Intravitreous injection of bevacizumab for chronic central serous chorioretinopathy

Background/PurposeTo evaluate the effect of intravitreal bevacizumab on subretinal fluid absorption in patients with chronic central serous chorioretinopathy (CSCR).Materials and methodsThis was a retrospective case series study. Patients with CSCR symptoms for > 3 months and who received intravitreal injection of bevacizumab were included. Ocular examinations were carried out at baseline and every follow-up visit, including visual acuity, fundus examination, and optic coherence tomography.ResultsTwelve eyes in 12 patients were included in this study. One month after injection, three of the 12 patients who had increased central macular thickness were considered nonresponders. Nine of the 12 patients who had decreased central macular thickness were considered to have responded to intravitreal bevacizumab injection. The response rate was 75%. In the response group, the mean central macular thickness significantly decreased, from 306.7 ± 77.8 μm to 204.3 ± 59.3 μm (p = 0.001) at 1 month. The mean Logarithm of the Minimum Angle of Resolution (logMAR) visual acuity was significantly improved from 0.72 ± 0.35 to 0.50 ± 0.28 (p = 0.008). Six of these nine patients had stable conditions lasting > 6 months. Three of them had recurrence.ConclusionIntravitreal bevacizumab injections improved subretinal fluid absorption in some patients with CSCR. It could be an alternative therapy for patients with CSCR, especially when they are not suitable for other treatments.     

玻璃体腔注射贝伐单抗治疗慢性CSC的长期疗效观察

目的：探讨玻璃体腔注射贝伐单抗(IVB)治疗慢性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的安全性和长期临床疗效。

方法：我们给予6例6眼慢性CSC患者玻璃体腔注射1.25mg/0.05mL IVB治疗。5例患者在第一次注射后3mo接受了第二次相同剂量的注射。注射后1,3,6,12,24mo时随访观察。观察指标包括治疗前后的最佳矫正视力、眼压、OCT、眼底荧光素造影(FFA)。

结果：第一次玻璃体腔注射IVB后,2例患者视网膜下液(SRF)完全吸收,但其中1例在随访至3mo复发; 3例患者SRF有小幅度上升或下降; 1例患者的SRF先上升后明显下降; 再次进行IVB后,3例患者SRF完全吸收,其他的3例患者SRF无明显变化。但是SRF的吸收与视力的变化并不是同步的。治疗前后1,2a患者的视力变化在统计学上没有显著性差异。随访期间所有患者眼压均在正常范围,无一例出现眼内炎。

结论：玻璃体腔注射IVB对于治疗慢性CSC患者是安全的,对促进SRF的吸收有一定效果,但从长期结果来看,IVB对于慢性CSC患者的远期视力预后无明显作用。     

Subthreshold diode laser micropulse photocoagulation versus intravitreal injections of bevacizumab in the treatment of central serous chorioretinopathy

Purpose

To evaluate the treatment of central serous chorioretinopathy (CSC) with either subthreshold diode laser MicroPulse (SDM) or intravitreal bevacizumab (BCZ).

Methods

This comparative, controlled, prospective study conducted over a period of 10 months examined 52 eyes of 52 patients with (a) treatment with SDM at the active leakage site guided by fluorescein angiography (FA) (n=16 eyes), (b) intravitreal injection of 1.25 mg BCZ (n=10 eyes), or (c) observation (n=26 eyes). Outcome measures included changes in retinal pigment epithelium (RPE) leakage at FA, central macular thickness (CMT), best-corrected visual acuity (BCVA), and 10° macular perimetry.

Results

At the end of the study, there was 12.5% persistent leakage in the SDM, compared with 60% in the BCZ and 92% in the control group. Mean CMT decreased by 94 μm in the SDM, 38 μm in the BCZ, and did not change in the control group. Mean BCVA improved more than 6 early treatment of diabetic retinopathy study letters in the SDM, decreased by one letter in the BCZ, and by two letters in the control group. In the SDM group, mean perimetric deficit improved by 1.5 decibels and corrected lost variance by 2.6. In the BCZ, it improved by 0.6, and in the control group by 0.5. Retreatment was required in 7/16 eyes of the SDM group (43.75%), and in 5/10 eyes of the BCZ group (50%).

