Idiopathic Central Serous Chorioretinopathy Research Articles

Subthreshold Diode Micropulse Photocoagulation for the Treatment of Chronic Central Serous Chorioretinopathy with Juxtafoveal Leakage

To report the visual and clinical outcomes of subthreshold diode micropulse (SDM) laser photocoagulation for chronic idiopathic central serous chorioretinopathy (ICSC) with juxtafoveal leakage. Prospective, noncomparative, interventional case series. Twenty-six eyes in 25 patients with persistent ICSC and juxtafoveal leakage longer than 4 months' duration. All eyes were assigned to SDM photocoagulation. Eyes were divided into 3 groups based on the findings of fluorescein angiography. Groups 1 and 2 were those patients with source leakage without and with associated retinal pigment epithelial atrophy (RPE), respectively, whereas group 3 consisted of patients with diffuse RPE decompensation with indeterminate source leakage. All patients were followed-up for at least 6 months. The preoperative and postoperative best-corrected visual acuity, number of sessions of SDM photocoagulation, foveal thickness, and resolution of subretinal fluid (SRF) evaluated by ocular coherence tomography (OCT) were recorded. Patients also were tested for the presence or absence of laser-related scotoma with Amsler grid screening. Groups 1, 2, and 3 consisted of, respectively, 6, 9, and 11 eyes. In group 1, all patients had total SRF resorption after 1 session of SDM photocoagulation. Eight eyes in group 2 had total SRF resorption after 1 to 3 sessions of SMD laser, whereas 1 patient had persistent SRF. In group 3, only 5 eyes had SRF resorption at the end of the follow-up, and the other 6 eyes needed photodynamic therapy for final SRF resorption. At the end of follow-up, the average preoperative foveal thickness was reduced by more than half of its original thickness. A gain of visual acuity of 3 lines or more was achieved in 15 eyes (57.7%), and a gain of between 1 and 3 lines was achieved in 6 eyes (23.1%). Subthreshold diode laser is effective in the treatment of ICSC with point source leakage. However, for eyes with diffuse leakage, a less favorable response was noted. A multicenter, randomized clinical trial is needed to ascertain the real efficacy and the appropriate settings of SMD for chronic ICSC. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Differential Optical Densities of Intraretinal Spaces

To test the hypothesis that hyporeflective spaces in the neuroretina found on optical coherence tomography (OCT) examination have different optical reflectivities according to whether they are associated with exudation or degeneration. Retrospective analysis of eyes with idiopathic perifoveal telangiectasia (IPT), diabetic macular edema (DME), idiopathic central serous chorioretinopathy (CSC), retinitis pigmentosa (RP), or cone dystrophy (CD) and eyes of healthy control subjects. OCT scans were performed. Raw scan data were exported and used to calculate light reflectivity profiles. Reflectivity data were acquired by projecting three rectangular boxes, each 50 pixels long and 5 pixels wide, into the intraretinal cystoid spaces, centrally onto unaffected peripheral RPE, and onto the prefoveolar vitreous. Light reflectivity in the retinal pigment epithelium (RPE), vitreous, and intraretinal spaces for the different retinal conditions and control subjects were compared. Reflectivities of the vitreous and the RPE were similar among the groups. Hyporeflective spaces in eyes with exudation (DME, RP, and CSC) had higher reflectivity compared with the mean reflectivity of the vitreous, whereas the cystoid spaces in the maculae of the eyes without exudation (CD and IPT) had a lower reflectivity than did the normal vitreous. Analysis of the light reflectivity profiles may be a tool to determine whether the density of hyporeflective spaces in the macula is greater or less than that of the vitreous, and may be a way to differentiate degenerative from exudative macular disease.

