Reduction Of Subretinal Fluid Research Articles

Optical Coherence Tomography-Based Positive Predictors of Eplerenone Therapy in Chronic Central Serous Chorioretinopathy: A Retrospective Study.

This study aimed to investigate optical coherence tomography (OCT) biomarkers as potential predictors of treatment response in chronic central serous chorioretinopathy (CSCR). It was a retrospective cohort study that included 42 patients with chronic CSCR. After complete ocular and hematological examinations, all patients received 50 mg/day of oral eplerenone for three months and were followed for at least six months. All participants were divided into two groups: Group 1 participants with a positive response to treatment (complete resolution of subretinal fluid (SRF) at six months) and Group 2 poor responders (moderate or less than 50% reduction in SRF from baseline). The primary outcome measure was the resolution of SRF, and various OCT biomarkers like central macular thickness (CMT), pigment epithelial detachments (PED), double-layer sign, elongation of the photoreceptor's outer segment, the integrity of the external limiting membrane, the integrity of the ellipsoid zone, hyperreflective foci in the outer segment, and subretinal deposits in the SRF were assessed. The mean age was 41.33 ± 10.75 years, and 34 participants were male. Thirty-seven (88.1%) of the participants had good responses to eplerenone, with the mean height of SRF decreasing significantly from a maximum of 269.74 µm to a minimum of 21.86 µm at six months (p<0.001). The mean CMT decreased from the first visit time point to the third visit time (p<0.001). Logistic regression analysis assessed the absence of PED and double-layer signs associated with a good response. The eplerenone therapy seems to be efficient for chronic CSCR, and OCT can be an invaluable aid to the treating physician.

Could a low-dose definitive radiation therapy be the optimal treatment for choroidal hemangioma?

PurposeTo determine the efficacy of low-dose intensity-modulated radiation therapy (IMRT)/volumetric intensity-modulated arc therapy (VMAT) in the treatment of symptomatic choroidal hemangioma (CH). Materials and methodsFifty-three consecutive patients with CH were retrospectively reviewed. All the patients underwent IMRT/VMAT as a unique treatment. Resolution of subretinal fluid (SRF), improvement of best-corrected visual acuity (BCVA), and reduction in tumor thickness were compared before and after radiotherapy. ResultsAfter definitive radiotherapy, 100 % of SRF and 76.7 % of exudative retinal detachment were resolved. 56.6 % of BCVA improvement in more than two lines was observed. The mean best-corrected visual acuity was 20/280 (range, 20/1200–20/40) at diagnosis and 20/100 (range, 20/1200–20/20) after treatment. The mean tumor thickness decreased significantly from 3.8 mm initially to 1.2 mm after treatment (p < 0.01). 66.0 % of patients were delivered with 21.6 Gy (range, 21.6–42 Gy), 84.9 % of fractional dose was 1.8 Gy (range, 1.8–2 Gy). No radiation-induced keratitis, retinopathy, or optic neuropathy were observed. Initial vision (p = 0.042), duration time of vision (p = 0.004), and tumor thickness (p = 0.049) were prognostic factors for vision recovery. ConclusionLow-dose IMRT/VMAT could effectively induce involution of the CH, with reduction of subretinal fluid and relief of damage to the neurosensory retina, which is an effective treatment mode for CH.

Bilateral Extensive Serous Retinal Detachment in a Patient with Multiple Myeloma

Purpose: To describe a case of bilateral serous retinal detachment in a patient with multiple myeloma.Case summary: A 75-year-old woman presented with sudden-onset of reduced visual acuity in both eyes which had begun 2 days prior. Initial ophthalmological assessment revealed that visual acuities were 0.03 in the right eye and 0.05 in the left eye. Optical coherence tomography indicated pronounced macular elevation and extensive subretinal fluid accumulation in the posterior pole of both eyes. Fluorescein angiography did not detect any significant vascular leakage. Blood tests showed an albumin level of 2.1 g/dL, and plasma protein electrophoresis revealed an M protein level of 0.19 g/dL. Multiple myeloma-related hypoalbuminemia and paraprotein were suspected. The patient's retinal statuses were closely monitored and compared with blood test outcomes. Over 2 months, there was significant improvement, characterized by decreasing macular elevation and reduction of subretinal fluid. This progress was sustained thereafter. Plasma protein electrophoresis showed a gradual decline in paraproteins which coincided with the amelioration of serous retinal detachment.Conclusions: We encountered a case of acute and extensive serous retinal detachment in both eyes of a patient with multiple myeloma. When fluorescein angiography does not definitively show vascular leakage, light chain deposition disease-related serous retinal detachment should be considered. In such instances, it is important to address and monitor the underlying multiple myeloma.

