Therapieoption bei chronischer Chorioretinopathia centralis serosa

Background

This article reports about the use of a combined photodynamic therapy (PDT) and intravitreal injection of bevacizumab as a treatment option in nine patients with chronic central serous chorioretinopathy (CSC).

Patients and methods

A total of nine male patients with chronic CSC were treated with standard PDT laser treatment with verteporfin and intravitreal injection of bevacizumab administered within 24?h. Before and 1, 3, 6, 9 and 12 months after treatment the results of visual acuity, fluorescein angiography (FA) and optical coherence tomography (OCT) examinations were documented.

Results

All patients showed an improvement in visual acuity of 1?C4 ETDRS lines. Mean visual acuity increased from baseline 20?/?40 to 20?/?25 after 3 months. FA and OCT findings showed a restitution of leakages and subretinal fluid in all cases. After 6?C12 months follow-up 8 patients had ongoing improvement in vision without recurrence of CSC.

Conclusion

The combination of PDT with bevacizumab in this case series appears to be an effective and safe therapy combination which is suitable as a therapeutic option for patients with chronic CCS without a tendency to recovery.     

Dreidimensionale Bildgebung bei Chorioretinopathia centralis serosa

Background

Conventional optical coherence tomography (OCT) has brought new insights to retinal diagnostics, but it is restricted due to its low scanning speed and limited resolution. In this study, high-resolution raster scanning OCT (HR-OCT) was used to identify typical changes in central serous chorioretinopathy (CSC).

Methods

Fifteen consecutive patients with acute CSC were imaged using HR-OCT with an axial image resolution of 6 μm. The scanned area measured 6×6 mm². Three-dimensional (3D) evaluation was performed using various analysing programmes.

Results

Topographic changes in CSC could be visualised with 3D reconstructions in all locations. Retinal thickness was measured with the automatic segmentation mode and quantified precisely. Results were presented in 2D and 3D maps. En-face imaging as a modality to present an integrative overview showed specific alterations in CSC.

Conclusion

HR-OCT was able to provide essential additional information about CSC when combined with appropriate analysing programmes, allowing the identification of typical differences. Aside from precise volumetric measurements, exact localisation of pathological deviations could be achieved.     

Chorioretinopathia centralis serosa und psychische Belastung

Background. To date we know little about the etiology of central serous chorioretinopathy. Former investigations discussed inadequate coping strategies and critical life-events as important psychological aspects. In this study we investigated the relationship between central serous chorioretinopathy and stress. Materials and Methods. 35 male patients with central serous chorioretinopathy (group1) were compared to 21 male patients with traumatic eye diseases. The evaluated data included sociodemographic data as well as data regarding the patients coping strategies, critical live-events before outbreak of the disease, personality factors and general physical complaints. Results. Group 1 showed a significantly higher amount of general physical complaints, measured with a complaints questionnaire (B-L). In a personality inventory (FPI-R) it scored significantly higher on the scales emotional instability and strain, significantly lower on the scale extraversion. Conclusion. The results indicate that patients with central serous chorioretinopathy are more stressed because of inadequate coping strategies, which can be seen in a higher amount of physical complaints.     

Chorioretinopathia centralis serosa und psychische Belastung

Hintergrund. Die ?tiologie der Chorioretinopathia centralis serosa ist bis heute nicht sicher gekl?rt. Vorangegangene Studien diskutierten u. a. inad?quate Bew?ltigungsstrategien und fehlende soziale Unterstützung bei Belastung als Ausl?sefaktoren. In der vorliegenden Untersuchung wurde der Frage nach einem Zusammenhang zwischen der Chorioretinopathia centralis serosa und psychischer Belastung nachgegangen.     

Intravitreales Bevacizumab bei chronischer Retinopathia centralis serosa

Central serous chorioretinopathy (CSCR) can lead to permanent visual loss in chronic cases. We report on a 57-year-old female patient with persistent findings over 6 months despite conservative therapy. A single intravitreal injection of bevacizumab led to a rapid morphologic and functional restitution without relapse or complication during the 19 weeks period after injection. Intravitreal injection of bevacizumab could be a therapeutic option for the treatment of chronic CSCR, however the results of appropriate studies must be awaited before it can be introduced into routine use.     

