High-resolution adaptive optics-trans-scleral flood illumination (AO-TFI) imaging of retinal pigment epithelium (RPE) in central serous chorioretinopathy (CSCR).

This study aims to correlate adaptive optics-transscleral flood illumination (AO-TFI) images of the retinal pigment epithelium (RPE) in central serous chorioretinopathy (CSCR) with standard clinical images and compare cell morphological features with those of healthy eyes. After stitching 125 AO-TFI images acquired in CSCR eyes (including 6 active CSCR, 15 resolved CSCR, and 3 from healthy contralateral), 24 montages were correlated with blue-autofluorescence, infrared and optical coherence tomography images. All 68 AO-TFI images acquired in pathological areas exhibited significant RPE contrast changes. Among the 52 healthy areas in clinical images, AO-TFI revealed a normal RPE mosaic in 62% of the images and an altered RPE pattern in 38% of the images. Morphological features of the RPE cells were quantified in 54 AO-TFI images depicting clinically normal areas (from 12 CSCR eyes). Comparison with data from 149 AO-TFI images acquired in 33 healthy eyes revealed significantly increased morphological heterogeneity. In CSCR, AO-TFI not only enabled high-resolution imaging of outer retinal alterations, but also revealed RPE abnormalities undetectable by all other imaging modalities. Further studies are required to estimate the prognosis value of these abnormalities. Imaging of the RPE using AO-TFI holds great promise for improving our understanding of the CSCR pathogenesis.

Long-term follow-up demonstrates change in conformation shape of the focal choroidal excavation lesions.

PURPOSE: This study aims to present long-term observation of 5 eyes with focal choroidal excavation (FCE), focusing on morphological changes in conformity of the lesion. METHODS: A retrospective case series was conducted, including 5 eyes of 5 patients with FCE. The study utilized multimodal imaging including color fundus photography, optical coherence tomography (OCT), enhanced depth imaging OCT (EDI-OCT), fundus fluorescein angiography (FFA), fundus autofluorescence (FAF), red free imaging, and OCT angiography. RESULTS: The mean age at diagnosis was 51 ± 10.65 years, with a mean follow-up period 37 ± 13.59 months. All cases were unilateral, with 1 presenting FCE as an isolated lesion, and one patient exhibiting 2 FCEs in one eye. The mean choroidal thickness measured by EDI-OCT was 268.2 ± 63.39 µm in the affected eye. One patient displayed choroidal thickening and pachyvessels. Of the 5 eyes, one had conforming and 4 non-conforming FCE. We observed a conversion in conformity in all patients, with 4 cases transitioning from non-conforming FCE to conforming type (3 spontaneously, 1 treatment-induced). In conforming FCE, a hyporeflective space appeared twice between neuroretina and retinal pigment epithelium with spontaneous regression. CONCLUSION: We observed change in shape from the conforming to non-conforming FCE and vice versa in all patients. We consider this small change in the hyporeflective space as non-pathologic and clinically insignificant.

Hyperplasia of the retinal pigment epithelium secondary to subthreshold laser treatment in chronic central serous chorioretinopathy.

PURPOSE: To assess the development of hyperplasia of the retinal pigment epithelium (HRPE) secondary to subthreshold laser treatment (STL) in chronic central serous chorioretinopathy (CSCR). METHODS: Prospective study including 149 eyes of 146 patients with CSCR with persistent subretinal fluid (SRF) that have undergone STL using the Navilas® device. Visual acuity (VA) optical coherence tomography (OCT) and fundus autofluorescence (FAF) were performed before and after the treatment. The HRPE was identified on OCT as a hyperreflective and dense material at the expense of the RPE that did not exist prior to the treatment. The demographics of the patients as well as the parameters of the STL treatments employed were registered. RESULTS: Seven HRPE cases after STL were identified, observing an incidence of 4.7% (7 out of 149 eyes). The mean age was 52.1 ± 3.6 years, being 6/7 males. The mean number of STL sessions was 1.3 ± 0.5. The mean total fluence applied was 52.2 ± 12.4 J/cm2 (range 35.37 to 76.39 J/cm2), using a duty cycle of 10% in all cases. The HRPE was subfoveal in 6 of the 7 cases. The SRF was resolved in 6 of the 7 patients. The mean VA loss was -14.1 ± 14.3 ETDRS letters. CONCLUSION: The development of HRPE secondary to STL in CSCR is an uncommon but severe adverse effect, probably related to the excessive energy employed. Further studies are warranted to minimize the incidence and to know the predictors of this complication after STL treatment to optimize the parameters that should be used.

