Plasma metabolomic profiling of central serous chorioretinopathy.

Our study aimed to investigate metabolites alterations in the blood plasma of central serous chorioretinopathy (CSC) patients and to identify the key biomarkers to increase the understanding of the mechanism of CSC at the molecular level. Quantitative and targeted metabolomics using liquid chromatography tandem-mass spectrometry (LCMS, Biocrates P500) assays were performed on plasma samples from the 42 subjects(CSC patients = 30, control = 12) enrolled at the Department of Ophthalmology of People's Hospital Peking University. A total of 61 altered metabolites were distinguished between CSC patients and controls. Taurine was selected as a candidate biomarker for CSC among 6 potential metobolites: taurine, glutamic acid, sarcosine, lactic acid, glutamine and C18_1. The P values of these potential metabolites were 1.01E-06, 7.35E-08, 1.27E-24, and 1.85E-10, 1.02E-05 and 8.59E-08, and the areas under the curve for them were 0.926, 0.991, 1.000, 0.900, 0.897 and 0.841, respectively. This study is the first to identify that taurine may be a biologically relevant biomarker for CSC and to provide a novel understanding of CSC.

The relationship between the central serous chorioretinopathy, choroidal thickness, and serum hormone levels.

PURPOSE: The purpose of this study were to compare the levels of serum cortisol, aldosterone, testosterone, dehydroepiandrosterone (DHEA), and renin hormone between patients with central serous chorioretinopathy (CSC) and a control group, and to investigate whether there was a difference regarding serum hormone levels in patients with acute/chronic CSC. METHODS: This prospective study included 30 CSC eyes, 30 fellow eyes, and 32 normal eyes of 32 healthy volunteers who were age and sex matched. The patients were classified as acute or chronic depending on the clinical, fluorescein angiography (FFA), and optical coherence tomography (OCT) findings. Serum cortisol, aldosterone, renin, total testosterone, and DHEA levels were measured. The levels of hormones were compared with the values of the control group. Choroidal thickness and central macular thickness were measured with spectral domain OCT. RESULTS: Fifteen patients had acute CSC, and 15 patients had chronic CSC. Serum testosterone levels were 357 ± 10.4 ng/ml in the CSC group, and 255.94 ± 7.43 ng/ml in the control group. The difference between them was statistically significant (p < 0.001). The difference between the levels of cortisol, renin, aldosterone, and DHEA was not statistically significant. Serum hormone levels were within the normal range for all patients and were not statistically different between the acute and chronic CSC groups. CONCLUSION: According to our results, CSC is related to elevated total testosterone levels. Testosterone may play a role in predisposing males to CSC.

The relation of somatotypes and stress response to central serous chorioretinopathy.

PURPOSE: To investigate a possible relationship between central serous chorioretinopathy (CSC) and specific body types and compositions (somatotypes), and to examine the cortisol stress response among CSC patients of different somatotypes in comparison with healthy subjects. METHODS: Prospective case-control study. A group of 28 patients with a previous or current diagnosis of CSC was compared with a group of 26 healthy subjects. Anthropometric measurements were used to estimate somatotype ratings in all subjects. Serum cortisol was measured at rest and following a stress-inducing computerized test in order to estimate response to stress in both groups. The main outcome measures included somatotype categorization and the change in serum cortisol following stress in both groups. RESULTS: No significant difference in somatotype composition was found between the groups. There was no statistically significant difference between the groups in the elevation of cortisol following the stress-inducing test. The sample size was too small to exclude or find any significant difference between the different 13 subgroups of somatotype composition in the elevation of cortisol. CONCLUSIONS: Our study did not show a typical somatotype related to CSC. While previous studies showed higher cortisol values in CSC patients, we did not see a higher elevation in blood cortisol following a stress response in this group in comparison with healthy subjects.

Relationship between mean platelet volume and central serous chorioretinopathy.

The aim of this study was to investigate the mean platelet volume (MPV) of patients with central serous chorioretinopathy (CSCR). Thirty patients were included in the study. Thirty healthy volunteers were recruited as the control group. All patients and control subjects underwent complete ocular examination. Hemoglobin, hematocrit, white blood cell, neutrophil, lymphocyte, platelet count, and MPV of the participants were recorded. Data of patients with CSCR were compared with the control subjects. Patients with CSCR had significantly higher MPV values (9.76 ± 1.36 fL) compared with the control subjects (8.37 ± 0.72 fL) (p = 0.004). No significant difference was found in platelet counts between the CSCR group and the control group (259 ± 53.75 and 243 ± 52.11 K/Ul, p = 0.253). According to the receiver operator characteristics curve analysis, the optimal cut-off value of MPV to predict the CSCR was >9.4, with 60.0 % sensitivity and 93.3 % specificity. Our results demonstrated that the MPV values were significantly higher in patients with CSCR. MPV may be used as a predictive tool for identifying risk for CSCR.

