Resorption Of Subretinal Fluid Research Articles

Influence of scleral thickness on photodynamic therapy outcomes in central serous chorioretinopathy.

To test the prognostic role of anterior scleral substantia propria (ASSP) thickness in predicting the 3-month response after half-dose photodynamic therapy (PDT) in central serous chorioretinopathy (CSCR) and to assess its clinical relevance of ASSP in different CSCR phenotypes. A prospective, exploratory, multi-centre cohort study conducted at IRCCS San Martino Hospital (Genoa, Italy) and Jules-Gonin Eye Hospital (Lausanne, Switzerland). Demographic and clinical data, and optical coherence tomography (OCT) were collected at baseline and 3 months after PDT. Based on OCT images, we categorized CSCR phenotypes and collected clinically relevant imaging metrics. ASSP thickness was obtained from four different measurements using anterior segment (AS) OCT. Multivariable regression models were performed to evaluate the distribution of ASSP thicknesses among different CSCR phenotypes and to test the prognostic role of ASSP thickness in discriminating between PDT responders (complete subretinal fluid reabsorption) and partial responders. The study cohort comprised 109 Caucasian patients (82 males, 75.2%) with a total of 142 eyes: 84 eyes simple (59.1%) versus 58 eyes complex (40.9%) CSCR. A linear normal model confirmed a positive association between complex CSCR and higher ASSP thickness (β = 26.1, 95% CL = 12.1/40.1, p < 0.001), with a low prevalence of ciliochoroidal effusion loculations in AS-OCT (1/142 eyes, 0.7%). ASSP thickening was positively linked to the presence of posterior cystoid retinal degeneration (PCRD; p = 0.002), indicating a potential role in the pathogenesis of severe CSCR phenotypes. In the subgroup of treated patients (61 eyes), 63.9% had a complete response after PDT. In these patients a logistic binary model highlighted a significantly higher risk of PDT non-responsiveness (OR = 9.62, 95% CL = 2.44/37.9, p = 0.001) associated with a 60-unit increase in ASSP thickness levels. By contrast, other anatomical parameters (i.e., body surface area, age, gender, axial length) showed no remarkable prognostic roles. This research highlighted the association of ASSP thickening with complex CSCR phenotype in Caucasian patients and its role in predicting PDT efficacy. These findings enhance our comprehension of the anatomical risk factors in patients affected with CSCR and potentially guide a better understanding of non-responsive cases to PDT treatment.

Bilateral serous retinal detachment in HELLP syndrome associated with post-partum sepsis and acute kidney injury: A case report

Serous retinal detachment (RD) can occur either during or after pregnancy, and is often associated with hypertensive disorders in pregnancy. A variant of pre-eclampsia–atypical pre-eclampsia–may present without proteinuria or hypertension. We report a case of a 26-year-old normotensive primigravida who developed sudden blurring of vision in both her eyes during puerperium. Fundoscopy revealed serous retinal detachment in both eyes. Optical coherence tomography (OCT) demonstrated sub-retinal fluid (SRF) in both eyes, and fundus fluorescein angiography (FFA) displayed leakage with pooling of dye all over the posterior pole. She responded well to oral and topical steroid eyedrops, and topical non-steroidal anti-inflammatory eyedrops. Her best-corrected visual acuity improved within a month, with resorption of subretinal fluid. Awareness about serous retinal detachment during/after pregnancy in the absence of hypertensive disorders is noteworthy. The visual prognosis is usually favorable, and this knowledge can allay fear and anxiety among patients.

Laser Treatment of Central Serous Chorioretinopathy - An Update.