Efficacy of Subthreshold Micropulse Laser for Central Serous Chorioretinopathy.

To evaluate the efficacy of a subthreshold micropulse laser (SML) in patients with central serous chorioretinopathy (CSCR). Retrospective clinical study conducted at the Departments of Ophthalmology at a university and a municipal hospital in Zurich, Switzerland. We enrolled acute and chronic CSCR patients with persistent subretinal fluid (SRF) treated with SML. Two treatment protocols (fluorescein/indocyanine green angiography or optical coherence tomography guided) were evaluated for efficacy after 3 and 6 months. The primary outcomes of the study were reduction and percentage of eyes with complete resolution of SRF 3 and 6 months after SML treatment. Secondary endpoints included changes in central subfield thickness (CST) and visual acuity (VA) after 3 and 6 months. The study involved 37 eyes (35 patients, 48.6% chronic). A statistically significant reduction in SRF height and CST could be shown, irrespective of SRF duration, type of CSCR, or chosen guidance after 3 and 6 months: SRF - 40 µm (p < 0.01), CST - 52 µm (p < 0.01). Percentage of eyes with complete resolution of fluid at 3 and 6 months after SML were 24.3 and 21.6%, respectively. No statistically significant functional improvement (VA) could be shown. Multivariable regression and linear mixed regression analyses did not identify statistically significant differences in SRF reduction, CMT change, or VA improvement with respect to the type of CSCR or the treatment plan used (p > 0.05). The effectiveness of SML in CSCR is under continuous debate. Our study findings demonstrate structural but only little functional changes with SML. In view of the shortage of verteporfin for photodynamic therapy, SML remains an important therapeutic option for CSCR patients.

Indocyanine green-enhanced transpupillary thermotherapy for juxtapapillary retinal capillary hemangioblastoma.

To study the clinical presentation and treatment outcomes of indocyanine green-enhanced transpupillary thermotherapy (ICG-TTT) for treatment-naïve juxtapapillary retinal capillary hemangioblastoma (JRCH). A prospective interventional case series. The technique involved ICG dye infusion 45 seconds prior to application of TTT. The main study outcomes were local tumor control, resolution of subretinal fluid (SRF), and improvement in best-corrected visual acuity (BCVA). Eight eyes of seven patients (5 males and 2 females) were included. The mean age was 26 years (range: 5-56 years). Systemic evaluation revealed von-Hippel Lindau (VHL) disease in five patients. The most common location was the temporal aspect of the optic disc (5 eyes). The mean basal diameter was 2.9 mm (range: 1-8 mm), and tumor thickness was 1.4 mm (range: 1-4 mm). All eight eyes were treated with multiple sessions of ICG-TTT (mean: 3 sessions). Six eyes received adjuvant intravitreal injection of dexamethasone implant (4 eyes) and/or bevacizumab (4 eyes). Post treatment, six eyes (75%) had tumor regression with reduction of SRF. One eye had a partial response with persisting SRF, and one eye showed poor response to TTT for which external beam radiotherapy was performed. At the last follow-up (median: 11 months; range: 6-29 months), the BCVA remained stable in seven eyes and improved in one eye (hand motion to 20/40). Multiple ICG-TTT sessions can be considered as an alternative treatment option for JRCH with effective local tumor control and SRF resolution.

Central Serous Chorioretinopathy. A Review.