Efficacy and safety of iodized lecithin tablets versus spironolactone in alleviating central serous retinopathy among Chinese patients with uncontrolled diabetes.

To compare the effectiveness and safety of spironolactone versus lecithin-bound iodine in patients with central serous retinopathy (CSR). Chinese diabetes patients aged>18 years with CSR with persistent increased level of subretinal fluid (SRF) were enrolled. Subjects were randomized to receive either oral lecithin-bound iodine (390µg/kg/day) or oral spironolactone (50mg/day) for 6 months. A total of 200 patients were randomized and completed the study. Compared to spironolactone group, patients treated with lecithin-bound iodine had greater proportion of eye with complete resolution (87% vs 81%, p>0.005). Higher improvement in height of SRF was observed in lecithin-bound iodine-treated patients as compared with Spironolactone-treated patients (91.2[87.5] vs 142.5 [121.1]; p>0.005). However, no statistically significant difference was observed on none of comparisons. Compared to Spironolactone, the patients treated with lecithin-bound iodine had greater improvement in lesion size, central macular thickness and best-corrected visual acuity. However, no statistically significant difference was observed in any of parameter assessed. (p>0.005). The results of the present study suggested that the lecithin-bound iodine was found more effective (nnumerically) than spironolactone in Chinese diabetes patients with CSR.

Extensive reduction in choroidal thickness after photodynamic therapy in eyes with central serous chorioretinopathy.

We examined the effect of reduced fluence (rf)-photodynamic therapy (PDT) of the macular area on the wide-field choroidal thickness in 20 eyes with central serous chorioretinopathy (CSC) and 20 age- and sex-matched control eyes. The choroidal thickness at the posterior pole was measured before and after rf-PDT, using a grid with inner and outer rings, each divided into superotemporal, inferotemporal, superonasal, and inferonasal quadrants, respectively, making up a total of nine subfields including the central 3 mm ring. Before treatment, all eyes showed wide-field choroidal thickening from the dilated vortex vein ampulla to the fovea, along the course of the vein. After rf-PDT of the macular area, the choroidal thickness significantly decreased, not only in the irradiated macular area but also outside the arcade vessels in all quadrants (p < 0.001 for all inner subfields; p = 0.035 and p = 0.024 for the outer superonasal and inferonasal subfields, respectively; p < 0.001 and p = 0.004 for the outer superotemporal and inferotemporal subfields, respectively). For control eyes, the choroidal thickness did not differ between the initial visit and follow-up 1.2 ± 0.7 months after the initial visit (p > 0.05 for all subfields). These findings provide new insights into the pathogenesis of CSC and explain the reasons for the effectiveness of rf-PDT for this condition.

