had RPE atrophic changes in 84% of cases. The other eye was assessed in 44 patients (51%). Fifty-five percent of them had signs of RPE atrophic changes. In the Egyptian population, CSCR is seen at younger age with higher male-to-female ratio and more frequent smokestack leaks than other populations. Despite younger age group, this series of patient showed higher frequency of bilateral and multifocal disease compared to other studies. Roles of psychological stress and choroidal ischemia in pathogenesis of CSCR need further evaluation.

Internal drainage for chronic macula-involving serous retinal detachment in idiopathic central serous chorioretinopathy

Conventional treatment of idiopathic central serous chorioretinopathy (ICSC) consists of argon laser, photodynamic therapy, or observation. However, in cases of atypical bullous ICSC with exudative detachment preventing any laser therapy, a surgical approach with external drainage of fluid has been performed. We present a case of ICSC with persistent macula involving exudative retinal detachment without evidence of uveitis that responded favorably to internal drainage by vitrectomy along with a scleral buckle placement. Our case, treated with internal drainage, also demonstrated successful long-term reattachment of the serous retinal detachment without any additional complications from the surgery.

The effect of eradicating Helicobacter pylori on idiopathic central serous chorioretinopathy patients

PurposeTo evaluate the effect of Helicobacter pylori (H. pylori) eradication on the remission of acute idiopathic central serous chorioretinopathy (ICSCR).Study designA prospective, randomized, placebo-controlled study of 53 participants.Main outcome measureTwenty-seven acute ICSCR patients tested positive for H. pylori were given an eradication H. pylori therapy, and another 26 patients with the same diagnosis received matching placebo medication. All participants were tested for the following items: (1) disappearance rate of subretinal fluid (SRF); (2) best-corrected visual acuity (BCVA); and (3) central retinal sensitivity at baseline, 2 weeks, 4 weeks, 8 weeks, and 12 weeks after treatment. The difference between the two groups was analyzed by PASW statistics version 18.0.ResultsAt each follow-up, the disappearance rate of SRF in the active treatment group seemed slightly better than in the control group, but no statistically significant differences were observed (P > 0.05 at each follow-up). The BCVA between the two groups also did not demonstrate statistically significant differences (P > 0.05 at each follow-up). Unlike the BCVA and the disappearance rate of SRF, we compared the change in central retinal sensitivity at 12 weeks after treatment; a statistical difference was observed (P = 0.042).ConclusionOur findings suggested that H. pylori eradication does not improve BCVA and the disappearance rate of SRF, but it could improve the central retinal sensitivity in acute ICSCR patients. We recommend that chronic ICSCR patients and more sensitive methods for H. pylori diagnosis should be involved in evaluating the effect of H. pylori eradication.

Time-Periodic Characteristics in the Morphology of Idiopathic Central Serous Chorioretinopathy Evaluated by Volume Scan Using Spectral-Domain Optical Coherence Tomography

To investigate the time-period characteristics associated with morphologic changes in idiopathic central serous chorioretinopathy (CSC) using volume scans acquired by spectral-domain optical coherence tomography (SD-OCT). Retrospective, observational, cross-sectional case series. Patients underwent visual acuity measurements, fundus examinations, fluorescein angiography, indocyanine green angiography, and SD-OCT volume scans. Patients were classified into 5 categories-acute CSC, early chronic (EC) CSC, late chronic (LC) CSC, sequelae of CSC, or recurrent CSC-according to the chronicity and the recurrence. We investigated the relationship between our classification and the detailed morphologic changes of the retinal pigment epithelium and outer retina that were observed in the SD-OCT images. A total of 76 eyes from 75 patients were included in this study. Serous retinal detachment was relatively higher in acute CSC. Low to flat pigment epithelial detachments (PEDs) were most commonly observed in all stages of CSC, especially in LC CSC, but some semicircular PEDs were occasionally observed in eyes with acute or EC CSC. Retinal dragging with fibrin was most frequently observed in eyes that were in the early stage of acute CSC. A thickened posterior surface of the detached retina was most commonly observed in eyes with acute CSC, whereas a thinned posterior surface of the detached retina was observed in eyes with LC CSC. Hyperreflective dots and subretinal exudates were more commonly observed in eyes with EC and LC CSC than in eyes with acute CSC. In eyes with recurrent CSC, 2 different patterns of SD-OCT findings were observed; these patterns resembled those that were found in either acute CSC or LC CSC. SD-OCT finding patterns in CSC eyes differ according to the chronicity and the recurrence of the disease. Detailed investigation of the retinal pigment epithelium and outer retina using SD-OCT could be useful for estimating the duration of CSC.