Central serous chorioretinopathy (CSC) is adisease characterized by serous detachment of the neuroretina, especially in the posterior pole of the eye. It is often accompanied by serous detachment of the retinal pigment epithelium (RPE) and associated with the leakage of fluid into the subretinal space through the defective RPE. CSC most often affects men of working age. The exact pathophysiology of the disease is not completely known. Based on indocyanine green angiography (ICG), which revealed increased permeability of choroidal vessels, and optical coherence tomography (OCT) showing increased choroidal thickness, choroidal vasculopathy is assumed to be the primary cause of CSC. In most cases, CSC has agood prognosis with spontaneous resorption of the subretinal fluid (SRF) and improvement of visual functions. However, in asmall percentage of patients the disease progresses to achronic or recurrent course, and can lead to irreversible functional and anatomical changes of the retina with afinal clinical picture of diffuse retinal pigment epitheliopathy (DRPE). The optimal treatment approach for patients with CSC remains controversial. In recent decades, myriad therapeutic approaches have been used in the treatment of chronic forms of CSC (cCSC); these included for example laser photocoagulation, pharmaceutical treatment, standard photodynamic therapy (PDT) or anti-VEGF. In recent years aless destructive method, specifically PDT in reduced dose regimens, either with areduced dose of verteporfin or the laser beam energy used, has been preferred in the treatment of cCSC. Comparable efficacy and safety has been demonstrated using reduced-dose or reduced-fluence PDT regimens in patients with cCSC, with an improvement in best-corrected visual acuity and reduction of SRF.

Central Serous Chorioretinopathy. A Review

Central serous chorioretinopathy (CSC) is a disease characterized by serous detachment of the neuroretina, especially in the posterior pole of the eye. It is often accompanied by serous detachment of the retinal pigment epithelium (RPE) and associated with the leakage of fluid into the subretinal space through the defective RPE. CSC most often affects men of working age. The exact pathophysiology of the disease is not completely known. Based on indocyanine green angiography (ICG), which revealed increased permeability of choroidal vessels, and optical coherence tomography (OCT) showing increased choroidal thickness, choroidal vasculopathy is assumed to be the primary cause of CSC. In most cases, CSC has a good prognosis with spontaneous resorption of the subretinal fluid (SRF) and improvement of visual functions. However, in a small percentage of patients the disease progresses to a chronic or recurrent course, and can lead to irreversible functional and anatomical changes of the retina with a final clinical picture of diffuse retinal pigment epitheliopathy (DRPE). The optimal treatment approach for patients with CSC remains controversial. In recent decades, myriad therapeutic approaches have been used in the treatment of chronic forms of CSC (cCSC); these included for example laser photocoagulation, pharmaceutical treatment, standard photodynamic therapy (PDT) or anti-VEGF. In recent years a less destructive method, specifically PDT in reduced dose regimens, either with a reduced dose of verteporfin or the laser beam energy used, has been preferred in the treatment of cCSC. Comparable efficacy and safety has been demonstrated using reduced-dose or reduced-fluence PDT regimens in patients with cCSC, with an improvement in best-corrected visual acuity and reduction of SRF.

Two-year Clinical Outcomes Following Photodynamic Acute Exudative Maculopathy in Patients with Chronic Central Serous Chorioretinopathy.

To analyze the two-year clinical outcomes following photodynamic therapy (PDT)-induced acute exudative maculopathy (PAEM) in patients with chronic central serous chorioretinopathy (cCSCR). Prospective observational study that included 64 eyes of 64 patients with cCSCR who received half-fluence PDT and had a 2-year follow-up. Patients were classified into 2 groups based on whether they had had PAEM at 3 days after treatment (PAEM+, n=22; ≥50 µm increase in subretinal fluid (SRF) or not (PAEM-, n=42). Best-corrected visual acuity (BCVA) and SRF changes evaluated with optical coherence tomography (OCT) were registered at 3 days, 1 month, 3 months, 1 year and 2 years after PDT. The number of recurrences, the appearance of outer retinal atrophy (ORA) and choroidal neovascularization (CNV) were analyzed. BCVA was 75.9±13.6 (20/32) and 82.0±11.0 letters (20/25) at two years in the PAEM+ and PAEM- groups, respectively (p=0.055). There were no differences in the BCVA change (4.2±7.7 vs 3.3±7.1 letters; p=0.654) and the SRF decrease (-117.3±74.2 vs -138.5±83.6 µm; p=0.323) at 2 years between patients with and without PAEM. No differences in the number of recurrences (p=0.267), the appearance of CNV (p=0.155) or ORA (p=0.273) between both groups were noted. Patients with cCSCR with and without PAEM presented similar results at 2 years in terms of BCVA gain, SRF reduction and complication rate.

