Choroidal vascularity index as an activity criterion and a treatment response measure in chronic central serous chorioretinopathy.

PURPOSE: This study aimed to evaluate the choroidal vascularity index (CVI) as an activity criterion in chronic central serous chorioretinopathy (CSC) and as a measure of treatment response after full-dose-full-fluence photodynamic therapy (fd-ff-PDT). METHODS: This fellow-eye-controlled, retrospective cohort study included 23 patients with unilateral chronic CSC treated with fd-ff-PDT (6 mg/m2 ; 50 µcm2 ; 83 s). Subfoveal choroidal thickness (SFCT, µm) and CVI (%) of the affected and fellow eyes at baseline as well as at 1, 3 and 6 months after fd-ff-PDT were compared. RESULTS: The patients' mean age was 43.4 ± 7.3 years, and 18 (78.3%) were male. CVI was comparable between the affected and fellow eyes at baseline (66.09 ± 1.56 vs. 65.84 ± 1.57, p = 0.59). However, it became significantly lower in the affected eyes 1 (64.45 ± 1.68 vs. 65.87 ± 1.19, p = 0.002), 3 (64.21 ± 2.08 vs. 65.71 ± 1.59, p = 0.009) and 6 (64.47 ± 2.19 vs. 65.62 ± 1.52, p = 0.045) months after fd-ff-PDT. The mean SFCT and the mean CVI were significantly decreased in the affected eyes at all follow-up visits compared with baseline after fd-ff-PDT (p < 0.001). CONCLUSION: At baseline, CVI was comparable between affected and fellow eyes. Therefore, its use as an activity criterion in chronic CSC patients is questionable. However, it was significantly decreased in fd-ff-PDT-treated eyes, supporting its role as a measure of treatment response in chronic CSC.

Effect of short-term meditation training in central serous chorioretinopathy.

PURPOSE: Stress and Type A personality are established risk factors for the development of central serous chorioretinopathy (CSC). Meditation is known to have a positive effect on reducing stress levels. This study aimed to assess the effect of short-term meditation training in patients of CSC. METHODS: A pilot study was conducted where 40 patients diagnosed with acute and non-resolving CSC were randomly assigned to either of two groups - meditation training and routine care (without meditation). The primary outcome measure was time to resolution of CSC based on optical coherence tomography and fluorescein angiography. Secondary outcome measures were changes in anxiety score (State-Trait Anxiety Inventory [STAI] scores) and blood pressure. The patients were followed up for a minimum period of 4 months. RESULTS: Twenty cases were included in each group. The demographic pattern, baseline swept-source optical coherence tomography parameters, and STAI scores were similar in both groups. The time to disease resolution was 9.4 ± 4.22 weeks in the meditation group and 19.5 ± 2.79 weeks in the nonmeditation group (P < 0.001). At 4 months, CSC had failed to resolve in 60% of patients with routine care compared with 8% in cases following short-term meditation training. STAI scores showed a reduction in stress levels in the meditation group. Furthermore, statistically significant improvement in systolic and diastolic blood pressures was also observed following meditation training. CONCLUSION: Short-term meditation training may be a useful approach in the management of patients with CSC as it tends to reduce stress and prehypertension, and promotes earlier resolution of the condition. However, patient's motivation to complete and pursue the meditation training is a significant barrier.

Low Fluence Photodynamic Therapy Versus Graded Subthreshold Transpupillary Thermotherapy for Chronic Central Serous Chorioretinopathy: Results From a Prospective Study.

BACKGROUND AND OBJECTIVE: The authors compare low fluence photodynamic therapy (PDT) against graded subthreshold transpupillary thermotherapy (TTT) for chronic central serous chorioretinopathy (CSC). PATIENTS AND METHODS: Forty-two eyes of 42 patients with chronic CSC were included in this prospective, nonrandomized, interventional trial. All patients were offered PDT as an initial intervention. If they declined PDT, TTT was offered. RESULTS: Twenty patients underwent PDT and 22 underwent TTT. The difference in best-corrected visual acuity between the TTT and PDT groups at baseline and at 6 months after treatment was not significant (P = .728). The mean foveal thickness decreased significantly in both groups (P = .001). However, patients in the TTT group required more treatments (P = .013) and longer time for resolution of the CSC (P = .013). CONCLUSIONS: Both PDT and TTT may be equally effective in the treatment of chronic CSC. Graded subthreshold TTT may be a cost-effective and safe alternative for PDT. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:334-338.].

Acupuncture for chronic central serous chorioretinopathy: a prospective case series.

