Evaluation of changes in macular structures after subthreshold micropulse laser therapy on chronic central serous chorioretinopathy.

PURPOSE: To evaluate the changes in macular structures following subthreshold micropulse laser (SHML) treatment for chronic central serous chorioretinopathy (cCSC). METHODS: Data of 33 eyes from 31 cCSC patients treated with SHML and followed up for at least 6 months has been included in this retrospective study. Main outcome measurements include resolution of subretinal fluid (SRF) and pigment epithelial detachment (PED), the recovery of ellipsoid zone (EZ) continuity, and the foveal outer nuclear layer (ONL) thickness along with its ratio. RESULTS: Mean observation period is 7.355 months (ranging from 6 to 24 months) and mean number of treatments administered is 1.839 (ranging from 1 to 5). 6 months after SHML treatment, there is a significant decrease in the area of SRF and PED (P < 0.001, P = 0.010, respectively). Additionally, the frequency of continuous EZ and the foveal ONL thickness reveal a significant increase (P<0.001, P = 0.005, respectively). The ratio of foveal ONL thickness is significantly higher after laser treatment, particularly in patients with a disease duration of ≤12 months (p = 0.022, P=0.036, respectively). CONCLUSION: SHML treatment proves to be effective in cCSC eyes, leading to satisfactory recovery of macular structures, especially the photoreceptor layer.

Surgical Treatment of Bullous Exudative Retinal Detachment Secondary to Atypical Bilateral Central Serous Chorioretinopathy

This study aimed to report the diagnostic process, treatment, and follow-up of a patient with bullous exudative retinal detachment (RD) associated with an atypical variant of bilateral central serous chorioretinopathy (CSCR). A 28-year-old woman was referred to our clinic for total bullous RD in the right eye with a vision level of light perception only. She had been previously diagnosed with idiopathic uveal effusion syndrome and treated with systemic corticosteroid therapy with no response, and was referred to us for scleral window surgery. Four-quadrant scleral window surgery with external drainage of the subretinal fluid was performed, resulting in a transient partial attachment of the retina. RD started to progress again within 3 weeks, which prompted comprehensive imaging together with more advanced systemic workup for systemic lupus erythematosus and other rheumatological and immunological diseases. Systemic corticosteroid therapy was initiated during this period but did not stop the progression and was discontinued after a short time. Fluorescein angiography and indocyanine green angiography revealed multifocal choroidal leakage foci and large choroidal vessels without any intraocular inflammation findings and led to the diagnosis of atypical CSCR. Pars plana vitrectomy (PPV), internal drainage of the subretinal fluid, endolaser to the focal leakage areas, and intravitreal aflibercept injection were performed. Visual acuity increased to 0.8 within 8 months after the surgery with no recurrence. Bullous exudative RD is a very rare and atypical form of CSCR, and a favorable outcome can be obtained with PPV and surgical drainage of subretinal fluid followed by laser photocoagulation.

Non-damaging retinal laser therapy in chronic central serous chorioretinopathy.

PURPOSE: To investigate the functional and anatomical outcomes of non-damaging retinal laser therapy (NRT), in cases with chronic central serous chorioretinopathy (CSCR). METHODS: Twenty-three eyes of 23 treatment-naïve chronic CSCR patients were included in this study. The irradiation of 577 nm yellow light was conducted on the serous detachment area after switching over to the NRT algorithm. Anatomical and functional changes after treatments were investigated. RESULTS: The mean age of the subjects was 48.68 ± 5.93 years (41-61). The mean best-corrected visual acuity (BCVA) and the mean central macular thickness (CMT) values were 0.42 ± 0.12logMAR (0.20-0.70) and 315.69 ± 61.25 µm (223-444) before NRT; and 0.28 ± 0.11logMAR (0.10-0.50) and 223.26 ± 60.91 µm (134-336) at the 2nd month follow-up visit (p < 0.001, for both). At the 2nd-month follow-up visit after NRT, complete resorption of subretinal fluid was observed in 18 eyes (78.3%) and incomplete resorption in five eyes (21.7%). Worse values of BCVA and CMT before NRT were found as increased risk for incomplete resorption (p = 0.002 and ρ = 0.612 for BCVA, and p < 0.001 and ρ = 0.715 for CMT). CONCLUSION: Significant functional and anatomical improvements can be observed in the early period after NRT in patients with chronic CSCR. Patients having worse baseline BCVA and CMT have increased risk for incomplete resorption.