Central serous chorioretinopathy and systemic corticosteroids in rheumatic diseases: report of three cases.

BACKGROUND: Central serous chorioretinopathy is a disorder often related to systemic corticosteroids, drugs commonly used in rheumatologists' clinical practice. Central serous chorioretinopathy prognosis is generally good but in some cases, it may lead to substantial loss of vision resulting in an important functional limitation for patients. It is very important to distinguish this pathology from other diseases involving retinal detachment. When central serous chorioretinopathy and uveitis coexist, it is mandatory to distinguish serous retinal detachment from a uveitis worsening, as the respective treatments can be radically different. CASE PRESENTATION: We describe three cases of central serous chorioretinopathy in patients taking systemic corticosteroids due to rheumatological diseases (ankylosing spondylitis, systemic lupus erythematosus and Behçet's disease). They were diagnosed and managed at our Multidisciplinary (Rheumatology-Ophthalmology) Uveitis Clinic. All three cases improved after corticosteroids dose tapering. CONCLUSION: Central serous chorioretinopathy must be kept in mind by rheumatologists as it is related to systemic corticosteroids.

Serum dehydroepiandrosterone sulphate, total antioxidant capacity, and total oxidant status in central serous chorioretinopathy.

BACKGROUND: The objective of this work is to evaluate plasma total antioxidant capacity (TAC), total oxidant status (TOS), and dehydroepiandrosterone sulphate (DHEA-S) levels in patients diagnosed with acute central serous chorioretinopathy (CSCR) and control samples. METHODS: The TAC, TOS, and DHEA-S levels were assessed in the plasma of 46 CSCR patients and compared with 40 control samples. RESULTS: The TAC level was 1.16 ± 0.08 and 1.20 ± 0.09 mmol Trolox eq./l; TOS level was 28.77 ± 33.33 and 19.95 ± 10.42 µmol H202/l; DHEA-S level was 203.79 ± 84.75 µg/dl and 249.36 ± 122.93 µg/dl in the CSCR group and in the control group, respectively. The plasma TAC and DHEA-S values were significantly lower in the CSCR group than in the control group (p = 0.027 and p = 0.046, respectively). There was no significant difference between the CSCR and the control groups in terms of age, gender, and TOS levels (p > 0.05). CONCLUSIONS: We demonstrated that the levels of plasma DHEA-S and antioxidative parameters were reduced in CSCR. Our results suggest that the antioxidant defense system may be inadequate or corrupted in CSCR. Reduced DHEA-S level is one of the factors that trigger this insufficiency.

Serum cortisol and testosterone levels in chronic central serous chorioretinopathy.

PURPOSE: To investigate the potential role of serum cortisol and testosterone levels in chronic central serous chorioretinopathy (CSC). MATERIAL AND METHODS: Serum cortisol and testosterone levels of six male patients with chronic CSC were evaluated by chemiluminescent immunassay. Hormone levels were compared with the normal reference values of healthy people. RESULTS: All patients were male, and the median age was 48 years (range: 42-54). The median duration of visual disturbance at presentation was 23 months (range: 12-48). Median 8:00 a.m. serum cortisol level was 11.6 µg/dl (min. 4.74, max. 18.3) and the cortisol levels were within the normal range in five of the six patients. All patients had normal serum testosterone levels, with a median value of 549.5 ng/ml (min. 246, max. 794). CONCLUSION: Serum cortisol and testosterone levels were within normal ranges and in patients with chronic CSC. The association between these hormones and chronic CSC might be weak.

Altered plasma cytokine levels in acute and chronic central serous chorioretinopathy.