Conclusion

SDM photocoagulation was superior to intravitreal injections of 1.25 mg BCZ in the treatment of CSC, which resulted in enhanced visual acuity and macular perimetry.     

康柏西普治疗慢性中心性浆液性脉络膜视网膜病变的疗效

目的:观察玻璃体腔注射康柏西普治疗慢性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的临床疗效.方法:选取2015-10/2016-05我院门诊确诊的9例9眼慢性CSC患者,给予玻璃体腔注射0.5mg/0.05mL康柏西普治疗(其中6眼1mo后再次给予相同剂量的玻璃体腔注射).注射后第1、2、6mo随访观察,观察指标包括治疗前后的最佳矫正视力(best-corrected visual acuity,BCVA)、眼压、OCT、眼底血管荧光素造影(fundus fluoresceine angiography,FFA)、脉络膜吲哚菁绿血管造影(indocyanine green angiography,ICGA)、黄斑中心凹厚度(central macular thickness,CMT)、黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT).结果:患者9例9眼中,7眼对康柏西普有明显应答,2眼患者无应答.玻璃体腔注药前9眼患者CMT平均值为373.12±72.43μm,康柏西普治疗后1、2、6mo时CMT分别为332.05±67.13、282.24±62.30、225.56±71.08μm,与治疗前相比均具有统计学差异(P<0.05).9眼患者治疗前SFCT厚度为422.11±64.82μm,无应答患者治疗前脉络膜厚度低于平均值,分别为353、65μm.9眼患者治疗后1、2、6mo的SFCT分别为391.45±75.24、365.53±63.07、355.40±66.65μm,治疗前与治疗后1mo相比差异无统计学意义(P=0.074),与治疗后2、6mo相比较有统计学差异(P<0.01).治疗前平均视力为0.53±0.32,注射后平均视力为0.65±0.20,无统计学差异(P>0.05).结论:慢性CSC玻璃体腔注射康柏西普可以有效促进视网膜下液的吸收,降低CMT.玻璃体腔注药后6mo内黄斑中心凹下脉络膜厚度较治疗前显著降低,而黄斑中心凹下脉络膜厚度可能是患者是否应答的一个指标.     

A pilot study of intravitreal bevacizumab for the treatment of central serous chorioretinopathy (Case reports)

BACKGROUND: We report the use of intravitreal bevacizumab as a new option in the treatment of central serous chorioretinopathy (CSC). METHODS: Five eyes with retinal pigment epithelium (RPE) leaks secondary to CSC received intravitreal bevacizumab (2.5 mg/0.1 cc), and underwent best corrected visual acuity, fluorescein angiography and optical coherent tomography before, 1, 3 and 6 months after treatment. RESULTS: All patients showed improvement in visual acuity, fluorescein angiographic leakage, and reduced or resolved neurosensory detachment following treatment. CONCLUSIONS: Intravitreal injection of bevacizumab was associated with visual improvement and reduced neurosensory detachment without adverse events in patients with CSC. Although these results are promising, further investigations would be helpful to understand this therapy for patients with CSC.     

中心性浆液性脉络膜视网膜病变的治疗进展

中心性浆液性脉络膜视网膜病变（csc）系一种主要在男性中青年人患病具有自限性的黄斑部疾病,多数患者可自行恢复,因此对其治疗结果解释时应谨慎。迄今有关CSC治疗的随机对照临床研究很少,主要是基于无对照组的观察性研究。本文对传统激光局部光凝、减量光动力疗法、微脉冲二极管激光阈下光凝、抗血管内皮生长因子药物玻璃体内注射、糖皮质激素拮抗剂、肾上腺素能受体抑制剂、碳酸酐酶抑制剂、小剂量阿斯匹林等CSC治疗方法进行简要介绍与评价。     

中心性浆液性视网膜脉络膜病变的多焦视网膜电图特征

目的 探讨中心性浆液性视网膜脉络膜病变(CSC)的多焦视网膜电图(mERG)特征。方法 对18例(18眼)CSC患者的患眼和对侧眼做多焦视网膜电图检查，记录61个部位反应，比较分析视网膜后极部不同区域的a波(第1个负波)和b波(第1个正波)平均反应振幅密度。结果 CSC眼组1～3环a波和b波平均反应振幅密度明显低于正常对照组，两者之间差异有显著性意义。结论 多焦视网膜电图能对CSC局部视功能进行定量定位测定，为疾病诊断和治疗效果监测提供重要手段。     