Electrophysiological and anatomical outcomes of subthreshold micropulse laser therapy in chronic central serous chorioretinopathy.

BACKGROUND: To evaluate short-term efficacy of subthreshold micropulse laser therapy on chronic central serous chorioretinopathy (CSC) electrophysiologically and anatomically. METHODS: This prospective study included 18 eyes with chronic CSC. Subthreshold micropulse laser therapy was applied to the eyes using Endpoint Management System (EpM). The efficacy of the treatment was evaluated with optical coherence tomography (OCT) and multifocal electroretinography (mfERG) measurements before and after one month of the treatment. RESULTS: The mean patient age was 47.3 ± 5.7 years (ranged between 36 and 56). The mean symptomatic time of the disease was 12.7 ± 3.33 months. Central macular thickness, choroidal thickness, subretinal fluid height and width showed statistically significant decreases after EpM treatment (p < 0.05). P 1 amplitude of ring 1, 3, 4, and 5 in mfERG increased significantly (p <  0.05). CONCLUSIONS: The study demonstrated that, in both OCT and electrophysiological evaluations, EpM subthreshold laser therapy resulted in anatomical and functional improvements in chronic CSC.

Central serous chorioretinopathy in pregnancy.

Objective: The objective of this work was to present two unusual cases of central serous chorioretinopathy (CSC) and the chosen therapeutic method. Materials and methods: In this article, two cases of CSC in pregnant patients were described. Results: The first case was a 35-year-old patient in the 16th week of pregnancy and the second one was a 26-year-old patient in the 20th week of pregnancy. Due to the contraindications associated to pregnancy, the therapeutic method chosen was subthreshold micropulse laser photocoagulation. The functional and anatomical evolution was very good in both patients. Discussion: In both cases, treatment of the disease was preferred to prevent important photoreceptor losses. After the treatment, very good anatomical and functional results were obtained. Conclusions: The micropulse laser is an effective solution for treating CSC. It is the only safe therapeutic solution during pregnancy. CSC can be associated with pregnancy, without necessarily suggesting pre-eclampsia. Abbreviations: CSC = central serous chorioretinopathy, SRF = subretinal fluid.

RESPONSE OF CHOROIDAL ABNORMALITIES TO PHOTODYNAMIC THERAPY VERSUS MICROPULSE LASER IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY: Place Trial Report No. 4.

PURPOSE: To compare the effects of half-dose photodynamic therapy (PDT) and high-density subthreshold micropulse laser on choroidal dysfunction evaluated by degree and extent of hyperfluorescence on indocyanine green angiography (ICGA) in chronic central serous chorioretinopathy. METHODS: Data from the multicenter, randomized, controlled PLACE trial were used in this study. Hyperfluorescent and hypofluorescent areas on ICGA, their association with subretinal fluid and visual function were assessed. RESULTS: In total, 146 patients were included (72 in the PDT and 74 in the high-density subthreshold micropulse laser treatment arm). A significantly greater decrease in the size of hyperfluorescent areas on ICGA at first visit after treatment was seen after PDT compared with high-density subthreshold micropulse laser (mean, -1.41 ± 2.40 mm2 vs. -0.04 ± 0.73 mm2, respectively; P < 0.001). A reduction in the degree of hyperfluorescence on ICGA decreased the odds of having persistent subretinal fluid on optical coherence tomography at first visit after treatment (B = 0.295; P = 0.019). There were no significant differences in best-corrected visual acuity and retinal sensitivity between the subgroup with novel hypofluorescence (n = 20, 28%) on ICGA at first visit post PDT, compared with the subgroup without novel hypofluorescence on ICGA after PDT. CONCLUSION: Choroidal abnormalities in chronic central serous chorioretinopathy can be effectively treated by ICGA-guided half-dose PDT but not with high-density subthreshold micropulse laser application.