TWO-YEAR CLINICAL OUTCOMES AFTER PHOTODYNAMIC ACUTE EXUDATIVE MACULOPATHY IN PATIENTS WITH CHRONIC CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: To analyze the 2-year clinical outcomes after photodynamic therapy-induced acute exudative maculopathy (PAEM) in patients with chronic central serous chorioretinopathy. METHODS: Prospective observational study that included 64 eyes of 64 patients with chronic central serous chorioretinopathy who received half-fluence photodynamic therapy and had a 2-year follow-up. Patients were classified into two groups based on whether they had had PAEM at 3 days after treatment (PAEM+, n = 22; ≥50 µ m) increase in subretinal fluid or not (PAEM-, n = 42). Best-corrected visual acuity and subretinal fluid changes evaluated with optical coherence tomography were registered at 3 days, 1 month, 3 months, 1 year, and 2 years after photodynamic therapy. The number of recurrences, the appearance of outer retinal atrophy, and choroidal neovascularization were analyzed. RESULTS: Best-corrected visual acuity was 75.9 ± 13.6 (20/32) and 82.0 ± 11.0 letters (20/25) at 2 years in the PAEM+ and PAEM- groups, respectively ( P = 0.055). There were no differences in the best-corrected visual acuity change (4.2 ± 7.7 vs. 3.3 ± 7.1 letters; P = 0.654) and the subretinal fluid decrease (-117.3 ± 74.2 vs. -138.5 ± 83.6 µ m; P = 0.323) at 2 years between patients with and without PAEM. No differences in the number of recurrences ( P = 0.267), the appearance of choroidal neovascularization ( P = 0.155), or outer retinal atrophy ( P = 0.273) between both groups were noted. CONCLUSION: Patients with chronic central serous chorioretinopathy with and without PAEM presented similar results at 2 years in best-corrected visual acuity gain, subretinal fluid reduction, and complication rate.

En-face optical coherence tomography hyperreflective foci of choriocapillaris in central serous chorioretinopathy.

The purpose of this study is to evaluate choroidal hyperreflective foci (HRF) changes in central serous chorioretinopathy (CSC) on en-face optical coherence tomography (OCT). Retrospective analysis of 42 patients with unilateral CSC (84 eyes, including fellow eyes for controls) and 42 age- and sex-matched controls. With 4.5 × 4.5 mm macular scans, structural en-face OCT choriocapillaris (CC) slabs were used to calculate the density and number of HRF in acute CSC eyes with serous retinal detachment (SRD), resolved CSC eyes without SRD, unaffected fellow eyes, control eyes, and 1-year follow-up eyes. Based on the 2-disc diameter (3000 µm), the en-face OCT scan was divided into foveal and perifoveal lesion and analyzed to consider the impact of SRF in HRF measurement. Regression analyses were performed on the several factors with HRF number and density in the acute and resolved CSC eyes. The perifoveal density and number of CC HRF was significantly lower in the resolved CSC eyes when compared to the acute CSC eyes (P = 0.002, both), fellow eyes (P = 0.042/density, 0.028/number), and controls (P = 0.021/density, P = 0.003/number). There was no significant difference between the acute CSC eyes, fellow eyes, controls, and 1-year follow-up eyes. As subfoveal choroidal thickness decreased and choroidal vascularity (CVI) increased, the perifoveal density and number of HRF was measured higher with a significant correlation in univariate regression analysis of the acute and resolved CSC eyes (all, P < 0.05). The authors hypothesized that stromal edema induced by choroidal congestion and hyperpermeability has the greatest influence on HRF measurement, possibly affected by inflammatory cells and materials extravasation.

Relationship between macular intervortex vein anastomosis and optical coherence tomography biomarkers in chronic central serous chorioretinopathy.