OBJECTIVE: The aim of this prospective observational study was to evaluate the effects of acupuncture at Erjian on chronic central serous chorioretinopathy (CSC). STUDY DESIGN: Prospective case series. METHODS: Nine patients with chronic CSC were recruited and each patient received 12 sessions of acupuncture treatment. Subjective symptom measures included complications, best-corrected visual acuity (BCVA), fluorescein leakage (via fluorescein fundus angiography), and central subfield foveal subretinal fluid (on optical coherence tomography (OCT)) at 3 months. Successful treatment was defined as the complete resolution of subretinal fluid observed by the OCT following completion of treatment. RESULTS: After 2 months of treatment, two patients showed improvements in visual acuity, a significant reduction in subretinal fluid and an improvement in BCVA to 0.5±0.10 (mean±SD). By contrast, four patients experienced no significant changes. After 3 months of treatment, four patients showed improvements in visual acuity and complete resolution of the subretinal fluid (mean BCVA=0.6), while parameters in two patients remained unchanged. Compared to baseline (before treatment), the proportions of patients experiencing visual improvement at 2 and 3 months were 33% (n=2) and 67% (n=4), respectively. No major complications were observed during the treatment course. CONCLUSIONS: Acupuncture might be a promising supplementary therapy for patients with CSC. However, this is ultimately only an exploratory study with a small sample size and no untreated comparator group to control for the natural history of the condition. Randomised controlled trials will be needed to demonstrate the efficacy and effectiveness of this approach.

Graded subthreshold transpupillary thermotherapy for chronic central serous chorioretinopathy.

BACKGROUND AND OBJECTIVE: To study the safety and efficacy of "graded" subthreshold transpupillary thermotherapy (TTT), a novel treatment protocol for chronic central serous chorioretinopathy (CSC) and an alternative to photodynamic therapy (PDT). PATIENTS AND METHODS: This retrospective pilot study included 10 eyes with chronic CSC that underwent TTT with 810-nm continuous diode laser treatment using a subthreshold power (60% reduced from threshold) for 60 seconds. Treatment was repeated at 20% increase in power from the baseline if submacular fluid persisted on optical coherence tomography (OCT) after 1 month (graded fashion). RESULTS: The mean chronic CSC duration was 20.3 ± 8.3 months. Eight eyes (80%) showed resolution of CSC on OCT. Mean number of TTT sittings required was 1.5. Although 5 eyes (50%) had 3 or more lines of improvement in Snellen visual acuity, 3 eyes (30%) had up to 2 lines of improvement. None of the patients developed macular burn or scar. CONCLUSION: The safety enhanced graded subthreshold TTT was beneficial in patients with chronic CSC.

Tratamiento de coriorretinopatía serosa central crónica mediante terapia fotodinámica de baja fluencia / Low-fluence photodynamic therapy in chronic central serous chorioretinopathy

Objetivo: Evaluar la seguridad y la eficacia en términos de agudeza visual (AV) y morfología macular mediante tomografía de coherencia óptica (OCT) de la aplicación de terapia fotodinámica de baja fluencia (LFPDT) con verteporfina en pacientes afectos de coriorretinopatía serosa central crónica (CCSC). Método: Análisis retrospectivo e intervencionista de casos consecutivos, no aleatorizados. Se siguieron un total de 16 ojos de 15 pacientes afectos de CCSC tratados con LFPDT. Se evaluaron mejor agudeza visual corregida (MAVC) mediante escala de optotipos ETDRS y grosor foveal central (CFT) en OCT como indicadores de resultados. Resultados: El seguimiento medio fue de 10,8 meses. La MAVC media mejoró de 58,125 a68,68 letras ETDRS, y el CFT se redujo de 280,5 a 172,18 micras, con desaparición del fluido subretiniano en 14 de los casos (87,5%), en 2 de ellos tras una segunda aplicación de LFPDT.No se registraron complicaciones asociadas al tratamiento. Conclusiones: LFPDT con verteporfina puede ser útil en CCSC para estabilizar o mejorar MAVCy reabsorber el fluido subretiniano y reducir el CFT. Se requieren estudios aleatorizados con seguimiento más prolongado para confirmar el papel de este tratamiento y optimizar losparámetros que permitan mayor eficacia y seguridad en su aplicación en pacientes afectos de CCSC(AU)

Objective: To evaluate safety and efficacy of low-fluence photodynamic therapy (LFPDT) withverteporfin in patients affected with chronic central serous chorioretinopathy (CCSC), interms of visual acuity (VA) and macular morphology measured with optical coherencetomography (OCT). Methods: A retrospective, nonrandomized and interventionist analysis was performed on16 eyes in 15 patients with CCSC treated with LFPDT. Best corrected visual acuity (BCVA) with ETDRS optotypes and central foveal thickness (CFT) in OCT were evaluated as outcomemeasures. Results: The mean follow-up was 10.8 months. The mean BCVA improved from 58.12 to 68.68 ETDRS letters, and CFT decreased from 280.5 to 172.18 microns, with subretinal fluidresolution in 14 eyes (87.5%), two of them after a second LFTPD. No complications related to treatment were recorded. Conclusions: LFPDT with verteporfin can be useful in CCSC to stabilise or improve BCVA, reabsorb subretinal fluid and reduce CFT. Randomised studies with a longer follow-up are required to assure the role of this treatment and to optimise parameters for higher efficacy and safety in CCSC patients(AU)