A novel multi-modal fundus image fusion method for guiding the laser surgery of central serous chorioretinopathy.

The angiography and color fundus images are of great assistance for the localization of central serous chorioretinopathy (CSCR) lesions. However, it brings much inconvenience to ophthalmologists because of these two modalities working independently in guiding laser surgery. Hence, a novel fundus image fusion method in non-subsampled contourlet transform (NSCT) domain, aiming to integrate the multi-modal CSCR information, is proposed. Specifically, the source images are initially decomposed into high-frequency and low-frequency components based on NSCT. Then, an improved deep learning-based method is employed for the fusion of low-frequency components, which helps to alleviate the tedious process of manually designing fusion rules and enhance the smoothness of the fused images. The fusion of high-frequency components based on pulse-coupled neural network (PCNN) is closely followed to facilitate the integration of detailed information. Finally, the fused images can be obtained by applying an inverse transform on the above fusion components. Qualitative and quantitative experiments demonstrate the proposed scheme is superior to the baseline methods of multi-scale transform (MST) in most cases, which not only implies its potential in multi-modal fundus image fusion, but also expands the research direction of MST-based fusion methods.

Subthreshold laser therapy with a standardized macular treatment pattern in chronic central serous chorioretinopathy.

PURPOSE: There is an ongoing controversial debate about the effectiveness of laser treatments in chronic central serous chorioretinopathy (cCSC). We performed a prospective non-randomized interventional study to learn about the effects of a subthreshold laser treatment (Topcon Endpoint Management™, Topcon Healthcare Inc., Tokyo, Japan) in patients with cCSC. METHODS: Patients with cCSC and a minimum symptom duration of 4 months were included and treated with a standardized laser pattern covering the macular area. Retreatment was performed every 3 months if persistent subretinal fluid was observed. The primary endpoint was resolution of subretinal fluid at 6 months. Further outcome parameters included best corrected visual acuity, microperimetry, central macular and subfoveal choroidal thickness. RESULTS: A total of 42 eyes of 39 patients were included. Mean patient age was 48 ± 10.6 years (range 25-67). Mean symptomatic time before inclusion into the study was 134 ± 133.4 weeks (16-518). Before inclusion, 78.6% of the patients had failed to resolve subretinal fluid under mineralocorticoid receptor antagonists and 14.3% had a recurrence after half-dose photodynamic therapy. Complete resolution of subretinal fluid was observed in 42.9% at 6 months and in 53.8% at 12 months after baseline. Central retinal thickness decreased from 398 ± 135 µm to 291 ± 68 µm (p < 0.001), subfoveal choroidal thickness changed slightly (430 ± 116 µm to 419 ± 113 µm, p = 0.026), microperimetry-derived macular function improved by 19.1 ± 4.7 dB to 21.3 ± 4.8 dB (p = 0.008) and mean BCVA improved by 4.9 ± 8.6 ETDRS letters (p < 0.001). CONCLUSION: The results show that the investigated laser treatment is effective in reducing subretinal fluid and leads to an improvement of functional parameters.

The efficacy of subthreshold micropulse yellow laser (577 nm) in chronic central serous chorioretinopathy.