PURPOSE: To evaluate plasma levels of selected cytokines and investigate their correlation with choroidal thickness (CT) in patients with acute and chronic central serous chorioretinopathy (CSC). METHODS: We enrolled 30 patients with acute CSC, 30 patients with chronic CSC and 20 controls. Plasma concentrations of 12 cytokines, interleukins IL-8, IL-1ß, IL-2, IL-4, IL-5, IL-6, IL-10 and IL-12 p70, granulocyte-macrophage colony-stimulating factor, interferon-γ, tumour necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF), were measured using multiplex immunoassays. Differences in cytokine levels between groups were assessed. We also investigated correlations between cytokine levels and CT using swept-source optical coherence tomography, as well as an association between plasma cytokine profile and systemic hypertension. RESULTS: We noted differences in IL-6 (p = 0.005), IL-10 (p = 0.03), IL-12 p70 (p = 0.028) and VEGF (p = 0.029) levels between groups. Pro-inflammatory IL-12 p70 and multidirectional IL-10 cytokines were upregulated, while pro-angiogenic VEGF was downregulated in chronic CSC as compared with controls (p = 0.005, p = 0.025 and p = 0.027, respectively). Interleukin-6 (IL-6) was upregulated in acute and chronic CSC (p = 0.030 and p = 0.005, respectively). Interleukin-5 (IL-5), IL-6 and IL-12 levels correlated with mean CT in acute CSC (p = 0.008, p = 0.003 and p = 0.044, respectively), while IL-8, IL-6 and TNF-α plasma levels correlated with hypertension in chronic CSC (p = 0.005, p = 0.033 and p = 0.001, respectively). CONCLUSION: We provided new evidence for the possible role of plasma cytokines in the pathogenesis of CSC. Our results suggest that IL-6 may be important in the pathophysiology of acute and chronic CSC. The association between inflammatory response and hypertension in patients with CSC was also confirmed.

Aqueous humor and plasma levels of vascular endothelial growth factor and interleukin-8 in patients with central serous chorioretinopathy.

PURPOSE: The purpose of this study was to determine aqueous vascular endothelial growth factor (VEGF) and interleukin-8 (IL-8) levels in patients with central serous chori-oretinopathy (CSC) before a single intravitreal bevacizumab injection. METHODS: Twelve eyes with symptomatic CSC were included. Samples from patients with cataracts served as controls. The levels of VEGF and IL-8 concentrations were measured in aqueous humor and plasma by multiplex bead assays. RESULTS: All patients with CSC showed an improvement in visual acuity and resolved neurosensory detachment after intravitreal bevacizumab injection. The aqueous humor levels of VEGF and IL-8 were not significantly increased in patients with CSC compared with the healthy control group (18.2 ± 24.8 vs. 35.3 ± 28.5 pg/mL, P > 0.05; 2.3 ± 0.4 vs. 2.8 ± 0.3 pg/mL, P > 0.05, respectively). The plasma levels of VEGF and IL-8 in patients with CSC were not different from those in the healthy control group. CONCLUSION: Vascular endothelial growth factor and IL-8 were not increased in the aqueous humor and plasma of patients with CSC. The effect of intravitreal bevacizumab injection as a treatment for CSC must be fully understood, and the true effect of anti-VEGF treatment in patients with CSC remains to be elucidated.

Lipocalin 2 as a potential systemic biomarker for central serous chorioretinopathy.

No systemic biomarker of Central Serous Chorioretinopathy (CSCR) has been identified. Lipocalin 2 (LCN2 or NGAL), alone or complexed with MMP-9 (NGAL/MMP-9), is increased in several retinal disorders. Serum levels of LCN2 and NGAL/MMP-9 were measured in CSCR patients (n = 147) with chronic (n = 76) or acute/recurrent disease (n = 71) and in age- and sex-matched healthy controls (n = 130). Samples with CRP > 5 mg/L, creatinine > 100 µmol/L, and/or urea > 7.5 mmol/L were excluded. Serum LCN2 was lower in CSCR patients than controls (81.4 ± 48.7 vs 107.3 ± 44.5 ng/ml, p < 0.0001), and lower in acute/recurrent CSCR than controls (p < 0.001) and chronic CSCR (p = 0.006). Serum NGAL/MMP-9 was lower in CSCR patients than controls (47.2 ± 40.7 vs 74.1 ± 42.6, p < 0.0001), and lower in acute/recurrent CSCR than controls (p < 0.001) and chronic CSCR (p = 0.002). A ROC curve showed that for LCN2 serum levels, the 80-ng/ml cutoff value allows to discriminate acute/recurrent CSCR from controls with 80.3% sensitivity and 75.8% specificity, and for NGAL/MMP-9 serum levels, a 38-ng/ml cutoff value allows to discriminate acute/recurrent CSCR from controls with 69.6% sensitivity and 80.3% specificity. In both acute and chronic CSCR, low serum LCN2 and NGAL/MMP-9, provide a biological link between the two CSCR forms, and potential susceptibility to oxidative stress and innate immune dysregulation in CSCR.

