Recurrent Central Serous Chorioretinopathy Research Articles

Comparative evaluation of central serous retinopathy in pilots and non-pilot patients: Retrospective study of central serous chorioretinopathy (CSC)

BackgroundCentral serous chorioretinopathy (CSC) is a disqualifying condition for pilots because of the importance of good vision to their jobs. The objective of this study was to evaluate the clinical diagnosis, treatment, and aviation medical assessment principles for CSC in military pilots. MethodsThe clinical data and aviation medical assessments of 15 pilots with CSC who were admitted to the Air Force Medical Center between January 2003 and December 2021 were analyzed, and three typical cases are reported. The relevant literature evaluation was conducted on 32 non-pilot patients with CSC. ResultsThe mean age of the 15 pilots was 37.47 ± 4.21 years, and they were all male. Fourteen were affected in a single eye (4 in the right eye and 10 in the left eye), while one was affected in both eyes. Two pilots were nonsmokers and did not consume alcohol; one was a smoker; four pilots consumed alcohol on a regular basis; and eight pilots were smokers and consumed alcohol on a regular basis. The mean best-corrected visual acuity (BCVA) increased from 0.83 ± 0.33 at the initial visit to 0.95 ± 0.44 at the final visit. The non-pilot group included 32 patients, 29 of whom were male and 3 of whom were female, with a mean age of 37.16 ± 10.02 years. Thirty-one patients had single-eye involvement (17 of the right eye and 14 of the left eye), while one patient had involvement of both eyes. Seventeen patients were nonsmokers and did not consume alcohol; two were smokers; four consumed alcohol on a regular basis; and nine were smokers and consumed alcohol on a regular basis. The mean BCVA increased from 0.64 ± 0.28 at the first visit to 0.90 ± 0.30 at the final visit. Patients in the pilot group had a high recurrence rate, which was associated with a low final BCVA and led to their disqualification from flying. ConclusionPilot and non-pilot patients did not differ significantly in terms of CSC clinical data. Chronic and recurrent CSC can be a vision-threatening disease; therefore, pilots must receive accurate and timely diagnosis.

Improvement in Central Serous Chorioretinopathy in Renal Transplant Recipients Following Hemodialysis: Case Report

Introduction: This case report describes an elderly man experienced recurrent central serous chorioretinopathy (CSCR) for several years following a kidney transplant. Despite various treatments, his subretinal fluid was unexpectedly absorbed following hemodialysis after the loss of graft kidney function. Optical coherence tomography (OCT) imaging and best-corrected visual acuity (BCVA) measures were taken. The patient has been followed for approximately 10 years. Conclusion: Hemodialysis should be considered early if there is persistent and refractory serous retinal detachment despite reducing or discontinuing glucocorticoid therapy and in the presence of decreased glomerular filtration rate.

Pathogenesis of Central Serous Chorioretinopathy and the Link Between Choroidal Hyperpermeability and Retinal Pigment Epithelium Pump Reversal

Purpose: To describe 6 cases of acute central serous chorioretinopathy (CSCR) and the response to laser treatment, focusing on the underlying pathogenic mechanism. Methods: Multimodal imaging from 6 eyes of 6 patients with acute and recurrent CSCR were reviewed including fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) at baseline and after laser therapy. Results: In 3 out of the 6 cases with acute CSCR, the hyporeflective lucency sign was identified with cross sectional and en face OCT and co-localized with an intense active inkblot retinal pigment epithelium (RPE) leak on FA. The development of this sign was suggestive of active leakage into the subretinal space displacing overlying subretinal hyperreflective material (SHRM) and suggestive of a reversal of RPE pump function. All six cases were treated with focal laser to directly target the intense leakage points with remarkable resolution of the fluid due to destruction of the RPE cells mediating reversal of pump function. Conclusions: Unlike chronic CSCR in which degenerative changes of the RPE lead to oozing of fluid into the subretinal space, in acute forms of CSCR including bullous CSCR, there are focal leaks of the RPE that actively drive fluid into the subretinal space suggestive of RPE pump reversal. We propose that pachychoroid disease causes increased hydrostatic pressure and increased resistance to the RPE pump thereby triggering a reversal in pump function. Understanding this concept can have therapeutic implications.