Central serous chorioretinopathy (CSC) is a disease characterized by a well-defined serous detachment of the neurosensory retina. Therapeutic options in chronic cases are limited, and side effects can result in a limited response. The aim of this article is to assess the efficacy of subthreshold micropulse laser therapy in patients with chronic central serous chorioretinopathy. The study included 20 eyes of 19 patients who had a history of chronic or chronic recurrent CSC and who underwent subthreshold micropulse laser therapy between January 2015 and June 2018. Twenty eyes of 19 patients with a mean age of 48.9 ± 9.40 years were included. The mean visual acuity was 0.24 ± 0.28 logMAR before laser, 0.19 ± 0.25 logMAR 3 months after laser, and 0.18 ± 0.27 logMAR after 6 months. A statistically significant difference was determined in terms of visual acuity before and after treatment (p = 0.0001). The mean central retinal thickness was 308.10 ± 95.25 µm before laser, 233.65 ± 81.17 µm 3 months after laser, and 203.88 ± 72.79 µm at 6 months. A statistically significant relationship was present between visual acuity and the duration of disease (p = 0.001), between visual acuity and the outer nuclear layer thickness (p = 0.005), and between the outer nuclear layer thickness and the duration of disease in chronic cases (p = 0.008). There was no evidence of retinal pigment epithelium or retinal damage on optical coherence tomography or fundus autofluorescence secondary to subthreshold micropulse laser therapy. Visual acuity appears to be more associated with the duration of disease and with changes in the outer nuclear layer thickness in chronic CSC. Subthreshold micropulse laser therapy seems to be effective at treating chronic CSC, while it increases success during early period of the disease before the development of permanent retinal damage.

The giant tear of retinal pigment epithelium following focal laser in central serous chorioretinopathy.

A 35-year-old male smoker presented with reduced vision in OD for the previous two years. He reported a further drop in the vision for the previous two weeks after he underwent focal laser elsewhere. Clinical examination and multimodal imaging confirmed a giant tear of the retinal pigment epithelium (RPE) and a focal leak of CSCR. He was managed with the focal laser to the active leak and lifestyle modification. The ocular condition remained stable. RPE rips in CSCR have been reported to occur spontaneously or with an intervention like exogenous use of steroids, or photodynamic therapy (PDT). This case highlighted the fact that focal laser can precipitate RPE rip in a case of CSCR with tense bullous PED. The physician should keep this fact in mind while counselling the patient before a laser procedure and suspect an RPE rip in a patient with CSCR who presents with an acute onset of vision loss.

Clinical Evaluation of Individualized and Navigated Microsecond Pulsing Laser for Acute Central Serous Chorioretinopathy.

BACKGROUND AND OBJECTIVE: A computational model has predicted parameters for using a navigated microsecond pulsing laser system to treat central serous chorioretinopathy (CSC). PATIENTS AND METHODS: A prospective, single-center, interventional case series was conducted for patients with acute CSC who were enrolled following screening and informed consent. Treatment involved laser pulse duration of 50 µs, 2.4% Duty Cycle, 100 µm spot size, and 10 ms pulse duration. RESULTS: Average best-corrected visual acuity (decimal) of 12 patients improved from 0.86 ± 0.03 at baseline to 0.97 ± 0.01 at 3 months. Baseline central retinal thickness decreased from 452.58 µm ± 24.53 µm at baseline to 249.25 µm ± 2.92 µm at 3 months. Retinal sensitivity improved from 24.1 dB ± 1.09 dB at baseline to 28.98 dB ± 0.23 dB at 3 months. In all cases, subretinal fluid was resorbed. CONCLUSION: The parameter sets derived from the computer model can be applied safely and effectively for CSC treatment using the navigated microsecond pulsing laser system. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:512-520.].

Prospective evaluation of changes in choroidal vascularity index after half-dose photodynamic therapy versus micropulse laser treatment in chronic central serous chorioretinopathy.

