Treatment of chronic central serous chorioretinopathy (cCSC) remains a topic of controversy. As cCSC is a disease that can wax and wane, treatment efficacy is difficult to assess especially when trials compare active treatments without any placebo/control group. In this study, we systematically reviewed short‐term efficacies of any cCSC treatment tested in randomized controlled trials (RCT) and employed network meta‐analyses to compare to non‐treatment controls. We searched 11 literature databases on 20 March 2022 for RCTs of treatment of cCSC. We identified 17 RCTs including a total of 1172 eyes. Treatments included conventional laser (44 eyes), half‐dose or half‐fluence photodynamic therapy (PDT) (298 eyes), ranibizumab (16 eyes), antioxidants (50 eyes), mineralocorticoid receptor antagonists (187 eyes), rifampicin (91 eyes), selective retina therapy (SRT) (67 eyes) and subthreshold micropulse laser (192 eyes). Compared with controls, significant benefit on complete subretinal fluid resolution was only obtained from half‐dose or half‐fluence PDT (OR: 20.6; 95% CI: 6.3–66.7; p < 0.0001) and conventional laser (OR: 36.4; 95% CI: 2.0–655.7; p = 0.015), and at an order of magnitude lower degree from SRT (OR: 3.4; 95% CI: 1.7–6.8; p = 0.00075). Compared with controls and after sensitivity analyses, significant benefit in the change in best‐corrected visual acuity was only obtained by half‐dose/‐fluence PDT (−0.13 logMAR; 95% CI: −0.20 to −0.06 logMAR; p = 0.00021). In conclusion, three treatment options provide significant improvement over no treatment: half‐dose/‐fluence PDT, conventional laser and to a much lesser degree SRT. Considering that conventional laser can only be applied for extrafoveal leaks, and the long‐term data available for PDT‐based treatments finding persisting treatment results, half‐dose or half‐fluence PDT is the only viable treatment option for patients with cCSC. Shortage issues with verteporfin should not lead to employment of ineffective treatment modalities, as they put patients at unnecessary risk of adverse events.

ImportancePatients with nonneovascular age-related macular degeneration (AMD) are encouraged to use the Amsler grid test for self-assessment to facilitate early diagnosis. The test is widely recommended, suggesting a belief that it signals worsening AMD, warranting its use in home monitoring.ObjectiveTo systematically review studies of the diagnostic test accuracy of the Amsler grid in the diagnosis of neovascular AMD and to perform diagnostic test accuracy meta-analyses.Data SourcesA systematic literature search was conducted in 12 databases for relevant titles from database inception until May 7, 2022.Study SelectionStudies included those with groups defined as having (1) neovascular AMD and (2) either healthy eyes or eyes with nonneovascular AMD. The index test was the Amsler grid. The reference standard was ophthalmic examination. After removal of obviously irrelevant reports, 2 authors (J.B. and M.S.) independently screened the remaining references in full text for potential eligibility. Disagreements were resolved by a third author (Y.S.).Data Extraction and SynthesisTwo authors (J.B. and I.P.) independently extracted all data and evaluated quality and applicability of eligible studies using the Quality Assessment of Diagnostic Accuracy Studies 2. Disagreements were resolved by a third author (Y.S.).Main Outcomes and MeasuresSensitivity and specificity of the Amsler grid for detecting neovascular AMD with comparators being either healthy control participants or patients with nonneovascular AMD.ResultsOf 523 records screened, 10 studies were included with a total of 1890 eyes (mean participant age ranging from 62 to 83 years). Sensitivity and specificity to diagnose neovascular AMD were 67% (95% CI, 51%-79%) and 99% (95% CI, 85%-100%), respectively, when comparators were healthy control participants and 71% (95% CI, 60%-80%) and 63% (95% CI, 49%-51%), respectively, when control participants were patients with nonneovascular AMD. Overall, potential sources of bias were low across studies.Conclusions and RelevanceAlthough the Amsler grid is easy and inexpensive to use for detection of metamorphopsia, its sensitivity may be at levels typically not recommended for monitoring. Coupling this lower sensitivity with only moderate specificity to identify neovascular AMD in a population at risk, these findings suggest that such patients typically should be encouraged to undergo ophthalmic examination regularly, regardless of any results of Amsler grid self-assessment.

