Vigorous Physical Activity as a Risk Factor for Central Serous Chorioretinopathy.

PURPOSE: To evaluate whether frequent vigorous physical activity (PA) is significantly associated with active central serous chorioretinopathy (CSCR) and may represent a risk factor for CSCR. DESIGN: Case-control study. METHODS: This was a multicenter study. The patient population comprised consecutive patients with active CSCR and a comparable control group of healthy participants. Both groups were interrogated about their PA using a shortened version of the International Physical Activity Questionnaire. The Ainsworth Compendium of Physical Activities was taken as a reference for the activities requiring vigorous effort and to quantify the energy expended, expressed in metabolic equivalent of task (MET). As a main outcome measure, a moderate/high practice of vigorous PA was opposed to an absent/low practice of vigorous PA in the 2 groups. RESULTS: A total of 105 patients with CSCR and 105 healthy controls were included in the study. Moderate/high vigorous PA was observed in 63.5% of the patients with CSCR and in 26% of the controls (P = .0001). The MET values of vigorous PA were 2173.2 ± 2081.5 in the CSCR group and 1216.3 ± 524 in the control group (P = .029). The potential risk of disease associated with moderate/high vigorous PA was 5.58 (odds ratio; 95% confidence interval 3.01-10.69, P = .0001). CONCLUSIONS: This study demonstrates a significant association of vigorous PA with CSCR, indicating an increased probability of disease by 5.58 times. Frequent and intense PA, with the hypertensive episodes that it entails, can break the precarious hemodynamic balance in the choroid of individuals predisposed to CSCR, thereby favoring choroidal vascular decompensation and active disease.

In-vivo visualization of the photoreceptors using Spectralis High Magnification Module imaging in central serous chorioretinopathy.

PURPOSE: To visualize photoreceptors using the Spectralis High Magnification Module (HMM) in a case of central serous chorioretinopathy (CSCR) and to correlate the findings with those of optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A). OBSERVATIONS: A 35-year-old Caucasian male presenting with chronic CSCR in the left eye was examined using HMM, OCT and OCT-A. The photoreceptors mosaic was assessed both in diseased and apparently uninvolved areas. A partial topographic correlation between the loss of photoreceptors on HMM images and an altered reflectivity of the photoreceptor layer on en-face OCT was noted. Interestingly, a correlation between the photoreceptor damage on HMM and choriocapillaris flow-void areas on OCT-A was seen. CONCLUSIONS AND IMPORTANCE: HMM is a non-invasive imaging modality, allowing the in-vivo visualization of photoreceptor damage in a diseased retina. A focal abnormal perfusion of the choriocapillaris might influence the integrity of the overlying photoreceptors in CSCR.

The choroidal rupture: current concepts and insights.

Choroidal rupture is a posterior segment affliction following a traumatic event that results in a break in the retinal pigment epithelium, Bruch membrane, and the underlying choriocapillaris. The visual prognosis may be extremely poor when involving the macular area or in cases with major comorbidities. On funduscopic examination the rupture appears as a whitish/yellowish curvilinear or crescent-shaped lesion with forked or tapered endings. Multimodal imaging including fluorescein angiography, indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography can provide a detailed assessment of the extent of damage and the onset of complications. Although there is no treatment for choroidal rupture per se, associated complications such as angle-recession glaucoma, retinal detachment, or exudative choroidal neovascularization might need therapeutic interventions. We describe the pathophysiology of choroidal rupture, the recent multimodal imaging findings, and the available treatment options for the management of complications.

Choroidal Structure after Half-Dose Photodynamic Therapy in Chronic Central Serous Chorioretinopathy.

The study aims to analyze the changes produced by half-dose photodynamic therapy (HD-PDT) in the choroid of eyes with chronic central serous chorioretinopathy (CSC) applying the binarization method to spectral domain optical coherence tomography (SDOCT) and OCT Angiography (OCTA) images. SDOCT and OCTA were performed before, one hour, one week, and one month after HD-PDT. Binarization with a modified Niblack method and analysis by ImageJ were applied. An average ratio between luminal part and total structure was calculated. Twenty-two eyes of 21 patients (20 male and 1 female; mean age 54.8 years) were enrolled. A statistically significant reduction of the central choroidal thickness was observed one week (from 407 µm to 362 µm, p = 0.034) and one month (from 407 µm to 341.5 µm, p = 0.0004) after HD-PDT. The baseline average ratio between luminal part and total structure was 33.4% in SDOCT, and 61.1% in OCTA. These values were 35.3% and 61% one hour, 33.9% and 60.4% one week, and 34.5% and 60.6% one month after HD-PDT, respectively. Overall, PDT seems to produce short-term changes on the luminal component of both choriocapillaris and choroid, which return to baseline status after one month from treatment. However, choroid stays significantly thinner after one month, with both luminal and interstitial components significantly reduced.

