Unilateral Central Serous Chorioretinopathy Research Articles

The effect of heart rate variability on the choroidal vascularity of the optical coherence tomography and angiography in central serous chorioretinopathy.

To investigate the correlation between the autonomic nervous system and choroidal vascularity in patients with central serous chorioretinopathy (CSC), using heart rate variability (HRV) analysis, optical coherence tomography (OCT) and OCT angiography (OCTA). We retrospectively analyzed data of 25 patients with unilateral CSC (50 eyes, including the unaffected fellow eyes) and 25 healthy controls. The assessment involved a 5-minute HRV analysis encompassing both frequency and time domains, especially low frequency (LF), high frequency (HF), and LF/HF ratio. In OCT (12 × 9mm) and en-face OCTA (3 × 3mm) scans, we measured parameters including choroidal vascularity index (CVI), choroidal vessel density in the middle and deep layers, and choriocapillaris flow void. Regression analysis was conducted to elucidate the associations between HRV parameters and OCT/OCTA measurements. Normalized LF(LFnorm) and LF/HF ratios were higher in patients with CSC than in healthy controls. LFnorm and the log-transformed ratio of LF to HF [log(LF/HF)] demonstrated a significant and borderline correlation with CVI in the linear regression analysis (P = 0.040, R2 = 0.171, and P = 0.059, R2 = 0.147, respectively). Both CVI and deep choroid vessel density showed a more significant association with LFnorm and log (LF/HF) in the non-linear quadratic regression analysis than in the linear analysis (all, P < 0.04, R2 > 0.25). The frequency-domain parameters of HRV, including LFnorm and log (LF/HF), demonstrated a significant association with indicators reflective of large choroidal vessel luminal area on macular OCT/OCTA scans. This observation implies complicated modulation of choroidal blood flow by the autonomic nervous system in CSC.

Quantitative optical coherence tomography angiography assessments in the fellow eyes of those with central serous chorioretinopathy

BackgroundTo analyze the vessel density (VD) of the retina and choriocapillaris (CC) layer and the structure of the foveal avascular zone (FAZ) in the fellow eyes of central serous chorioretinopathy (CSC) patients by using optical coherence tomography angiography (OCTA).MethodsThis was a case–control study. Unilateral CSC patients and age-matched healthy subjects were recruited from the Affiliated Eye Hospital of Wenzhou Medical University between July 2016 and July 2021. All eyes were divided into three groups: acute CSC (aCSC), chronic CSC (cCSC), and healthy controls. Both aCSC and cCSC were again divided into two subgroups: the affected eyes and the fellow eyes. In this study, all parameters of VD and FAZ were measured by self-software of OCTA.ResultsA total of 231 eyes of 137 subjects were included, with 47 aCSC patients, 47 cCSC patients, and 43 healthy controls. In the fellow eyes of CSC, the retinal VD was significantly lower (all P < 0.05), and the FAZ was significantly larger (all P < 0.05) in the cCSC group than in healthy controls, while no difference was detected in the CC layer. There was no significant difference between the aCSC group and healthy controls in all OCTA parameters. In the affected eyes of CSC, the superficial retinal vessel density (SRVD) was significantly higher (all P < 0.05) in healthy controls than in the aCSC and cCSC groups, while the deep retinal vessel density (DRVD) was significantly lower (all P < 0.05) and the FAZ was larger (all P < 0.05) in the cCSC group than in the aCSC group and healthy controls. A liner regression equation was established: Y (BCVA, best corrected visual acuity) = 3.692–0.036✱X1 (DRVD-Fovea)-0.031✱X2 (FD-300, vessel density around the 300 μm width of the FAZ), R2 = 0.427.ConclusionBased on OCTA measurements, this study revealed that the retinal microvascular network was impaired even in the fellow eyes of those with cCSC, which should arouse attention to the observation of unilateral CSC.