To explore subretinal fluid (SRF) morphology in chronic central serous chorioretinopathy (cCSC) after one session of either high-density subthreshold micropulse laser (HSML) treatment or half-dose photodynamic therapy (PDT). Methods:We retrospectively obtained optical coherence tomography (OCT) scans from a subset of patients from a randomized controlled trial on treatment-na€ ıve eyes with cCSC allocated to either HSML treatment or half-dose PDT. OCT scans were evaluated prior to treatment and 6-8 weeks posttreatment, where we measured maximum SRF height and width, calculated the maximum height-tomaximum width-ratio (maxHWR) and calculated the total SRF volume.Results: Forty-one eyes of 39 cCSC patients were included. SRF morphology ranged from flat to dome-shaped, quantified as maxHWR ranging between 0.02 and 0.12. SRF volume was median 0.373 ll (range: 0.010-4.425 ll) and did not correlate to maxHWR (rho = À0.004, p = 0.982). Halfdose PDT was superior to HSML treatment in complete SRF resolution (RR = 3.28, p = 0.003) and in morphological changes of SRF (D maximum height , p = 0.001; D maximum width , p < 0.001; D volume , p = 0.025). SRF resolved completely in 19/22 PDT-treated eyes (86%) and 5/19 HSML-treated eyes (26%). SRF volume increased in five eyes (26%) after HSML treatment, and in none of the eyes after half-dose PDT. SRF morphology at baseline did not predict treatment outcomes. Conclusion:SRF morphology changed after both HSML treatment and half-dose PDT in cCSC, with SRF disappearing in most PDT-treated patients, whereas SRF volume increased in a sizeable proportion of HSML-treated patients. Baseline SRF characteristics measured in this study were unable to predict outcomes after either HSML treatment or half-dose PDT.

Introduction: The transition from a normal fundus to one with early drusen (≥ 20 small hard drusen) to age-related macular degeneration (AMD) in the form of drusen ≥ 63 µm in diameter is of interest, because small hard drusen may be precursors of large drusen. Study of AMD precursors lesions may provide valuable insight into factors that initiate AMD. Here, the progression of drusen was studied over an interval of 20 years in a population-based twin cohort. Methods: Single-center, 20-year follow-up of 138 twins, including biometry, fundus optical coherence tomography, and fundus photography. Macular characteristics were hierarchically classified as (per eye) 1) < 20 small hard drusen, 2) ≥ 20 small hard drusen, 3) drusen ≥ 63 µm, or 4) ≥ 20 small hard drusen combined with drusen ≥ 63 µm. Additive and dominant genetic effects as well as shared and non-shared environmental effects were analyzed in a bivariate biprobit model with a classic liability-threshold approach and polygenic modeling with random effects. Results: Median participant age was 59 (range 41 - 66) years. Of 25 (18%) cases of incident macular drusen, 7 had ≥ 20 small hard drusen, and 18 had drusen ≥ 63 µm at follow-up, whereas no participant had developed both traits simultaneously. Smoking was associated with incident ≥ 20 small hard drusen (p = 0.04) and incident drusen ≥ 63 µm (p = 0.003). Having ≥ 20 small hard drusen at baseline was associated with incident drusen ≥ 63 µm at follow-up (p = 0.02). Development of drusen ≥ 63 µm was attributable to 49% genetic effects and 51% environmental effects. Conclusion: The risk of progressing from 0-19 small hard macular drusen per eye to having ≥ 20 small hard drusen or drusen ≥ 63 µm at follow-up was associated with smoking and genetic predisposition. Having ≥ 20 small hard drusen in the absence of drusen ≥ 63 µm at baseline was associated with incident drusen ≥ 63 µm when examined 20 years later. The study confirms that small hard macular drusen is a forewarning of AMD and that progression to AMD may be hindered by avoidance of smoking.

Purpose Intravitreal injections and cataract surgery are two common procedures in the elderly. Posterior capsular rupture (PCR) is a rare but important complication of cataract surgery. We systematically reviewed the literature on previous intravitreal injections as a risk factor of PCR and performed meta‐analyses to provide pooled summary risk estimates. Methods We searched 13 literature databases on 1 June 2021 for studies evaluating the risk of PCR in eyes undergoing cataract surgery with data on previous intravitreal injections. Data extraction was made independently by two authors and discussed afterwards until reaching consensus. Random effects meta‐analyses on the pooled odds ratio (OR) of PCR in eyes with previous intravitreal injections were made using MetaXL 5.3. Results Six studies on 1 051 097 eyes undergoing cataract surgery were eligible for the qualitative and quantitative review. Previous history of intravitreal injections was present in 7034 eyes (majority was anti‐VEGF). Our meta‐analyses revealed that any previous intravitreal injection was a risk factor for PCR with an OR of 2.30 (95% CI 1.39–3.81). For each previous intravitreal injection, the risk of PCR was OR 1.04 (95% CI 1.01–1.08) (equivalent of relative risk ~1.04). In other words, risk of PCR increases by 4% for each previous intravitreal injection. Conclusions Previous intravitreal injection is a risk factor for PCR and should be taken into account when planning cataract surgery. However, to be regarded as a clinically significant risk of PCR, a substantial number of previous intravitreal injection (e.g. ≥10) should have been administered, considering that the a priori risk of PCR is very low (~1%).