SIGNIFICANCE Central serous chorioretinopathy (CSCR) is still a therapeutic challenge with no criterion standard treatment. However, anatomic changes at the level of the retinal pigment epithelium could prove of predictive value in the course of the disease for selective treatment in cases of increased risk of chronicity. PURPOSE This pilot study analyzes the efficacy for treating acute CSCR with combined systemic acetazolamide 250 mg twice a day and nepafenac 0.1% eye drops three times a day in comparison with an untreated control group. It also evaluates the presence a pigment epithelial detachment (PED) as a risk factor for chronic CSCR. METHODS Nineteen consecutive patients (group 1) with new or new onset of recurrent CSCR were treated with oral acetazolamide and nepafenac eye drops for at least 2 months. A control group of 14 patients (group 2) with new or new onset of recurrent CSCR were untreated while under regular observation for 4 months. Primary end points were central macular thickness and best-corrected visual acuity after 4 months. Secondary end points were complete regression of subretinal fluid at 3 months and association of PED at baseline with recurrent or chronic CSCR imaged by optical coherence tomography. RESULTS Group 1 showed significantly faster resolution of subretinal fluid with a mean central macular thickness at 4 months of 271 ± 85 μm compared with 322 ± 79 μm for group 2 (P < .05), but with no functional benefit with a best-corrected visual acuity at 4 months of 0.8 ± 0.2 for group 1 compared with 0.9 ± 0.1 for the control group (P < .05). Patients with a small flat PED were at a higher risk of developing chronic CSCR compared with patients with a dome-shaped or no PED (P < .05). CONCLUSIONS Central serous chorioretinopathy remains a therapeutic challenge. This pilot study shows faster resolution of subretinal fluid with treatment but without functional benefit compared with observation. The presence of small, flat PED was associated with development of chronic CSCR.

Photo-activated chromophore for keratitis crosslinking (PACK-CXL) 1-4 may become an attractive treatment for developing and emerging countries where access to ophthalmic care and medical equipment is limited. 5 PACK-CXL treatment has the potential to be performed at the slit-lamp within 3 to 5 minutes. 3 We have addressed a remaining concern: is the stromal riboflavin distribution affected by gravity if the ultraviolet irradiation takes place in the upright position? Freshly enucleated porcine eyes were incubated in 0.1% hypoosmolar riboflavin solution without dextran for 30 minutes and then divided into three groups: corneas fixed in a vertical position for 30 minutes (n = 4), corneas fixed in a vertical position for 60 minutes (n = 8), and corneas fixed in a horizontal position for 60 minutes (n = 8). Four corneas were immersed in 0.9% sodium chloride for 60 minutes and served as fluorescence controls. The fluorescence signal of each cornea was measured with a spectrophotometer. Statistical significance was determined with Student's t tests and a confidence interval of 95%. After 30 minutes, there was no difference (P = .22) between superior and inferior riboflavin saturation, whereas a statistically significant (P = .002) gradient of 3.36% was found after 60 minutes (Figure 1). Gravitational influence on the riboflavin distribution was observed only after 60 minutes of vertical positioning. Given that a PACK-CXL treatment typically lasts for 3 to 30 minutes, 2-4 this difference can be considered not clinically relevant. Limitations of this study include a small sample size and the use of porcine instead of human corneas.

This pilot study demonstrates for the first time a possible significant reduction in retinal arterial caliber under aflibercept treatment for diabetic macular oedema. Further studies are needed to verify whether this response to intravitreal anti-VEGF treatment also signifies an improvement in retinal vascular homeostasis.

Large-vessel GCA is an underdiagnosed and undertreated type of GCA that does not typically affect the cranial arteries but rather larger proximal aortic branches. When associated with ocular complications, it can be a puzzling diagnostic dilemma for the eye care provider.

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