Outcomes of macular buckling with a T-shaped buckle for myopic tractional maculopathies associated with posterior staphyloma: An Indian experience.

Purpose:To report the anatomic and visual outcomes following macular buckling in patients affected by pathological myopia-associated foveoschisis (FS) and macular detachment with or without macular hole (MH).Methods:A retrospective interventional consecutive case series wherein 25 highly myopic eyes (mean axial length 28.46 mm; range, 25–33.8 mm) of 24 patients (16 females and 8 males; mean age 54.1 years; range, 35–74 years) presenting with macular detachment associated with a posterior staphyloma (PS), who underwent macular buckling, were evaluated. Patients with absence or reduction in subretinal fluid by more than 90% during the final follow-up along with inversion of contour of staphyloma were considered to have a successful anatomical outcome and those with improvement or maintenance in visual acuity were considered to have a successful functional outcome. The mean duration of follow-up was 11.2 months.Results:At the time of initial presentation, the mean age of the 24 patients was 54.1 ± 10.28 years. Macular detachment along with FS was present in all cases, whereas full-thickness macular hole-related retinal detachment was present in nine cases. Swept-source optical coherence tomography parameters showed reduction of FS with foveal reattachment in all eyes except one at last visit. Mean axial length decreased from 28.5 mm preoperatively (range 26–33.8 mm) to 26.2 mm (range 24–29.3 mm). The mean best-corrected visual acuity changed from 1.16 log MAR to 1.096 Log MAR (P = 0.165). Visual acuity improved in 10 eyes (40%), remained stable in 11 eyes (44%) and decreased in 4 eyes (16%).Conclusion:Macular buckling is a good surgical technique with encouraging anatomic and visual outcomes in patients with myopic macular detachment associated with PS. Highly selective cases of myopic traction maculopathy can have a viable option of macular buckle surgery in stabilizing the retinal tractional changes, and thereby, vision loss.

Subthreshold micropulse laser treating residual macular subretinal fluid after rhegmatogenous retinal detachment surgery

We report the effect of micropulse laser (MPL) treating a case of residual subretinal fluid (SRF) after rhegmatogenous retinal detachment (RRD) surgery. A 38-year-old male patient presenting with residual SRF 6 months following RRD surgery. Initial central macular thickness (CMT) was 243 μm. A 3 × 3 MPL macular grid was performed with moderate reduction of SRF (CMT = 191 μm). Five months following second MPL session, we noted a complete resolution of SRF (CMT = 98 μm) and fundus autofluorescence did not show any laser scare. Micropulse laser might represent a new non-invasive efficient treatment for residual SRF after RDD surgery. MPL effect seemed to be delayed and close follow-up was necessary.

Routine Clinical Practice Treatment Outcomes of Eplerenone in Acute and Chronic Central Serous Chorioretinopathy.

Purpose: To evaluate efficacy of eplerenone therapy vs. observation on resolution of subretinal fluid (SRF) in patients with acute and chronic central serous chorioretinopathy (CSCR) in routine clinical practice. Methods: Retrospective comparative case series of eyes diagnosed with CSCR treated with eplerenone or observation. Primary outcome measure was maximum height of SRF at 12 months. Secondary outcome was percentage of eyes with complete resolution of SRF, percentage of eyes with reduction of SRF ≥50%, and best corrected visual acuity (VA) at 12 months. Separate analysis was conducted for eyes with acute and chronic CSCR. Results: Sixty-eight eyes of 60 patients (82% male) were included. Eleven of the 38 eyes with acute CSCR, and seven of the 30 eyes with chronic CSCR, received eplerenone. Subretinal fluid decreased from baseline to 12 months in acute (287 ± 221 to 31 ± 63 µm) and chronic (148 ± 134 to 40 ± 42 µm) CSCR. Kaplan-Meier curves were similar for treated and observed eyes and COX regression analysis did not show a significant difference in SRF resolution in treated vs. observed eyes (p = 0.6 for acute, p = 0.2 for chronic CSCR). Conclusion: This routine clinical practice outcome study did not show evidence of efficacy of eplerenone on resolution of SRF in acute nor chronic CSCR.