Chorioretinopathia centralis serosa (CCS)

In the acute stage central serous chorioretinopathy (CSC) is characterized by serous retinal detachment. Monofocal or multifocal structural changes of the pigment epithelium layer are common. Unilateral blurred vision is the major clinical symptom. The pathogenesis is unclear but corticosteroids and stress may trigger the disease. Normal vision often returns spontaneously within a few months. Therapeutic options are at a low evidence level. Carbonic anhydrase, mild laser photocoagulation, selective retinal therapy, photodynamic therapy and the intravitreal injection of bevacizumab have been reported. The authors suggest a treatment strategy on the basis of the available data.     

Selektive Retina-Therapie bei Retinopathia centralis serosa mit Pigmentepithelabhebung

BACKGROUND: Selective Retina Therapy (SRT) is a new and innovative laser treatment modality that selectively treats the retinal pigmentary epithelium while sparing the photoreceptors. This therapeutic concept appears to be particularly suitable for treating patients with acute or chronic central serous chorioretinopathy (CSC). We present preliminary results obtained in five patients who had CSC associated with pigmentary epithelium detachment (PED) and serous subretinal fluid (SRF) and who were treated with SRT. METHODS: This case series was made up of five male patients (mean age 47 years) with chronic CSC and SRF resulting from PED. Examinations performed before and at 1 month and 3 months after the treatment were: BCVA, FLA, OCT (Zeiss OCT III). For SRT, confluent treatment of the PED (area of leakage) was carried out using a pulsed frequency-doubled, Q-switched Nd-YLF prototype laser (lambda=527 nm, t= 1.7 s, 100 Hz, energy = 150-250 J). RESULTS: Best corrected visual acuity at baseline was 0.53, while after 4 weeks it was 0.56 and after 12 weeks, 0.5. At baseline leakage was seen at the PED on fluorescein angiography in all patients. After 4 weeks leakage activity was no longer noted on angiography in 4 of 5 patients. OCT at baseline showed SRF at the edge of the PED in all patients, but in 4 of the 5 patients this was no longer detectable after 4 weeks. CONCLUSION: SRT is a safe and effective treatment for patients with CSC in which PED has caused SRF. Not a single case of rip syndrome was observed in this study, even though the PED was treated confluently. Since SRT spares the photoreceptors it is particularly suitable for the treatment of CSC, especially when the origin of leakage is located close to the fovea. The results indicate that SRT leads to reconstruction of the outer blood-retina barrier.     

Diagnostik und Differenzialdiagnostik bei akuter retinaler Nekrose

Multiple viruses have been identified as causative agents in acute retinal necrosis (ARN). Retinal biopsies, analysis of intraocular antibody synthesis, and polymerase chain reaction (PCR) have identified varicella zoster virus, herpes simplex virus types 1 and 2, and cytomegalovirus. The differential diagnosis of ARN includes atypical ocular toxoplasmosis, some white dot syndromes, and other forms of retinal vasculitides such as Behçet’s disease. Because therapeutic intervention varies greatly in these acute situations, identification of the causative agent is essential. Serology is rarely helpful, whereas analysis of aqueous humor or vitreous samples provides clues to the etiology. Aqueous humor antibody testing and PCR have demonstrated excellent diagnostic power with high sensitivity and high specificity. This review is intended to provide an overview of the diagnostics and differential diagnosis of this rare but important disorder.     

Krypton and argon laser coagulation in chorioretinitis centralis serosa

Central serous chorioretinopathy was treated by laser photocoagulation of the site of fluorescein dye leakage. In 22 cases, in most of which the leakage was located in the nasal macular area or close to the foveola, krypton red was used, and in 85 cases argon blue-green. There was a significantly greater improvement after treatment with the krypton laser, and healing also tended to be faster than with the argon laser.     

Psoriasis und Hypogonadismus bei chronischer Blepharokeratokonjunktivitis Ein Fallbericht

Background. Ocular symptoms occur in approximately 10% of patients with psoriasis vulgaris. Patient. We report the clinical course of a 35-year-old male patient with obstructive meibomian gland dysfunction, keratoconjunctivitis and reduced reflex secretion of both eyes. Psoriasis vulgaris and hypothalamic hypogonadism were also present. Genetic testing (cytogenetic and DNA analysis) was performed because of additional facial dysmorphia, brachydactylia and obesity. No chromosomal anomaly was found and no genetic syndrome has yet been diagnosed. The therapeutic regimen included preservative-free artificial tears, occlusion of the puncta and a systemic dose of doxycycline. Dermatological symptoms were treated topically and the hypogonadism was treated with intramuscular injections of testosterone. Conclusion. Lacrimal and meibomian glands are influenced by androgens. Therefore hormonal dysfunction can also have contributed to the blepharokeratoconjunctivitis in this patient.