Complete Resolution of Central Serous Chorioretinopathy Cases Treated with Low Power Mode Laser Technology : A Novel Approach

Introduction : Central serous chorioretinopathy (CSC) is an idiopathic condition mostly affecting men in their 20s to 50s. It is characterized by serous fluid accumulation behind the neurosensory retina resulting in a localized macular detachment. Aldosterone-receptor antagonist and photodynamic laser therapy are the current mainstay of treatments, although most CSC cases can resolves spontaneously within 2 to 3 months. Low power mode (LPM) laser has emerged as a new effective technology to treat CSC.
 Case Illustration : Case 1: A 50-year-old male was diagnosed with recurrent chronic CSC since 2 months ago. His visual acuity declined even after given oral aldosterone receptor antagonist for two weeks, so he was scheduled to undergo LPM. After three weeks of laser treatment, CSC resolved and the visual acuity improved (Figure1). Case 2 : A 47-year-old male complained of decreased vision and metamorphopsia on his right eye since two weeks ago. He was diagnosed with CSC and underwent LPM. Three weeks after LPM, his vision improved and the metamorphopsia resolved (Figure2). LPM helps the migration of retinal pigment epithelium (RPE) cells to restore the outer blood-retinal barrier through expression of heat shock proteins. We used MC-500ViXi laser system (Nidek Co., Gamagori, Japan) and the laser parameters used in this study were 100?m spot size, 0.01s exposure time, 0.25-0.5 spacing, and 30% LPM ratio.
 Discussion : 
 Conclusion : LPM is a new yet promising treatment modalities to treat acute and chronic CSC. Its low power nature makes LPM a safe choice of treatment with less damage to the surrounding retina.

Wait-and-see and other factors associated with recurrence risk in central serous chorioretinopathy patients: A systematic review and meta-analysis of cohort studies

Background: Central serous chorioretinopathy (CSC) is a common macular disease characterized by serous retinal detachment and leakage spots at the level of the retinal pigment epithelium. While acute CSC is often self-limiting, chronic and recurrent CSC can lead to permanent vision loss. The identification of risk factors associated with recurrent CSC is crucial for preventive measures and appropriate management. This systematic review aims to determine the various risk factors for the recurrence of central serous chorioretinopathy, with a particular focus on the "wait and see" approach and other contributing factors. Methods: The review protocol was registered in PROSPERO (ID: CRD42023413852). A systematic literature search was conducted across four databases (PubMed, Cochrane, Embase, and ScienceDirect) using the keywords "((Central serous chorioretinopathy) AND (Recurrence) AND (Risk))". Meta-analyses were performed using Review Manager 5.4. Results: A total of five studies met the inclusion criteria for all factors, while three studies were selected for meta-analyses regarding the "wait and see" approach. The analysis revealed four significant risk factors for CSC recurrence: patient's clinical condition, therapy administration, age and gender, and patient history. Additionally, a meta-analysis based on three studies involving 1025 eyes demonstrated a statistically significant difference between CSC patients who received no therapy (wait and see) and those who underwent specific therapeutic interventions, with a relative risk of 1.82 (95% CI 1.49–2.22, I2 95%, P <0.00001). Conclusions: Early identification of risk factors, including the ‘wait and see’ approach and other factors, is crucial in preventing the recurrence of central serous chorioretinopathy. Patients at high risk of recurrence should receive vigilant treatment and routine monitoring to avoid permanent vision loss. This systematic review provides valuable insights for clinical decision-making and emphasizes the importance of individualized management strategies for CSC patients.

Comparison of Nailfold Videocapillaroscopy with Retinal and Choroidal Vascular Parameters in Patients with Central Serous Chorioretinopathy.