Ayurveda holistic management of acute unilateral central serous chorioretinopathy with pigmentary epithelial detachment: A case report

Abstract Central serous chorioretinopathy (CSCR) is characterized by localized serous detachment of neurosensory retina secondary to leakage of fluid from choriocapillaris, accumulating under the macula, with or without pigmented epithelial detachment. A 30-year-old male presented with complaints of sudden painless diminished vision and floaters in the right eye for 5 days. The patient had no previous history of any ocular disease and no significant systemic illness. The visual acuity as per LogMAR was 0.5 in the right eye and 0 in the left eye. The fundus examination showed round elevated detachment around the macula, which was confirmed by optical coherence tomography, showing neurosensory detachment due to serous fluid accumulation under the macula along with small pigmentary epithelial detachment. Management was done on an outpatient basis over 2.5 months, which included both internal and topical interventions along with Yoga therapy. The disease was resolved in 2.5 months with complete resolution of serous fluid. The visual acuity was brought back to normal, that is, LogMAR 0. CSCR cases can be successfully treated with an Ayurvedic holistic approach, and they respond better when treated at an early stage. These practices can be considered as an alternative.

Role of Psychological Stress and Choroidal Thickness in Central Serous Chorioretinopathy.

Central serous chorioretinopathy (CSCR) is a disease with a multifactorial aetiology. To evaluate the role of psychological stress and choroidal thickness in patients with CSCR. This was a hospital-based, analytical cross-sectional study, conducted at Christian Medical College, Vellore, India, from 2018 February to 2019 September, after the approval of the Institutional Review Board and Ethics Committee. Patients who satisfied the eligibility criteria of the study, were selected from the outpatient clinics of the Department of Ophthalmology. Twenty-five patients with unilateral CSCR (Group 1 - cases), and 50 age and gender-matched patients without CSCR (Group 2 - controls), randomly selected in a 1:2 ratio, were enrolled after obtaining informed consent. Psychological stress was assessed using Cohen Perceived Stress Scale (PSS-10). All patients had a Swept Source optical coherence tomography scan of the macula. Subfoveal choroidal thickness (SFCT) of both eyes of all participants was measured using a standard protocol. The data were collated and analysed, using Independent samples t-test and Chi-square/ Fisher's exact test, as appropriate, with IBM SPSS Statistics for Windows, version 21 (IBM Corp., Armonk, N.Y., USA). There was a significant difference between the two groups in mean stress scores (p <0.01), as well as stress categories (p <0.01). Although there was no significant difference in the prevalence of hypertension between the two groups (p = 0.33), there was a significant difference both in the mean systolic (p <0.01) and diastolic (p <0.01) blood pressure between the two groups. We found a significant difference between mean SFCT of CSCR eyes (421+/- 78.34 μm) and control eyes (314.24 +/- 52.48 μm, p <0.01), as well as between fellow eyes (396.20 +/- 68.79 μm) and control eyes (314.24 +/- 52.48 μm, p <0.01). However, there was no significant difference in the mean SFCT of CSCR eyes and fellow eyes (p =0.24). The findings reiterate the concept that the underlying pathophysiological changes leading to CSCR involve both the eyes of the patient. Psychological stress and hypertension may be factors that play an important role in the etiopathogenesis of the pachychoroid-related changes leading to CSCR. Stress relief measures, with a holistic approach to management, should be an integral part of the therapeutic strategies for CSCR.

Scleral thickness in the fellow eyes of patients with unilateral central serous chorioretinopathy.

The sclera is reportedly thicker in eyes with central serous chorioretinopathy (CSC) than in healthy control eyes. We compared the scleral thicknesses of the affected and unaffected fellow eyes of patients with unilateral CSC. We retrospectively examined the findings of 115 patients with unilateral CSC. Comparisons of the spherical equivalent (SE), axial length, anterior chamber depth (ACD), subfoveal choroidal thickness (SCT), scleral thickness, and presence of peripheral ciliochoroidal effusion (CE) of the affected and fellow eyes were made. Using anterior segment optical coherence tomography, scleral thickness was measured vertically, 6 mm posterior to the scleral spur in the superior, temporal, inferior, and nasal directions. No significant differences in scleral thickness in all four directions, SE, axial length, ACD, and frequency of CE were found between the affected and unaffected fellow eyes. The only significant difference between the affected and fellow eyes was observed in the SCT (398.8 µm vs. 346.6 µm, P < 0.001). A thickened choroid seems to have a direct effect on CSC development. In contrast, the affected and fellow eyes showed no significant difference in scleral thickness, indicating that scleral thickening may be a predisposing factor for the development of CSC.

