Clinical Landscape of Central Serous Chorioretinopathy in Germany: Retina.net CSC Registry Report Number 1.

INTRODUCTION: The German Registry of central serous chorioretinopathy (CSC) collects data on CSC patients in a nationwide multicenter approach to analyze epidemiology, risk factors, clinical presentations, as well as diagnosis and treatment patterns. METHODS: In this multicenter cohort study, patients with CSC were enrolled in nine tertiary referral centers in Germany between January 2022 and June 2023. After consenting to the study, demographic data, risk factors, reported symptoms, best-corrected visual acuity (BCVA), funduscopic findings, disease severity, and diagnostic and treatment decisions were recorded and analyzed. RESULTS: A total of 539 eyes of 411 CSC patients were enrolled in this study including 308 males (75%) and 103 females (25%). Patients were predominantly of Caucasian origin and had a mean age of 55.5 years (IQR 41.0-70.0). 28% of eyes were classified as acute (<4 months duration) CSC, 28% as chronic (>4 months duration) CSC, 21% as inactive CSC, 11% as chronic atrophic CSC, and 12% as CSC with secondary CNV. 128 patients (31%) demonstrated bilateral CSC. The most common risk factors reported were psychological stress (52%), smoking (38%), arterial hypertension (38%), and a history of or current use of steroids (30%). Most frequently encountered symptoms included decreased visual acuity (76%), metamorphopsia (49%), relative scotoma (47%), blurred vision (19%), and dyschromatopsia (9%). The mean logMAR BCVA on initial examination was 0.2 (≈20/30, IQR 0.2-0.4) but showed significant variation with a tendency of lower BCVA in chronic cases. At the baseline visit, 74% of the overall cohort received no treatment, while 19% underwent local treatment and only 2% underwent systemic treatment. Of the local therapies, anti-VEGF injections were the most frequently performed procedure (33%, mainly for secondary CNV), followed by micropulse laser (28%), focal nonpulsed laser (23%), verteporfin photodynamic therapy (14%), and nonsteroidal anti-inflammatory eye drops (2%). Among intravitreal anti-VEGF agents, aflibercept was used most frequently, followed by bevacizumab and ranibizumab. CONCLUSION: This registry represents one of the largest cohorts of European patients with CSC to date. Patient age and the proportion of women were higher than expected and bilateral active disease was lower than anticipated, highlighting that neither age nor gender should be overemphasized when diagnosing CSC. Therapeutic interventions are heterogeneous and include verteporfin photodynamic therapy, micropulse laser, and anti-VEGF injections in case of secondary CNV.

Subaxial Cervical Spine Injury in the Elderly and Treatment-Related Mortality - Anterior or Posterior Approach. / Subaxiale Halswirbelsäulenverletzungen des alten Menschen und therapiebedingte Mortalität ­ sind ventrale oder dorsale Operationsverfahren besser?

BACKGROUND: Subaxial cervical spine injury especially in the elderly can be associated to severe complications and disability. Until today there is no consensus concerning the best operative treatment. A potential superiority of anterior or posterior fixation is the subject of controversial discussions. OBJECTIVES: The aim of this study was to compare the outcome of anterior and posterior fixation after subaxial cervical spine trauma in the elderly focussing on the postoperative mortality. MATERIAL AND METHODS: A retrospective cohort analysis was performed to analyse the data of 43 patients. Especially mortality data were collected. RESULTS: A total of 43 patients was identified. Anterior fixation was performed in 21 patients, posterior fixation was performed in 22 patients. There were no significant differences between these groups. Although statistical significance was not reached, a slightly higher mortality was found among patients undergoing anterior fixation (52,4 vs. 31,8%). Furthermore the male sex, a higher age, translation injuries, long duration of operation and hospitalisation as well as postoperative complications were slightly associated to a higher mortality. CONCLUSIONS: Subaxial cervical spine trauma is associated to a high mortality in the elderly. Although neither anterior nor posterior fixation could show a significant superiority, every surgical decision making should be performed individually for each patient balancing the advantages and disadvantages of each method.