BACKGROUNDS: To evaluate the optical coherence tomography (OCT) biomarkers of patients with central serous chorioretinopathy (CSC) according to the presence or absence of direct anatomical relation to intervortex vein anastomosis (IVA) on indocyanine green angiography. METHODS: We reviewed the records of 39 patients with chronic CSC. Patients were categorized in 2 groups: presence of IVA(Group A) or absence of IVA(Group B) in the macular region. Localization of IVA was categorized in 3 areas according to ETDRS grid:inner 1 mm circle (area-1), 1-3 mm middle circle (area-2) and 3-6 mm outer circle (area-3). RESULTS: There were 31 eyes in Group A,21 eyes in Group B. Mean age of the patients was 52.5 ± 11.3years in Group A,47.2 ± 11years in Group B(p<0.001).Mean initial visual acuity (VA) was 0.38±0.38LogMAR in Group A, 0.19±0.21LogMAR in Group B(p<0.001).Mean subfoveal choroidal thickness(SFCT) was 436.3 ± 134.3µ in Group A,480.2 ± 136.6µ in Group B(p<0.001).Localization of IVA in area-1 was correlated with inner choroidal attenuation (ICA) and leakage on IVA(p = 0.011,p = 0.02). Localization of IVA in area-3 was correlated with irregular lesions on RPE(p = 0.042).Smokestack configuration,intraretinal cysts and ICA were correlated with worse initial VA(p<0.001,p = 0.001 and p = 0.04).Shaggy subtype of photoreceptor disruption was associated with better initial VA(p = 0.003). CONCLUSIONS: We detected older age, worse initial VA and thinner SFCT in patients with chronic CSC and macular region IVA(m-IVA). Long term follow-up of patients with and without m-IVA may exhibit the difference in treatment outcomes and development of neovasculopathy.

An Automatic Image Processing Method Based on Artificial Intelligence for Locating the Key Boundary Points in the Central Serous Chorioretinopathy Lesion Area.

Accurately and rapidly measuring the diameter of central serous chorioretinopathy (CSCR) lesion area is the key to judge the severity of CSCR and evaluate the efficacy of the corresponding treatments. Currently, the manual measurement scheme based on a single or a small number of optical coherence tomography (OCT) B-scan images encounters the dilemma of incredibility. Although manually measuring the diameters of all OCT B-scan images of a single patient can alleviate the previous issue, the situation of inefficiency will thus arise. Additionally, manual operation is subject to subjective factors of ophthalmologists, resulting in unrepeatable measurement results. Therefore, an automatic image processing method (i.e., a joint framework) based on artificial intelligence (AI) is innovatively proposed for locating the key boundary points of CSCR lesion area to assist the diameter measurement. Firstly, the initial location module (ILM) benefiting from multitask learning is properly adjusted and tentatively achieves the preliminary location of key boundary points. Secondly, the location task is formulated as a Markov decision process, aiming at further improving the location accuracy by utilizing the single agent reinforcement learning module (SARLM). Finally, the joint framework based on the ILM and SARLM is skillfully established, in which ILM provides an initial starting point for SARLM to narrow the active region of agent, and SARLM makes up for the defect of low generalization of ILM by virtue of the independent exploration ability of agent. Experiments reveal the AI-based method which joins the multitask learning, and single agent reinforcement learning paradigms enable agents to work in local region, alleviating the time-consuming problem of SARLM, performing location task in a global scope, and improving the location accuracy of ILM, thus reflecting its effectiveness and clinical application value in the task of rapidly and accurately measuring the diameter of CSCR lesions.

[Research progress of pachychoroid disease spectrum].

Pachychoroid disease spectrum encompasses central serous chorioretinopathy,polypoidal choroidal vasculopathy,pachychoroid pigment epitheliopathy,pachychoroid neovasculopathy,focal choroidal excavation,peripapillary pachychoroid syndrome and peripheral exudative hemorrhagic chorioretinopathy,etc. The typical choroidal changes of the spectrum are abnormally dilated pachyvessels,choroidal thickening with overlying retinal pigmentary epithelium changes. However,the clinical manifestations and prognosis of entities described within pachychoroid spectrum are different. Significant advances in multimodal imaging have enabled a deeper understanding of the pachychoroid disease spectrum. This paper reviews the pathophysiological alterations,multimodal imaging features and possible pathogenesis of pachychoroid disease spectrum.

Blue-light fundus autofluorescence imaging of pigment epithelial detachments.