This study seeks to evaluate the results of nailfold videocapillaroscopies (NVCs) among patients with central serous chorioretinopathy (CSC) and their correlation with the choroid and retinal parameters. The examined group included 152 patients with acute, recurrent, chronic and neovascular CSC (34 F, 118 M, mean age 45.9 ± 8.9) and 41 healthy controls (12 F, 29 M, mean age 47 ± 11.5). The NVC examination, ophthalmoscopy, angio-OCT and OCT were performed. In addition, the medical history regarding chronic general disorders and known risk factors were recorded. Abnormal NVC patterns and the dilated apical part of capillaries were found only in CSC patients (p = 0.000). Neoangiogenesis was observed in 25 acute (58.14%), 22 recurrent (42.31%), 16 chronic (36.36%) and 5 neovascular patients (45.45%) and 2 control subjects (4.88%) (p = 0.000). Glomerular capillaries were found in 8 acute (18.6%), 17 recurrent (31.48%), 25 chronic (56.82%) and 8 neovascular patients (72.73%) (p = 0.000). Meandering capillaries were more common in acute and recurrent CSC and glomerular capillaries were more common in chronic and aneurysmal dilations in neovascular CSC. The observed digital microcirculation abnormalities in patients with CSC, such as dilation, meandering, tortuosity and glomerular, may confirm systemic micro-vasculopathy. The potential role of the NVC examination in assessing the CSC prognosis requires further evaluation.

Presentation and outcome of central serous chorioretinopathy with and without pachychoroid.

The present study compared clinical features and outcomes of central serous chorioretinopathy (CSC) with and without pachychoroid. It was a retrospective, longitudinal, record-based study which included eyes with CSC. Patients underwent spectral domain optical coherence tomography and differentiated between pachychoroid and non-pachychoroid groups. Eyes were divided into pachychoroid and non-pachychoroid groups based on the subfoveal choroidal thickness of 300 microns and the presence of pachyvessels. A total of 250 eyes of 250 patients were divided into pachychoroid and non-pachychoroid with 125 eyes in each group. Mean ages of patients in pachychoroid and non-pachychoroid groups were 45.7 ± 9.4 years and 47.4 ± 10.2 years, respectively. Mean initial best-corrected visual acuity (BCVA) was 0.40 ± 0.42 in pachychoroid and 0.39 ± 0.38 in non-pachychoroid group (p = 0.9). Mean final BCVA was 0.37 ± 0.9 in pachychoroid and 0.21 ± 0.33 in non-pachychoroid group (p = 0.04). 36 (28.8%) eyes in pachychoroid and 60 (48%) eyes in non-pachychoroid group had spontaneous resolution of CSC (p = 0.007). A total of 39 (31.2%) eyes in pachychoroid and 13 (10.4%) in non-pachychoroid group had recurrent CSC at the end of follow-up. CSC eyes with pachychoroid had more recurrent episodes and less spontaneous resolution compared to CSC eyes in non-pachychoroid group. Final visual acuity was worse in eyes with CSC and pachychoroid. These findings need to be validated in a larger sample size with a prospective study design.

Analysis of retinal sensitivity between acute and recurrent central serous chorioretinopathy by microperimetry

PurposeTo evaluate the retinal sensitivity of macular region in acute and recurrent central serous chorioretinopathy (CSCR) using microperimetry. MethodsThis was a retrospective observational study. Twenty-five eyes of 25 subjects diagnosed with either acute or recurrent CSCR without any previous treatment were included in this study. All subjects underwent complete ophthalmological examinations, including central retinal thickness (CRT) using spectral domain OCT and the retinal sensitivity assessments of macular region using microperimeter MP-3. The mean global macular sensitivity (GMS) of 64 loci in the 20° central macular area and the local macular sensitivity (LMS) of the test locations in affected region of serous retinal detachment (SRD) were analyzed. ResultsTwelve eyes of 12 subjects with acute CSCR (Group A) and 13 eyes of 13 subjects with recurrent CSCR (Group R) were enrolled. Clinical parameters, including age, duration, mean LogMAR best-corrected visual acuity and CRT, were not statistically significant (p = 0.688, 0.080, 0.222, 0.394, respectively) between Group A and Group R. There were significant differences in the GMS and LMS between the two groups. Compared to group A (24.9 ± 1.6 dB), the mean GMS of group R was significantly (p = 0.018) lower (23.0 ± 2.0 dB). Furthermore, the mean LMS of group R (20.8 ± 3.4 dB) was also significantly lower (p = 0.026) than that of group A (22.3 ± 3.1 dB). ConclusionsRecurrent CSCR often show worse retinal function in focal areas of the affected macular areas than in acute CSCR. Microperimetry may be a promising method for distinguish between the acute and recurrent CSCR.