En-face optical coherence tomography hyperreflective foci of choriocapillaris in central serous chorioretinopathy

The purpose of this study is to evaluate choroidal hyperreflective foci (HRF) changes in central serous chorioretinopathy (CSC) on en-face optical coherence tomography (OCT). Retrospective analysis of 42 patients with unilateral CSC (84 eyes, including fellow eyes for controls) and 42 age- and sex-matched controls. With 4.5 × 4.5 mm macular scans, structural en-face OCT choriocapillaris (CC) slabs were used to calculate the density and number of HRF in acute CSC eyes with serous retinal detachment (SRD), resolved CSC eyes without SRD, unaffected fellow eyes, control eyes, and 1-year follow-up eyes. Based on the 2-disc diameter (3000 μm), the en-face OCT scan was divided into foveal and perifoveal lesion and analyzed to consider the impact of SRF in HRF measurement. Regression analyses were performed on the several factors with HRF number and density in the acute and resolved CSC eyes. The perifoveal density and number of CC HRF was significantly lower in the resolved CSC eyes when compared to the acute CSC eyes (P = 0.002, both), fellow eyes (P = 0.042/density, 0.028/number), and controls (P = 0.021/density, P = 0.003/number). There was no significant difference between the acute CSC eyes, fellow eyes, controls, and 1-year follow-up eyes. As subfoveal choroidal thickness decreased and choroidal vascularity (CVI) increased, the perifoveal density and number of HRF was measured higher with a significant correlation in univariate regression analysis of the acute and resolved CSC eyes (all, P < 0.05). The authors hypothesized that stromal edema induced by choroidal congestion and hyperpermeability has the greatest influence on HRF measurement, possibly affected by inflammatory cells and materials extravasation.

En Face Choroidal Vascularity in Both Eyes of Patients with Unilateral Central Serous Chorioretinopathy.

The aim of this study was to evaluate the choroidal vascularity analyzing en face optical coherence tomography (OCT) images in patients with unilateral central serous chorioretinopathy (CSC). We retrospectively evaluated 40 eyes of 20 CSC patients and 20 eyes of 10 gender- and age-matched healthy individuals. The sample consisted of: (1) CSC affected eyes; (2) unaffected fellow eyes; (3) healthy eyes. Multiple cross-sectional enhanced depth imaging OCT scans were obtained to create a volume scan. En face scans of the whole choroid were obtained at 5μm intervals and were binarized to calculate the choroidal vascularity index (CVI). The latter, defined as the proportion of the luminal area to the total choroidal area, was calculated at the level of choriocapillaris, superficial, medium and deep layers. No significant differences between choriocapillaris, superficial, medium and deep CVI were found in both eyes of CSC patients, whereas a significant different trend of changes was found in healthy eyes. Nevertheless, the en face CVI shows no difference between affected fellow and healthy eyes. In conclusion, CSC-affected eyes and fellow eyes showed a similar vascular architecture, with no statistical difference between all choroidal layers.

Repeatability of choriocapillaris flow voids by optical coherence tomography angiography in central serous chorioretinopathy.

To assess the repeatability of flow signal voids (FSV) measurements of the choriocapillaris (CC) and choroid (CH) in central serous chorioretinopathy (CSCR) by Swept-Source optical coherence tomography angiography (SS-OCTA). Cross-sectional study including 104 eyes of 52 patients with unilateral CSCR. Two consecutive macular 6x6 mm SS-OCTA scans (Plex Elite 9000; Zeiss, Dublin, CA) were obtained from the affected eyes with persistent subretinal fluid (SRF) (CSCR group) and the fellow unaffected eyes (control group). FSV area and the number of contours measurements were analyzed using three slabs: inner CC, outer CC and CH. The repeatability of the measurements was assessed with intraclass correlation coefficients (ICC) and coefficients of variation (CV). In the CSCR group, ICCs for the FSV area in the three slabs were all ≥0.859, observing higher values for the outer CC and the CH (0.959 and 0.964) than for the inner CC (0.859). Similar ICC values were obtained for the FSV area in control eyes, observing the highest values for the outer CC (0.949), followed by the CH (0.932) and inner CC (0.844). Regarding the FSV number of contours measurements, ICCs were higher for the outer CC and CH (0.949 and 0.932) than for inner CC (0.844). CV for the FSV area was 4.7%, 3.8% and 8.6% in the CSCR eyes and 4.8%, 3.9% and 9.3% in the control group for the inner CC, outer CC and CH respectively. SS-OCTA offers good repeatability to quantify macular FSV in CSCR eyes and fellow eyes.