BACKGROUND: Pigment epithelial detachments (PEDs) occur in association with various chorioretinal diseases. With respect to the broad clinical spectrum of PEDs we describe fundus autofluorescence (FAF) characteristics of PEDs. METHODS: Ninety-three eyes of 66 patients (mean age 71.9 ± 11.1) with uni- or bilateral PED ( ≥ 350 µm) were included in a retrospective cross-sectional study. PEDs were secondary to age-related macular degeneration (n = 79), central serous chorioretinopathy (n = 7), polypoidal choroidal vasculopathy (n = 2), pattern dystrophy (n = 3) or idiopathic PED (n = 2). FAF images were recorded using confocal scanning laser ophthalmoscopy (488 nm excitation wavelength, detection of emission >500 nm). Diagnosis of PED was confirmed using spectral-domain optical coherence tomography. A qualitative FAF grading system was established, and grading was performed by two independent readers. RESULTS: PEDs showed highly variable characteristics on FAF imaging. FAF within the area of PED was found to be irregular/granular (n = 59, 63.4%), increased (n = 28, 30.1%), decreased (n = 3, 3.2 %), or normal (n = 3, 3.2%). Accompanying FAF changes included condensation of macular pigment (n = 67, 72.0%), focally increased FAF at the PED apex (n = 14, 15.1%) or elsewhere (n = 52, 55.9%), focally decreased FAF (n = 23, 24.7%), a cartwheel-like pattern (n = 10, 10.8%), a doughnut sign (n = 6, 6.5%), and a halo of decreased FAF encircling the PED (completely n = 20, 21.5% or incompletely n = 20, 21.5%). CONCLUSIONS: PEDs show a variety of abnormal patterns on FAF imaging. These changes in FAF signals may be secondary to morphological and metabolic alterations within corresponding retinal layers and do not necessarily correspond with the underlying PED subtype or a specific pathology.

Quantitative analysis of choroidal vasculature in central serous chorioretinopathy using ultra-widefield swept-source optical coherence tomography angiography.

We aimed to quantitatively compare the choroid blood flow and choroid thickness at the periphery among eyes with central serous chorioretinopathy (CSC), fellow eyes and healthy eyes using ultra-widefield swept-source optical coherence tomography angiography (UWF SS-OCTA). Retrospective analysis of 49 patients with CSC (98 eyes, including unaffected fellow eyes) and 49 age and sex matched controls were included. We obtained 3-dimensional data of vertical 20 mm × horizontal 24 mm × scan depth 6 mm, comprising 9 subfields (superotemporal, upper, superonasal, temporal, central, nasal, inferotemporal, lower, inferonasal regions). CSC eyes presented with greater density of large-vessel choroidal layer in all the 9 subfields compared with controls. Compared with normal eyes, CSC eyes had greater choroidal thickness (superotemporal, upper, superonasal, temporal, central, nasal, inferotemporal, and inferonasal subfields) and choroidal volume (superotemporal, upper, superonasal, temporal, central, and nasal subfields). Compared with control eyes, the choriocapillaris density in the superotemporal, inferotemporal and inferonasal subfields was greater in patients with CSC. Our study may provide further evidence for the congestion of vortex vein in the pathogenesis of CSC. UWF SS-OCTA can be used to evaluate the abnormalities of the choroidal structures even at the periphery in eyes with CSC.