A Case of Idiopathic Central Serous Chorioretinopathy in a 12-year-old Male Treated with Bevacizumab

A 12-year-old male presented with a chief complaint of a 1-month-history of decreased visual acuity in his right eye. The patient had no past history of steroid use or other systemic diseases. On fundus examination, which included fluorescent angiography (FAG) and optical coherence tomography (OCT), the patient was diagnosed with idiopathic central chorioretinopathy, whose clinical course was monitored without any specific treatments. At the time of admission, the best-corrected visual acuity was 0.5 in the right eye and 1.0 in the left eye. On fundoscopy, a serous detachment of 1 disc diameter in size was observed in the posterior pole. According to the FAG and the OCT, serous neurosensory detachment was present. After two months of monitoring the clinical course, the best corrected visual acuity in the right eye was 0.8, and there was improvement of neurosensory retinal detachment. However, OCT detected recurrence after five months, and the corrected visual acuity was decreased to 0.6. Bevacizumab was then injected into the vitreous cavity. Complete resolution of the subretinal fluid resulted eight months later, and the corrected visual acuity improved to 1.0.

Choroidal thickness in both eyes of patients with unilaterally active central serous chorioretinopathy

To assess the change in the choroidal thickness of the unaffected eyes in patients with unilateral central serous chorioretinopathy (CSC). Thirty eyes with unilateral idiopathic CSC and 30 age-matched normal eyes were included in this study. Choroidal thickness was evaluated from images obtained by enhanced depth image optical coherence tomography. The choroidal thicknesses of the affected eyes, unaffected eyes, and normal eyes were analyzed. Choroidal vascular dilation and hyperpermeability on indocyanine green angiography (ICGA) were analyzed and correlated with the changes in choroidal thickness. The mean choroidal thicknesses of the affected eyes, unaffected fellow eyes, and normal individuals were 445.58±100.25, 378.35±117.44, and 266.80±55.45 μm, respectively. Compared with normal eyes, subfoveal choroidal thickness was increased significantly in the eyes with active CSC and in the unaffected fellow eyes (P<0.001 in both groups). The choroidal thickness was significantly greater in the eyes with active CSC than in the unaffected fellow eyes (P=0.003). ICGA revealed choroidal vascular hyperpermeability in 28 (93.3%) eyes with CSC and in 23 (73.3%) unaffected fellow eyes. Choroidal vascular dilation was detected in 21 (70.0%) eyes with CSC and in 18 (60.0%) unaffected fellow eyes. Increased choroidal thickness in patients with unilateral CSC was noted not only in the affected eyes, but also in the unaffected fellow eyes. The results of this study suggest that CSC might be an essentially bilateral disorder.