Central serous chorioretinopathy

Background Central serous chorioretinopathy is a condition typically affecting young adults between 25 and 50 years of age. It is predominating in type A personality trait men. Central serous chorioretinopathy is defined clinically as a detachment of the sensory retina that is commonly unilateral but can also be bilateral. Laser photocoagulation has been used widely with central serous chorioretinopathy to prevent recurrence and to speed recovery time. Photodynamic therapy is emerging as a potential treatment for chronic central serous chorioretinopathy. The prognosis for resolution and visual recovery for patients with central serous chorioretinopathy is excellent. Approximately 95% of patients with central serous chorioretinopathy will recover to a final visual acuity of 20/30. Case reports Patient 1 was a 57-year-old man who reported to the clinic with a complaint of central scotoma involving the left eye. He also had a decrease in best-corrected visual acuity of 20/30 in the left eye. Idiopathic central serous chorioretinopathy was diagnosed, and observation was the management choice. At the 6-month follow-up, the patient's left eye visual acuity had returned to 20/20. Patient 2 was a 63-year-old man who reported to the clinic with decreased central vision of the left eye. His best-corrected visual acuity in that eye was 20/40. This was an unusual case because of the patient's age and the risk of macular degeneration. With fluorescein angiography and optical coherence tomography, the diagnosis of central serous chorioretinopathy was confirmed. At the 10-month follow-up the patient's acuity had returned to 20/20 in the left eye. Patient 3 was a 59-year-old man who reported to the clinic with decreased vision in the left eye. His best-corrected visual acuity was 20/60 in that eye. He is a kidney transplant recipient and was taking 60 mg of prednisone. The patient was found to have steroid-induced central serous chorioretinopathy. Observation was the management of choice for several months without resolution. Focal laser photocoagulation was performed at the 6-month follow-up, which did not help, and his ultimate visual acuity in the left eye was 20/400. He returned to the clinic 3 years later with the same complaint in his right eye. The patient was again found to have steroid-induced central serous chorioretinopathy but in the right eye, with a best-corrected visual acuity of 20/30. Because of the failure of photocoagulation in the left eye, observation was the chosen management option. The central serous chorioretinopathy did not resolve, and because of this it was decided that the patient's nephrologist be contacted to suggest a decrease in the patient's oral prednisone dose. The nephrologist decreased his prednisone from 60 mg daily to 5 mg daily. With this change, the patient's visual acuity stabilized at 20/25. The central serous chorioretinopathy was still present but without subjective visual complaints. Conclusion Central serous chorioretinopathy is a condition that normally affects type A personality trait men. Also, patients taking any type of corticosteroids must be watched closely for the development of central serous chorioretinopathy. There is no good course for treatment, with observation being the best management choice. Photodynamic therapy may become the treatment choice for patients with chronic central serous chorioretinopathy, but more studies on the use of photodynamic therapy need to be completed.

Retinal pigment epithelial rip associated with idiopathic central serous chorioretinopathy

Retinal pigment epithelial rip associated with idiopathic central serous chorioretinopathy

Can Long-term Corticosteroids Lead to Blindness? A Case Series of Central Serous Chorioretinopathy Induced by Corticosteroids

Introduction: Long-term, high-dose corticosteroid therapy is well-known to cause systemic and ocular complications. A lesser known complication is chronic central serous chorioretinopathy (CSCR). Although idiopathic central serous chorioretinopathy (CSCR) is known to be mild with spontaneous recovery and minimal effects on the final visual acuity, chronic CSCR as a complication of long- term steroid therapy behaves differently, and may cause irreversible visual impairment. Clinical Picture: Three cases of chronic, recurrent CSCR were precipitated by long-term corticosteroids prescribed for post-renal transplant immunosuppressive therapy, post-pituitary surgery and pemphigus vulgaris. Treatment and Outcome: Two cases resolved with tapering of corticosteroids while one case was treated by focal laser photocoagulation. Two eyes had severe impairment of vision as a result of subretinal scar formation while the other 4 eyes had mild reduction of visual acuity from retinal epithelium pigment atrophy. Conclusion: Long-term corticosteroid therapy can be complicated by severe, chronic and recurrent CSCR and occasionally peripheral exudative retinal detachment. This may result in subretinal fibrosis and permanent loss of vision. Key words: Opioid dependence, Partial agonist, Primary care setting

The Importance of Specific IgG, IgE Antibodies to Retinal S Protein, Type II Collagen and Alternaria in Idiopathic Central Serous Chorioretinopathy

The Importance of Specific IgG, IgE Antibodies to Retinal S Protein, Type II Collagen and Alternaria in Idiopathic Central Serous Chorioretinopathy

Acute bilateral central serous chorioretinopathy following intra-articular injection of corticosteroid

There is increasing evidence in the literature implicating the use of exogenous steroids through various routes as a risk factor for the development of idiopathic central serous chorioretinopathy (ICSC). We report a case of acute bilateral ICSC following intra-articular injection of corticosteroids.

