Central Serous Chorioretinopathy Associated with Topical Latanoprost Therapy

Purpose: To report a case of central serous chorioretinopathy (CSC) as a possible complication of latanoprost treatment.

Methods: A 65-year-old woman presented with a 1-week history of blurred vision and metamorphopsia in her right eye. She was previously diagnosed with unilateral glaucoma, and treatment was initiated with topical latanoprost 0.005% for the right eye. The symptoms occurred 1 month after initiation of glaucoma treatment.

Results: Visual acuity (VA) of the patient had reduced to 20/50 in right eye. Fluorescein angiography revealed a focal RPE leak near to the fovea with neurosensory detachment due to CSC, which was confirmed by optical coherence tomography. After cessation of the therapy, her clinical and morphological status improved spontaneously. The neurosensory detachment resolved almost completely and VA improved to 20/20 simultaneously.

Conclusions: The authors report the first case of CSC associated with latonoprost therapy. This case demonstrates that topical latanoprost may lead to the development of CSC.     

Para-Vertical Meridian Visual Field Defects in Chronic Central Serous Chorioretinopathy

We report two cases with a variant of chronic central serous chorioretinopathy (CSC) resulting in curious visual field defects which are aligned with the vertical meridian and correspond exactly to the abnormalities seen in the fundus on both fundus photography and fluorescein angiography.     

中心性浆液性脉络膜视网膜病变的屈光变化幅度与视力预后

目的：探讨中心性浆液性脉络膜视网膜病变（CSC）患眼的屈光变化幅度及其与视力预后的关系。方法：对23例原为正视眼的单眼活动期CSC患眼作随访前后屈光状态及矫正视力的检测。随访时间3至12个月（平均7．2个月）。结果：随访前15只患眼（65．2％）呈轻度远视状态，而对侧健眼呈远视状态的为5只眼（21．7％），远视率在患眼与健眼的分布上差异有显著性意义（P＜0．01）。随访后仅5只患眼（21．7％）仍呈远视状态，随访前后患眼远视率比较差异有显著性意义（P＜0．01）。随访前经验光矫正视力增进3行或以上的患眼90．9％在随访后矫正视力可达到1．0或以上。结论：大部分CSC患眼由于黄斑区神经上皮脱落、水肿而呈暂时性的轻度远视；通过活动期患眼屈光状态及矫正视力的检测，对患眼视力预后的评价有一定的价值。     

中心性浆液性脉络膜视网膜病变的微视野检查

目的:探讨中心性浆液性脉络膜视网膜病变(Centralserouschorioretinopathy,CSC)的微视野检查特征。方法:应用MP-1微视野计(MP-1NidekTechnologies,Vigonza,Italy)检测了19例(21只眼)CSC患者,年龄30～50岁,平均(39.3±6.8)岁。其中迁延型5只眼、急性型6只眼、恢复型5只眼、复发型5只眼。其中视力≥1.0的10只眼、0.6～0.9的6只眼、≤0.5的5只眼。正常对照20例(20只眼),年龄30～50岁,平均年龄(37.6±6.7)岁。记录患眼和正常眼的固视情况,以及中心20°的光敏感度。结果:不同类型及不同视力的患眼与正常眼的2°固视率和4°固视率差异无显著性意义。不同类型及不同视力的患眼与正常眼相比,黄斑20°视网膜平均光敏感度(Meansensitivity,MS)明显下降,差异具有显著性意义(P<0.05)。不同类型及不同视力患眼之间的视网膜MS差异具有显著性意义(P<0.05)。结论:MP-1微视野计检查可以量化地评价CSC患眼的固视情况和黄斑区MS,进一步提高了患眼的功能评价。     

Rapid Resolution of Graft-versus-Host-Disease-Related Central Serous Chorioretinopathy

Abstract

We present a 23-year-old female patient who developed bilateral, multifocal CSCR three months after BMT and two months after developing GvHD. At the time of diagnosis, her medications included cyclosporine and high-dose oral steroid for GvHD. CSCR resolved quickly after the resolution of GvHD, along with rapid tapering of steroids and restoration of emotional wellbeing. Rapid tapering of systemic steroids under close monitoring of a hematologist in the setting of resolved mild GvHD may facilitate prompt resolution of CSCR.     

Central Serous Chorioretinopathy in Giant Cell Arteritis

A 66-year-old woman started oral prednisone for temporal artery biopsy (TAB) proven GCA and developed central haziness OD > OS. Visual acuity worsened to 20/100 OD and 20/25 OS. Clinical exam, optical coherence tomography (OCT) and fluorescein angiography (FA) revealed central serous chorioretinopathy (CSCR). The patient was treated with focal laser therapy for CSCR and steroid taper. Patients with giant cell arteritis on high dose steroids may present with significant loss of visual acuity and field. CSCR (precipitated by steroids) should be considered in the differential diagnosis as increasing the steroid dose for presumed visual loss secondary to GCA might worsen rather than improve the visual outcome.     

An Unusual Case of Central Serous Chorioretinopathy in a Patient with Acute Retinal Necrosis

Purpose: In acute retinal necrosis, which is caused by herpes virus, urgent treatment is essential. Design and Methods: Here we present a 47years old male patient, who developed an acute retinal necrosis in his left eye. Therapy was initiated with systemic aciclovir and corticosteroids. Results: During the course of disease our patient achieved improvement of acute retinal necrosis but he developed central serous chorioretinopathy. Conclusions: The development of central serous chorioretinopathy in our patient was most probably due to the systemic corticosteroids he received. Especially in patients with an intraocular inflammation this diagnosis may lead to severe differential diagnostic problems.     