Natural Course of Pachychoroid Pigment Epitheliopathy.

To investigate the natural course of pachychoroid pigment epitheliopathy (PPE). A retrospective cohort study. From the Kyoto central serous chorioretinopathy (CSC) cohort consisting of 548 patients with CSC as of September 2020, we included consecutive unilateral patients with acute or chronic CSC between January 2013 and December2016. All patients underwent complete ophthalmic examination, including multimodal imaging such as fundus autofluorescence, spectral-domain optical coherence tomography, and fluorescein angiography/indocyanine green angiography and/or optimal coherence tomography angiography. The fellow eyes of eyes diagnosed with CSC were screened for PPE, and their natural course was evaluated. We also evaluated the association of ARMS2 rs10490924, CFH rs800292, TNFRSF10A rs13278062, and GATA5 rs6061548 genotypes with the natural course. Incidence of CSC, pachychoroid neovasculopathy, and pachychoroid geographic atrophy (GA). In total, 165 patients with unilateral CSC (mean age, 55.7±12.6 years; female, 22.4%) were included from the Kyoto CSC cohort. Among them, 148 (89.7%) were diagnosed as having PPE in their non-CSC eye. Survival analysis revealed that 16.8% of PPE eyes developed CSC during the 6-year follow up, whereas non-PPE eyes did not. Although genetic factors did not have significant association with CSC development (P>0.05, log-rank test), choroidal vascular hyperpermeability (CVH) and subfoveal choroidal thickness (SFCT) were significantly associated with CSC incidence (P=0.001, log-rank test). Survival analysis showed that eyes without CVH and eyes with SFCT < 300 μm did not develop CSC during the 6-year follow-up. Pachychoroid neovasculopathy developed in only 1 eye with PPE during a follow-up of 46.4 months. Pachychoroid GA did not develop in any of the studied eyes. This study revealed a natural history of PPE in a relatively large Japanese cohort. Choroidal vascular hyperpermeability and SFCT were significant risk factors for the development of CSC in PPE eyes. Although the current results cannot be generalized for all eyes with PPE, these findings present an important clinical implication.

The quantitative evaluation of retinal layers after resolution of subretinal fluid in acute central serous chorioretinopathy.

To evaluate the average retinal layer thicknesses in eyes with unilateral acute central serous chorioretinopathy (CSC) (with subretinal fluid (SRF)) and after complete resolution of SRF in these eyes and to compare the results with those obtained in healthy eyes. Fifty-four eyes of 27 patients with unilateral acute CSC (CSC in active phase) who had complete resolution of SRF and 25 eyes of 25 healthy control subjects enrolled in this retrospective study. The average thicknesses of the retinal layers were measured by segmentation analysis of optical coherence tomography at baseline and 6 months after complete resolution of SRF. The mean outer nuclear layer (ONL) thickness was significantly lower in eyes with CSC than in fellow eyes (p < 0.001). The mean ONL thickness was increased after resolution of SRF, but still low compared to unaffected fellow eye and the increment was not statistically significant (p > 0.05). There were significant strong inverse correlations between visual acuity and ONL thicknesses at baseline and 6 months after complete resolution of SRF (p < 0.001, r = - 0.810; p < 0.001, r = - 0.705, respectively). ONL thickness was thinned in cases with acute CSC, and although there was some increment in ONL thickness 6 months after complete resolution of SRF, it was still thinner compared to unaffected fellow eyes.

Wide-field OCT-angiography assessment of choroidal thickness and choriocapillaris in eyes with central serous chorioretinopathy.