CONCENTRATION OF CYTOKINES IN THE AQUEOUS HUMOR OF PATIENTS WITH CENTRAL SEROUS CHORIORETINOPATHY

To evaluate the levels of aqueous humor cytokines in the eyes of patients with central serous chorioretinopathy (CSC) before an intravitreal injection of bevacizumab. In a prospective interventional trial, 20 eyes of 20 patients with symptomatic CSC of at least 3 months duration and 20 eyes of 20 patients with cataract as control were included. Eyes with CSC received a single intravitreal injection of bevacizumab (1.25 mg/0.05 mL). Aqueous humor samples were collected from patients and controls. Multiplex bead assays were used for measurement of cytokines, including vascular endothelial growth factor and platelet-derived growth factor. Similar vascular endothelial growth factor levels and significantly decreased platelet-derived growth factor levels were measured in the aqueous humor of eyes from patients with CSC compared with controls (P = 0.172 and P = 0.004, respectively). There was a significant inverse correlation between the vascular endothelial growth factor and platelet-derived growth factor in patients (r = -0.555; P = 0.026). Interleukin 6, interleukin 8, and monocyte chemoattractant protein-1 were detectable, but not significantly different between the patients and controls. The results of the current study suggest that platelet-derived growth factor contributes to the pathogenesis of CSC; however, the roles of vascular endothelial growth factor in CSC are unclear and warrant further investigation.

Half-dose verteporfin photodynamic therapy for bullous variant of central serous chorioretinopathy: a case report

IntroductionCentral serous chorioretinopathy is characterized by serous neurosensory detachment of the macula and it usually resolves spontaneously with good visual prognosis. In some patients, however, the serous retinal detachment might be very extensive and can result in bullous exudative retinal detachment. We evaluated the use of half-dose verteporfin photodynamic therapy for the treatment of bullous retinal detachment in idiopathic central serous chorioretinopathy.Case presentationWe report the case of a 51-year-old Chinese man who presented with blurred vision in his right eye and superior visual field defect due to bullous variant of central serous chorioretinopathy. No improvement in vision and retinal detachment was noted after three months of observation and a short course of oral acetazolamide. He was then treated with half-dose verteporfin photodynamic therapy and his visual acuity improved from 20/70 to 20/25 within one month of treatment. Three months after photodynamic therapy, there was complete resolution of sub-retinal fluid and bullous retinal detachment. No recurrence of central serous chorioretinopathy was noted in three years of follow-up.ConclusionWe report the beneficial effect of photodynamic therapy with half-dose verteporfin as a treatment option for bullous retinal detachment caused by central serous chorioretinopathy.

Photodynamic Therapy Rescue for Subretinal Fluid Exacerbation After Focal Laser Treatment in Idiopathic Central Serous Chorioretinopathy

PurposeTo report a case of subretinal leakage after focal laser treatment for idiopathic central serous chorioretinopathy (ICSC). This rare complication was successfully treated with photodynamic therapy (PDT).MethodsInterventional case report.ResultsA 36-year-old male presented with ICSC in his right eye. After a period of observation without resolution, he was treated with focal laser. That treatment resulted in a massive exacerbation of his subretinal fluid. PDT was successfully used to treat the severe exacerbation with rapid resolution of the subretinal fluid, improvement in visual acuity, decreased leakage on fluorescein angiography, and reduction of subretinal fluid on ophthalmoscopic exam and by optical coherence tomography.ConclusionsOphthalmologists should consider the use of PDT in cases where focal laser causes an exacerbation of subretinal fluid in ICSC.

The efficacy of intravitreal bevacizumab for idiopathic central serous chorioretinopathy

To evaluate the efficacy of intravitreal bevacizumab injection in the treatment of central serous chorioretinopathy (CSC). In a prospective interventional case series, 40 eyes of 40 patients with idiopathic CSC at least 3months in duration were included. Patients were treated with once or twice intravitreal bevacizumab injections initially and completed at least 12months follow-up. Main outcomes measures were the resolution of neurosensory detachment, best-corrected visual acuity, and findings on fluorescein and indocyanine green angiography. Thirty-three of 40 eyes (82.5%) showed complete absence of subretinal fluid at the macula within 3months following initial intravitreal bevacizumab injection. Eyes exhibiting resolution of subretinal fluid revealed improvement in fluorescein and indocyanine green angiographic findings. The rate of intense hyperfluorescence on indocyanine green angiography was higher in eyes exhibiting resolution of subretinal fluid than eyes exhibiting incomplete absorption of subretinal fluid after intravitreal bevacizumab (72.7 and 28.5%, respectively, p = 0.039). Intravitreal bevacizumab injections generally resulted in anatomic improvement for CSC and may constitute a therapeutic option in CSC. The effect after intravitreal bevacizumab injection for CSC might be related to the hyperfluorescence on indocyanine green angiography.