Fundus autofluorescence in acute and chronic central serous chorioretinopathy

Background: A prospective evaluation of the pattern of fundus autofluorescence in cases of acute versus chronic central serous chorioretinopathy (CSR). Methods: A prospective, cross‐sectional, single‐centre investigation was performed using three diagnostic techniques, namely, fundus autofluorescence, optical coherence tomography and fundus fluorescein angiography to evaluate a sample of patients (n = 42 eyes) with both acute (n = 25 eyes) and chronic (n = 17 eyes) CSR. Results: Hypoautofluoresecence was found in 80 per cent (20 eyes) and 88.2 per cent (15 eyes) of eyes in the acute and chronic central serous chorioretinopathy groups, respectively, corresponding to the leakage points depicted by fluorescein angiography. Hypoautofluoresence corresponding to the areas of subretinal fluid accumulation was seen in 92 per cent (23 eyes) and 82.3 per cent (14 eyes) of the acute and chronic central serous chorioretinopathy groups, respectively. In two eyes (11.6 per cent) with chronic CSR, hyperautofluorescent changes were noted at the previous leakage points. In the acute CSR group, speckled hyperautofluorescence was detected in nine eyes (36 per cent) after the resolution of subretinal fluid. In the chronic CSR group, simultaneous speckled hyperautofluorescence was detected in the previous areas of subretinal fluid accumulation in 12 eyes (70.5 per cent). Conclusion: Fundus autofluorescence imaging delineates endogenous fluorescence derived mainly from lipofuscin within the retinal pigment epithelium (RPE) layer and therefore permits evaluation of functional alterations in the RPE in numerous retinal diseases. Data from fundus autofluorescence revealed distinctive findings in acute and chronic CSR. Fundus autofluorescence imaging may be used as a supplementary diagnostic tool for identifying patients with CSR and differentiation may be made between acute and chronic cases.     

Central serous chorioretinopathy: A review

Central serous chorioretinopathy (CSC) is the fourth most common non-surgical retinopathy associated with fluid leakage. The pathogenesis is not yet completely understood, but changes in the choroid, sclera and RPE have been described associated with venous congestion of choroidal outflow. CSC can be categorised into acute, chronic, and recurrent subtypes with recent classifications of simple and complex based on the area of RPE change seen on fundus autofluorescence. A multimodal imaging approach is helpful in the diagnosis and management of CSC and secondary complications such as type 1 neovascularisation. Although spontaneous resolution with relatively good visual outcomes is common, treatment should be considered in patients with persistent or recurrent SRF. Treatment options include laser, systemic medications, intravitreal therapy, and surgery. Of these, argon laser for focal extramacular fluid leaks and photodynamic therapy of leakage identified by indocyanine-green angiography currently have the greatest supportive evidence.     

Oral eplerenone for the management of chronic central serous chorioretinopathy

AIM: To examine eplerenone (Inspra, Pfizer), a mineralocorticoid receptor antagonist, as a treatment option for chronic central serous chorioretinopathy (CSCR). METHODS: A retrospective consecutive case series was conducted for patients receiving oral eplerenone for chronic CSCR. At baseline and each follow-up visit, spectral domain optical coherence tomography (SD-OCT) imaging was performed, including manual measurements of the height and diameter size of subretinal fluid. The primary outcome measure was the reduction in subretinal fluid following initiation of therapy. RESULTS: A total of 17 eyes of 13 patients treated with 25 and 50 mg of oral eplerenone per day were identified. Subretinal fluid (SRF) decreased over time following eplerenone therapy (P= 0.007 and P = 0.002, diameter and height respectively). Maximum SRF height decreased from a mean of 131.5 μm at baseline to 15.3 μm at day 181+. SRF diameter decreased from an average of 2174.4 μm at baseline to 46.9 μm at day 181+. LogMAR visual acuity improved from 0.42 (Snellen equivalent: 20/53) at baseline to 0.29 (Snellen equivalent: 20/39) at day 181+ (P = 0.024). Central subfield thickness (CST) decreased from 339.5 μm at baseline to 270.3 μm at day 181+ (P = 0.029). CONCLUSION: Eplerenone therapy resulted in significant anatomic and visual improvements in eyes with chronic CSCR.     