Detection of macular ganglion cell complex loss and correlation with choroidal thickness in chronic and recurrent central serous chorioretinopathy.

To investigate the association of ganglion cell complex thickness (GCCt), global loss volume percentage (GLV%), and focal loss volume percentage (FLV%) with structural and functional findings among patients with chronic central serous chorioretinopathy (CCSC) and recurrent central serous chorioretinopathy (RCSC) by optical coherence tomography (OCT). Among 29 patients with monocular affected central serous chorioretinopathy (CSC), 15 had CCSC, and 14 had RCSC. The GCCt, FLV%, GLV%, and subfoveal choroidal thickness (SFCT) and sublesional choroidal thickness (SLCT) values were determined using OCT, and the association of these characteristics with neural structure parameters, choroidal morphology, features and functional alterations were estimated for the CCSC and RCSC patients. In CCSC, the affected eyes had significantly lower GCCt values than the fellow eyes in the macular regions (all P<0.05), with the highest GCCt observed in the inferior area. A significant association was found between the GCCt in different regions and the change in best corrected visual acuity (BCVA; r=-0.696; -0.695; -0.694, P<0.05) in CCSC patients. A statistically significant moderate negative correlation indicated that long-term CCSC was associated with greater differences in the GCCt in different regions between affected and fellow eyes (r=-0.562; r=-0.556; r=0.525, P<0.05). Additionally, observation of thickened SFCT was associated with a worse FLV% (r=0.599; r=0.546, P<0.05) in both groups. Similarly, thickened SLCT was associated with FLV% in RCSC patients (r=0.544, P<0.05). The distribution and GCCt are associated with the duration and visual outcomes of CCSC, whereas there is no correlation among RCSC patients. FLV% may be instrumental in differentiating the various outer choroidal vessels (pachyvessels) in long-term CSC. These results suggest that neural structure parameters may aid in estimating and predicting the recovery of altered morphology and function in CCSC and RCSC patients.

Time-dependent recurrence and resolution of pigment epithelial detachment in central serous chorioretinopathy

BackgroundCortisol plays a role in the pathogenesis of central serous chorioretinopathy (CSC). CSC patients have abnormal time-dependent changes in cortisol levels. Here we report a rare case of a patient with central serous chorioretinopathy whose pigment epithelial detachment (PED) exhibited time-dependent recurrence and resolution.Case presentationA 47-year-old man presented in 2016 for vision loss in the left eye related to recurrent CSC. During follow-up, his PED was observed to resolve spontaneously while he was still in our clinic and recurred the next morning. Such time-dependent changes of the PED were observed in several next follow-ups without any intervention. After excluding possible external factors, the abnormal diurnal variation of cortisol was considered as the internal factor affecting PED.ConclusionsThis is the first article that described the spontaneous time-dependent recurrence and resolution of PED without external interference, where endogenous cortisol may be responsible. Interventions against the abnormal cortisol level might be a potential treatment strategy for CSC. More research is urged to explore the impact of the diurnal change in cortisol levels on eyes with CSC.

Multimodal Imaging Based Predictors for the Development of Choroidal Neovascularization in Patients with Central Serous Chorioretinopathy

This study evaluated predictors for choroidal neovascularization (CNV) associated with central serous chorioretinopathy (CSCR) based on multimodal imaging. A retrospective multicenter chart review was conducted on 134 eyes of 132 consecutive patients with CSCR. Eyes were classified as per the multimodal imaging-based classification of CSCR at baseline into simple/complex CSCR and primary episode/recurrent/resolved CSCR. Baseline characteristics of CNV and predictors were evaluated with ANOVA. In 134 eyes with CSCR, 32.8% had CNV (n = 44) with 72.7% having complex CSCR (n = 32), 22.7% having simple (n = 10) and 4.5% having atypical (n = 2). Primary CSCR with CNV were older (58 vs. 47, p = 0.00003), with worse visual acuity (0.56 vs. 0.75, p = 0.01) and of longer duration (median 7 vs. 1, p = 0.0002) than those without CNV. Similarly, recurrent CSCR with CNV were older (61 vs. 52, p = 0.004) than those without CNV. Patients with complex CSCR were 2.72 times more likely to have CNV than patients with simple CSCR. In conclusion, CNV associated with CSCR was more likely in complex CSCR and older age of presentation. Both primary and recurrent CSCR are implicated in CNV development. Patients with complex CSCR were 2.72 times more likely to have CNV than patients with simple CSCR. Multimodal imaging-based classification of CSCR supports detailed analysis of associated CNV.