Central serous chorioretinopathy induced by corticosteroids

Five patients were diagnosed as having central serous chorioretinopathy (CSC) during systemic corticosteroid treatment based on medical records and fluorescein angiography. Twenty-eight previously reported corticosteroid-induced CSC cases in addition to these 5 were examined to clarify clinical differences between idiopathic CSC and corticosteroid-induced CSC. Nine previously reported cases of corticosteroid-induced multifocal posterior pigment epitheliopathy (MPPE) were also reviewed. The corticosteroid-induced CSC patients were older and less male-dominant. In MPPE, bilateral involvement was noted in most cases and females were dominant. We found two patient groups; in the short latency group, the onset of CSC occurred within 70 days of corticosteroid administration and in the prolonged latency group, more than 6 months after. The daily dose of prednisolone for the former usually exceeded 20 mg/day, in contrast to the latter, at less than 20 mg/day. Immunosuppressive drugs such as cyclophosphamide made it possible to diminish the onset daily dose.

Intravitreal Ranibizumab in the Treatment of Choroidal Neovascularization Associated with Idiopathic Central Serous Chorioretinopathy

We evaluate the functional and anatomic outcome after intravitreal ranibizumab treatment in patients with choroidal neovascularization (CNV) related to chronic central serous chorioretinopathy (CSC). This is a small case series of 5 eyes with CNV associated with chronic CSC treated with intravitreal injection of 0.5 mg ranibizumab in the Jules Gonin University Eye Hospital from July 2007 to July 2009. Baseline and monthly follow-up visits included best-corrected visual acuity (BCVA), fundus examination, and optical coherence tomography (OCT). Fluorescein and indocyanine green angiography (ICG) were performed at baseline and repeated at least every 6 months. We studied 5 eyes of 4 patients with a mean age of 66 years. Mean follow-up was 21 months (SD 1.9). The mean number of intravitreal injections administered for each patient was 10 (SD 4.6). The mean initial BCVA was 0.23 (decimal equivalent) (logMAR 0.64, SD 0.13). At the last follow-up, mean BCVA was 0.44 decimal equivalent (logMAR 0.36, SD 0.31). Mean central macular thickness (CMT) measured with OCT was 330 microm (SD 43) at baseline and decreased at the final follow-up to 243 microm (SD 44 ). Persistent intraretinal or subretinal fluid on OCT and/or multifocal areas of increased choroidal permeability on ICG angiographies were present in all patients at the last follow-up visit. Intravitreal ranibizumab appeared to be an effective treatment of CNV related to chronic CSC. However, residual intraretinal or subretinal fluid and increased choroidal permeability persisted. Prospective controlled studies are warranted to evaluate the long-term safety and efficacy of intravitreal ranibizumab.

Intravitreal Bevacizumab for the Treatment of Central Serous Chorioretinopathy.

The benefit of intravitreal bevacizumab injection in the long-standing idiopathic central serous chorioretinopathy is described. Intravitreal injection of 1.25 mg of bevacizumab was given to a patient, who complained of reduced vision for 10 months due to idiopathic central serous chorioretinopathy. Within a week, his visual acuity improved from 20/80 to 20/25; 3 months later, the visual acuity reached 20/20 with complete resolution of the serous retinal detachment, as was demonstrated by optical coherence tomography. No recurrences or complications were found for a period of 6 months.