中心性浆液性脉络膜视网膜病变的治疗

中心性浆液性脉络膜视网膜病变好发于中青年男性,大多数病例视网膜下积液可自行吸收,视力预后良好,但也有部分患者迁延不愈,生活质量明显下降.目前临床尚无针对性治疗方法,近几年来随着人们对此病的重视和影像学的快速发展,其早期诊断率不断提高,药物、激光及各种新兴治疗方法的应用也使治愈率不断提高.本文就目前对该病的各种治疗方法进行综述,探讨中心性浆液性视网膜脉络膜病变的可行性治疗方案及其利与弊.     

Role of Avastin in management of central serous chorioretinopathy

Purpose

To evaluate the short-term safety and efficacy of intravitreal bevacizumab for the treatment of intraretinal or subretinal fluid accumulation secondary to central serous chorioretinopathy (CSC).

Design

Prospective interventional series non-comparative study.

Setting

Department of Ophthalmology, Al-Minya University Faculty of Medicine, Egypt.

Methods

The study included 20 eyes of 20 patients with central serous chorioretinopathy (CSC), Out of them 10 eyes with acute CSC (group I), 6 eyes with chronic CSC (defined as symptoms present for longer than 6 months) and four eyes with recurrent (defined as more than one episode of the disease) chronic and recurrent cases are considered in one group (group II), all patients were injected with intravitreal Avastin (IVA) 1.25 mg (0.05 mL) of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] as a primary treatment. At baseline and follow up visits patients had best corrected visual acuity (BCVA), IOP assessment, dilated fundus examination, fundus photography, fluorescein angiography (FA) and optical coherence tomography (OCT) imaging is used for measurement of central retinal thickness (CRT). Main outcome measures were the resolution of neurosensory detachment, improvement in visual symptoms and visual acuity, and resolution of leakage in FA. Secondary outcome and measures were the need for re-injection and the adverse effects. The mean number of injections was 2 (range 1–3 injections) 6–8 weeks intervals and follow up for 6 months (range 5–7 months). All finding at baseline and each follow up visit were reported and compared.

Results

The mean age of all patients was 40.3 years ± 6.5 (range 25–50 years), 15 males and five females patients. In acute CSC group, the mean baseline BCVA was 20/60 (log MAR 0.48) and improved to 20/30 (log MAR 0.18) with statistically significance difference change (P < 0.003) and in (chronic and recurrent group), the mean baseline VA was 20/80 (log MAR 0.60) and improved to 20/40 (log MAR 0.30) with statistically significance difference change (P < 0.002). The mean baseline CRT for all patients was 486 ± 86 μm (range, 386–580), decreased to 316 ± 56 μm (range, 276–368) after 1 months with statistically significance difference change (P < 0.02) and to 272 ± 52 μm (range 220–338) at last follow up with statistically significance difference change from the baseline (P < 0.001).

Conclusions

Intravitreal Avastin (IVA) injection was associated with visual improvement and reduced neurosensory detachment without adverse events in patients with CSC. Although these results are promising, further randomized controlled studies would be helpful to understand this therapy for patients with CSC.     

Congenital optic pits and central serous chorioretinopathy

Purpose: The reporting of the occurrence of central serous chorioretinopathy in a patient with congenital optic pits. Methods: A 31-year-old man complained of blurred vision in the right eye for 1 week. He had a visual acuity of 20/25 in the right eye. He underwent ophthalmoscopy and fluorescein angiography. Results: Ophthalmoscopy revealed serous detachment of macula with its margin not adjacent to the margin of optic disc. Fluorescein angiography showed a typical ink blot appearance of dye leakage. Conclusions: Central serous chorioretinoapthy can occur in the patient with congenital optic pits. Detailed ophthalmoscopic and fluorescein angiographic studies are necessary to establish the diagnosis of optic pits associated with macular detachment. Various mechanisms have been reported to explain the serous macular detachment in patients with optic pits including vitreous and cerebrospinal fluid leakage through the optic pit and from there into the subretinal space. The present case further denotes that central serous chorioretinopathy in the presence of optic pits can be due to leakage from the retinal pigment epithelium.     

