Ocular photodynamic therapy for serous macular detachment in the diffuse retinal pigment epitheliopathy variant of idiopathic central serous chorioretinopathy

PURPOSE: To describe the anatomical and functional outcome of verteporfin ocular photodynamic therapy (PDT) in serous retinal detachment caused by the diffuse retinal pigment epitheliopathy form of chronic idiopathic central serous chorioretinopathy. DESIGN: Interventional case report. METHOD: A 48-year-old Caucasian man with unilateral exudative retinal detachment from diffuse retinal pigment epitheliopathy and visual acuity of 20/40 was managed with verteporfin PDT applied sequentially in three separate spots targeting all retinal pigment epithelium leaks identified with intravenous fluorescein angiography (IVFA). Outcome measures included visual acuity, biomicroscopic appearance, and leakage on IVFA.Clinical practice.Subretinal fluid resolved within 2 weeks; visual acuity returned to 20/20 with no recurrence at 6 months of follow-up. There was no leakage on IVFA posttreatment and no obvious toxicity.To our knowledge, this is the first report of PDT causing resolution of macular detachment in diffuse retinal pigment epitheliopathy. Its long-term results with regard to the prognosis of the disease and the recurrence rate remain to be evaluated.     

Prevalence of Helicobacter pylori in central serous chorioretinopathy and diffuse retinal epitheliopathy: a complementary study

INTRODUCTION: In 2001, Mauget-Faysse et al. found a prevalence of Helicobacter pylori infection of 56.3% in 16 patients with central serous chorioretinopathy (CSC) and diffuse retinal epitheliopathy (DRE). This prevalence was twice that of the French population. This complementary study aimed to verify these results. PATIENTS: and method: Between 1996 and 2002, 78 patients living in the southeast of France with CSC/DRE were included in this study. H. pylori infection was assessed by the 13C-urea breath test. Diagnosis was confirmed by fundus biomicroscopy, fluorescein and ICG angiographies and retinal OCT scans (from 2002). Results were analyzed with the Chi2test. RESULTS: Out of 78 patients, there were 60 males (76.9%) and 18 females (23.1%), with a mean age of 53 years (range, 29-80 years); 27 had CSC (34.6%) and 51 had DRE (65.4%). H. pylori infection was detected as positive in 31 patients (39.7%) and negative in 47 (60.3%). Men were detected positive in 43.3% of cases, compared to women detected positive in only 27.8%. The difference in prevalence of H. pylori between the study population (39.7%) and the overall population of 58,419,710 inhabitants of France in 1999 (25.4%) was found statistically highly significant (p = 0.0036). DISCUSSION: and conclusion: These results may indicate a possible association between H. pylori infection and CSC/DRE manifestations. These data confirm the first results of the 2001 prospective pilot study and also show a higher prevalence of H. pylori infection in men than in women.     

Helicobacter pylori in central serous chorioretinopathy and diffuse retinal epitheliopathy. Results of the first prospective pilot study

PURPOSE: Helicobacter pylori has been implicated in focal occlusive arterial diseases in young people. Central serous chorioretinopathy (CSC) and diffuse retinal epitheliopathy (DRE) being suspected vascular occlusive diseases of choriocapillaris, the purpose of this study was to determine the prevalence of H. pylori infection in patients with long-lasting (>6 months) CSC and/or DRE. METHODS: Sixteen consecutive patients living in southeastern France were included in this prospective pilot study. H. pylori infection was assessed by the (13)C-urea breath test, serology, as well as histology of gastric biopsy specimens in some cases. RESULTS: Evidence for H. pylori infection was detected in nine out of the 16 patients with active long-lasting CSC/DRE (56.3%). H. pylori-infected patients more frequently presented gastric pain (four of nine H. pylori-positive patients: 44%) than H. pylori-negative patients (one out of seven: 14%). Men were more frequently H. pylori-positive (seven men out of ten: 70%) than women (two women out of a total of six: 33%). DISCUSSION: When the prevalence of H. pylori infection (56.3%) was compared to the prevalence in a historical control population from southeastern France (27.5%), it was found to be significantly higher (P<0.05). CONCLUSION: These results may indicate a possible association between H. pylori infection and CSC/DRE manifestations. This new etiopathogenic hypothesis deserves to be confirmed in a national or international multicenter study because it could lead to a new therapeutic approach in CSC/DRE, i.e., Helicobacter pylori eradication.     

Internal drainage for chronic macula-involving serous retinal detachment in idiopathic central serous chorioretinopathy

Conventional treatment of idiopathic central serous chorioretinopathy (ICSC) consists of argon laser, photodynamic therapy, or observation. However, in cases of atypical bullous ICSC with exudative detachment preventing any laser therapy, a surgical approach with external drainage of fluid has been performed. We present a case of ICSC with persistent macula involving exudative retinal detachment without evidence of uveitis that responded favorably to internal drainage by vitrectomy along with a scleral buckle placement. Our case, treated with internal drainage, also demonstrated successful long-term reattachment of the serous retinal detachment without any additional complications from the surgery.     

