Multimodal retinal imaging in central serous chorioretinopathy treated with oral eplerenone or photodynamic therapy

Rabiolo, Alessandro; Zucchiatti, Ilaria; Marchese, Alessandro; Baldin, Giovanni; Sacconi, Riccardo; Montorio, Daniela; Cicinelli, Maria Vittoria; Querques, Lea; Bandello, Francesco; Querques, Giuseppe

doi:10.1038/eye.2017.290

Cited by 25 publications

(26 citation statements)

References 42 publications

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“…As recently reported, oral eplerenone treatment does not affect choriocapillaris density, similarly to our findings [6,25].…”

Section: Discussionsupporting

confidence: 93%

“…Some studies have reported vessel density modifications mainly of DCPD, probably related to mechanical displacement of retinal vessels caused by SRF. In CCSC eyes, due to the pathogenesis of the disease typically involving choroid and outer retinal layers, DCP vessel density reduction after eplerenone was not statistically significant [25]. Similarly, OCTA analysis in our sample showed no chorioretinal vascular changes after the systemic therapy.…”

Section: Discussionmentioning

confidence: 55%

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

Toto

D’Aloisio

Mastropasqua

et al. 2019

JCM

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Background: To investigate anatomical/functional changes after oral eplerenone therapy for chronic central serous chorioretinopathy (CCSC) in successfully treated eyes and fellow eyes and assess timing of foveal subretinal fluid (SRF) resolution. Methods: Twenty-one eyes of 21 patients suffering from CCSC with monolateral foveal SRF successfully treated with oral eplerenone were enrolled in this retrospective study (group 1). The fellow eyes (21 eyes; group 2), healthy or affected by CCSC, without foveal SRF were considered in the analysis. A control healthy group was enrolled as well (healthy controls; n = 21). Main outcome measures during follow-up included changes of best corrected visual acuity (BCVA, logMAR), central macular thickness (CMT; µm), SRF (µm), subfoveal choroidal thickness (SFCT; µm), superficial capillary plexus density (SCPD, %), deep capillary plexus density (DCPD, %), and choriocapillaris density (CCD, %) and percentage of eyes showing foveal SRF resolution at different time points. Results: Functional and anatomical parameters significantly improved during the study in group 1. BCVA increased significantly (p < 0.001), while CMT, SFCT, and SRF decreased significantly (p < 0.001; p < 0.001, and p = 0.037, respectively). SCPD, DCPD, and CCD did not show any statistically significant difference during follow-up. In 71.4% of eyes, resolution of SRF was observed within 60 days and in the remaining 28.6%, at 120 days. In fellow eyes, SFCT decreased significantly (p < 0.001), whilst all other parameters did not modify. Conclusions: Eplerenone treatment in chronic CSCR potentially improves recovery of retinal and choroidal morphology as well as visual acuity gain. A complete resolution of foveal SRF was observed in all eyes during a 4-month follow-up, with most eyes healing at 2 months.

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“…As recently reported, oral eplerenone treatment does not affect choriocapillaris density, similarly to our findings [6,25].…”

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 55%

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

Toto

D’Aloisio

Mastropasqua

et al. 2019

JCM

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“…Full or half-fluence photodynamic therapy (PDT) still plays a key role in the treatment of CSC in order to reduce choroidal hyperpermeability. Several studies have confirmed the efficacy of PDT, showing a reduction in serous retinal detachment and a decrease in choroidal thickness, but the safety effects are still debated over the long term [ 27 – 32 ]. Intravitreal anti-vascular endothelial growth factor (VEGF) agents have been given to reduce vascular permeability, although the exact role of VEGF in the pathogenesis of CSC is still unclear [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Eplerenone Versus Observation in the Treatment of Acute Central Serous Chorioretinopathy: A Retrospective Controlled Study