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.

Treatment outcomes of optic disc pit maculopathy over two decades.

Aim:To study the long-term outcomes of optic disc pit maculopathy.Methods:Electronic medical records of 154 patients with optic disc pit were reviewed and 50 patients with optic disc pit maculopathy who met the study criteria were included in the study. Demographic profile of patients, along with clinical characteristics, optical coherence tomography (OCT) features and change in best-corrected visual acuity (BCVA) was recorded. Patients were treated either by observation, barrage laser alone or pars plana vitrectomy (PPV) with optional additional surgical procedures. The primary outcome measures were the change in BCVA and resolution of fluid on OCT.Results:The mean age of patients was 29.96 years (3–62 years) with a follow-up of 27.16 months. The mean baseline BCVA in observation, laser and vitrectomy group was log MAR 0.94, 0.76 and 0.87 and final BCVA was log MAR 0.9, 0.67 and 0.46, respectively. There was a statistically significant improvement in the final BCVA and reduction in subretinal fluid with resolution of the schisis cavity in vitrectomy group than in other groups. On regression analysis significant association was found between final BCVA with baseline BCVA (R2 = 0.815, p = 0.002), use of C3 F8 endotempanode (p = 0.004) ILM peeling (p = 0.012) and use of triamcinolone (TA; p = 0.003). No significant association was found with juxtapapillary endolaser (p = 0.062).Conclusions:In patients with disc pit maculopathy, PPV lead to better functional and anatomical outcomes as compared to laser or observation alone. Use of surgical adjuvants like ILM peeling, TA and C3F8 tamponade improved the outcomes, unlike juxtapapillary endolaser treatment.

Oral Mineralocorticoid-Receptor Antagonists: Choroidal Parameters Changes Using OCT in Central Serous Chorioretinopathy.

To evaluate the efficacy and safety of oral eplerenone in the treatment of acute and chronic central serous chorioretinopathy (CSCR). Treatment-naïve patients with acute (< 3 months) and chronic (≥ 3 months) CSCR were enrolled in this prospective, nonrandomized, interventional, comparative case series. Patients with acute CSCR were either treated with oral eplerenone (acute case group; n = 16) or observed only (acute control group; n = 8). All chronic patients (chronic group; n = 25) were treated with oral eplerenone. Eplerenone was prescribed 25 mg twice per day for 3 months. Best-corrected visual acuity (BCVA) and optical coherence tomography measures, including subretinal fluid (SRF) height, subfoveal choroidal thickness (CT), central CT, central choroidal volume (CV), and total CV, were assessed at baseline and 3-month follow-up (FU) visit. BCVA improvement and SRF reduction at 3-month FU relative to baseline were observed in all three study groups. SRF was completely resolved in 13 patients (81.2%) in the acute case group, four patients (50%) in the acute control group, and eight patients (32%) in the chronic group. The acute case group showed greater SRF decrease relative to baseline compared to the chronic group (P = .009), but the resolution of SRF between acute cases and an acute control group was not statistically significant (P = .076). Subfoveal CT, central CT, total CV, and central CV were significantly reduced at the 3-month FU compared to baseline in both affected and the fellow eyes in the acute case and chronic groups, whereas no change was observed in either eyes in the acute control group. At 3 months' FU, the mean logMAR visual acuity demonstrated no significant difference among the study groups (P = .08). Eplerenone was well-tolerated, and no serious side effect was detected. Oral eplerenone is a safe and effective treatment option for both acute and chronic CSCR. Resolution of SRF was more significant in acute CSR cases comparative to chronic cases. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:726-733.].

Navigated laser photocoagulation in patients with non-resolving and chronic central serous chorioretinopathy.