Helicobacter pylori and idiopathic central serous chorioretinopathy.

Idiopathic central serous chorioretinopathy (ICSC) is a disease that typically affects middleaged adults and involves the sensory retina, the retinal pigment epithelium (RPE) and the choroid. Patients usually have mild visual loss. ICSC generally resolves without therapy, although the disease can become chronic with ensuing RPE decompensation. Some patients, particularly older adults, can also develop choroidal subretinal neovascularisations (CNV), which may lead to a severe loss in visual acuity. Although the aetiopathogenesis of the disease is still incompletely understood, a correlation with psychophysical stress supports the idea that the disease may be "adrenergically conditioned", leading to the development of one or several defects in the RPE, with subsequent focal leakage of serous fluid and its retention in the subretinal space. An association between ICSC and the Helicobacter pylori (HP) infection has also been recently documented, suggesting that this organism may possibly be involved in the development of some cases of ICSC. Pathogenetic mechanisms that may explain the contribution of HP in the development of ICSC are postulated.

Helicobacter pylori and idiopathic central serous chorioretinopathy.

Idiopathic central serous chorioretinopathy (ICSC) is a disease that typically affects middleaged adults and involves the sensory retina, the retinal pigment epithelium (RPE) and the choroid. Patients usually have mild visual loss. ICSC generally resolves without therapy, although the disease can become chronic with ensuing RPE decompensation. Some patients, particularly older adults, can also develop choroidal subretinal neovascularisations (CNV), which may lead to a severe loss in visual acuity. Although the aetiopathogenesis of the disease is still incompletely understood, a correlation with psychophysical stress supports the idea that the disease may be "adrenergically conditioned", leading to the development of one or several defects in the RPE, with subsequent focal leakage of serous fluid and its retention in the subretinal space. An association between ICSC and the Helicobacter pylori (HP) infection has also been recently documented, suggesting that this organism may possibly be involved in the development of some cases of ICSC. Pathogenetic mechanisms that may explain the contribution of HP in the development of ICSC are postulated.

Five to 15 year follow-up of resolved idiopathic central serous chorioretinopathy.

To recognize the long-term sequelae of resolved idiopathic central serous chorioretinopathy (ICSC) in relation to visual acuity, contrast sensitivity, and lesion size between time elapsed since disease onset. Patients were recruited from fluorescein angiogram records between January 1985 and December 1995 with confirmed ICSC. Visual acuity, contrast sensitivity, and digital fundus photographs were recorded on follow-up. Comparison with the initial red-free photographs were made. There was no statistically significant deterioration of visual acuity over time compared to eyes with ICSC after initial resolution and the normal eyes. The change of lesion size over time was also statistically insignificant. Contrast sensitivity compared to visual acuity showed positive correlation in both ICSC and normal eyes, but the results were statistically insignificant. Lesion size correlates negatively with visual acuity and contrast sensitivity although this was statistically insignificant. This study shows little, if any, correlation between time and progression of retinal pigment epitheliopathy following resolution of ICSC. Visual acuity did not seem to worsen over time. Our data were not statistically significant, but it does give insight into the natural history of what is still a relatively poorly understood disease.

Ocular Photodynamic Therapy in Choroidal Neovascularization Complicating Idiopathic Central Serous Chorioretinopathy

Two consecutive patients with idiopathic central serous chorioretinopathy and decreased vision subsequent to subfoveal choroidal neovascular membranes were treated with photodynamic therapy applied using the protocol of the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study Group. Main outcome measures included best-corrected visual acuity, biomicroscopic appearance, and leakage on fluorescein and indocyanine green angiography. Photodynamic therapy offered anatomical, angiographic, and functional improvement. After an initial complete response, the patients required re-treatment at 3 and 4 months, respectively. Cessation of leakage with improvement in visual acuity occurred, but subretinal fibrosis posed a possible limitation for full functional recovery. Although choroidal neovascular membranes complicating idiopathic central serous chorioretinopathy portend a poor visual prognosis, the overall response to photodynamic therapy was favorable.