Intravitreal Bevacizumab in Treatment of Idiopathic Persistent Central Serous Chorioretinopathy: A Prospective, Controlled Clinical Study

Purpose: To evaluate and determine the effect of intravitreal bevacizumab in treatment of persistent central serous chorioretinopathy.Methods: This prospective, comparative clinical study included 30 eyes of 30 patients with persistent, symptomatic central serous chorioretinopathy of 3 months’ duration or more. Fifteen eyes of 15 patients were treated with intravitreal injections of 2.5 mg (0.1 ml) bevacizumab (treatment group). Fifteen eyes of 15 patients with the same characteristics who declined treatment were an acceptable control group. The visual and anatomic responses were observed with best-corrected visual acuity and central foveal thickness measured by optic coherence tomography at baseline,1, 3, and 6 months after treatment.Results: Twelve (80%) eyes in the treatment group compared with 8 (53.3%) eyes in the control group showed morphologic restitution at 6 months (P < 0.01). All 15 (100%) treated eyes had stable or improved vision, compared with 10 (66.6%) eyes in the control group (P < 0.01). At 6 months, the mean ± SD central foveal thickness for the treatment group remained significantly lower compared to the control group, with 174 ± 68 µm and 297 ± 172 µm, respectively (P < 0.001). Injection-related complications were not encountered.Conclusions: Our results indicate that intravitreal bevacizumab injection may be a new, promising treatment option for select patients with idiopathic persistent central serous chorioretinopathy. Continued studies with intravitreal bevacizumab in this population will help to establish its long-term efficacy.

Low dose verteporfin (1.5mg/m2) in chronic idiopathic central serous chorioretinopathy

Abstract Purpose In chronic idiopathic central serous chorioretinopathy (ICSC), recent studies indicate that photodynamic therapy (PDT) could be effective in subretinal fluid resorption with reduced dose of verteporfin (3mg/m2) and reduced fluence PDT. However safety and cost issues remain to be addressed. This prospective randomized controlled study has been designed to evaluate the efficacy of a further reduced dose of verteporfin for PDT in chronic ICSC. Methods Patients with chronic ICSC greater than 3 months of documented duration were included. Visual acuity had to be &lt;20/40. The patients were randomly assigned to 2 treatment groups. They received either 3 mg/m2 or 1,5 mg/m2 verteporfin and reduced fluence PDT. All patients had visual acuity, ocular coherent tomography (OCT), fluorescein and indocyanine green (ICG) angiography on inclusion, follow up was based on ETDRS and OCT at 6 weeks, 3 and 6 months. Results Ten patients were included, randomized to each treatment group. Mean duration of symptoms prior to PDT was 6 months. After 6 month follow‐up, no significant difference between the 2 groups was observed: the reduction of mean foveal thickness was equivalent in both groups. In all treated eyes, visual acuity remained stable or improved. OCT showed a reduction in serous detachment in 2 eyes of 10 eyes, complete resolution was demonstrated in 8 of 10 eyes. None of the eyes required more than 1 treatment for recurrent serous detachment. Conclusion Our preliminary data suggest that PDT leads to resolution of serous detachments and visual improvement in patients with chronic ICSC even with a low dose of verteporfin. This will reduce the cost of PDT for each patient. Long term follow‐up should enable to address safety issues.

Morphological changes in the retinal pigment epithelium on spectral-domain OCT in the unaffected eyes with idiopathic central serous chorioretinopathy