et al. 2018

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IntroductionTo investigate the effects of eplerenone compared to observation in the treatment of acute central serous chorioretinopathy (CSC).MethodsCharts of consecutive patients with a diagnosis of acute CSC (visual symptoms < 12 weeks) were reviewed. Included patients were divided into a treatment group (treated with eplerenone) and a control group (observation). Main outcome measures included changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), height of subretinal fluid (SRF) and subfoveal choroidal thickness (CT) at 1 and 3 months in the two groups.ResultsFifteen eyes of 15 patients (2 female, 13 male) and 12 eyes of 12 patients (1 female, 11 male [p = 1.000]) were included in the treatment and control groups, respectively. The mean age was 44 ± 9 (30–65) and 47 ± 11 years (28–66 years, p = 0.493), respectively. In the treatment group, BCVA improved significantly at 1 month (p = 0.018) and 3 months of follow-up (p = 0.011), while a non-significant improvement was seen in the control group. At 3 months, 12 of 15 eyes (80%) in the treatment group demonstrated complete SRF resolution, versus 3 of 12 eyes (25%) in the control group (p = 0.007). In the treatment group, SRF and CMT were significantly reduced at the 1-month follow-up (p = 0.014, p = 0.028, respectively) and the 3-month follow-up (p < 0.001 for both analyses), while in the control group the changes were not statistically significant. Eplerenone was well tolerated in all patients.ConclusionPatients affected by acute CSC treated with eplerenone achieved greater and faster resolution of the disease compared to the observation group. Eplerenone may represent an attractive new first-line treatment option for acute CSC.

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“…Some instruments use their own proprietary software, these include Cirrus (AngioPlex software, Carl Zeiss Meditec, Inc., Dublin, CA, USA), [ 5 , 10 ] AngioVue software (Optovue, Inc., Fremont, CA, USA), [ 11 , 12 ] and RS -3000 Advance (Nidek, Gamagori, Japan). [ 6 ] In the majority of the studies, however, images are exported and post-processed with a variety of different thresholding methods, including fixed cutoffs, [ 13 – 15 ] dynamic cutoff (e.g., mean, [ 9 , 16 , 17 ] ImageJ [National Institutes of Health, Bethesda, MD] default algorithm, [ 18 ] Otsu’s algorithm), [ 19 , 20 ] prototype software, [ 21 , 22 ] and more complex methods combining preprocessing filters and multilevel thresholds strategies. [ 23 – 26 ] It is still uncertain whether different algorithms lead to the same or, at least, similar results and findings from many studies could have been influenced by the algorithm utilized.…”

Section: Introductionmentioning

confidence: 99%

Comparison of methods to quantify macular and peripapillary vessel density in optical coherence tomography angiography

et al. 2018

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PurposeTo compare macular and peripapillary vessel density values calculated on optical coherence tomography angiography (OCT-A) images with different algorithms, elaborate conversion formula, and compare the ability to discriminate healthy from affected eyes.MethodsCross-sectional study of healthy subjects, patients with diabetic retinopathy, and glaucoma patients (44 eyes in each group). Vessel density in the macular superficial capillary plexus (SCP), deep capillary plexus (DCP), and the peripapillary radial capillary plexus (RCP) were calculated with seven previously published algorithms. Systemic differences, diagnostic properties, reliability, and agreement of the methods were investigated.ResultsHealthy eyes exhibited higher vessel density values in all plexuses compared to diseased eyes regardless of the algorithm used (p<0.01). The estimated vessel densities were significantly different at all the plexuses (p<0.0001) as a function of method used. Inter-method reliability and agreement was mostly poor to moderate. A conversion formula was available for every method, except for the conversion between multilevel and fixed at the DCP. Substantial systemic, non-constant biases were evident between many algorithms. No algorithm outperformed the others for discrimination of patients from healthy subjects in all the retinal plexuses, but the best performing algorithm varied with the selected plexus.ConclusionsAbsolute vessel density values calculated with different algorithms are not directly interchangeable. Differences between healthy and affected eyes could be appreciated with all methods with different discriminatory abilities as a function of the plexus analyzed. Longitudinal monitoring of vessel density should be performed with the same algorithm. Studies adopting vessel density as an outcome measure should not rely on external normative databases.

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Multimodal retinal imaging in central serous chorioretinopathy treated with oral eplerenone or photodynamic therapy

Cited by 25 publications

References 42 publications

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

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

Eplerenone Versus Observation in the Treatment of Acute Central Serous Chorioretinopathy: A Retrospective Controlled Study

Comparison of methods to quantify macular and peripapillary vessel density in optical coherence tomography angiography

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