Ocular photodynamic therapy for serous macular detachment in the diffuse retinal pigment epitheliopathy variant of idiopathic central serous chorioretinopathy

Purpose To describe the anatomical and functional outcome of verteporfin ocular photodynamic therapy (PDT) in serous retinal detachment caused by the diffuse retinal pigment epitheliopathy form of chronic idiopathic central serous chorioretinopathy. Design Interventional case report. Method A 48-year-old Caucasian man with unilateral exudative retinal detachment from diffuse retinal pigment epitheliopathy and visual acuity of 20/40 was managed with verteporfin PDT applied sequentially in three separate spots targeting all retinal pigment epithelium leaks identified with intravenous fluorescein angiography (IVFA). Outcome measures included visual acuity, biomicroscopic appearance, and leakage on IVFA. Setting Clinical practice. Results Subretinal fluid resolved within 2 weeks; visual acuity returned to 20/20 with no recurrence at 6 months of follow-up. There was no leakage on IVFA posttreatment and no obvious toxicity. Conclusion To our knowledge, this is the first report of PDT causing resolution of macular detachment in diffuse retinal pigment epitheliopathy. Its long-term results with regard to the prognosis of the disease and the recurrence rate remain to be evaluated.

Retinal atrophy in idiopathic central serous chorioretinopathy

PURPOSE: To study retinal atrophy in idiopathic central serous chorioretinopathy (ICSC). DESIGN: Observational case series. METHODS: Twenty-four eyes in 23 consecutive patients aged 33 to 67 years and 50 eyes in 25 healthy volunteers aged 24 to 70 years were studied. Observational procedures included: biomicroscopy, fundus photography, fluorescein angiography, optical coherence tomography, photocoagulation. Retinal thickness after resolution of detachment, definite attenuation being defined as foveal thickness less than the mean −2 SD in healthy volunteers; duration of symptoms; best-corrected visual acuity (BCVA). RESULTS: Definite retinal attenuation, retinal thickness ranging from 51% to 74% of normal, was found in nine eyes of nine patients with idiopathic central serous chorioretinopathy (ICSC). Their duration of symptoms was longer ( P = .0014) and their BCVA was lower ( P = .015) than eyes in patients with normal-range foveal thickness who, nevertheless, had thinner foveae than healthy subjects ( P = .10). The most severe reduction of foveal thickness, to half the normal (three eyes of three patients), was associated with BCVA 0.5 or less, multifocal retinal pigment epithelial abnormalities, and more than 10 years’ duration of symptoms. Retinal attenuation was seen only after a duration of symptoms of more than 4 months, being most pronounced in the photoreceptor layer, particularly in the fovea. CONCLUSION: Foveal attenuation in ICSC is associated with more than 4 months’ duration of symptoms and persistent BCVA reduction despite resolution of the serous detachment. We found no other likely cause of atrophy than the prolonged absence of contact between photoreceptors and retinal pigment epithelial cells.

Factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy.

To investigate factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy (ICSC). Retrospective consecutive case series that included patients with ICSC who were younger than 50 years of age at the time of initial examination and were followed up for > or =3 years. The mean follow-up for 101 involved eyes of 61 patients was 9.8 years (median, 8.0 years). Eyes were stratified into two groups based on visual acuity at the final examination: Group 1, visual acuity of 2040 or better; and Group 2, visual acuity of worse than 2040. Findings identified as potential risk factors for reduced vision at the final follow-up examinations for Group 1 versus Group 2 included the following: macular retinal pigment epithelium atrophy (90.8% versus 96.0%, respectively; P = 0.68); persistent pigment epithelial detachment or persistent subretinal fluid (5.3% versus 28.0%, respectively; P = 0.004); recurrences (39.5% versus 68.0%, respectively; P = 0.020); laser treatment (28.9% versus 32.0%, respectively; P = 0.80); and submacular choroidal neovascularization (0.0 versus 8.0%, respectively; P = 0.059). Factors associated with reduced visual acuity during long-term follow-up of patients with ICSC included persistent pigment epithelial detachment and/or subretinal fluid, recurrences, and submacular choroidal neovascularization.

Bullous variant of idiopathic central serous chorioretinopathy

BACKGROUNDSpontaneous bullous serous retinal detachment (RD) with subretinal exudation complicating idiopathic central serous chorioretinopathy (ICSC) is a rare and infrequently described clinical entity. Clinical observations are described on this variant...