To evaluate the efficacy of navigated focal laser photocoagulation in patients with chronic central serous chorioretinopathy (CSCR) and active leakage on fluorescein angiography (FA). Thirty-two eyes of 32 patients (age 48 ± 11, m/f = 24/8) with persistent or recurrent CSCR (> 3months) who received navigated laser photocoagulation (Navilas®) of leaking point(s) between June 2013 and 2016 were included in this retrospective case series. Outcome parameters after 4weeks and 3months were the number of patients presenting with complete resolution of subretinal fluid, the volume of subretinal fluid measured on SD-OCT (Spectralis Heidelberg Engineering©), and best corrected visual acuity (BCVA/ (Snellen equivalent). Complete resolution of subretinal fluid was achieved in 17 eyes (50%) after 4weeks and in 24 eyes (75%) after 3months with an average number of 1.3 laser procedures (range 1-3). Five eyes displayed a nearly complete resolution with a reduction of over 80% of the subretinal fluid compared to baseline. Three eyes showed no reduction in subretinal fluid. BCVA improved from median 0.58 (range 0.16-1.25) to 0.66 (0.16-1.0) (p = 0.001). The seven patients who had been treated within the central 1mm of the ETDRS-OCT Grid but outside the avascular foveal zone showed an improvement of BCVA from median 0.6 (range 0.2-1.0) to 0.8 (0.2-1.0). No patient experienced a treatment-induced visual loss. Laser treatment with Navilas® using eye tracking and FA-based planning is a safe and effective alternative therapy in patients with chronic CSCR.

Long term outcomes for patients treated with half-fluence photodynamic therapy for chronic central serous chorioretinopathy: a case series.

A case series was used to evaluate the efficacy of half-fluence photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSCR). Patients were treated with standard-dose verteporfin and half-fluence PDT. Totally 13 eyes from 11 patients were included. The mean patient age was 52.0y. There was a mean reduction in central retinal thickness of 107.0 microns. Totally 7/13 eyes (53.8%) achieved resolution of subretinal fluid (SRF) on optical coherence tomography (OCT) scan after 1 treatment with PDT. Four eyes had further treatment with PDT; of these 1 eye achieved resolution of SRF. Seven of the 13 eyes (53.8%) achieved an improvement of more than 5 ETDRS letters. One patient experienced acute macula oedema 1d post PDT treatment. These results support the hypothesis that half-fluence PDT can have a positive effect in chronic CSCR for a gain in visual acuity and reduction in sub-retinal fluid. Acute macula oedema is a rare but potential adverse effect of half-fluence PDT.

CHANGE OF CHOROIDAL VOLUME IN UNTREATED CENTRAL SEROUS CHORIORETINOPATHY.

Choroidal hyperpermeability plays a central role in the pathophysiology of central serous chorioretinopathy (CSC). In active CSC undergoing treatment, choroidal thickness decreases if subretinal fluid (SRF) resolves. This study aimed to investigate the change in choroidal thickness and volume in eyes with untreated CSC. The authors retrospectively analyzed 27 eyes with treatment-naïve CSC (25 patients), who had a follow-up of 4 to 6 weeks. Retinal and choroidal volume and SRF were segmented manually and calculated using the Spectralis OCT built-in software (Spectralis; Heidelberg Engineering). In treatment-naïve eyes with CSC, an increase in SRF was significantly associated with an increase in choroidal thickness and volume (rho = 0.93, P < 0.01). Eyes with greater baseline choroidal volume showed a significantly greater decrease in SRF during follow-up (rho = -0.47, P = 0.03). In this study, an increase in SRF was associated with an increase in both choroidal thickness and volume in eyes with treatment-naïve CSC. Eyes with thicker baseline choroidal volume showed a greater reduction in SRF.

Eplerenone for chronic central serous chorioretinopathy-a randomized controlled prospective study.