Purpose: To assess wide-field changes in choroidal thickness and choriocapillaris in eyes with central serous chorioretinopathy (CSC) compared with the fellow eyes and eyes from healthy individuals using wide-field swept-source (SS) OCT-Angiography (OCTA). Methods: A cross-sectional study in which 68 eyes from 34 individual patients affected by unilateral CSC and 32 eyes of 32 age- and sex-matched healthy subjects were evaluated. All subjects underwent wide-field SS-OCTA examination to quantify choroidal thickness and vascular density of the choriocapillaris. To assess the wide-field changes, we developed five 4-by-4mm square regions located in the posterior pole and in the four quadrants of the peripheral retina (superotemporal, inferotemporal, superonasal, and inferonasal subfields, respectively). Results: The choroidal thickness of eyes with CSC was greater than that of the fellow eyes in the central and inferonasal subfields (p < 0.001 for the central subfield and p = 0.006 for the inferonasal subfield, respectively). Compared with the choroidal thickness of healthy eyes, that of patients with CSC were significantly greater in all the subfields (p < 0.05 for the fellow eyes and p < 0.05 for eyes with CSC, respectively). Compared with that of healthy eyes, the vascular density of choriocapillaris in eyes of patients with CSC were significantly greater in the central and superotemporal subfields (p < 0.05 for the fellow eyes and p < 0.05 for eyes with CSC, respectively). In the central region, the vascular density of choriocapillaris of the fellow eyes was greater than eyes with CSC (p = 0.023). Conclusion: CSC appears to be a bilateral disease with asymmetric manifestations. Local factors of the diseased eyes may play an important role in the development of CSC, during which dynamic and regional changes in the choriocapillaris may have happened. Wide-field swept-source OCTA provided a useful tool to study the pathogenesis of CSC.

Three-dimensional choroidal vascularity index in central serous chorioretinopathy using ultra-widefield swept-source optical coherence tomography angiography.

BackgroundTo map and compare the three-dimensional choroidal vascularity index (3D-CVI) in eyes with unilateral central serous chorioretinopathy (CSC), fellow eyes and control eyes using ultra-widefield swept source optical coherence tomography (UWF SS-OCTA).MethodsIn this prospective observational study, the 3D-CVIs were measured in 9 subfields or 1 × 1 mm grids by the UWF SS-OCTA with a viewing angle of horizontal 24 × vertical 20 mm. The proportions of vortex vein anastomoses and their corresponding CVI in the central regions were compared among the CSC, fellow and control eyes. Correlations of CVI and vascular density of the large choroidal vessel layer/choriocapillaris layer/choroidal thickness (CT) were also assessed.ResultsThirty-two eyes in 32 patients with unilateral CSC and 32 normal eyes were included in the study. The mean CVI in the eyes with CSC was significantly greater than that in the fellow eyes of CSC and control eyes (41.99 ± 3.56% vs. 40.38 ± 3.855%, P = 0.003; 41.99 ± 3.56% vs. 38.93 ± 4.067%, P = 0.004, respectively). The CVIs in superotemporal, inferotemporal and inferonasal regions were significantly higher in CSC eyes than control eyes (P = 0.03, P = 0.02, P = 0.008). In CSC eyes, there was a linear positive correlation between 3D-CVI and vascular density of the large choroidal vessel layer and CT in all subfields. The proportion of vortex vein anastomoses in CSC was 25/32 (78.1%), and significantly higher in fellow and control eyes (P < 0.001). The average central CVI was significantly higher in CSC eyes with anastomoses than in CSC eyes without anastomoses (42.8 ± 5.1% vs. 38.4 ± 2.7%, P = 0.039). CVIs in superior, central, inferior, superonasal, nasal and inferonasal regions were significantly correlated with vortex vein anastomoses (P < 0.05), regardless of CSC, fellow or healthy eyes. In addition, whether there were vortex vein anastomoses, CVI in superotemporal region was significantly higher in eyes with CSC (P = 0.002) and fellow eyes (P = 0.014), compared to control eyes. No significant correlation was found between hypertension and CVIs in the three groups.ConclusionRemodeling of choroidal drainage routes by venous anastomosis between superior and inferior vortex veins may be common in CSC. The 3D-CVI could be a comprehensive parameter to evaluate the choroid vasculature and help understand the pathogenesis of pachychoroid spectrum disease.