Masqueraders of central serous chorioretinopathy

Central serous chorioretinopathy (CSCR) is one of the most common chorioretinal pathologies affecting middle-aged men worldwide. Although it has a self-limited course, a significant number of patients suffer from chronic and recurrent episodes. This often leaves the patient with various degrees of visual impairment. The situation is further aggravated by the fact that it is one of the most common conditions to be misdiagnosed. Because of overlapping features with other diseases or the atypical presentation of the disease itself, CSCR is a great mimicker and is one of the commonest causes of referral. We describe some of the conditions which can masquerade as CSCR.     

中心性浆液性脉络膜视网膜病变治疗方法的研究进展

中心性浆液性脉络膜视网膜病变( central serous chorioretinopathy,CSC)是中心视力损失的一项重要原因,它主要好发于中青年男性,以后极部浆液性神经上皮层脱离伴有视网膜色素上皮( retinal pigment epithelium,RPE)水平的渗漏为特征。大多数急性CSC患者会自发吸收,但是对于持续性神经上皮层脱离的慢性CSC患者可能会发展为进展性的视力下降。本文对近年来关于CSC治疗方法的研究进展作简要综述,主要从激光光凝、光动力学疗法( PDT)、玻璃体内抗血管内皮生长因子治疗、醛固酮受体拮抗剂四方面进行阐述。     

中心性浆液性脉络膜视网膜病变早期氪激光治疗疗效评价

目的评价中心性浆液性脉络膜视网膜病变(cen-tral serous chorioretinopathy,CSC)早期激光治疗的效果。方法回顾性分析44例(44眼)CSC初发早期(病程<3月)病例的激光光凝治疗疗效和随访结果,并与同期CSC初发晚期(病程≥3月,13例13眼)和复发病例(11例11眼)的相应治疗比较。结果初发早期CSC病变早期激光治疗,在治疗后1月和3月内,可分别获得77·3%和90.9%显效率,明显优于同期CSC初发晚期和复发病例的相应疗效(P<0.05);激光治疗后6月、12月和36月的随访期内CSC病情迁延不愈或反复发作的比率分别是2.4%、4.8%和10.0%,也明显少于其他组别的相应比率(P<0.05)。结论氪激光治疗CSC可较快提高视力、缩短病程、减少复发率。病程<3月的CSC初发早期病例是激光治疗的最佳、需(极力争取)及时治疗的指征。     

Diagnosis and interventions for central serous chorioretinopathy: review and update

Most acute cases of central serous chorioretinopathy resolve spontaneously with minimal visual impairment. The small percentage of eyes developing chronic or recurrent disease that do warrant treatment is often difficult to control. Emergent investigations and treatments have added to the established options available to manage these cases. Optical coherence tomography has proved valuable for both imaging subtle fundoscopic findings and monitoring disease progression. Fluorescein angiography aids identification of pigment epithelial leaks and targets the use of argon laser treatment if outside the fovea. Fluorescein angiography also assists differentiation from other choroidal pathologies such as choroidal neovascularization and polypoidal choroidal vasculopathy. Where the diagnosis is uncertain, indocyanine green angiography can demonstrate classic midphase hyperpermeability. This is also useful to guide the application of photodynamic therapy. Newer treatments such as intravitreal anti‐vascular endothelial growth factor are as yet unproven.     

中心性浆液性脉络膜视网膜病变的多焦视网膜电图

目的 :观察中心性浆液性脉络膜视网膜病变 (简称中浆 )的多焦视网膜电图 (multifocalelectroretinography ,m ERG)特点。方法 :应用RETIScanmultifocalERGVersion 3.15系统 ,对 16例单眼中浆患者进行研究。患眼为研究组 ,对侧眼为对照组。刺激为 6 1个六边形 ,从中央到周边共分 5个环 ,同时测定 31°视野范围的一阶反应 (first orderkernel) ,并进行双眼对照。结果 :在 1环和 2环上 ,患眼组的a波、b波幅值降低 ;1环的b波潜伏期明显延长。结论 :中浆患眼黄斑中心区a波、b波幅值明显下降 ,b波潜伏期明显延长