PERIPHERAL CHOROIDAL THICKNESS DETERMINED BY WIDE-FIELD OPTICAL COHERENCE TOMOGRAPHY IN EYES WITH CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: To determine the central and peripheral choroidal thickness in eyes with central serous chorioretinopathy (CSC) and to compare these thicknesses values with those of control normal eyes. METHODS: Wide-field optical coherence tomographic images of 24 eyes of 19 patients with CSC and 14 normal eyes of 7 individuals were recorded. A 20-mm vertical scan through the fovea was obtained with the Xephilio optical coherence tomographic S1 (Canon, Japan), a wide-field optical coherence tomographic device. The subfoveal choroidal thickness and the thickness at 5 mm superior (S5) and inferior (I5), 7 mm superior (S7) and inferior (I7), 8.5 mm superior (S8) and inferior (I8), and 10 mm superior (S10) and inferior (I10) from the fovea in the CSC eyes and normal eyes were compared. RESULTS: There was no significant difference in the age ( P = 0.8) or the refractive error ( P = 0.7) between the CSC and normal eyes. The choroidal thickness was significantly thicker in the eyes with CSC than that in the normal eyes at subfoveal choroidal thickness ( P < 0.01), S5 ( P = 0.01), and S7 ( P = 0.02). However, there was no significant difference in the choroidal thickness at the more peripheral points (all P > 0.1). CONCLUSION: The thickened choroid in CSC was observed at the fovea and the area just superior to the fovea. The pathogenesis of CSC may be associated with the choroidal thickening confined to the fovea and superior foveal area.

Laboratory evidence on a direct correlation between acute central serous chorioretinopathy and tenascin C, metalloprotein 1, BAX, BCL2, subfatin and asprosin.

PURPOSE: Central serous chorioretinopathy (CSCR) is an eye disease of unknown etiology that presents with reduced visual acuity, choroidal thickening (distance between Bruch's membrane and the chorioscleral border), and subretinal fluid leakage. In the present study, the goal was to investigate the role of the interrelated tenascin C, metalloprotein-1, BAX, BCL2, subfatin and asprosin molecules in the pathogenesis of CSCR. METHOD: Thirty CSCR patients and 30 controls were included. CSCR was diagnosed by optical coherence tomography imaging. A 5mL blood sample was collected from all participants after overnight fasting. Compounds in the blood samples were studied with the Enzyme-Linked Immunosorbent Assay (ELISA) method. RESULTS: Patients with CSCR were found to have macular thickening (P: 0.08) and statistically significantly reduced visual acuity (P: 0.034) compared to controls. With regard to serum parameters, there were statistically significant increases in tenascin C, metalloprotein-1, BAX, BCL2, subfatin and asprosin levels compared to controls. We found a positive correlation between macular thickness and tenascin C (r+0.670, P<0.001), metaloprotein-1 (r+0.714, P<0.001), BAX, BCL2 (r+0.771, P<0.001), subfatin and asprosin levels and a negative correlation between visual acuity and tenascin C (r+0.605 P<0.001), metaloprotein-1 (r+0.704, P<0.001), BAX, BCL2 (r+0.738, P<0.001), subfatin and asprosin levels. CONCLUSION: The molecules studied herein were negatively correlated with visual acuity and positively correlated with macular thickness, suggesting that these molecules might have a role in the pathogenesis of CSCR. Thus, we predict that these molecules could be new candidates for the diagnosis and follow-up of CSCR in the future.

Assessing central serous chorioretinopathy with deep learning and multiple optical coherence tomography images.

Central serous chorioretinopathy (CSC) is one of the most common macular diseases that can reduce the quality of life of patients. This study aimed to build a deep learning-based classification model using multiple spectral domain optical coherence tomography (SD-OCT) images together to diagnose CSC. Our proposed system contains two modules: single-image prediction (SIP) and a final decision (FD) classifier. A total of 7425 SD-OCT images from 297 participants (109 acute CSC, 106 chronic CSC, 82 normal) were included. In the fivefold cross validation test, our model showed an average accuracy of 94.2%. Compared to other end-to-end models, for example, a 3D convolutional neural network (CNN) model and a CNN-long short-term memory (CNN-LSTM) model, the proposed system showed more than 10% higher accuracy. In the experiments comparing the proposed model and ophthalmologists, our model showed higher accuracy than experts in distinguishing between acute, chronic, and normal cases. Our results show that an automated deep learning-based model could play a supplementary role alongside ophthalmologists in the diagnosis and management of CSC. In particular, the proposed model seems clinically applicable because it can classify CSCs using multiple OCT images simultaneously.