Микроимпульсное лазерное воздействие в лечении центральной серозной хориоретинопатии с субфовеолярной локализацией точки фильтрации

Purpose. To evaluate the efficacy of micropulse laser exposure (MPLE) in treating central serous chorioretinopathy with subfoveolar localization of filtration point. Material and methods. The study included 39 individuals (39 eyes) with unilateral central serous chorioretinopathy. Male – 28, female – 11. Mean age was 33.8 years old. The follow-up was 4–24 weeks. All patients were divided into two groups. Main group included 12 patients (12 eyes) who underwent micropulse laser exposure with 810 nm wavelength. Control group included 27 patients (27 eyes) with the natural course of the disease. Results and discussion. Clinical and functional results of treating patients in the control group showed positive dynamics of decreasing the mean value of the neuro epithelium detachment height before treatment from 438 mkm up to 356.5 mkm and 128 mkm in 4 and 16 weeks respectively which in turns explained the increase in visual acuity (BCVA) from 0.5 ± 0.093 to 0.7 ± 0.041 in 4 weeks and in 24 weeks follow-up – 0.9–1.0. Conclusion. Micropulse laser exposure (MPLE) with subfoveolar localization of filtration point is a method of choice that is highly effective and safe in treating of central serous chorioretinopathy. The absence of self-recovering demands laser treatment. Keywords: subfoveolar localization of filtration point, laser treatment, neuroepithelium.

INNER AND OUTER CHOROIDAL CHANGES IN THE FELLOW EYE OF PATIENTS WITH UNILATERAL CENTRAL SEROUS CHORIORETINOPATHY.

To quantitatively evaluate the inner and outer choroidal changes in the fellow eyes of patients with unilateral central serous chorioretinopathy (CSC). We analyzed data from patients with a diagnosis of unilateral CSC who had structural optical coherence tomography (OCT) and swept-source OCT angiography obtained. An additional group of age-matched healthy patients was included for comparison. The main outcome measures were: (1) choriocapillaris flow deficits' quantitative metrics; (2) choroidal luminal (LCA) and stromal (SCA) areas; and (3) choroidal vascularity index. Fellow unaffected eyes from 60 patients with unilateral CSC and 30 healthy subjects were included in the analysis. Mean ± SD age was 47.5 ± 9.9 years in the unilateral CSC group and 50.7 ± 10.8 years in the control group (P = 0.410). In the structural OCT assessment, both the LCA and SCA were increased in the unilateral CSC group (0.33 ± 0.11 and 0.29 ± 0.10 mm2) compared with healthy controls (0.28 ± 0.08 and 0.27 ± 0.05 mm2), although only differences in LCA reached a statistical significance (P = 0.041 and P = 0.286 for LCA and SCA, respectively). The choroidal vascularity index was higher in CSC patients (53.7 ± 3.6 and 50.9 ± 5.5%, P = 0.045). In the OCT angiography evaluation, the choriocapillaris flow deficits' percentage and number were increased in those patients affected by unilateral CSC. In multiple regressions, the strongest association with choriocapillaris percentage of flow deficits was with the presence of pachychoroid pigment epitheliopathy signs in the study eye (P < 0.0001). Our results corroborate the hypothesis that inner and outer choroidal changes affect both eyes of patients with unilateral disease.

Accommodation Is Decreased in Eyes with Acute Central Serous Chorioretinopathy.

This is a case-control study showing changes in accommodation in eyes with acute central serous chorioretinopathy. We found that decreased accommodative amplitude in the affected eyes may indicate suppression of parasympathetic activity in those eyes as one of the pathophysiological mechanisms controlling choroidal thickness and perfusion. This study aimed to evaluate the changes of accommodation in patients with acute central serous chorioretinopathy. Patients with unilateral central serous chorioretinopathy, with and without foveal involvement, as well as patients after resolution of subretinal fluid and healthy age-matched controls were included. Accommodative amplitude was measured and compared between eyes with active or resolved central serous chorioretinopathy, fellow eyes of active central serous chorioretinopathy individuals, and eyes of controls. Correlation between accommodative amplitude and ocular and demographic parameters was calculated. Nineteen acute central serous chorioretinopathy patients (16 males and 3 females, 38.1 ± 5.1 years) and 17 age-matched controls (13 males and 4 females, 37.2 ± 5.4 years) were included. Accommodative amplitude in the study eyes of central serous chorioretinopathy patients was lower than that in the fellow unaffected eyes (1.25 ± 1.0 and 2.54 ± 0.94 D, respectively; P = .002) or in the eyes of healthy controls (2.41 ± 1.38 D, P = .002). In central serous chorioretinopathy eyes, after resolution of subretinal fluid or without foveal involvement, the median accommodative amplitude was lower than that in fellow eyes (1.6 [95% confidence interval, 0.83 to 1.75] and 2.7 D [95% confidence interval, 1.23 to 3.61], respectively; P = .004). No correlation was found between accommodative amplitude in affected central serous chorioretinopathy eyes and different parameters, except for age ( r = -0.47, P = .04). Acute central serous chorioretinopathy is associated with a substantial reduction of accommodative amplitude.