PURPOSE: To assess whether treatment of chronic central serous chorioretinopathy (cCSC) with photodynamic therapy (PDT) and high-density subthreshold micropulse laser (HSML) results in choroidal vascularity index (CVI) changes that may account for the treatment effect. METHODS: Patients with cCSC were prospectively included and analyzed. Patients received either half-dose PDT or HSML treatment. CVI of the affected and unaffected eye was obtained before treatment, 6 to 8 weeks after treatment, and 7 to 8 months after treatment. RESULTS: At baseline, 29 eyes (29 patients) were included both in the PDT and in the HSML group. The mean (± standard deviation) CVI change in the HSML group between before PDT and 6 to 8 weeks after PDT was - 0.009 ± 0.032 (p = 0.127), whereas this was 0.0025 ± 0.037 (p = 0.723) between the visit before PDT and final visit. The patients in the PDT group had a CVI change of - 0.0025 ± 0.037 (p = 0.723) between the visit before PDT and first visit after PDT, and a mean CVI change of - 0.013 ± 0.038 (p = 0.080) between the visit before PDT and final visit. There was no significant correlation between CVI and BCVA at the measured time points, in both the HSML group (p = 0.885), and in the PDT group (p = 0.904). Moreover, no significant changes in CVI occurred in the unaffected eye at any time point. CONCLUSIONS: PDT and HSML do not significantly affect CVI, and therefore a CVI change may not be primarily responsible for the treatment effect. The positive treatment effect of both interventions may rely on other mechanisms, such as an effect on choriocapillaris and/or retinal pigment epithelium function.

Clinical Application of Fluorescein Angiography-Free Navigated Focal Laser Photocoagulation in Central Serous Chorioretinopathy.

BACKGROUND AND OBJECTIVE: To present clinical application of fluorescein angiography (FA)-free focal laser photocoagulation (FLP) of the leakage point in patients with central serous chorioretinopathy (CSC). PATIENTS AND METHODS: A prospective case series included 16 eyes of 16 patients with non-resolved CSC. The leakage point was identified with optical coherence tomography (OCT) as a small single pigment epithelium detachment (PED) localized in the upper half of the neurosensory detachment with an area of photoreceptor outer segments layer thinning above this PED. FLP was performed with the Navilas 532 system. RESULTS: All patients achieved complete resolution of the subretinal fluid within a mean time of 6.5 ± 1.8 weeks. The mean best-corrected visual acuity statistically significantly increased from 0.08 ± 0.09 (20/25) at baseline to 0.0 ± 0.04 (20/20) at 2 months after FLP (P = .0005). CONCLUSION: FA-free, OCT-guided navigated FLP is an effective and safe option to treat a significant number of patients with CSC. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e118-e124.].

A pilot prospective study of 577-nm yellow subthreshold micropulse laser treatment with two different power settings for acute central serous chorioretinopathy.

To compare the efficacy of 50% threshold power with 25% threshold power of 577-nm subthreshold micropulse laser (SMPL) for acute central serous chorioretinopathy (CSC). Prospective, interventional, non-randomized, comparative case series. A total of 54 patients (54 eyes) with acute CSC were enrolled. Twenty-four eyes received 25% threshold power and 30 eyes received 50% threshold power of 577-nm SMPL. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and complete absorption of subretinal fluid (SRF) were evaluated at 1 month and 3 months. The complete absorption rate of SRF in the 50% power group was significantly greater than that in the 25% power group at 1 month (70.0% vs 25.0%, p < 0.001) and at 3 months (83.3% vs 54.2%, p < 0.001). Mean BCVA improved from 0.34 ± 0.20 LogMAR to 0.02 ± 0.13 LogMAR in the 50% power group and from 0.27 ± 0.15 LogMAR to 0.14 ± 0.21 LogMAR in the 25% power group with a significant difference between the two groups after 3 months (p = 0.027). In the 50% power group, the CMT decreased from 491.6 ± 154.8 µm at baseline to 231.3 ± 92.3 µm at 1 month and 228.2 ± 88.1 µm at 3 months, and in the 25% power group, the CMT decreased from 444.9 ± 164.1 to 306.8 ± 102.6 µm at 1 month and 254.5 ± 101.7 µm at 3 months. There was statistical difference of CMT at 1 month (p = 0.009) but no significant difference at 3 months between the two groups (p = 0.232). SMPL with 50% threshold power may be more effective than 25% threshold power for acute CSC.