TNFRSF10A downregulation induces retinal pigment epithelium degeneration during the pathogenesis of age-related macular degeneration and central serous chorioretinopathy.

Age-related macular degeneration (AMD) and central serous chorioretinopathy (CSC) are common diseases that can cause vision loss in older and younger populations. These diseases share pathophysiological conditions derived from retinal pigment epithelium (RPE) dysfunction. Tumor necrosis factor receptor superfamily 10A (TNFRSF10A)-LOC389641 with the same lead single-nucleotide polymorphism (SNP) (rs13278062) is the only overlapped susceptibility locus found in both AMD and CSC through genome-wide association studies. This lead SNP has been reported to alter the transcriptional activity of TNFRSF10A. This study aimed to elucidate the function of TNFRSF10A in RPE degeneration using human primary RPE cells and Tnfrsf10 knockout (Tnfrsf10-/-) mice. TNFRSF10A was found to be localized in human RPE. In vitro assays revealed that a T allele of rs13278062, the risk allele for AMD and CSC, downregulated TNFRSF10A transcription in RPE, leading to decreased cell viability and increased apoptosis through protein kinase C-α (PKCA) downregulation. Treatment with phorbol 12-myristate 13-acetate, a PKC activator, rescued the cell viability. Morphological RPE abnormality was found in the retina of Tnfrsf10-/- mice. Our data suggest that downregulation of TNFRSF10A expression inactivates PKCA signaling and causes cellular vulnerability of the RPE, which may contribute to the pathogenesis of AMD and CSC.

Retinal pigment epithelium aperture in acute central serous chorioretinopathy: Another novel possible pathological mechanism.

PURPOSE: To present retinal pigment epithelium (RPE) aperture related to an avascular pigment epithelium detachment (PED) secondary to acute central serous chorioretinopathy (CSC). METHODS: Case report. RESULTS: A 47-year-old man diagnosed as acute CSC presented with RPE aperture in the superonasal area of the macula in his left eye during follow-up. At 2-week follow-up, his decimal best-corrected visual acuity (BCVA) was improved from 0.08 to 0.6 and subretinal fluid was partially absorbed. However, the near-infrared reflectance demonstrated a round mild hyperreflective lesion on the superonasal area of the macula. On spectral-domain optical coherence tomography (SD-OCT), RPE band of the round lesion discontinued but RPE fractured edges without shrinkage and curling. Fundus autofluorescence (FAF) showed RPE aperture appeared as round hypoautofluorescence and hyperautofluorescence outlined its borderline. OCT angiography demonstrated that no evidence of neovascularization within the sub-RPE space. En Face OCT confirmed that the RPE aperture developed at the edge of the PED lesion. At 8-month follow-up, his decimal BCVA was improved to 1.0 and SD-OCT demonstrated spontaneous resolution of subretinal fluid and restoration of RPE structure, with complete flattening of PED. However, FAF revealed hypoautofluorescence mingled with slight hyperautofluorescence within the lesion. CONCLUSIONS: To the best of our knowledge, this is the first report of an RPE aperture secondary to acute CSC. Our case indicated another novel possible pathological mechanism that in the relatively healthy RPE, increased hydrostatic pressure simply itself could contribute to RPE aperture.

The Cortisol Response of Male and Female Choroidal Endothelial Cells: Implications for Central Serous Chorioretinopathy.