To evaluate the efficacy and safety of eplerenone for chronic nonresolving central serous chorioretinopathy (CSC). Prospective, double-blind, randomized placebo-controlled study. Nineteen eyes of 17 patients with persistent subretinal fluid (SRF) due to CSC were enrolled and randomized to receive eplerenone 50mg/day or placebo for 3months, followed by a 3-month follow-up. The main outcome measure was change in SRF from baseline to 3months of treatment. Secondary outcomes included change in SRF at any time-point, complete resolution of SRF, improvement in choroidal thickness and change in best-corrected visual acuity (BCVA). Thirteen eyes were treated with eplerenone and six with placebo. Both groups showed reduction in SRF throughout the treatment period, with a significant reduction at months 1, 3 and 5 only in the treatment group. Twenty-three per cent in the treatment group and 30.8% per cent in the placebo group experienced complete resolution of SRF. A significant improvement in BCVA was noted in the placebo group at 4months, as well as a significant difference in BCVA between groups at 3months in favour of the placebo group (p=0.005). There was no significant difference in choroidal thickness in either group throughout the study period. No adverse events related to eplerenone were noted in the treatment group. In this study, eplerenone was not found to be superior to placebo in eyes with chronic CSC.

Acupuncture for chronic central serous chorioretinopathy: a prospective case series.

The aim of this prospective observational study was to evaluate the effects of acupuncture at Erjian on chronic central serous chorioretinopathy (CSC). Prospective case series. Nine patients with chronic CSC were recruited and each patient received 12 sessions of acupuncture treatment. Subjective symptom measures included complications, best-corrected visual acuity (BCVA), fluorescein leakage (via fluorescein fundus angiography), and central subfield foveal subretinal fluid (on optical coherence tomography (OCT)) at 3 months. Successful treatment was defined as the complete resolution of subretinal fluid observed by the OCT following completion of treatment. After 2 months of treatment, two patients showed improvements in visual acuity, a significant reduction in subretinal fluid and an improvement in BCVA to 0.5±0.10 (mean±SD). By contrast, four patients experienced no significant changes. After 3 months of treatment, four patients showed improvements in visual acuity and complete resolution of the subretinal fluid (mean BCVA=0.6), while parameters in two patients remained unchanged. Compared to baseline (before treatment), the proportions of patients experiencing visual improvement at 2 and 3 months were 33% (n=2) and 67% (n=4), respectively. No major complications were observed during the treatment course. Acupuncture might be a promising supplementary therapy for patients with CSC. However, this is ultimately only an exploratory study with a small sample size and no untreated comparator group to control for the natural history of the condition. Randomised controlled trials will be needed to demonstrate the efficacy and effectiveness of this approach.

Spironolactone in the treatment of nonresolving central serous chorioretinopathy: a comparative analysis

PurposeTo evaluate the effect of spironolactone, a mineralocorticoid receptor antagonist, for naïve and nonresolving central serous chorioretinopathy.MethodsA retrospective chart review was conducted of all central serous chorioretinopathy patients at one center treated with spironolactone (50 mg once a day) or observation. Thirty eyes of 30 patients with central serous chorioretinopathy and persistent subretinal fluid (SRF) for at least 8 weeks were enrolled. Patients were followed at monthly intervals with examination and optical coherence tomography. The primary outcome measure was the changes in SRF thickness from baseline to the apex of the serous retinal detachment. Secondary outcome included the best‐corrected visual acuity (BCVA).ResultsThe mean duration of central serous chorioretinopathy before enrollment in study eyes was 11.13 ± 2.40 weeks. Spironolactone demonstrated statistically significant visual acuity improvement (0.12 ± 0.09) and SRF reduction (273.07 ± 71.16 μm) at 3 months compared to baseline (0.25 ± 0.17, p = 0.003; 432.57 ± 108.99 μm, p = 0.001, respectively). Eight of the 14 patients with spironolactone had complete resolution of SRF at 3 months, compared to six of the 16 patients under observation (p = 0.377). Data analysis showed a statistically significant improvement in SRF and visual acuity in spironolactone treated eyes as compared with the same eyes under observation (p = 0.043, p = 0.047, respectively). There were no complications related to treatment observed.ConclusionsIn naïve eyes with persistent SRF due to central serous chorioretinopathy, spironolactone had a positive effect in the reduction of SRF and recovery of visual acuity.