Abstract 1

Introduction: Central serous chorioretinopathy (CSCR) is an underdiagnosed retinal disorder characterized by well-definedmacular neurosensory retinal detachment and/or detachment of retinal pigment epithelium. However, it is quitesurprising that, we found only one case report in previous literatures describing CSCR in a patient who receivedsteroid therapy for GO. We report two cases where patients developed recurrent CSCR while under systemicsteroid therapy for severe thyroid ophthalmopathy. Case 1: A 34 years old man with severe thyroid orbitopathy complained of profound reduction in vision in right eyemore than left eye within one month of start of intravenous methylprednisolone (IVMP). He completed 12 cycles of weekly IVMP followed by rituximab infusion because of inadequate response to steroids. His bestcorrected visual acuity (BCVA) in both eyes dropped from 6/6 to 1/60. Fundus examination showed small andhyperemic optic nerve head with thickened nerve fibre layer in both eyes and right serous macular detachmentwith punctate yellow sub-retinal deposits. Optical coherence tomography (OCT) confirmed the diagnosis ofCSCR in right eye. Finally Orbital radiation was advised to save remaining vision in both eyes. His BCVA improved to right eye 6/18 and left eye 6/6. Case 2: A 34 years old man with Grave’s disease of 6 months duration complicated by severe orbitopathy presentedwith blurring of vision and central scotoma of left eye after 2 weeks of start of oral prednisolone 80 mg/day intapering doses. His BCVA in left eye dropped from 6/6 to 6/9 with marginal improvement in orbitiopathy andsubjective symptom. Fundus examination showed a ring reflex with subretinal fluid at fovea in the left eye. OCT revealed typical lesions consistent with CSCR in left eye. There was marked improvement in proptosisafter decompression surgery with stable BCVA of 6/6 both eyes over the next follow ups. Conclusion: As it is a frequently encountered sight threatening disorder related to systemic GCs. It’s important forendocrinologists and ophthalmologists to be mindful about the possible complication of CSCR while treatingGrave’s Orbitopathy.

Topical Nepafenac 0.1% or 0.3% for the Treatment of Central Serous Chorioretinopathy: A Case Series of Chronic and Recurrent Disease and Review of the Literature

Central serous chorioretinopathy (CSCR) is a disease involving leakage of serous fluid through the retinal pigment epithelium, resulting in neurosensory retinal detachment. The majority of acute CSCR cases resolve spontaneously. However, treatment options for chronic and recurrent cases are lacking. In this case series, topical nepafenac 0.1% and 0.3% were investigated as novel treatments for chronic and recurrent CSCR. We performed a retrospective case series analysis of six patients diagnosed with chronic recurrent CSCR. Data from patient medical records were collected, including age range, gender, subjective complaints, Snellen visual acuity (VA), clinical eye examination, central macular thickness (CMT) on optical coherence tomography, prior treatments, time of follow-up, and time to resolution of CSCR. The six cases of chronic and recurrent CSCR in this study were treated with 0.1% and/or 0.3% topical nepafenac. The mean age of the six cases was 52 years. There was an average gain in vision of 2.5 lines in Snellen VA, and a final Snellen VA of 20/20 was achieved in each case. The average time to complete resolution of CSCR was 3.33 months. The decrease in CMT ranged from 105 µm to 507 µm, with an average decrease of 240 µm, and subretinal fluid resolved completely in all the six cases.