Elevated Steroid Hormone Levels in Active Chronic Central Serous Chorioretinopathy.

Purpose: Chronic central serous chorioretinopathy (cCSC) is characterized by fluid accumulation between photoreceptors and the retinal pigment epithelium of which the cause is unknown. Associations with steroid use, stress, pregnancy, and the male sex suggest a role for the steroid hormone system in the disease. Here, we performed a comprehensive analysis of the steroid hormone system in active cCSC. Methods: Serum hormone levels of 17 steroid hormones were measured in 46 male Caucasian patients with active cCSC and 46 male Caucasian age-matched controls using the AbsoluteIDQ stero17 kit. Results: Elevated levels of androsterone, estrone, etiocholanolone, and androstenedione were observed in cCSC patients compared with controls. Median hormone levels in cCSC patients versus controls, respectively, were as follows: androsterone, 0.84 ng/mL (interquartile range [IQR] = 0.61-1.06) versus 0.69 ng/mL (IQR = 0.48-0.96, P = 0.031); estrone, 0.12 ng/mL (IQR = 0.10-0.15) versus 0.10 ng/mL (IQR = 0.08-0.11; P = 0.0048); etiocholanolone, 0.19 ng/mL (IQR = 0.15-0.29) versus 0.13 ng/mL (IQR = 0.099-0.20, P = 0.0061). Mean levels of androstenedione were 3.10 ng/ml (SD = 1.03) versus 2.55 ng/mL (SD = 0.95), in cCSC patients versus controls, respectively. Additionally, Spearman's correlations between aldosterone and 11-deoxycortisol, androsterone, DHEA, DHEAS, and E1 differed between cCSC patients and controls, as well as between andosterone and E1, and between DHT and 17OHP. Conclusions: We present a comprehensive overview of the status of the steroid hormone system in active cCSC. Levels of four hormones were elevated in cCSC patients compared with controls, and the relationships between steroid hormones was altered, indicating that the balance in the steroid hormone system is altered in cCSC patients.

An unusual case of multifocal central serous chorioretinopathy with low serum cortisol managed using eplerenone.

In this report, we describe a rare case of a 44-year-old Asian male with acute central serous chorioretinopathy (CSC) with bullous exudative retinal detachment. Endocrinology evaluation revealed hypothalamic-pituitary-adrenal axis suppression with low serum cortisol. Furthermore, neuroimaging revealed the presence of a pituitary microadenoma. He was treated with systemic eplerenone and hydrocortisone. After 12 weeks, bullous detachment completely resolved. Our case is a unique description of acute CSC with underlying low serum cortisol levels that responded to treatment with mineralocorticoid antagonist. This case highlights the various endocrine abnormalities other than the raised serum cortisol that can occur in patients with CSC.

Can Hypothyroidism Cause Acute Central Serous Chorioretinopathy?

Purpose: To evaluate selected systemic findings, especially thyroid functions, in acute central serous chorioretinopathy (CSC) patients.Materials and Methods: In all, 71 consecutive acute CSC patients who fulfilled the inclusion criteria and 70 age-matched healthy control subjects were included in the study. Systemic findings, including serum levels of thyroid hormones, thyroid stimulating hormone (TSH), mean arterial pressure (MAP), pulse rate, serum lipid levels and optical coherence tomography findings, were compared between the groups. Independent samples t-test was used for statistical analysis.Results: The mean ages of the CSC and control groups were 41.06 ± 6.49 and 40.06 ± 7.08 years old, respectively. Retinal thickness, choroidal thickness, TSH levels, pulse rate and MAP were significantly different between CSC patients and healthy control subjects (range of p values: <0.001-0.042). In the logistic regression analysis, MAP, serum triglyceride concentration and central choroidal thickness were positively associated with CSC (range of p values: <0.001-0.035).Conclusion: Acute CSC patients had significantly higher pulse rates and MAP and significantly thicker choroidal thickness than were found in healthy subjects. TSH levels were also significantly higher in CSC patients than in controls. Hence, hypothyroidism might be associated with CSC.

Antiretinal antibodies in central serous chorioretinopathy: prevalence and clinical implications.