To report the changes seen in the retinal pigment epithelium (RPE) morphology in the asymptomatic eyes of patients with idiopathic central serous chorioretinopathy (ICSC) using spectral-domain Cirrus (TM) high-definition optical coherence tomography (HD-OCT). In a prospective case series, 17 consecutive patients with unilateral ICSC underwent spectral-domain Cirrus (TM) HD-OCT scans for both affected and opposite asymptomatic eye. Three-dimensional single-layer RPE map was studied in both eyes for morphological alterations, and findings were correlated with clinical presentation, fluorescein angiogram, and 5 Line raster scan. Additionally, three-dimensional (3D) single-layer RPE maps done in 111 healthy volunteers served as control. In patients with ICSC, 3D single-layer RPE analysis of asymptomatic eyes showed presence of RPE bumps in 16 (94%) eyes and pigment epithelium detachment (PED) in 2 (11.8%) eyes. The 5 Line raster scan was normal in all eyes. Of 222 normal (control) scans, 18 showed RPE bumps and none showed PED. Conclusions 3D single-layer RPE map showed abnormal pattern in the asymptomatic eyes of patients with unilateral ICSC. Spectral-domain optical coherence tomography showed morphologic alterations in retinal pigment epithelium in both eyes of patients with idiopathic central serous chorioretinopathy.

Serum cortisol and testosterone levels in idiopathic central serous chorioretinopathy

Context:The preferential occurrence of idiopathic central serous chorioretinopathy (ICSC) in males with a typical Type A personality and behavior and a relative absence in females is a possible indicator towards the role of serum cortisol and /or the male sex hormone testosterone.Aims:To study levels of cortisol and testosterone in ICSC.Settings and Design:Case-control study in a tertiary care teaching hospital.Materials and Methods:The study was conducted on 23 cases of ICSC. Twelve patients with unilateral sudden painless loss of vision of less than one month duration served as controls. Serum cortisol and testosterone levels at 8.00 a.m. were estimated by radioimmunoassay in both groups.Statistical analysis used:Statistical analysis was done using SPSS 13.0 software. Independent Sample t-test was applied to analyze statistical significance between the two groups.Results:Mean age of patients with ICSC was 37.1 ± 9.7 years and 96% of the patients were males. Mean serum cortisol levels were significantly higher (P=0.002) in patients with ICSC i.e., 495.02 ± 169.47 nano moles/liter (nmol/L) as compared to controls i.e., 362.25 ± 51.54 nmol/L. Mean serum testosterone levels were 3.85 ± 1.81 nano grams/ml (ngm/ml) and 4.23 ± 1.89 ngm/ml in cases and controls respectively and the difference was not statistically significant (P=0.58).Conclusions:ICSC is associated with elevated 8.00 a.m. serum cortisol levels. However, mean serum testosterone levels in both patients of ICSC and controls were within normal range.

Photodynamic therapy as treatment of chronic idiopathic central serous chorioretinopathy

Chronic idiopathic central serous chorioretinopathy (ICSC) is characterized by persistent, recurrent, and multifocal serous detachments of the neurosensory retina. Our objective is to evaluate the visual and anatomical outcomes of patients who underwent photodynamic therapy (PDT) with Verteporfin for chronic ICSC. A retrospective review of 13 eyes of 12 patients (mean age 55, range 45-66 years) treated with PDT for chronic ICSC between June 2004 and January 2008 was conducted. Two eyes that subsequently developed choroidal neovascularization were excluded. Best corrected visual acuity (BCVA) and clinical examination prior to PDT and at most recent follow-up were recorded. Fluorescein angiography (FA) and optical coherence tomography (OCT) findings prior to and following treatment were reviewed. Mean duration of symptoms prior to PDT was 26.7 months (range 3-108 months). Mean follow-up duration was 21.9 months (range 2-42 months). BCVA improved in seven of eleven eyes (mean 1.7 lines, range 1-3 lines), two eyes remained unchanged, and two eyes worsened. Complete resolution of serous detachment was demonstrated in 9 of 11 eyes by FA or OCT and 10 of 11 eyes by clinical examination. One eye showed a reduction in serous detachment by OCT and clinical exam. Three eyes required two treatments for recurrent serous detachment following initial treatment. Our data suggest that PDT leads to resolution of serous detachments and visual improvement in patients with chronic ICSC. Further follow-up would be prudent to assess the long-term outcomes and safety in this patient population.