Acute Unilateral Central Serous Chorioretinopathy after Immunization with Pfizer-BioNTech COVID-19 Vaccine: A Case Report and Literature Review

ABSTRACTIntroductionA 43-year-old Caucasian male presented to our ophthalmology clinic with blurry vision and metamorphopsia in his right eye, 24 hours after receiving the first dose of the Pfizer–BioNTech COVID-19 vaccine.MethodsClinical examination and imaging tests were consistent with acute unilateral central serous chorioretinopathy (CSCR) that completely resolved after 2 months without any treatment. He had no significant ophthalmic or medical history. He also lacked the classical risk factors for CSCR such as recent psychosocial stressors, Type-A personality traits, history of exogenous steroid use, connective tissue disorders and obstructive sleep apnea.ResultsThis appears to be only the second reported case of CSCR, temporally associated with a recombinant COVID-19 mRNA vaccine. We also present a summary of published reports demonstrating intraocular complications associated with the novel recombinant COVID-19 mRNA vaccines.ConclusionFindings in this report should not deter COVID-19 vaccinations given the rarity of aforementioned ocular complications and the greater benefit of protection from COVID-19 infection. Medical practitioners, however, should remain mindful of potential ocular complications, given the greater likelihood of occurrence with increasing vaccination booster rates.

Possible role of Spironolactone in a sample of Iraqi patients with acute central serous chorioretinopathy

Background: Central serous chorioretinopathy (CSCR) is an idiopathic condition aggravated by exogenous or endogenous glucocorticoids. Vascular deregulation in the choroid is a new hypothesis regarding central serous chorioretinopathy occurrence. The inhibition of choroidal mineralocorticoid receptors has a great role in shortening the duration of CSCR by inhibiting choroidal vasodilatation and leak. Objective: To assess the effect of oral spironolactone on subretinal fluid, central macular thickness and visual acuity in patients with acute CSCR compared to observation. Subjects and Methods: a hospital based, randomized clinical trial carried out at outpatient clinic in Ibn-Alhaitham Teaching Eye Hospital/ Baghdad, enrolling 60 patients with acute unilateral CSCR, allocated randomly (every other patient) to either receiving spironolactone 25 mg orally, twice daily for 2 months (30 patients) or observation only (30 patients). The follow-up included visual acuity measurement, central macular thickness and subretinal fluid height examinations by ocular coherence tomography (OCT) at one- and two-months post enrollment for all patients. Results: Complete absorption of subretinal fluid was observed in 21(70%) of the eyes in the treatment group and in 6(20%) in the control group at two-months. Visual acuity and mean macular thickness improved significantly in both groups at the one- and two- months, mean changes was larger in treatment group compared to control group at the two-month-follow up endpoint. Conclusion: Oral spironolactone imparted greater improvement in central macular thickness and faster resolution of sub retinal fluid in patients with acute central serous chorioretinopathy versus observation.

Widefield Choroidal Thickness of Eyes with Central Serous Chorioretinopathy Examined by Swept-Source OCT