Central serous chorioretinopathy: Towards an evidence-based treatment guideline.

Central serous chorioretinopathy (CSC) is a common cause of central vision loss, primarily affecting men 20-60 years of age. To date, no consensus has been reached regarding the classification of CSC, and a wide variety of interventions have been proposed, reflecting the controversy associated with treating this disease. The recent publication of appropriately powered randomised controlled trials such as the PLACE trial, as well as large retrospective, non-randomised treatment studies regarding the treatment of CSC suggest the feasibility of a more evidence-based approach when considering treatment options. The aim of this review is to provide a comprehensive overview of the current rationale and evidence with respect to the variety of interventions available for treating CSC, including pharmacology, laser treatment, and photodynamic therapy. In addition, we describe the complexity of CSC, the challenges associated with treating CSC, and currently ongoing studies. Many treatment strategies such as photodynamic therapy using verteporfin, oral mineralocorticoid antagonists, and micropulse laser treatment have been reported as being effective. Currently, however, the available evidence suggests that half-dose (or half-fluence) photodynamic therapy should be the treatment of choice in chronic CSC, whereas observation may be the preferred approach in acute CSC. Nevertheless, exceptions can be considered based upon patient-specific characteristics.

Correlation between fundus autofluorescence and central visual function in chronic central serous chorioretinopathy.

PURPOSE: To find possible correlations between the morphologic macular changes revealed by fundus autofluorescence (FAF) and the functional parameters such as visual acuity and retinal sensitivity in patients with chronic central serous chorioretinopathy (CSC). DESIGN: Prospective, cross-sectional study. METHODS: Forty-six eyes (39 consecutive patients) with chronic CSC were studied with FAF and microperimetry (MP). Retinal sensitivity value maps were exactly superimposed over FAF images. The following microperimetric parameters were applied: central 10-degree visual field, 4-2-1 strategy, 61 stimulation spots, white monochromatic background, stimulation time 200 ms, stimulation spot size Goldmann III. A possible relationship between MP and FAF was investigated. RESULTS: Mean best-corrected visual acuity (BCVA) was 20/32 (median 20/25, range 20/20-20/200). BCVA was significantly correlated with FAF findings (Mann-Whitney test; P < .0001). A positive concordance between FAF and MP evaluation was also found (total concordance of 0.720 with a kappa of Cohen of 0.456). The hypo-autofluorescent areas showed decreased retinal sensitivity, while adjacent areas of increased FAF could be associated to both normal and decreased retinal sensitivity. Absolute scotoma, defined as 0 dB retinal sensitivity, corresponded with absence of autofluorescence. CONCLUSIONS: Altered FAF in chronic CSC patients has a functional correlation quantified by microperimetry. This study confirms the impact of FAF changes on retinal sensitivity and their value to reflect the functional impairment in chronic CSC.

Vitreomacular traction hinders the effectiveness of anti-VEGF therapy in a patient with exudative age-related macular degeneration.

PURPOSE: To report a case of exudative age-related macular degeneration (AMD) complicated by vitreomacular traction and treated with intravitreal bevacizumab. METHODS: Interventional case report. An 83-year-old man presented with exudative AMD with subretinal fluid. Optical coherence tomography (OCT) revealed vitreomacular traction in the left eye. The visual acuity was 20/200. Two monthly intravitreal injections of bevacizumab into the eye were performed; after the vitreomacular traction was resolved, another series of bevacizumab injections were given. RESULTS: After the first 2 injections of bevacizumab, OCT indicated that the macular appearance was unchanged, and visual acuity was reduced to 20/250. The second series of injections resolved the submacular exudation and vision improved to 20/160. CONCLUSION: In this case, the presence of vitreomacular traction seemed to hinder resolution of submacular exudation after intravitreal injection of bevacizumab. The role of the vitreomacular interface in the effectiveness of antivascular endothelial growth factor therapy in exudative AMD should be considered.

Risk factors for posterior cystoid retinal degeneration in central serous chorioretinopathy.