Navigated laser photocoagulation in patients with non-resolving and chronic central serous chorioretinopathy.

PURPOSE: To evaluate the efficacy of navigated focal laser photocoagulation in patients with chronic central serous chorioretinopathy (CSCR) and active leakage on fluorescein angiography (FA). METHODS: Thirty-two eyes of 32 patients (age 48 ± 11, m/f = 24/8) with persistent or recurrent CSCR (> 3 months) who received navigated laser photocoagulation (Navilas®) of leaking point(s) between June 2013 and 2016 were included in this retrospective case series. Outcome parameters after 4 weeks and 3 months were the number of patients presenting with complete resolution of subretinal fluid, the volume of subretinal fluid measured on SD-OCT (Spectralis Heidelberg Engineering©), and best corrected visual acuity (BCVA/ (Snellen equivalent). RESULTS: Complete resolution of subretinal fluid was achieved in 17 eyes (50%) after 4 weeks and in 24 eyes (75%) after 3 months with an average number of 1.3 laser procedures (range 1-3). Five eyes displayed a nearly complete resolution with a reduction of over 80% of the subretinal fluid compared to baseline. Three eyes showed no reduction in subretinal fluid. BCVA improved from median 0.58 (range 0.16-1.25) to 0.66 (0.16-1.0) (p = 0.001). The seven patients who had been treated within the central 1 mm of the ETDRS-OCT Grid but outside the avascular foveal zone showed an improvement of BCVA from median 0.6 (range 0.2-1.0) to 0.8 (0.2-1.0). No patient experienced a treatment-induced visual loss. CONCLUSIONS: Laser treatment with Navilas® using eye tracking and FA-based planning is a safe and effective alternative therapy in patients with chronic CSCR.

Yellow (577 nm) micropulse laser versus half-dose verteporfin photodynamic therapy in eyes with chronic central serous chorioretinopathy: results of the Pan-American Collaborative Retina Study (PACORES) Group.

PURPOSE: To compare the functional and anatomical outcomes of eyes with chronic central serous chorioretinopathy treated with yellow micropulse (MP) laser versus half-dose verteporfin photodynamic therapy (PDT). METHODS: This is a multicentre, retrospective comparative study of 92 eyes treated with yellow MP laser (duty cycle of 5%, zero spacing between spots, spot size varied from 100 to 200 µm, power varied from 320 to 660 mW, and the pulse burst duration was 200 ms) and 67 eyes treated with PDT (half-dose verteporfin (3 mg/m2) infused over 10 min), followed by laser activation for 83 s. Spot sizes varied from 400 to 2000 µm. RESULTS: In the MP group, at 12 months of follow-up, the mean best corrected visual acuity (BCVA) improved from the logarithm of the minimum angle of resolution (logMAR) of 0.41±0.27 at baseline to 0.21±0.26 (P<0.0001), 48.9% (45/92) of eyes had an improvement of ≥3 lines of BCVA from baseline, 48.9% (45/92) of eyes remained within 2 lines of baseline BCVA, and only 2.2% (2/92) of eyes lost ≥3 lines of BCVA from baseline. In the PDT group, at 12 months of follow-up, the mean BCVA changed from logMAR of 0.50±0.34 at baseline to 0.47±0.34 (P=0.89), 19% (13/67) of eyes had an improvement of ≥3 lines of BCVA from baseline, 73% (49/67) of eyes remained within 2 lines of baseline BCVA, and 7% (5/67) of eyes lost ≥3 lines of BCVA from baseline. There were no adverse events attributable to the yellow MP laser treatment. One eye in the PDT group developed choroidal neovascularisation, which was treated with three intravitreal bevacizumab injections. CONCLUSIONS: Both PDT and MP are effective in restoring the macular anatomy. In places where PDT is not available, yellow MP laser may be an adequate treatment alternative.

Topography-guided identification of leakage point in central serous chorioretinopathy: a base for fluorescein angiography-free focal laser photocoagulation.