Laser treatment has been a mainstay for management of central serous chorioretinopathy for a few decades. Different types of lasers have been used and non-damaging retinal laser is the most recent option. The aim of this review is to provide an update on this form of treatment, based on the research published during last 5 years, in comparison with earlier studies published. A MEDLINE database search was performed with a combination of the following terms: central serous chorioretinopathy and laser photocoagulation or subthreshold laser or subthreshold micropulse laser or nanosecond laser or microsecond laser or end-point management or photodynamic therapy. Results were analyzed separately for each modality of laser treatment. Reports published in recent years confirm findings of previous research and do not distinguish treatments of this clinical entity. Among all analyzed laser options, photodynamic therapy provides the fastest and most prominent morphological improvements, including subretinal fluid resorption and reduction of choroidal thickness. This modality is also associated with fewer recurrences than with other treatments. Subthreshold micropulse laser allows the physician to maintain and, in selected cases, improve the patient's vision. Conventional photocoagulation is still effective, especially with the introduction of navigated laser systems. Despite the availability of variable laser treatment options, long-term functional improvements in chronic cases are minor for each modality. Long-lasting central serous chorioretinopathy cases with significantly altered retinal morphology do not usually present with functional improvement, despite satisfactory morphological outcomes. Early initiation of treatment has the potential to prevent visual loss and to improve the patient's quality of life.

Changes in the outer nuclear layer and choroidal vascularity during the manifest and quiescent phases of acute central serous chorioretinopathy

To investigate alteration of outer nuclear layer (ONL) and choroidal vascularity index (CVI) in different status of central serous chorioretinopathy (CSC). A retrospective review of 65 CSC eyes with subretinal fluid (manifest CSC) and 40 control eyes was conducted in a single tertiary university hospital. Differences in best-corrected visual acuity (BCVA), ONL, and CVI were compared. CVI was assessed both in the entire choroid (CVI-EC) and around the 1500 μm leakage area (CVI-1500). Measurements were repeated after the subretinal fluid resorption (quiescent CSC), and compared. CSC eyes showed worse BCVA, thinner ONL and greater CVI than controls. Quiescent CSC showed a recovery of ONL compared to the manifest CSC, along with the BCVA improvement. The resolution of the CSC revealed a decrease across all three choroidal areas (total, stromal and luminal), with a more pronounced reduction in the stromal than in the luminal choroidal area, leading to an increase in the CVI. This phenomenon was shown in both CVI-EC and CVI-1500. Conclusively, ONL thickness can be used as a quantitative biomarker for photoreceptor function in CSC. Increased CVI may reflect a disease activity. The stromal choroidal area is particularly sensitive in illustrating leakage from the choroidal vasculature.

Leaking beehive honey sign an unusual case of central serous chorioretinopathy

Central serous chorioretinopathy is the fourth most common retinopathy after age-related macular degeneration, diabetic retinopathy and branch retinal vein occlusion. It’s usually unilateral and affect young or middle-aged men with M: F - 3:1 whereas female tend to be older. It’s a common ocular disease characterized by decompensation of the retinal pigment epithelium, which results in neurosensory retinal detachment, serous pigment epithelium detachment, and retinal pigment epithelium atrophy. Early identification and treatment are needed to prevent complications. Conclusion: Patients may require early intervention to prevent loss of photoreceptor layer integrity. Though Majority of cases are self-resolving, mineralocorticoid antagonists can be given for faster resorption of subretinal fluid. Photo Dynamic Therapy may be required for cases of chronic Central Serous Chorioretinopathy.

Results of treatment of optic disc pit maculopathy in children

Purpose: to analyze the anatomical and functional results of the differentiated treatment of optic disc pit maculopathy in children.Material and methods. We examined 23 children aged 5–17 years with an o ptic disc pit maculopathy. 10 children underwent retinal laser coagulation (LC) along the borders of the optic disc pit (1–3 sessions), 13 children underwent pars plana vitrectomy with gas tamponade (C2F6) in combination with retinal LC. In addition to the standard ophthalmological examination, all children underwent optical coherence tomography of the macular area of the retina before treatment and at different times after it.Results. In the group of children who underwent LC, the initial value of the maximum retina elevation averaged 525 ± 140 μm (from 346 to 882 μm). After laser treatment, all children showed a decrease in retinal elevation by 32 to 602 μm. 3 children had complete resorption of subretinal fluid during follow-up periods from 5 to 13 months. Best corrected visual acuity (BCVA) remained stable in 5 children, increased by 0.04–0.6 in 4 children, and decreased by 0.1 in one child. In the group of surgically treated children, the elevation of the retina before the intervention averaged 919 ± 143 μm (from 614 to 1420 μm) (p &lt; 0.05). After the intervention, this parameter decreased in all children by 91 to 811 μm, complete resorption of subretinal fluid was observed in 4 children during follow-up periods from 4 to 6 months. BCVA remained stable in 5 children, increased in 7 children by 0.1–0.7, and decreased by 0.4 in one child due to the progression of the cataract.Conclusion. The differentiated approach to the treatment of optic disc pit maculopathy in children proved to be highly efficient, depending on the height of retinal elevation in the macular zone before the start of treatment.