PURPOSE: To identify factors associated with the development of posterior cystoid retinal degeneration (PCRD) in central serous chorioretinopathy (CSC). METHODS: The authors retrospectively studied 51 eyes of 51 patients with chronic CSC and subretinal or intraretinal exudation documented by optical coherence tomography (OCT), and evaluated the association of hypertension, systemic use of corticosteroids, duration of symptoms, subretinal fibrosis, and large laser scars with the development of PCRD. RESULTS: Twenty-four eyes (47%) had PCRD and 27 eyes (53%) had serous macular detachment without cystoid retinal changes. Multivariate analysis showed that a duration of symptoms exceeding 5 years (odds ratio [OR], 25.4; 95% confidence interval [CI], 2.8-233.2; P = 0.004) and subretinal fibrosis (OR, 19.1; 95% CI, 1.8-205.1; P = 0.015) were significantly associated with PCRD. CONCLUSION: Disease duration longer than 5 years and subretinal fibrosis are associated with the development of PCRD in CSC. Prospective evaluations could substantiate the associations found in this study and further clarify their significance.

Posterior cystoid retinal degeneration in central serous chorioretinopathy.

PURPOSE: To study the pattern of cystoid retinal changes in the posterior fundi of eyes with chronic central serous chorioretinopathy (CSC) using optical coherence tomography (OCT). METHODS: We retrospectively studied 34 eyes with chronic CSC and cystoid retinal changes at the posterior pole documented by OCT. We analyzed the distribution of cystoid retinal changes with respect to the fovea and chorioretinal lesions. RESULTS: Generally, cystoid retinal changes occurred in the papillomacular region (21 eyes); foveal involvement was observed in 20 eyes. Large cystoid changes in the central macula with concentric perifoveal lesion extension were detected in three eyes. Cystoid changes tended to occur where the retina adhered to subretinal fibrosis, large laser scars, or spontaneous atrophy of the retinal pigment epithelium and the choroid. Visual acuity ranged from 20/20 to 20/400. In nine eyes in which the cystoid changes spared the foveal center, visual acuity was 20/40 or better. CONCLUSION: Cystoid retinal degeneration in eyes with chronic CSC was distributed outside of the fovea and was not necessarily associated with severely reduced visual acuity. "Posterior cystoid retinal degeneration" defines this pathologic pattern appropriately. OCT findings suggest that intraretinal exudation and cystoid changes in chronic CSC develop through the formation of chorioretinal adherences.

Photodynamic therapy of subfoveal choroidal neovascularization secondary to reticular pattern dystrophy: three-year results of an uncontrolled, prospective case series.

PURPOSE: To investigate the effects of photodynamic therapy (PDT) on subfoveal choroidal neovascularization (CNV) secondary to reticular pattern dystrophy (RPD) of the retinal pigment epithelium. DESIGN: Open-label, prospective, interventional case series. METHODS: Thirteen eyes diagnosed with subfoveal CNV associated with RPD were considered. Complete ophthalmic examinations were performed at baseline and thereafter at three-month intervals for three years. Primary outcome measure was the number of eyes with <15 letters loss (approximately <3 lines) at 12, 24, and 36 months, compared with baseline. Secondary outcome measures included CNV progression and number of PDT sessions. RESULTS: Seven eyes showed a decrease in best-corrected visual acuity of at least three lines at three-year examination. Each eye received a median number of treatments of two, zero, and zero in years one, two, and three, respectively. CONCLUSIONS: PDT does not appear to guarantee long-term vision stabilization in RPD-related subfoveal CNV, and alternative therapies should be investigated.

The foveal photoreceptor layer and visual acuity loss in central serous chorioretinopathy.

PURPOSE: To describe changes of the foveal photoreceptor layer using optical coherence tomography (OCT) in central serous chorioretinopathy (CSC) and evaluate the correlation with visual acuity (VA) loss. DESIGN: Observational case series. METHODS: We studied 28 eyes with acute or chronic CSC using high-resolution OCT. The tomographic findings of the detached foveal photoreceptor layer were compared with VA. Sixteen eyes also were evaluated after foveal reattachment. RESULTS: The outer photoreceptor layer (OPL) in the detached fovea was preserved in 14 eyes, of which 13 had symptoms for <1 year and atrophic in 14 eyes with symptoms for >1 year. The preserved OPL had an even profile in 7 eyes and a granulated profile in 7 eyes. Mean VA was 0.19 logMAR with a preserved OPL and 0.72 logMAR with an atrophic OPL (P <.001). Cases seen after the detachment resolved included 6 eyes with preserved even OPL, 5 eyes with preserved granulated OPL, and 5 eyes with atrophic OPL. Mean final VA was 0.06 logMAR in eyes with preserved OPL and 0.90 logMAR in eyes with atrophic OPL (P <.001). The VA improved in 73% of eyes with preserved OPL and no eyes with atrophic OPL (P = .025). The VA recovered completely in 83% of eyes with preserved even OPL and no eyes with preserved granulated OPL (P = .015). CONCLUSION: High-resolution OCT demonstrates changes in the foveal photoreceptor layer in CSC that highly correlate with VA loss and may predict visual recovery after macular reattachment.