Serous retinal detachment resembling central serous chorioretinopathy following organ transplantation

Two patients developed unilateral serous retinal detachments of the macula resembling idiopathic center serous chorioretinopathy within 9 months of cardiac transplantation, while one renal transplant recipient developed bilateral serous detachments within 6 months of surgery. In two cases (three eyes), dense, yellow, fibrlin-like exudates were present in the subretinal fluid. At the time of presentation, each of the three patients had a modest elevation of blood urea nitrogen. Laser photo-coagulation was performed in three eyes with limited success, although ultimately the detachments resolved leaving only mild visual impairment (6/9 vision). The differential diagnosis of visual loss in the transplant population includes serous detachment of the sensory retina as well as more serious chorioretinal infections related to immunosuppression.Presented at the First Aegean Retina Meeting, Iraklion, Crete, 11 July 1989     

Retinal vascular loss in idiopathic central serous chorioretinopathy with bullous retinal detachment

Three patients with idiopathic central serous chorioretinopathy (ICSC) and bullous retinal detachment (RD) were examined at least 2 years after the onset of the disease in one patient and over 10 years in the other two patients. There were large areas of retinal pigment epithelium (RPE) degeneration in each patient. Interestingly, there was loss of retinal vascular trees in the inferior peripheral retina where the subretinal fluid presumably persisted for a long time. In one patient, there was a retinal neovascularization with sea-fan formation along the border of the vascular loss. To the authors' knowledge, this finding has not been described in the literature.     

Bullous variant of idiopathic central serous chorioretinopathy

BACKGROUND: Spontaneous bullous serous retinal detachment (RD) with subretinal exudation complicating idiopathic central serous chorioretinopathy (ICSC) is a rare and infrequently described clinical entity. Clinical observations are described on this variant form in 11 patients, the largest series reported to date. METHODS: 13 eyes of 11 Indian patients having this entity were followed up clinically and angiographically for 12-24 months (retrospective, longitudinal). None of the patients had any previous history of other diseases nor were they on any medications. Four eyes received laser treatment (group A); nine eyes were not treated (group B). RESULTS: All 11 patients were male, aged 23-49 years (median 37 years). The clinical and photographic records revealed subretinal exudation and inferior bullous serous RD complicating ICSC with evidence of large, single or multiple, leaking retinal pigment epithelial detachments (PEDs) in all the cases. In group A, resolution of serous RD occurred in 12 weeks (median) with a visual recovery of >/=20/30 in three out of four eyes while in group B resolution of serous retinal detachment was observed in 14 weeks (median) with eight out of nine eyes achieving a visual acuity of >/=20/30. Subretinal fibrosis developed in two eyes in group A and none of the eyes in group B. CONCLUSION: The disease is an exaggerated form of ICSC and can occur spontaneously without any history of corticosteroid therapy. Recognition of this atypical presentation is important to avoid inappropriate treatment. These observations suggest that with respect to the duration of the disease and the final visual outcome laser therapy offers no additional benefit over the natural course of this variant form of ICSC.     

Retinal atrophy in idiopathic central serous chorioretinopathy

PURPOSE: To study retinal atrophy in idiopathic central serous chorioretinopathy (ICSC). DESIGN: Observational case series. METHODS: Twenty-four eyes in 23 consecutive patients aged 33 to 67 years and 50 eyes in 25 healthy volunteers aged 24 to 70 years were studied. Observational procedures included: biomicroscopy, fundus photography, fluorescein angiography, optical coherence tomography, photocoagulation. Retinal thickness after resolution of detachment, definite attenuation being defined as foveal thickness less than the mean -2 SD in healthy volunteers; duration of symptoms; best-corrected visual acuity (BCVA). RESULTS: Definite retinal attenuation, retinal thickness ranging from 51% to 74% of normal, was found in nine eyes of nine patients with idiopathic central serous chorioretinopathy (ICSC). Their duration of symptoms was longer (P =.0014) and their BCVA was lower (P =.015) than eyes in patients with normal-range foveal thickness who, nevertheless, had thinner foveae than healthy subjects (P =.10). The most severe reduction of foveal thickness, to half the normal (three eyes of three patients), was associated with BCVA 0.5 or less, multifocal retinal pigment epithelial abnormalities, and more than 10 years' duration of symptoms. Retinal attenuation was seen only after a duration of symptoms of more than 4 months, being most pronounced in the photoreceptor layer, particularly in the fovea. CONCLUSION: Foveal attenuation in ICSC is associated with more than 4 months' duration of symptoms and persistent BCVA reduction despite resolution of the serous detachment. We found no other likely cause of atrophy than the prolonged absence of contact between photoreceptors and retinal pigment epithelial cells.     