Исследование непосредственной клинической эффективности бролуцизумаба при лечении ВМД

Purpose. Analysis of direct clinical efficacy of brolucizumab in choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD). Material and methods. A clinical evaluation of effectiveness of using Beovu® (Novartis Pharma AG, Switzerland) was carried out in 25 patients (25 eyes) with neovascular AMD, mean age old patients was 68 ± 5 years. Dynamic monitoring was carried out using optical coherence tomography: localization and area of neovascular complex, density and thickness of newly formed vessels (angiography mode). 3 monthly injections of Beovu® were performed (at a dose of 6.0 mg/0.05 ml). The observation period was 4 months. Results. After the 1st injection of Beovu®, there was statistically significant decrease in the average indexes of central retinal thickness (CRT) and macular volume (MV) relative to initial. At the same time, an increase in best corrected visual acuity (BCVA) was observed (p = 0.044). A similar trend persists for average values of CRT and MV after each of the 3 injections. It is noteworthy that in all patients, after 3 injections, the minimum values of CRT were achieved – 268 (263; 270) versus 298 (284; 302) µm (p &lt; 0.001). There was also a clear trend towards an increase in BCVA from 0.3 (0.2; 0.45) to 0.6 (0.4; 0.6) in all studied cases (p &lt; 0.001). In 22 of 25 patients, after 1 month, adhesion of the neuro- and pigment epithelium was recorded with complete resorption of subretinal fluid, in 3 patients – after three monthly intravitreal injections of Beovu®, while the subretinal fluid was not recorded in them. Subjectively, all patients noted improvement in quality and contrast of central vision in the operated eyes. Conclusion. After each injection of Beovu®, there was progressive statistically significant reduction in macular area parameters – CRT and MV in combination with an increase in mean BCVA values from 0.3 (0.2; 0.45) initially to 0.6 (0.4; 0.6) by the 4th month of observation. Keywords: vascular endothelial growth factor, anti-VEGF, brolucizumab, Beovu®, age-related macular degeneration, neovascular age-related macular degeneration, wet age-related macular degeneration

Bilateral multifocal serous retinal detachments after multiple trauma: a case report

We present a patient with bilateral multifocal serous retinal detachments after multiple trauma in a car accident without preceding corticosteroid treatment. A 37-year-old patient was admitted to our hospital after he had suffered multiple body injuries in a car accident. After being woken from an induced coma, he complained of blurry vision in his left eye, so he underwent a complete ophthalmic examination – several serous retinal detachments were found at the posterior pole of both eyes, along with thickened choroids. As there was no intraocular inflammation, accelerated hypertension or other changes indicating other causes of serous retinal detachments, and since we observed a steady spontaneous subretinal fluid resorption, we classified our case as an atypical central serous chorioretinopathy. Alternatively, serous retinal detachments could have occurred due to transient alterations in choroidal circulation following cerebral injury. In conclusion, this case report adds new data on the occurrence of serous retinal detachments and discusses their possible aetiology in the trauma setting. Care must be taken not to miss any other underlying pathology needing treatment.

Functional and Anatomical Outcomes of Anti-Vascular Endothelial Growth Factor Treatment for Exudative Age-Related Macular Degeneration with or without Obstructive Sleep Apnea.

