Anatomical and Functional Changes of the Retina and the Choroid after Resolved Chronic CSCR

Toto, Lisa; D’Aloisio, Rossella; Mastropasqua, Rodolfo; Antonio, Luca Di; Nicola, Marta Di; G, Di Martino; Evangelista, Federica; Erroi, Emanuele; Doronzo, Emanuele; Mariotti, Cesare

doi:10.3390/jcm8040474

Cited by 14 publications

(7 citation statements)

References 23 publications

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“…Choroidal vasculature alterations are rarely reported in the literature after other treatments in CCSCR. Toto et al did not find any changes in retinal capillary plexuses or choroidal vasculature after eplerenone treatment of CSCR [46]. Fujita et al presented a small series of 6 patients in whom OCTA revealed choriocapillaries recovery after half-dose PDT treatment (improvement of flow signal) [47].…”

Section: Discussionmentioning

confidence: 99%

Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy

Gawęcki¹,

Jaszczuk-Maciejewska²,

Jurska-Jaśko³

et al. 2019

BMC Ophthalmol

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Purpose Central serous chorioretinopathy (CSCR) is a complex ocular entity that, in its chronic form, can lead to serious visual impairment and morphological damage to the retina. The aim of the current retrospective study was to evaluate the damage present after long-standing but resolved central serous chorioretinopathy and refer it to healthy individuals. Correlations between measurable factors—for example, duration of the disease, baseline retinal morphological parameters, or patient age and/or their degree of impairment—were also assessed. Materials and methods The study group consisted of thirty-two eyes (13 female and 19 male, mean age 49.6 years SD +/− 10.5) with chronic central serous chorioretinopathy (mean duration 18.9 months SD +/− 15.4) in which complete resolution of subretinal fluid was achieved after subthreshold micropulse laser treatment. Inclusion criterion was a lack of subretinal fluid within the whole area of the central retina scanned by the spectral domain optical coherence tomography. The group was extracted out of 51 cases of chronic CSCR that were treated with that method. They were analyzed according to final best-corrected visual acuity and retinal morphological parameters as measured by spectral optical coherence tomography with angiography option (OCTA). Results were compared with the outcomes of a control group, which consisted of 40 eyes of healthy individuals with full distance visual acuity (0.0 logMAR, 1.0 Snellen) never treated with subthreshold micropulse laser. Statistical analysis included regarding correlation between final visual acuity and final central retinal thickness and retinal and functional parameters prior to treatment. Results Final best-corrected visual acuity after chronic central serous chorioretinopathy was 0.23 logMAR (0.6 Snellen) and central retinal thickness was 39.32 μm smaller than in controls. No correlation was found between final visual acuity and retinal thickness and duration of the disease, patient age, and baseline morphological retinal parameters. OCTA scans revealed impaired choriocapillaries flow signal even following resolution of the disease. Conclusion Chronic central serous chorioretinopathy is a potentially damaging clinical entity that results in serious visual impairment, retinal thinning, and choroidal flow defects. Further research is needed to determine precisely the timepoint of this damage.

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Section: Discussionmentioning

confidence: 99%

Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy

Gawęcki¹,

Jaszczuk-Maciejewska²,

Jurska-Jaśko³

et al. 2019

BMC Ophthalmol

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“…In the latter study cohort, the mean time to complete foveal SRF resolution was 10.5 ± 8.0 months after treatment initiation and, at 24 months, foveal SRF resolution was achieved in 13 eyes (81%). Toto and colleagues [21] also demonstrated that eplerenone is effective in improving visual function and morphological parameters in eyes with chronic CSC. In their study cohort, a percentage of 71.4% of eyes had resolution of SRF within 2 months, while the remaining 28.6% had resolution at the 2-month follow-up visit.…”

Section: Discussionmentioning

confidence: 99%

Optical Coherence Tomography Parameters as Predictors of Treatment Response to Eplerenone in Central Serous Chorioretinopathy