To examine widefield (WF) changes in the choroidal thickness of eyes with central serous chorioretinopathy (CSC). An observational study. Twenty-two patients (20 men and 2 women) with treatment-naïve unilateral CSC and 28 normal eyes of 28 age-matched, healthy participants (21 men and 7 women). We performed enhanced depth imaging of swept-source (SS) OCT with a viewing angle of vertical 20 mm× horizontal 23 mm. Moreover, we developed a grid consisting of 9 subfields, with diameters of 3, 9, and 18 mm; the inner and outer rings were enclosed by circles with diameters of 3 and 9 mm and 9 and 18 mm, respectively, which were divided into 4 subfields-superotemporal, inferotemporal, superonasal, and inferonasal. Widefield changes in choroidal thickness. The mean duration from the presumed onset of CSC was 6.8 ± 3.1 months during the examination. Compared with that in normal eyes, the choroidal thickness in eyes of patients with CSC was significantly greater in all subfields (P < 0.020 for fellow eyes; P < 0.001 for eyes with CSC). Compared with that in fellow eyes, the choroidal thicknesses in eyes of patients with CSC were significantly greater, except for the outer superotemporal and inferonasal subfields (P < 0.001 for all inner subfields; P < 0.001 for the outer superonasal and inferotemporal subfields). In areas with dilated vortex veins, choroidal thickening was observed from the vicinity of the vortex vein ampulla to the macula along the course of the veins. Choroidal thickening on the dominant side was significantly greater than that on the nondominant side (P= 0.015 for the nasal subfield of the inner ring; P= 0.003 and P<0.001 for the temporal subfields of the inner and outer rings, respectively). Enhanced depth imaging of SS-OCT facilitated the analysis of WF changes in choroidal thickness in both healthy patients and patients with CSC. The local factors of the affected vortex vein and systemic risk factors may be involved in the pathogenesis of CSC.

Choroidal vascular alterations evaluated by ultra-widefield indocyanine green angiography in central serous chorioretinopathy.

This study aims to evaluate choroidal vascular alterations in patients with central serous chorioretinopathy (CSC) using ultra-widefield (UWF) indocyanine green angiography (ICGA). This was a retrospective case-control study conducted at a single tertiary eye center. In total, 36 eyes in patients with either unilateral (24 patients) or bilateral (six patients) treatment-naïve CSC and 30 eyes in 24 age-matched controls were evaluated. The number of quadrants with vortex vein engorgement on UWF ICGA was evaluated. Dilated choroidal vessels affecting the macula were regarded as extended vortex vein engorgement. Choroidal vascular hyperpermeability (CVH) area on late-phase ICGA was quantified using stereographic projection. The parameters were compared with clinical and optical coherence tomographic findings. Eyes with CSC had larger CVH area, thicker choroid, and more quadrants with vortex vein engorgement and extended vortex vein engorgement compared with control eyes (all P < 0.001). In patients with unilateral CSC, affected eyes had larger CVH area, thicker choroid, and more extended vortex vein engorgements compared with unaffected fellow eyes (all P < 0.001), but vortex vein engorgement did not significantly differ. CVH was significantly correlated with extended vortex vein engorgement (P < 0.001) and subfoveal choroidal thickness (P = 0.007). The increased number and binocular symmetry of engorged vortex veins suggest an anatomical predisposition for CSC. CVH area and extended vortex vein engorgement were indicators of choroidal outflow congestion. These parameters may serve as diagnostic clues or predictors of disease development in eyes with CSC.

Interocular asymmetry in distribution of leaks in central serous chorioretinopathy.

To study interocular asymmetry in distribution of leaks in central serous chorioretinopathy (CSC). Patients with unilateral CSC were included in this retrospective multicenter study. All patients received multimodal imaging. The prevalence of leaks within 1 disk diameter (DD) peripapillary area and the mean shortest distance between a leak and the optic disk edge was analyzed for the right and left eyes separately based on FA images. Clinical and morphological characteristics were collected and compared between eyes with a peripapillary leak and eyes with a leak elsewhere. In total, 152 eyes (77 right eyes and 75 left eyes) of 152 patients (128 males and 24 females) with a mean age of 45.2 ± 9.8years were included. The mean distance from the leak to the edge of the optic disk was statistically significantly lower (p = 0.0003), and the prevalence of the leaks within the 1 DD-peripapillary area was higher in the left eye than in the right eye (32.1% versus 10.7%, respectively, p = 0.0017). The eyes with a peripapillary leak had a longer duration of the disease (p < 0.05), a wider area of retinal pigment epithelium alteration (p < 0.001), and a higher prevalence of outer retinal atrophy (p < 0.001) compared to the eyes with a leak elsewhere. The left eye showed closer location of the leak to the optic disk edge and higher prevalence of leaks within the peripapillary area. The cases with peripapillary leak commonly demonstrated characteristics of chronic CSC despite relative preservation of visual acuity.