(1) To investigate the functional and anatomical outcomes of anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with exudative age-related macular degeneration (AMD) with or without obstructive sleep apnea (OSA); (2) In total, 65 patients with AMD with or without OSA who received three consecutive doses of intravitreal anti-VEGF injections were enrolled. The primary outcomes-best-corrected visual acuity (BCVA) and central macular thickness (CMT)-were assessed at 1 and 3 months. Moreover, morphological changes observed through optical coherence tomography were analyzed; (3) In total, 15 of the 65 patients had OSA and were included in the OSA group; the remaining 50 patients were included in the non-OSA (control) group. At 1 and 3 months after treatment, BCVA and CMT had improved but did not differ significantly between the groups. More patients in the OSA group demonstrated subretinal fluid (SRF) resorption at 3 months after treatment than in the non-OSA group (p = 0.009). Changes in other imaging biomarkers, such as intraretinal cysts, retinal pigment epithelium detachment, hyperreflective dots, and ellipsoid zone disruptions, did not differ significantly between the groups; (4) Our results suggest that the BCVA and CMT outcomes 3 months after anti-VEGF treatment are similar between patients with and without OSA. Moreover, patients with OSA may exhibit superior SRF resorption. A large-scale prospective study is mandatory to evaluate the association between SRF resorption and visual outcomes in AMD patients with OSA.

Non-damaging retinal laser therapy in chronic central serous chorioretinopathy.

To investigate the functional and anatomical outcomes of non-damaging retinal laser therapy (NRT), in cases with chronic central serous chorioretinopathy (CSCR). Twenty-three eyes of 23 treatment-naïve chronic CSCR patients were included in this study. The irradiation of 577nm yellow light was conducted on the serous detachment area after switching over to the NRT algorithm. Anatomical and functional changes after treatments were investigated. The mean age of the subjects was 48.68 ± 5.93years (41-61). The mean best-corrected visual acuity (BCVA) and the mean central macular thickness (CMT) values were 0.42 ± 0.12logMAR (0.20-0.70) and 315.69 ± 61.25µm (223-444) before NRT; and 0.28 ± 0.11logMAR (0.10-0.50) and 223.26 ± 60.91µm (134-336) at the 2nd month follow-up visit (p < 0.001, for both). At the 2nd-month follow-up visit after NRT, complete resorption of subretinal fluid was observed in 18 eyes (78.3%) and incomplete resorption in five eyes (21.7%). Worse values of BCVA and CMT before NRT were found as increased risk for incomplete resorption (p = 0.002 and ρ = 0.612 for BCVA, and p < 0.001 and ρ = 0.715 for CMT). Significant functional and anatomical improvements can be observed in the early period after NRT in patients with chronic CSCR. Patients having worse baseline BCVA and CMT have increased risk for incomplete resorption.

A variant of combined treatment for chronic central serous chorioretinopathy complicated by type 1 choroidal neovascularization

Purpose: to evaluate the effectiveness of combined treatment of chronic central serous chorioretinopathy (CSCRP) complicated by type 1 choroidal neovascularization (CNV) by subthreshold micropulse laser exposure (SMILE) and intravitreal injection of angiogenesis inhibitors ( IIAI). Material and methods. 37 patients (20 men and 17 women) with monolateral chronic recurrent CSCRP complicated by type 1 CNV, aged 35 to 57 (ave. 43.6 ± 6.7 yrs.) at the moment of first referral, were divided into two groups. The retrospective group included 15 patients (15 eyes) whose first phase of treatment consisted in IIAI (up to 5 injections with an interval of one month). Those who showed no treatment effect were given a SMILE procedure one day before the 6th injection. If neurosensory retinal detachment persisted, the combined treatment (SMILE + IIAI) was repeated monthly until the neurosensory retina could be fully attached, whereupon the patients were transferred to monotherapy with anti-VEGF injections, gradually increasing the interval between the injections. The main group included 22 patients (22 eyes), whose treatment began with a single IIAI. If no neurosensory retinal detachment resorption occurred, the patients received a SMILE procedure one day before the second IIAI injection. The combined treatment was repeated monthly until neurosensory retinal detachment completely resorbed, then the treatment continued with IIAI alone with a gradual increase of intervals between the injections. Results. The number of IIAI in the main group (5 to 8, ave. 6.1 ± 0.8) was significantly lower than in the retrospective group (8 to 10, ave. 8.8 ± 0.77). Best corrected visual acuity increased in both groups, but the main group showed a better central photosensitivity, which is associated with the faster reattachment of neurosensory retina. By the end of the follow-up period, the area of type 1 CNV, and the thickness of the choroid were significantly lower in the main group as compared to the retrospective group. The combined treatment did not cause a single case of complication. Conclusion. The proposed combination of laser exposure followed by IIAI is a safe method for treating complicated forms of CSCRP, which quickens the resorption of subretinal fluid and reduces the number of treatment procedures.