Retinal atrophy in idiopathic central serous chorioretinopathy

PURPOSE: To study retinal atrophy in idiopathic central serous chorioretinopathy (ICSC).DESIGN: Observational case series.METHODS: Twenty-four eyes in 23 consecutive patients aged 33 to 67 years and 50 eyes in 25 healthy volunteers aged 24 to 70 years were studied. Observational procedures included: biomicroscopy, fundus photography, fluorescein angiography, optical coherence tomography, photocoagulation. Retinal thickness after resolution of detachment, definite attenuation being defined as foveal thickness less than the mean −2 SD in healthy volunteers; duration of symptoms; best-corrected visual acuity (BCVA).RESULTS: Definite retinal attenuation, retinal thickness ranging from 51% to 74% of normal, was found in nine eyes of nine patients with idiopathic central serous chorioretinopathy (ICSC). Their duration of symptoms was longer (P = .0014) and their BCVA was lower (P = .015) than eyes in patients with normal-range foveal thickness who, nevertheless, had thinner foveae than healthy subjects (P = .10). The most severe reduction of foveal thickness, to half the normal (three eyes of three patients), was associated with BCVA 0.5 or less, multifocal retinal pigment epithelial abnormalities, and more than 10 years’ duration of symptoms. Retinal attenuation was seen only after a duration of symptoms of more than 4 months, being most pronounced in the photoreceptor layer, particularly in the fovea.CONCLUSION: Foveal attenuation in ICSC is associated with more than 4 months’ duration of symptoms and persistent BCVA reduction despite resolution of the serous detachment. We found no other likely cause of atrophy than the prolonged absence of contact between photoreceptors and retinal pigment epithelial cells.     

中心性浆液性脉络膜视网膜病变色素上皮功能状态分析

目的 分析中心性浆液性脉络膜视网膜病变(CSC)视网膜色素上皮(RPE)损害性质.方法 应用海德堡眼底造影系统对67例(67只眼主检)临床确诊CSC患者进行绿色激光眼底照相、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)检查.对18例适于光凝治疗的患者直接光凝封闭RPE渗漏点,并观察视网膜下液吸收速度.结果 64只眼绿色激光眼底像显示浆液性视网膜脱离(盘脱)同时FFA显示RPE渗漏点,3例绿色激光眼底像显示明显盘脱而FFA未显示RPE渗漏点.所有FFA显示RPE渗漏点相对应的ICGA处均显示脉络膜循环异常.43/64(67.19%)患眼在与RPE渗漏点相对应之外其他部位脉络膜也出现了循环异常.盘脱平均面积为(12.91±8.84)mm2,视网膜下液平均吸收时间为(23.38±9.70)d.结论 CSC患者为弥漫性脉络膜循环异常、弥漫性RPE功能损害,且功能损害先于结构破坏.     

Axial length in unilateral idiopathic central serous chorioretinopathy

AIM: To evaluate the axial length (AXL) in unilateral idiopathic central serous chorioretinopathy (CSC). METHODS: This retrospective case-control study was comprised of a consecutive case series of 35 patients with acute unilateral idiopathic CSC, and age- and sex-matched 50 control eyes. AXL of both eyes of unilateral CSC patients and the control eyes were investigated. AXL was measured by ultrasonic biometry, and the adjusted AXL was calculated for CSC eyes as measured AXL plus differences of foveal thickness between CSC and normal fellow eyes in millimeters. The main outcome measures were comparison of AXL between CSC, fellow and control eyes. RESULTS: The mean age of 35 CSC patients was 45.5y, and 31 males were included. The adjusted AXL of CSC eyes was 23.52 mm, and the AXL of fellow eyes was 23.46 mm, and of control eyes 23.94 mm. The AXL of both CSC and fellow eyes were significantly shorter than control eyes (CSC vs control, P=0.044; fellow vs control, P=0.026). There was no statistically significant difference in AXL between CSC and fellow eyes. CONCLUSION: In unilateral idiopathic CSC, the AXL of CSC and fellow eyes are shorter than that of control eyes. Short AXL may be related with choroidal circulation abnormality in CSC.     

特发性中心性浆液性脉络膜视网膜病变的光学相干断层成像

目的　探讨特发性中心性浆液性脉络膜视网膜病变 ( idiopathic central serous chorioretinopathy,IC-SC)光学相干断层成像术 ( optical coherence tomography,OCT)改变的诊断特点与其临床应用价值。方法　对临床上诊断为 ICSC的 40例 ( 41只眼 )患者做 OCT和荧光素眼底血管造影检查、测量和分析。结果　 40例 ( 41只眼 ) IC-SC的 OCT图像均表现为黄斑中心的视网膜神经上皮层局限性脱离 ,脱离范围在 70 5～ 5 72 0 μm(平均 3 0 5 0 .80 49±13 3 7.5 619μm) ,高度 5 5～ 491μm(平均 2 69.85 3 7± 114.2 796μm)。 4只眼合并有色素上皮层浆液性脱离。并经统计表明脱离范围、高度与视力相关。结论　 OCT作为一种客观的无损伤的视网膜断层扫描技术 ,其高分辨率的特性在 ICSC的诊断、定量分析和病程随访中具有重要的价值和特别的优势     

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.     

Correlation between retinal pigment epitheliitis and central serous chorioretinopathy

A 37-year-old woman had sudden blurred vision in her right eye due to multifocal disturbances of the macular retinal pigment epithelium. Fluorescein angiography showed multiple pigment epithelial window defects with minimal late hyperfluorescence. The course of the disease, interpreted as retinal pigment epitheliitis, was complicated by a central serous chorioretinopathy. The possible relation between the two entities is discussed.