Topical Nepafenac 0.1% or 0.3% for the Treatment of Central Serous Chorioretinopathy: A Case Series of Chronic and Recurrent Disease and Review of the Literature

Central serous chorioretinopathy (CSCR) is a disease involving leakage of serous fluid through the retinal pigment epithelium, resulting in neurosensory retinal detachment. The majority of acute CSCR cases resolve spontaneously. However, treatment options for chronic and recurrent cases are lacking. In this case series, topical nepafenac 0.1% and 0.3% were investigated as novel treatments for chronic and recurrent CSCR. We performed a retrospective case series analysis of six patients diagnosed with chronic recurrent CSCR. Data from patient medical records were collected, including age range, gender, subjective complaints, Snellen visual acuity (VA), clinical eye examination, central macular thickness (CMT) on optical coherence tomography, prior treatments, time of follow-up, and time to resolution of CSCR. The six cases of chronic and recurrent CSCR in this study were treated with 0.1% and/or 0.3% topical nepafenac. The mean age of the six cases was 52 years. There was an average gain in vision of 2.5 lines in Snellen VA, and a final Snellen VA of 20/20 was achieved in each case. The average time to complete resolution of CSCR was 3.33 months. The decrease in CMT ranged from 105 µm to 507 µm, with an average decrease of 240 µm, and subretinal fluid resolved completely in all the six cases.

Recurrent central serous chorioretinopathy in a surgically closed traumatic macular hole

A 36-year-old gentleman with history of central serous chorioretinopathy (CSCR) developed full thickness macular hole in the right eye with recurrence of CSCR 2 weeks after blunt trauma to his right eye. Vitrectomy resulted in complete closure of the macular hole and resolution of the subretinal fluid. Post macular hole surgery he developed two episodes of CSCR recurrence with no reopening of the hole. This report hypothesises the possible mechanisms underlying this unusual association and explains how a surgically manipulated macular tissue could endure significant submacular fluid accumulation.

Central Serous Chorioretinopathy: A Review of Pathogenesis, Risk Factors, Diagnostic Methods and the Current Treatments

Central serous chorioretinopathy (CSCR) is characterized by serous detachment of the neurosensory layer at the macula. It has a relatively high recurrence rate and mainly affecting middle-aged males. The etiology and pathogenesis of the disease still remain ambiguous. But choroidal changes which increase choroidal vascular permeability are the basic pathology of CSCR. Different diagnostic methods such as FAF, FFA, OCT, OCTA, ICG could be used to detect its biomarkers such as choroidal thickness, choroidal vascularity index, hyperreflective dots for exact diagnosis and treatment response. Acute CSCR generally self-limited, but in recurrent or chronic forms may cause permanent visual loss due to progressive and irreversible damage in the photoreceptor layer of retinal pigment epithelium atrophy. Several treatment alternatives have been reported, such as PDT, intravitreal Anti-VEGF, TTT, Laser, Mineralocorticoid receptor antagonist for chronic and recurrent CSCR.

A pilot study of scleral thickness in central serous chorioretinopathy using anterior segment optical coherence tomography

The aim of this study is to compare the scleral thickness of central serous chorioretinopathy (CSC) eyes with controls using anterior segment optical coherence tomography (AS OCT). This prospective case control study included 15 patients (15 eyes) with CSC and 15 age and gender matched healthy subjects. All subjects underwent spectral domain OCT with enhanced depth imaging and swept source AS OCT of temporal sclera. We investigated difference in scleral thickness between the two groups and relationship between choroidal and scleral thickness. Among the 15 eyes in the study group, 1 eye had acute CSC, 4 had recurrent CSC, 7 had inactive CSC, and 3 had chronic CSC. There was no significant difference in terms of age, gender, axial length and spherical equivalent between the two groups. The choroidal and scleral thickness of the study group were significantly greater than those of the control group (P < 0.001, P = 0.034). Choroidal thickness was positively correlated with scleral thickness (P = 0.031). A thick sclera along with a thick choroid were demonstrated in CSC eyes using AS OCT. Scleral characteristics might be involved in the pathogenesis of CSC by affecting outflow resistance of venous drainage in choroidal circulation.