Селективная микроимпульсная индивидуальная ретинальная терапия при навигационном лечении центральной серозной хориоретинопатии с подбором параметров путем предварительного тестирования

Aim: to evaluate the outcomes of selective micropulse individual retinal therapy (SMIRT) in navigation-guided treatment for central serous chorioretinopathy (CSCR) by selecting parameters by preliminary testing. Patients and Methods: 61 patients (61 eyes) aged 36–58 with acute CSCR and transparent media were enrolled. The patients were divided into two groups. In the study group (31 eyes), CSCR treatment was performed using SMIRT technology and Laser system. Micropulse mode was applied. According to the computer simulation, this mode implies selective destruction of the retinal pigment epithelium with minimal damage to the neurosensory retina and choroid. Parameters were customized for each patient by preliminary testing and evaluation of the results by short-wavelength fundus autofluorescence (488 nm). Laser spots were applied close to each other to completely cover the leakage points revealed by fluorescein angiography. Control group patients (30 eyes) did not receive laser treatment. Follow-up examinations were performed 1, 3, 6, and 12 months after enrollment. Results: after one year, complete resorption of subretinal fluid was reported in all eyes in the study group and 10 eyes (33.3%) in the control group. In the study group, the best-corrected visual acuity (BCVA) increased from 0.85±0.02 to 0.98±0.02 (p&lt;10-8), while central photosensitivity increased from 24.34±0.33 to 29.15±0.17 dB (p&lt;6×10-6). In the control group, BCVA decreased from 0.84±0.02 to 0.77±0.03, while photosensitivity slightly increased from 25.09±0.32 to 25.32±0.72 dB. Conclusion: navigation-guided treatment for CSCR using the SMIRT technology with selecting parameters by preliminary testing has demonstrated high efficacy and safety. This tool can be used when leakage points are located in the fovea. KEYWORDS: selective micropulse individual retinal therapy (SMIRT), central serous chorioretinopathy, micropulse, navigation, customized approach. FOR CITATION: Volodin P.L., Ivanova E.V. Selective micropulse individual retinal therapy in the navigation-guided treatment for central serous chorioretinopathy with parameter selection by preliminary testing. Russian Journal of Clinical Ophthalmology. 2023;23(3):112–118 (in Russ.). DOI: 10.32364/2311-7729-2023-23-3-1.

Morphological integrity of the outer retinal layers and visual prognosis in chronic central serous chorioretinopathy after half-dose photodynamic therapy: a qualitative SD-OCT analysis.

The study aims to investigate the morphological integrity of the outer retinal layers (ORLs) (an ellipsoid layer (EL) + external limiting membrane) and visual prognosis in chronic central serous chorioretinopathy (CSCR) with subretinal fluid (SRF) completely resorbed after half-dose photodynamic therapy (HD PDT) using enhanced-depth imaging (EDI) spectral domain optical coherence tomography (SD-OCT). This retrospective study included 40 eyes of 38 chronic CSCR patients treated with HD PDT between December 2012 and June 2016. However, only 34 eyes (85%) with complete SRF resorption 3months after HD PDT had their 6th and 12th month data analyzed. Morphological integrity of the ORLs was further analyzed in relation to best-corrected visual acuity (BCVA) and disease duration. Thirty-four eyes of 34 patients (male/female: 82.35/17.65%) with mean age of 49.90 ± 7.80 (32-61) years were studied. The mean logMAR BCVA improved significantly from 0.52 ± 0.31 at baseline to 0.34 ± 0.36 and 0.26 ± 0.26 at the 6th and 12th months after HD PDT, respectively (p < 0.001). The proportion of eyes with completely normal morphological ultrastructural integrity of the ORLs was 44.12% at the 6th month, which increased to 64.71% at the 12th month after HD PDT. However, the EL morphological disruption was associated with significantly lower mean logMAR BCVA 12months after HD PDT (p = 0.029). The disease duration had no effect on mean logMAR BCVA gain. Even after complete resorption of serous neurosensory retinal detachment after HD PDT in chronic CSCR, the ORLs, especially the EL, may not be anatomically restored. The EL morphological ultrastructural integrity seems to be the most important factor influencing visual prognosis.

