Pachychoroid Spectrum Diseases in Patients with Cushing’s Syndrome: A Systematic Review with Meta-Analyses

Abstract

Cushing’s syndrome is a rare disease with an endogenous cause of excess cortisol secretion. More evidence substantially links cortisol levels to the pachychoroid spectrum diseases. In this systematic review and meta-analysis, we summarize available evidence on pachychoroid spectrum diseases in patients with Cushing’s syndrome. We performed a systematic literature search in 11 databases on 21 May 2022. Studies were considered eligible if they performed retinal examination of a consecutive group of patients with Cushing’s syndrome using optical coherence tomography (OCT) scans. We extracted data on subfoveal choroidal thickness in patients with Cushing’s syndrome compared to matched controls. We also extracted data on the prevalence of pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CSC), and polypoidal choroidal vasculopathy (PCV). We identified six eligible studies with a total of 159 patients with Cushing’s syndrome. On average, patients with Cushing’s syndrome have 49.5 µm thicker subfoveal choroidal thickness compared to matched healthy individuals. Pachychoroid spectrum diseases were relatively common in these patients: PPE in 20.8%, CSC in 7.7%, and PCV in 2.8%. We conclude that there should be low threshold to recommend ophthalmic examination to patients with Cushing’s syndrome, and that a macular OCT is recommended during this examination.

Risk of Central Serous Chorioretinopathy in Male Androgen Abusers

“…Success of these shunts demonstrate a high gender preference; they are more likely to be successful among males [32,33]. Thus, taken together, it may be that males are more prone to the development of vascular anastomoses [9], and that sex hormones are innocent bystanders that have gained disproportional focus due to the role of another group of steroids: the corticosteroids [12].…”

“…The CSC pathophysiology remains incompletely understood, but clinical findings of dilated choroidal vessels, anastomoses, and vascular hyperpermeability point to a venous overload hypothesis [3,9], which has also been linked to a thicker sclera [10,11]. Exposure to corticosteroids is a strong risk factor for CSC [12]. Male sex is another strong risk factor for CSC [9,13].…”

Analysis of Systemic and Serum Risk Factors in Patients with Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy

“…AMD is a heterogeneous disorder involving the complex interplay between aging, environmental risk factors, and genetic susceptibility [38,39]. PCV is suggested to belong to the pachychoroid spectrum of diseases, the pathogeneses of which might be associated with vortex veins or running patterns of choroidal vessels [40,41]. Despite the overlap of clinical or pathophysiological features, alterations in the levels of plasma markers appear to differ between nAMD and PCV [42][43][44][45].…”

Blinded by Stress: A Patient and Physician Perspective on Central Serous Chorioretinopathy

“…The condition was first described in 1866 by von Graefe and later associated with stress by Bennett in 1955 [ 6 , 7 ]. Exogenous and endogenous sources of corticosteroids are the most important risk factor [ 8 , 9 ]. In this case, Mr. Jacob Mark is a young adult male with unremarkable medical history, but with a long history of psychological stress.…”