PURPOSE: To investigate the possible role of autoimmune reactions directed against retinal tissue in central serous chorioretinopathy (CSC), by analysing the presence of serum antiretinal antibodies (ARAs) and establishing their clinical relevance. METHODS: Sixty-three patients with CSC were included, and clinical characteristics were collected. Serum samples of all patients with CSC, 101 uveitis patients and 60 healthy donors were analysed for the presence of ARAs by indirect immunofluorescence. Furthermore, all CSC serum samples were analysed on Western blot. Correlations between laboratory findings and clinical features of CSC were determined by logistic regression. RESULTS: Antiretinal antibodies (ARAs) were present in 54% of the patients with CSC, in 46% of uveitis patients (p = 0.153) and in 17% of healthy controls (p < 0.001). The majority of ARAs in CSC were directed against photoreceptors (27%), which occurred significantly more often compared to uveitis patients (15%, p = 0.039) and to healthy controls (5%, p = 0.003). No associations between clinical CSC characteristics and the presence of ARAs were found. CONCLUSION: Serum ARAs are present in more than half of the patients with CSC, and especially, ARAs directed against photoreceptors were detected more frequently compared to both healthy controls and uveitis patients. Further research is warranted to unravel the role of ARAs in the pathogenesis of CSC.

The relation of the serum aldosterone level and central serous chorioretinopathy - a pilot study.

OBJECTIVE: The aim of this study was to investigate the serum aldosterone level and abnormal levels of mineral corticoid in patients with the central serous chorioretinopathy (CSC). PATIENTS AND METHODS: All recruited patients with CSC received fundus fluorescein angiography (FFA), enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) and serum aldosterone assay. The patients were classified into spontaneously resolved group and unresolved group according to a 3-months follow-up of Optical Coherence Tomography (OCT) examination. Patients from unresolved group were recruited to receive treatment with 40 mg spironolactone orally for 2 months. After the treatment, the EDI-OCT and best corrected visual acuity (BCVA) were performed again to assess the treatment efficacy. RESULTS: The study included 61 patients (72 eyes) with 34 patients in the unresolved group and 27 patients in the resolved group. The aldosterone level was significantly associated with the subfoveal choroidal thickness (SFCT) of revolved CSC eyes (r=0.342, p<0.05) as well as the SFCT of unresolved CSC eyes (r=0.348, p<0.05). And the aldosterone level in the unresolved CSC group was greater than that in the spontaneously resolved group (161.8 ± 50.1 ng/dl vs. 122.5 ± 50.5 ng/dl, p<0.05). The central macular thickness and SFCT were decreased significantly (p<0.05) after the treatment with 40 mg/d spironolactone for two months. CONCLUSIONS: The unresolved CSC patients were characterized by high level of aldosterone and thickened SFCT. Spironolactone treatment was associated with the improvement of chronic CSC. Besides, the side effect of spironolactone treatment was rare.

Thiol/Disulfide Homeostasis in Patients with Central Serous Chorioretinopathy.

PURPOSE: To evaluate dynamic thiol/disulfide homeostasis in patients with chronic central serous chorioretinopathy (cCSC). METHODS: This prospective study included 34 cCSC cases and 37 healthy individuals who were age- and sex-matched. A new colorimetric method for measuring thiol/disulfide homeostasis was used. Native thiol, total thiol/disulfide levels, disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios were measured. RESULTS: The age and gender distributions were similar in both main groups. The mean duration of disease was 47.29 ± 24 months. Native and total thiol levels were significantly lower among the cCSC group relative to the control group (p < 0.001). There was not a statistically significant difference between the cCSC and the control group in terms of disulfide levels (p = 0.492). While disulfide/native thiol and disulfide/total thiol ratios were elevated, the native thiol/total thiol ratio was decreased in the cCSC group (p = 0.017, 0.021, 0.036, respectively). Ratios obtained using plasma native thiol, total thiol, and disulfide levels differed significantly between the both groups. CONCLUSION: Disulfide/thiol ratio was significantly greater in cCSC patients relative to healthy control subjects. Our results suggest that the oxidative process is involved in the pathogenesis of the cCSC.

Frequency of Systemic Risk Factors in Central Serous Chorioretinopathy.