Лечение хориоидальной неоваскуляризации, ассоциированной с друзами диска зрительного нерва

Purpose. To describe a rare clinical case of bilateral choroidal neovascularization (CNV) associated with optic nerve head (ONH) drusen and to report a positive functional and clinical outcome of intravitreal injections of vascular endothelial growth factor inhibitors (anti-VEGF) in this patient. Material and methods. A 39-year-old man with ONH drusen complained of decreased visual acuity and distortion of objects. During the examination, the bilateral CNV was detected in peripapillary area. The patient received two consecutive intravitreal injections of anti-VEGF in the right eye and one injection in the left eye. Results. After the treatment, reabsorption of subretinal fluid and an increase of visual acuity were observed. There were no complications associated with injections. The best-corrected visual acuity remains stabilized at 20/20 at three years of followup. According to the optical coherence tomography parameters, there was no negative dynamics of CNV. Conclusion. ONH drusen may cause several complications, including the development of CNV and significant decrease in visual acuity, due to the CNV progression. Follow-up of patients with ONH drusen is necessary for early diagnosis and treatment of complications. The differential sign of CNV associated with ONH drusen is a localization in the peripapillary area nasal to the fovea. A search of the literature revealed only a few publications on the use of anti-VEGF in patients with CNV associated with ONH drusen. This method was effective and demonstrated positive functional and clinical outcome in the presented clinical case. Key word: subretinal neovascularization; choroidal neovascularization; optic nerve head drusen; optical coherence tomography; antivascular endothelial growth factor therapy

Prediction of the response to photodynamic therapy in patients with chronic central serous chorioretinopathy based on optical coherence tomography using deep learning

To assess the prediction of the response to photodynamic therapy (PDT) in chronic central serous chorioretinopathy (CSCR) based on spectral-domain optical coherence tomography (SD-OCT) images using deep learning (DL). Retrospective study including 216 eyes of 175 patients with CSCR and persistent subretinal fluid (SRF) who underwent half-fluence PDT. SD-OCT macular examination was performed before (baseline) and 3 months after treatment. Patients were classified into groups by experts based on the response to PDT: Group 1, complete SRF resorption (n=100); Group 2, partial SRF resorption (n=66); and Group 3, absence of any SRF resorption (n=50). This work proposes different computational approaches: 1st approach compares all groups; 2nd compares groups 1vs. 2 and 3 together; 3rd compares groups 2vs. 3. The mean age was 55.6±10.9 years and 70.3% were males. In the first approach, the algorithm showed a precision of up to 57% to detect the response to treatment in group 1 based on the initial scan, with a mean average accuracy of 0.529±0.035. In the second model, the mean accuracy was higher (0.670±0.046). In the third approach, the algorithm showed a precision of 0.74±0.12 to detect the response to treatment in group 2 (partial SRF resolution) and 0.69±0.15 in group 3 (absence of SRF resolution). Despite the high clinical variability in the response of chronic CSCR to PDT, this DL algorithm offers an objective and promising tool to predict the response to PDT treatment in clinical practice.

Development of the selective micropulse individual retinal therapy depends on age and type on the Fitzpatrick scale.