Endogenous Hypercortisolism in recurrent Central Serous Chorioretinopathy

Background: Central Serous Chorioretinopathy (CSCR) is an important cause of nonsurgical retinopathy leading to moderate to severe visual loss. Almost 50% cases undergo recurrence, and one of the recognizable risk factors is endogenous hypercortisolism.&#x0D; Aims and Objective: Our study intended to its presence in recurrent CSCR patients compared to non-chorioretinal disorder.&#x0D; Materials and Methods: Eighteen-month cross-sectional comparative study done on recurrent CSCR patients and matched refractive error patients comprised the comparison group. Use of exogenous steroids and diagnosed conditions of hypercortisolism were excluded. Sample size for both the groups was 34 in each. After taking history and performing ocular examination, blood samples for serum cortisol estimation collected in the morning and in the evening in patients of both the groups. Results analyzed using standard statistical methods.&#x0D; Results: All patients of recurrent CSCR were males. The mean serum levels of cortisol were higher than laboratory reference range during both times of the day in recurrent CSCR patients, and these levels were significantly higher than those in the comparison groups.&#x0D; Conclusion: Recurrent CSCR patients have higher level of endogenous cortisol compared to the non-chorioretinal patients, and its early recognition and management would certainly benefit the patients.

One-year results of half-dose versus one-third-dose photodynamic therapy in chronic or recurrent central serous chorioretinopathy

BackgroundCentral serous chorioretinopathy (CSC) is characterized by an accumulation of subretinal fluid (SRF) in the macula. It is usually treated by laser photocoagulation or photodynamic therapy (PDT) with consisting of different doses and power. This study aimed to compare the efficacy of half-dose PDT and one-third-dose PDT in chronic or recurrent CSC.MethodsA retrospective review of patients with chronic or recurrent CSC who were treated with either a half-dose or one-third-dose PDT, and had follow up 12 months afterwards. Best-corrected visual acuity (BCVA), central retinal thickness (CRT) and resolution of subretinal fluid (SRF) at baseline as well as 1, 3, 6 and 12 months post-PDT were assessed.ResultsForty-six eyes and 20 eyes received half-dose and one-third-dose PDT, respectively. The study showed efficacy of the one-third-dose PDT compared with half-dose PDT in BCVA improvement (0.10±0.04 logMAR for one-third-dose versus 0.17±0.04, for half-dose, P=0.148) and CRT improvement (125.6±24.6 μm for one-third-dose versus 139.1±16.54, for half-dose, P=0.933) at 12 months. The SRF recurrence rate was significantly higher in the one-third-dose PDT group compared with the half-dose PDT group (40.0% versus 15.2%, P=0.027) at 12-months.ConclusionAt 12 months, the one-third-dose PDT was effective in terms of BCVA and CRT improvement, when compared with half-dose PDT. However, this study showed that one-third-dose PDT had a higher recurrence rate of SRF.

The efficacy of subthreshold micropulse yellow laser (577 nm) in chronic central serous chorioretinopathy.

Central serous chorioretinopathy (CSC) is a disease characterized by a well-defined serous detachment of the neurosensory retina. Therapeutic options in chronic cases are limited, and side effects can result in a limited response. The aim of this article is to assess the efficacy of subthreshold micropulse laser therapy in patients with chronic central serous chorioretinopathy. The study included 20 eyes of 19 patients who had a history of chronic or chronic recurrent CSC and who underwent subthreshold micropulse laser therapy between January 2015 and June 2018. Twenty eyes of 19 patients with a mean age of 48.9 ± 9.40 years were included. The mean visual acuity was 0.24 ± 0.28 logMAR before laser, 0.19 ± 0.25 logMAR 3 months after laser, and 0.18 ± 0.27 logMAR after 6 months. A statistically significant difference was determined in terms of visual acuity before and after treatment (p = 0.0001). The mean central retinal thickness was 308.10 ± 95.25 μm before laser, 233.65 ± 81.17 μm 3 months after laser, and 203.88 ± 72.79 μm at 6 months. A statistically significant relationship was present between visual acuity and the duration of disease (p = 0.001), between visual acuity and the outer nuclear layer thickness (p = 0.005), and between the outer nuclear layer thickness and the duration of disease in chronic cases (p = 0.008). There was no evidence of retinal pigment epithelium or retinal damage on optical coherence tomography or fundus autofluorescence secondary to subthreshold micropulse laser therapy. Visual acuity appears to be more associated with the duration of disease and with changes in the outer nuclear layer thickness in chronic CSC. Subthreshold micropulse laser therapy seems to be effective at treating chronic CSC, while it increases success during early period of the disease before the development of permanent retinal damage.