OBJECTIVE: To determine the frequency of various systemic risk factors associated with acute central serous chorioretinopathy (CSCR) in our setup. STUDY DESIGN: Descriptive case series. PLACE AND DURATION OF STUDY: Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, from July 2011 to June 2014. METHODOLOGY: All consecutive patients with acute CSCR who presented in the outpatient department during the study period were recruited. Clinical findings were endorsed on a pre-devised proforma with special emphasis on inquiring about known systemic risk factors for CSCR in detail from each patient. Patients were managed conservatively with control of modifiable risk factors and topical 0.1% Nepafenac eye drops. Analysis of data was done using SPSS version 13.0. RESULTS: Forty-four eyes of 42 patients were eligible for final analysis. The mean age of study population was 37.38 ±6.31 years with 38 (90.47%) male patients. Elevated serum cortisol and serum testosterone levels were found in 3 and 2 patients, respectively. Known systemic risk factors for CSCR were present in 36 (85.71%) patients with emotional stress/psychiatric disorder 15 (35.71%), Type Apersonality 11 (26.19%), smoking 10 (19.04%), hypertension 5 (11.90%), and acid peptic disease 4 (9.52%) were the most frequently found risk factors. CONCLUSION: Emotional stress/psychiatric illness, hypertension, acid peptic disease and use of exogenous steroids and other medicines are the established risk factors for CSCR that can be modified/withdrawn to reduce the morbidity related to CSCR.

Evaluation and correlation of stress scores with blood pressure, endogenous cortisol levels, and homocysteine levels in patients with central serous chorioretinopathy and comparison with age-matched controls.

CONTEXT: Stress had been associated with the development of central serous chorioretinopathy (CSC). The study was designed to evaluate the effect of stress on other risk factors of CSC such as serum cortisol levels, serum homocysteine levels, and blood pressure (BP) in CSC patients. AIMS: To compare stress scores, serum cortisol and serum homocysteine levels, and BP of CSC patients with that of control population and to correlate stress scores of CSC patients with BP, serum cortisol levels, and serum homocysteine levels. MATERIALS AND METHODS: Stress scores, serum morning and evening cortisol levels, serum homocysteine levels, systolic and diastolic BP of 54 CSC patients were measured and compared with that of 54 age- and sex-related controls using Student's t-test. Stress scores of CSC patients were correlated with systolic and diastolic BP, serum morning and evening cortisol levels and serum homocysteine levels and Pearson correlation coefficient (r) were calculated. RESULTS: Stress scores, serum homocysteine levels, serum morning and evening cortisol levels, and systolic and diastolic BP were all elevated in CSC patients as compared with age- and sex-related controls (P < 0.05). Stress scores of CSC patients were found to correlate strongly with serum homocysteine levels, serum morning and evening cortisol levels, and systolic and diastolic BP, with r values 0.82, 0.8, 0.8, 0.8, and 0.81, respectively (P < 0.0001). CONCLUSIONS: Stress scores were elevated in CSC patients and were strongly correlated with serum homocysteine and cortisol levels and BP.

Comparison of Serum Cortisol and Testosterone Levels in Acute and Chronic Central Serous Chorioretinopathy.

PURPOSE: To compare the levels of serum cortisol and testosterone in acute and chronic central serous chorio-retinopathy (CSC). METHODS: Serum cortisol and testosterone levels in 30 patients with either acute or chronic CSC were evaluated using chemiluminescent immunoassay. RESULTS: The mean age was 42.43 ± 6.37 years (range, 32 to 56 years). The mean 8:00 to 9.00 a.m. serum cortisol level was 12.61 ± 4.74 µg/dL (range, 6.58 to 27.42 µg/dL). The mean serum testosterone level was 5.88 ± 1.57 ng/dL (range, 2.81 to 9.94 ng/dL). The mean visual acuity was 20 / 65.07 ± 40.56 (range, 20 / 25 to 20 / 200). There was no statistically significant difference in the mean levels of serum cortisol and testosterone between the acute and chronic cases (p > 0.05), but there was a statistically significant difference in the mean presenting visual acuity in the two groups (p < 0.05). CONCLUSIONS: All except one patient in the acute group had normal levels of serum cortisol. Testosterone levels were within the normal range in both the acute and chronic cases of CSC. There is unlikely to be any statistically significant difference in the mean levels of serum cortisol and testosterone between the acute and chronic cases, but there may be a statistically significant difference in the mean presenting visual acuity in these groups.

Hip-implant related chorio-retinal cobalt toxicity.

A 39-year-old female with elevated serum cobalt levels from her bilateral hip prostheses presented with a 3-week history of blurred vision in her left eye. Optical coherence tomography revealed patchy degeneration of the photoreceptor-retinal pigment epithelium (RPE) complex. The lesions were hypofluorescent on indocyanine green angiography. We postulate that this is a case of implant-related chorio-retinal cobalt toxicity.