To develop a selective micropulse individual retinal therapy (SMIRT) based on the age and appearance type of the patient, to derive a formula for calculating power, and evaluate clinical efficacy for the treatment of central serous chorioretinopathy (CSCR). 73 patients (aged 30-65years) with acute CSCR and types 1-4 on the Fitzpatrick scale were divided into 2 groups. In the first group (33 patients), the testing of the micropulse mode (50µs, 2.4%, 10ms, 100µm, 0.4-1.9W) on the Navilas 577s laser system defined as selective by computer modeling was performed. A logistic regression function based on probability damage detection (PDD) of the 1584 laser spots from power, age, and type on the Fitzpatrick scale was constructed. PDD is the probability of detecting the laser spots using the autofluorescence method. The second group was divided into 4 subgroups of 10 eyes each. Groups 2.1, 2.2, and 2.3 were treated without preliminary testing. The power for Groups 2.1, 2.2, and 2.3 was obtained with the inverse PDD function, so that PDD was 50%, 70%, and 90%, respectively. Control group 2.4 went without treatment. The transmission and absorption coefficients of laser radiation of the eye depend on the age and the Fitzpatrick scale type. In Groups 2.1-2.3, complete resorption of subretinal fluid was observed 3months after CSCR treatment in 5 (P < 0.35), 8 (P < 0.023), and 10 eyes (P < 0.0008) out of 10, respectively. The developed SMIRT is effective for CSCR treatment with PDD 90%.

Utility of an additional photodynamic therapy session after multiple failed PDT treatments in chronic central serous chorioretinopathy

PurposeTo assess the efficacy of an additional photodynamic therapy (PDT) in chronic central serous chorioretinopathy (cCSCR) patients who have two or more previous failed PDTs. MethodsTen eyes of 10 patients with cCSCR who had received two or more PDTs without complete resolution of the subretinal fluid (SRF) or with early recurrence (before 3 months) were included. An additional half-fluence PDT was performed. Swept-source optical coherence tomography (OCT) and OCT angiography were performed before, 3 days, 1 month, 3 months, 6 months and 12 months after treatment. Age, gender, best-corrected visual acuity (BCVA), subfoveal choroidal thickness, SRF and vessel occlusion in the choriocapillaris (CC) were collected. ResultsThe median number of previous PDTs was 3 (range 2 to 4). BCVA before and 12 months after treatment was 72 letters (50 to 95) and 78 letters (55 to 100) (p=0.094). Median initial SRF was 94 µm (50 to 306), being 0 µm (range 0 to 81) at the end of the follow-up (p=0.007). After the additional PDT, 8 out of 10 patients had a complete SRF resorption. All the patients except one who had a complete response (7/8) had an occlusion in the CC 3 days after PDT. ConclusionDespite previous failed PDTs in cCSCR, good anatomical results can be achieved, this being more likely if an early vessel occlusion in the CC is observed. Even when the BCVA did not improve, the high rate of fluid resolution could justify the additional PDT treatment in order to maintain visual function.

Тактика лечения осложненных форм центральной серозной хориоретинопатии по данным предоперационных ОКТ-предикторов

The purpose is to determine preoperative OCT predictors and, based on the data obtained, to develop a treatment strategy for patients with a chronic form of central serous chorioretinopathy (CSCRP) complicated by choroidal neovascularization (CNV) type 1. Material and methods. A retrospective analysis of 53 patients with a chronic form of CSCRP complicated by CNV type 1 was carried out, 30 men (56.6 %) and 23 women (43.4 %). The first (control) group included 27 patients for whom inhibitors angiogenesis intravitreal injection (IAIVI) monotherapy was effective, and a positive clinical response after the first IAIVI was observed. The second (main) group included 26 patients in whom IAIVI as monotherapy did not lead to the sensorineural retina reattachment, and combined treatment was performed: one day before IAIVI, selective micro-pulse laser exposure (SMPLE) was performed. All patients underwent optical coherence tomography (OCT) and OCT in angio mode (OCTA) on the device “RTVue XR Avanti Angiovue” (Optovue, USA). Results. In patients with a chronic form of CSCRP complicated by CNV type 1, the main OCT predictors indicating the predominance of the role of one of the two co-existing pathologies are the initial thickness of the choroid and the area of CNV type 1. The initial pachychoroidal vascular change, which has a value of more than 490 microns, and the area of CNV not exceeding 0.300 mm2, indicate the predominance of CSCRP as the main mechanism of transudative detachment of the sensorineural retina and require combined treatment (SMPLE + IAIVI). Conclusion. The identified predictors contribute to the timely selection of a pathogenetically sound treatment method, which accelerates the resorption of subretinal fluid and promotes faster sensorineural retina reattachment, thereby improving the functional results of the treatment. Keywords: central serous chorioretinopathy, choroidal neovascularization, optical coherence tomography, selective micro-pulse laser exposure, angiogenesis inhibitors intravitreal injection.