PURPOSE: To identify optical coherence tomography (OCT) findings associated with the leakage points in patients with central serous chorioretinopathy (CSC) to provide fluorescein angiography (FA)-free focal laser photocoagulation (FLP) of the leakage point. METHODS: A retrospective study included 48 patients with CSC (48 eyes). Colocalisation of leakage points with pigment epithelial detachments (PEDs) and with areas of photoreceptor outer segments (PROS) layer thinning was evaluated with OCT. Using FA for each leakage point, the relationship to neurosensory detachment was evaluated with retro-mode confocal scanning laser ophthalmoscopy. RESULTS: Coincidence with PED was found in 52 of 65 (80.0%) leakage points. The PROS thinning was found in 47 of 52 (90.4%) of the PEDs coincided with leakage point. The mean distance from the upper border of neurosensory detachment to the leakage point was 27.3%±13.0% of the vertical dimension of the neurosensory detachment. CONCLUSION: This study demonstrates that PEDs localised in the upper half of the neurosensory detachment area and associated with the PROS thinning area coincided with the leakage point in a significant number of patients with CSC. The patients with non-resolving CSC with a small single PED localising in the upper one-third to one-half of the neurosensory detachment area with an area of PROS thinning above this PED may undergo FA-free OCT-guided FLP treating whole PED.

SUBFOVEAL CHOROIDAL THICKNESS AND VASCULAR DIAMETER IN ACTIVE AND RESOLVED CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: To determine the subfoveal choroidal thickness and analyze Haller's layer, Sattler's layer, and large choroidal vessel diameter in eyes with active central serous chorioretinopathy (CSC) and after resolution of CSC. METHODS: Ocular and clinical features of 32 eyes with CSC were analyzed retrospectively from October 2014 to September 2015. Subfoveal choroidal thickness and thicknesses of Haller's layer and Sattler's layer were measured in the active and resolved states. The diameter of the subfoveal choroidal hyporeflective lumen (i.e., the large choroidal vessel in Haller's layer) was also measured. RESULTS: The mean subfoveal choroidal thickness, mean thickness of Haller's layer, and mean choroidal vessel diameter were significantly less after the resolution of CSC (P < 0.001). However, the thickness of Sattler's layer did not change after the resolution of CSC (P = 0.731). There were no significant differences among the different treatment modalities. CONCLUSION: After the resolution of CSC, the subfoveal choroidal thickness and thickness of Haller's layer declined, but the reduced diameter of subfoveal choroidal vessels accounted for only about half of the total thickness changes in the choroid. These results suggest that nonvascular smooth muscle cells might play a role in the thickening of the choroid during CSC and possibly in the pathogenesis and progression of CSC.

Acute uveal effusion during phacoemulsification with preoperative central serous chorioretinopathy: a case report.

BACKGROUND: We report a case of acute uveal effusion during phacoemulsification in an eye with preoperative chronic central serous chorioretinopathy (CSC). CASE PRESENTATION: A 55-year-old man with a history of chronic CSC for >18 months presented with bilateral opaque lenses. A preoperative ophthalmic examination showed suspected lenticonus and risky anatomical features, including a thick ciliary body, and anterior rotation of the ciliary process and iris root in both eyes. Optical coherence tomography (OCT) detected CSC in the left eye, but the results of fundus photography and B-scan ultrasonography were unremarkable. The anterior chamber flattened during phacoemulsification. Anterior vitrectomy was quickly performed for suspected infusion misdirection syndrome, and was followed by uneventful surgery. On postoperative day 1, fundus photography, type B ultrasound, and OCT revealed uveal exudation in the macula of the left eye. On postoperative day 50, the patient's visual acuity recovered to 20/32, and fundus photography, ultrasonography, and OCT revealed complete resolution of the uveal effusion. CONCLUSIONS: This case suggests an association between preoperative CSC and uveal effusion during surgery, because choroidal hyperperfusion and hyperpermeability were present in the patient's CSC-affected eyes.