CONTEXT: Central serous chorioretinopathy (CSC) is a severe ocular disease characterized by fluid accumulation under the retina and abnormalities in the underlying vascular layer, the choroid. CSC has a striking prevalence in males of 80% to 90% of total patients. Corticosteroids are the most pronounced extrinsic risk factor for CSC. Choroidal endothelial cells (CECs) are important for the vascular integrity of the choroid, but the effects of corticosteroid effects in these cells are unknown. OBJECTIVE: We aimed to reveal the potential steroidal contribution to CSC. METHOD: We characterized the expression of the glucocorticoid, mineralocorticoid, and androgen receptor in the human choroid using immunohistochemistry. Using RNA-sequencing, we describe the cortisol response in human CECs derived from 5 male and 5 female postmortem donors. RESULTS: The glucocorticoid receptor was highly expressed in the human choroid, whereas no to minimal expression of the mineralocorticoid and androgen receptors was observed. The extensive transcriptional response to cortisol in human primary cultured CECs showed interindividual differences but very few sex differences. Several highly regulated genes such as ZBTB16 (log2 fold change males 7.9; females 6.2) provide strong links to choroidal vascular regulation. CONCLUSIONS: The glucocorticoid receptor predominantly mediates the response to cortisol in human CECs. Interindividual differences are an important determinant regarding the cortisol response in human cultured CECs, whereas intrinsic sex differences appear less pronounced. The marked response of particular target genes in endothelial cells to cortisol, such as ZBTB16, warrants further investigation into their potential role in the pathophysiology of CSC and other vascular conditions.

Incidence of central serous chorioretinopathy (2011-2018): a nationwide population-based cohort study of Japan.

AIMS: The aim of this study was to elucidate the epidemiological background of central serous chorioretinopathy (CSC), including its incidence and treatment pattern. METHODS: This was a population-based longitudinal cohort study using a nationwide health insurance claims database of the Japan Ministry of Health, Labour and Welfare (MHLW). As Japan employs universal health coverage, the database covers more than 95% of claims issued in Japan. We accessed all data stored in the database with permission from the MHLW. We traced all individuals aged 30 years or older and identified individuals with new onset of CSC between January 2011 and December 2018. CSC cases were categorised by age and sex for each year, and incidence rate was calculated. We also identified major treatments for CSC to elucidate the initial treatment pattern. RESULTS: During the 8-year period, 247 930 incidences of CSC were identified, among which 75.9% were men. The crude incidence rate (per 100 000 person-years) in the general population aged 30 years or older was 34.0 (95% CI 33.9 to 34.2), in men was 54.2 (95% CI 53.9 to 54.4) and in women was 15.7 (95% CI 15.5 to 15.8). The mean age of onset was lower in men than in women (50.5±12.5 years vs 54.7±13.5 years). Most of the patients with newly diagnosed CSC (86.8%) did not receive major treatment. CONCLUSIONS: The current study provides the nationwide population-based evidence to clarify the detailed epidemiology of CSC. These results could help to understand the pathogenesis and mechanisms of CSC in the future.

Posterior choroidal fluid loculation in central serous chorioretinopathy presenting as a choroidal elevation: A rare Pachychoroid phenotype.

PURPOSE: To describe an unusual variant of central serous chorioretinopathy (CSC) presenting as a choroidal elevation with subretinal fluid and its response to accepted treatment modalities of CSC. DESIGN: A retrospective case series. SUBJECTS: Six eyes of three patients, two males and one female, with a mean age of 55.3 years, were included in the study. All of them had Pachychoroid features, solitary choroidal elevation and subretinal fluid on optical coherence tomography (OCT); none of the patients had a previous episode of CSC. METHODS: Patients were studied with biomicroscopy, ultrasonography, fluorescein angiography and indocyanine green angiography. Systemic evaluation to rule out inflammatory and infective pathologies, and an oncologist referral also was done. Patients were managed in the line of central serous chorioretinopathy, using conservative treatment, focal laser and oral eplerenone. MAIN OUTCOME MEASURES: Resolution of subretinal fluid and choroidal elevation. RESULTS: Complete resolution of choroidal elevation and subretinal fluid was noted in all the three patients. There was no recurrence till the end of follow-up. CONCLUSION: Pachychoroid disease may present as solitary choroidal elevation with subretinal fluid due to exaggerated posterior choroidal fluid loculation and has a favourable outcome. However, it should be considered after exclusion of other differential diagnoses.