Early changes in choriocapillaris flow voids as an efficacy biomarker of photodynamic therapy in central serous chorioretinopathy

PurposeTo assess the early changes produced in the choriocapillaris (CC) and choroidal vasculature using swept-source optical coherence tomography angiography (SS-OCTA) in patients with persistent central serous chorioretinopathy (CSCR) as predictors of the efficacy after photodynamic therapy (PDT). MethodsProspective observational study in 52 eyes of 52 patients with persistent subretinal fluid (SRF). SS-OCTA scans of the 6 × 6 mm macular region were assessed before; 2–3 days, one month and three months after half-fluence PDT. Vessel occlusion in the CC and choroid was measured as flow signal voids (FSV). ResultsA 3.67 ± 4.12 and 2.76 ± 3.63 fold increase in CC and CH FSV, due to vessel occlusion, was observed at 2–3 days after PDT versus baseline. There was less SRF at 3 months in patients with an increase in FSV (≥1-fold) compared to those without this increase (<1-fold) after PDT (p ≤ 0.003). An association between the increase in CC and choroidal FSV at the early control (2–3 days) and the height of SRF at 1 month was found (R=-0.405; p = 0.002 and R=-0.356; p = 0.008 respectively). In a multivariate model, the SRF at one month was not associated with age, gender, visual acuity, or FSV (p ≥ 0.288). At 3 months, flow restoration was achieved in the choroid versus the baseline (p = 0.619), but there was a persistent increase in the CC FSV (p = 0.008). ConclusionsEarly vessel occlusion by OCTA after PDT in CSCR was associated with good treatment response. Therefore, an increase in FSV immediately after PDT could be a biomarker to predict SRF resorption.

Acute Serous Retinal Detachment after the Same Operating Session of Uncomplicated Cataract Surgeries: A Case Series.

To report four cases of acute serous retinal detachment (ASRD) after the same operating session of uncomplicated cataract surgeries. In this case series, data of patients who developed ASRD after uncomplicated phacoemulsification with intraocular lens implantation during the same operating session were collected. Diagnosis was made on the first postoperative day, when all patients had a very low best-corrected visual acuity (BCVA), despite a good aspect of the anterior segment, without significant keratopathy and with only trace cells in the anterior chamber. Spectral-domain optic coherence tomography (SD-OCT) revealed serous retinal detachment with subretinal fluid accumulation in the macular area. Patients received a parabulbar injection of 40 mg/mL triamquinolone in addition to usual the postoperative topical treatment of 0.1% dexamethasone and 0.3% netilmicin eye drops. Patients were examined postoperatively on days 1, 3, 7, and 1 month. BCVA and central foveal thickness (CFT) measured by SD-OCT were evaluated at each visit. A relationship between demographics, preoperative ocular conditions, systemic diseases, parameters of surgery, and the development of ASRD was analyzed. After a single operating session of 10 uneventful cataract surgeries, operated by the same expert surgeon, on postoperative day 1, ASRD was detected in 4 patients (3 male, 1 female; mean age 71 ± 4.1 years). Preoperatively, the mean BCVA was 0.6 ± 0.1 decimals and mean CFT was 191.3 ± 13.7 µm. On the first postoperative day, mean BCVA was 0.01 ± 0.1 decimals, and all eyes had serous retinal detachment, with a mean CFT of 682.0 ± 97.4 µm. On the following visits, BCVA improved and CFT reduced significantly. On day 7, BCVA was at least 0.7 decimals in all eyes, with complete reabsorption of subretinal fluid. At 1 month, mean BCVA was 1.0 ± 0.0 decimals and no eye had recurrence of serous retinal detachment, with a mean CFT of 202.3 ± 26.7 µm. No relevant data were found on other parameters investigated. Acute serous retinal detachment is a rare event that can occur after uncomplicated phacoemulsification, which in our cases, resolved in a few days without recurrence.