Borrelli

Zuccaro

Zucchiatti

et al. 2019

JCM

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Purpose: To present data on clinical response to eplerenone over a 1-year period in patients with central serous chorioretinopathy (CSC), and to evaluate optical coherence tomography (OCT) variables as predictors of treatment response at 3- and 12-month follow-up visits. Methods: Patients with acute or chronic CSC treated with eplerenone were retrospectively included. Clinical and imaging characteristics were recorded at baseline and at the 3-month and 12-month follow-up visits. Changes from baseline in quantitative measurements were calculated at each follow-up. Logistic regression analysis was computed to correlate clinical and OCT parameters at baseline with response to treatment at 3 and 12 months of follow-up. Results: A total of 50 eyes of 50 patients were included in the study. Mean ± SD best corrected visual acuity (BCVA) was 0.20 ± 0.14 Logarithm of the Minimum Angle of Resolution (LogMAR) at baseline and significantly improved at both the 3-month (0.12 ± 0.13 LogMAR, p < 0.0001) and 12-month (0.10 ± 0.12 LogMAR, p < 0.0001) follow-up visits. At the 3-month follow-up visit, 25 out of 50 eyes (50.0%) demonstrated macular complete subretinal fluid (SRF) resolution, while 13 eyes (26.0%) showed macular partial SRF resolution, and 12 eyes (24%) had neither partial nor complete macular SRF resolution. Among those patients with macular partial or complete SRF resolution at 3 months and thus not shifted to photodynamic therapy, 36 out of 38 cases had macular complete SRF resolution at the 12-month follow-up visit. There was a significant change from baseline at both follow-up visits in all anatomical OCT parameters (except for reduction in choroidal thickness that did not reach the statistical significance at the 12-month follow-up visit). Several OCT parameters at baseline were independently significant predictors for macular subretinal fluid complete resolution at 3 months, including (i) a thicker subfoveal choroidal thickness; (ii) a smaller subretinal fluid maximum diameter; (iii) a lower number of serous pigment epithelium detachments; and (iv) a lower number of intraretinal hyperreflective foci. Conclusion: Treatment with eplerenone in CSC patients is confirmed to be beneficial for both anatomical and functional outcomes. We identified attractive OCT metrics that could potentially be used as a tool to select patients who might mainly benefit from this treatment.

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“…Factors such as choroidal hyperpermeability have been described to explain this process [ 13 ]. In addition, leakage sites have been captured by various choroidal imaging techniques like fluorescein angiography (FA) and indocyanine green angiography (ICGA) to facilitate diagnosis ( Figure 1 ) [ 14 ]. These imaging methods are described in detail below.…”

Section: Introductionmentioning

confidence: 99%

Current Choroidal Imaging Findings in Central Serous Chorioretinopathy

Nkrumah

Maltsev

Manuel

et al. 2020

Vision

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Background: Central serous chorioretinopathy (CSCR) is a chorioretinal disease affecting mostly middle age males. It is marked by the serous detachment of the neurosensory layer at the macula. This review of the literature provides a framework of the current characteristic/relevant imaging findings of CSCR. Although the pathogenesis of CSCR is unclear, the choroid plays a major role and its changes are fundamental to the diagnosis and treatment of CSCR. Methods: A systematic literature search focusing on current multimodal imaging for CSCR was performed. Only articles reporting on original clinical data were selected, studies in a language other than English were included only if an English abstract was provided. Additional sources included articles cited in the references list of the first selected articles. We deduced imaging findings based on current and relevant literature on the topic. Results: We found that sub foveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) were greater in eyes with acute CSCR than in eyes with chronic CSCR or normal eyes. There was increased choroidal thickness (CT) in the macula compared to peripapillary region. In healthy eyes, the highest CVI was found in the nasal region followed by the inferior, temporal, and superior quadrant. The area with the least CVI was the macula. In eyes with CSCR, 100% had asymmetric dominant vortex veins compared to 38% in normal eyes. Conclusion: Choroidal imaging has advanced the diagnosis of CSCR. This has led to numerous imaging biomarkers like CVI, CT, and hyper-reflective dots for early detection and possible prognostication of CSCR. More techniques like wide field scans and en face imaging are being employed to characterize the choroid in CSCR.

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Anatomical and Functional Changes of the Retina and the Choroid after Resolved Chronic CSCR

Cited by 14 publications

References 23 publications

Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy

Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy

Optical Coherence Tomography Parameters as Predictors of Treatment Response to Eplerenone in Central Serous Chorioretinopathy

Current Choroidal Imaging Findings in Central Serous Chorioretinopathy

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