Macular serous retinal detachment caused by subretinal leakage in tilted disc syndrome

Objective To describe a previously unreported complication of tilted disc syndrome: serous retinal detachment, caused by subretinal leakage, that mimics chronic idiopathic central serous chorioretinopathy (ICSC). Design Retrospective cohort study. Participants Five patients (five eyes) participated. Main outcome measures Fluorescein angiographic features were measured. Results All patients presented with visual loss and metamorphopsia. Fundus examination showed features typical of tilted disc syndrome, including obliquely directed long axis of the disc, situs inversus, retinal pigment epithelium conus, hypopigmentation and staphylomatous ectasia inferonasal to the optic disc, as well as a serous retinal detachment. Fluorescein angiography showed a site of leakage or multiple focal areas of staining and atrophy of the retinal pigment epithelium that correlated to the linear pigmentary changes observed at the junction with the inferior staphyloma. The fluorescein angiographic pattern was very similar to that of chronic ICSC. Spontaneous healing occurred in one case, and successful photocoagulation of the site of leakage was applied in two cases; two eyes could not be photocoagulated because of diffuse leakage in the macular region. Conclusions To the authors’ knowledge, macular serous retinal detachment due to subretinal leakage has not been reported as a complication of tilted disc syndrome. The authors hypothesize that choriocapillary and pigment epithelial disturbances at the junction of the inferior staphyloma permit the subretinal leakage, but the pathogenesis of this complication remains unclear. A study of larger series of such patients is needed to identify the most appropriate management of these cases, which first need to be differentiated from a chronic form of ICSC.

Extrafoveal photostress recovery test in glaucoma and idiopathic central serous chorioretinopathy

BACKGROUND/AIMSA photostress recovery test was designed to differentiate macular diseases from optic nerve disorders, but recently an abnormal recovery time was reported in glaucoma. The purpose of this study was...

Laser Surgery of the Posterior Segment

Part 1 Principles: principles of photocoagulation. Part 2 Photocoagualation of the posterior segment: diabetic retinopathy diabetic macular edema retinal vein occlusion peripheral retinal neovascularizations choroidal neovascularizations idiopathic central serous chorioretinopathy fundus vascular anomalies nonvascular intraocular tumours retinal breaks and detachment miscellaneous disorders. Part 3 Complications: complications of photocoagulation.

Corticosteroid-induced central serous chorioretinopathy

Five patients were identified by medical records and fluorescein angiography as having developed central serous chorioretinopathy (CSC) during corticosteroid treatment. These five and 28 previously reported corticosteroid-induced CSC occurrences were studied to clarify the differences between idiopathic CSC and corticosteroid-induced CSC. Nine previously reported occurrences of corticosteroid-induced multiple posterior pigment epitheliopathy (MPPE) were also reviewed. Corticosteroid-induced CSC patients were older and less male-dominant; in MPPE, female patients predominated and most had bilateral involvement. The onset of CSC was within 70 days of corticosteroid administration in the short latency group, and more than 6 months after administration in the prolonged latency group. Daily doses of prednisolone usually exceeded 20 mg in the short latency group and was less than 20 mg in the prolonged latency group. Immunosuppressive agents such as cyclophosphamide were related to a lower daily dose at onset.

Central Serous Chorioretinopathy in Women

Central serous chorioretinopathy is a disorder that typically affects young and middle-aged men. Although extensive information is available pertaining to the clinical features of central serous chorioretinopathy in men, little is known about this condition in women. The authors reviewed the medical records and photographic files of women who received a diagnosis of central serous chorioretinopathy. The women were divided into three groups for data analysis: idiopathic, exogenous corticosteroid use, and pregnancy. Fifty-one women with active central serous chorioretinopathy were evaluated. These findings in women with idiopathic serous chorioretinopathy were similar to those described in men, with the exception that women tend to be older at the time of onset. Central serous chorioretinopathy in women taking exogenous corticosteroids more likely was characterized by bilateral involvement and subretinal fibrin. Central serous chorioretinopathy in pregnant women typically developed in the third trimester and resolved spontaneously within 1-2 months after delivery. Idiopathic central serous chorioretinopathy is similar in women and men, with the exception that women tend to be more older at the time of onset. The finding of exogenous corticosteroid use in a significant number of women in our study provides further support that cortisol may play a role in the development of central serous chorioretinopathy. The mechanism by which cortisol influences the development of central serous chorioretinopathy is unclear.