Vision-Related Quality of Life, Anxiety and Depression in Congolese Patients with Polypoidal Choroidal Vasculopathy.

OBJECTIVE: To assess the impact of polypoidal choroidal vasculopathy (PCV) on quality of life (QoL) and mental health in a cohort of Congolese patients. METHODS: Fifteen PCV patients and 26 age-matched controls completed the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the Hospital Anxiety and Depression Scale (HADS) questionnaire. Outcome measures were QoL and HADS scores, frequency of anxiety and depression, correlations between best-corrected distance visual acuity (BCDVA) and QoL and HADS scores. Risk factors for anxiety and depression were also determined. RESULTS: The QoL composite score was (54.9 ± 24.2) in patients and (94.5 ± 4.5) in controls, p <.001. Patients scored higher on HADS-A (9.5 ± 3.4) and HADS-D (6.7 ± 4.7) than controls (3.0 ± 2.7 and 1.5 ± 2.6), all p <.001. Anxiety and depression were present in 73.3% and 46.7% of patients, respectively, versus 1% each of controls (p <.001). Every unit improvement in best eye's BCDVA increased QoL composite score by 24.3, but decreased HADS-D by 5.9. Macular lesions decreased QoL by 34.5 while increasing HADS-A and HADS-D scores by 4.2 and 4.4, respectively. A history of stroke also increased the HADS-A score by 5.9. CONCLUSIONS: PCV impairs the QoL and induces both anxiety and depression in Congolese PCV patients. Screening for QoL, anxiety and depression in PCV patients at first presentation will help detect those in need of psychological support.

Psychosomatic aspects in patients with central serous chorioretinopathy.

AIMS: Patients with central serous chorioretinopathy were tested for psychosomatic symptoms and social support at the onset of their ailments; their personality profiles were also tested. METHODS: 24 consecutive outpatients at the department of ophthalmology, Freiburg University Hospital, Freiburg, Germany, presenting with central serous chorioretinopathy filled in the following standardised questionnaires: Symptom Checklist 90-R (SCL 90-R), Symptom List, Questionnaire on Social Support, and Sixteen Personality Factor Questionnaire. RESULTS: The sample (n=24) included 22 male patients with an average age of 44.1 years. Three quarters of the patients have children and live with their families; three quarters are white collar workers or self employed; one quarter are skilled blue collar workers. 12 patients were suffering from the ailment for the first time; 12 patients were undergoing a relapse. Mean visus of the affected eye was 0.8. The Symptom List yielded an inconspicuous total score for psychosomatic symptoms. In the SCL 90-R, nine out of 24 patients (37%) evinced elevated psychic stress. The total value of the questionnaire on social support showed good social support. In the Sixteen Personality Factor Questionnaire, the patients showed heightened emotional instability and insecurity as well as flexibility and spontaneity. CONCLUSION: The sociodemographic data confirm that central serous chorioretinopathy is predominantly an ailment of middle aged, socially well integrated men. This study suggests elevated psychic stress a few weeks after the onset of the ailment. The personality factors in the patients with central serous chorioretinopathy found in this study have to be verified with other populations. These results did not clearly show that psychosocial factors have a definite role in the aetiology of central serous chorioretinopathy. In order to make any clear assertions about this matter, further longitudinal studies on the progression of psychosocial parameters with larger patient samples would be indispensable.

Helicobacter pylori and idiopathic central serous chorioretinopathy.

Idiopathic central serous chorioretinopathy (ICSC) is a disease that typically affects middleaged adults and involves the sensory retina, the retinal pigment epithelium (RPE) and the choroid. Patients usually have mild visual loss. ICSC generally resolves without therapy, although the disease can become chronic with ensuing RPE decompensation. Some patients, particularly older adults, can also develop choroidal subretinal neovascularisations (CNV), which may lead to a severe loss in visual acuity. Although the aetiopathogenesis of the disease is still incompletely understood, a correlation with psychophysical stress supports the idea that the disease may be "adrenergically conditioned", leading to the development of one or several defects in the RPE, with subsequent focal leakage of serous fluid and its retention in the subretinal space. An association between ICSC and the Helicobacter pylori (HP) infection has also been recently documented, suggesting that this organism may possibly be involved in the development of some cases of ICSC. Pathogenetic mechanisms that may explain the contribution of HP in the development of ICSC are postulated.

Central serous choroidopathy in pregnancy.

Central serous choroidopathy is a spontaneous serous detachment of the sensory retina, usually affecting adults between 20 to 50 years of age but is also found in patients older than 60 years of age. This disease usually affects males with a male to female ratio of 8-10 to 1. Many aetiological or associated factors have been described. Here we report a 39-year-old pregnant lady presented with left central serous chorioretinopathy preceded by an unusual emotional disturbance. She was not given any photocoagulative treatment to avoid possible photocoagulative complications. Post delivery, she presented with resolution of the CSC.

[Central serous chorioretinopathy: a study of six cases observed in Abidjan between 2003 and 2005, suggesting a role played by the Ivorian political-military crisis]. / Choriorétinopathie séreuse centrale: étude de 6 cas observés à Abidjan entre 2003 et 2005, rôle évoqué de la crise ivoirienne.

OBJECTIVE: This study aimed to show that central serous chorioretinopathy is present in Ivory Coast and that the emotional and psychosocial context plays an important role in this disorder's pathogenesis. PATIENTS AND METHOD: The authors report six central serous chorioretinopathy cases based on angiographic diagnosis, five in Black African subjects and one in a European subject. These cases were observed over a period of 2 years during the Ivorian political-military crisis. RESULTS: In a center where angiography has been a current practice since 1999, up to 2002 479 angiographies were done without a single central serous chorioretinopathy case being diagnosed. After the beginning of the political-military crisis, six cases of central serous chorioretinopathy were observed out of 417 angiographies over a period of 2 years. All the patients were males, between 20 and 50 years old, five were Black Africans and one was a white European. Their professions varied (a contractor, a soldier, a business executive, for example). The angiography showed break points in ink spots in the majority of the cases, with one case showing multiple break points. All the patients were emotionally distraught because of the uncertainty of the political situation. CONCLUSION: This study confirms that central serous chorioretinopathy does indeed exist in the Black African subject, as it exists in the leucoderma subject without discrimination. This study emphasizes the anxiety and extreme emotional context as an initiating factor in the occurrence of central serous chorioretinopathy.

Alexithymia and emotional distress in patients with central serous chorioretinopathy.

The authors studied 31 consecutive patients newly diagnosed with central serous chorioretinopathy (CSC) as compared with 31 age- and gender-matched control subjects, assessing emotional distress (ED), nine psychopathological symptoms, critical life events, and alexithymia. Results showed no difference in the number of critical life events; however CSC patients showed elevated ED and elevated scores on seven psychopathological symptoms, including hostility. Controlling for ED, CSC patients showed elevated alexithymia sum scores. Alexithymia was correlated with hostility. Our findings point to personality-based difficulties in emotional regulation associated with hostility in CSC.

Idiopathic central serous chorioretinopathy--a physical complication of stress?

The adverse psychological sequelae of stress are well recognized by occupational health specialists. Potential adverse physical effects, such as ischaemic heart disease, are more contentious but are biologically plausible. This report outlines a case of idiopathic central serous chorioretinopathy (ICSC), an uncommon but potentially sight-threatening condition, which is widely accepted amongst ophthalmologists to be stress related. The condition is not referred to in standard occupational health texts or databases. The report includes a brief review of the ophthalmological literature on which the connection between ICSC and stress has been made, and a need for further research promoted.