从吲哚青绿血管造影表现分析中心性浆液性脉络膜视网膜病变

目的:通过分析中心性浆液性脉络膜视网膜病变(Central Serous Chorioretinopathy,CSCR)的吲哚青绿血管造影(Indocyanine Green Angiography,ICGA)特征,探讨该病的病理特点及治疗机理。方法:使用海德堡血管造影仪对35例临床诊断为CSCR患者进行ICGA及眼底荧光血管造影(FFA)同步分析,解释和讨论造影结果。结果:35例病例中,有29例(83％)在ICEA中发现的病灶超过FFA所见病灶数,25例(71.4％)为双眼,所有FFA的病灶处均有ICGA改变,且ICGA所见病灶范围大于FFA病变。结论:脉络膜通透性改变是中浆的早期改变,由此引起其上方视网膜色素上皮(RPE)功能失代偿和缺损可能是中浆的主要发病机制。中浆的激光和药物治疗效果和原理需要进一步探讨。眼科学报1999;15:81—84。     

Frequency of Erectile Dysfunction in Males with Central Serous Chorioretinopathy

Objectives: To evaluate the frequency of sexual dysfunction and associated factors in patients with central serous chorioretinopathy (CSCR). Material and methods: Fifty-eight CSCR patients who met the inclusion criteria and 99 age- and sex-matched healthy controls were prospectively investigated for sexual dysfunction and associated factors. All participants were investigated using the Beck Depression Inventory (BDI), Beck Anxiety Scale (BAS), and the15-question Index of Erectile Function-15 (IIEF-15) and by extensive examination of CSCR, associated factors, and confounding factors. Results: The mean ages of the patient and control groups were 46.95±11.27 and 45.3±10.93 years, respectively (p=0.370). The erectile function, orgasmic function, sexual desire, sexual satisfaction, and overall sexual satisfaction scores of the patient group were significantly lower than those of the control group (p<0.001). Severe erectile dysfunction (ED) was diagnosed in 3 (5.2%), moderate ED in 10 (17.2%), mild-to-moderate ED in 7 (12.1%), and mild ED in 15 (25.9%) patients in the patient group, whereas no severe or moderate ED was diagnosed in the control group. The erectile function score was found to be negatively correlated with age and BMI. No sexual parameters were found to be correlated with choroidal thickness (CT) in either the patient or control group. Conclusion: CSCR patients experience a higher incidence of sexual dysfunction compared to healthy individuals without CSCR. The exclusion of confounding factors suggests that factors involved in CSCR pathogenesis may also play a role in ED.     

Ring-Shaped Subretinal Fibrinous Exudate in Central Serous Chorioretinopathy

Purpose

To clarify the pathologic changes of the ring-shaped, grayish white subretinal fibrinous exudate in central serous chorioretinopathy (CSC), we examined patients with fluorescein angiography (FA) and optical coherence tomography (OCT).

Methods

Using OCT, we prospectively examined 13 consecutive patients (12 men, one woman) (13 eyes) with acute CSC. The fundi were scanned by OCT through the ring-shaped, grayish white lesion.

Results

FA showed focal dye leakage at the center of the ring-shaped, grayish white subretinal exudates. In the area of the exudates, OCT showed moderately or highly reflective masses bridging the neurosensory retina and the retinal pigment epithelium in all eyes. Because the area of the pellucid core of the ring-shaped exudate showed an optically clear space beneath the neurosensory retina, the subretinal reflective masses were separated on cross-sectional images in all 13 eyes. Pigment epithelium detachment was observed in the area of the grayish white lesion by OCT and FA in 7 of the 13 eyes.

Conclusions

In eyes with a ring-shaped, grayish white exudate in CSC, OCT and FA findings indicate that the pellucid core of the exudate is the route of the exudative fluid from the choroid into the subretinal space. A surrounding grayish white lesion seems to be fibrinous exudate that has accumulated in the subretinal space. Jpn J Ophthalmol 2005;49:516–519 © Japanese Ophthalmological Society 2005     

Central Serous Chorioretinopathy Following Pulse Corticosteroid Therapy in Multiple Sclerosis

The purpose of this paper was to report a case of central serous chorioretinopathy following pulse corticosteroid therapy in multiple sclerosis. The patient was a 40-year-old female patient admitted to neurology clinic with muscle weakness and difficulty in moving. Having the diagnosis of multiple sclerosis, she was hospitalised for the treatment of the acute attack. Pulse intravenous methylprednisolone therapy was introduced and on the third day of the therapy, patient reported acute visual loss. Magnetic resonance imaging was performed to exclude optic neuritis. Complete eye examination and imaging of the fundus revealed retinal pigment epithelial detachment as the cause of the visual loss. Corticosteroids (endogenous or exogenous) are known risk factors for central serous chorioretinopathy. As retinal pigment epithelial detachment is a component of central serous chorioretinopathy, systemic corticosteroid was thought to be responsible for acute visual loss in this case. Steroid therapy was gradually tapered and acetazolamid was introduced. Her visual acuity improved but retinal pigment epithelial detachment was found to be persisting 2 years later. Although optic neuritis, the most common ocular presentation, is generally responsible for acute visual loss in multiple sclerosis, one should consider that systemic corticosteroid therapy for the acute attack may be in charge.     

Association of Near-Infrared and Short-Wavelength Autofluorescence With the Retinal Sensitivity in Eyes With Resolved Central Serous Chorioretinopathy

PurposeThe purpose of this study was to compare the results of near-infrared autofluorescence (NIRAF) and short-wavelength autofluorescence (SWAF) imaging of eyes with resolved central serous chorioretinopathy (CSC) and to assess the retinal sensitivity (RS) in areas with abnormal autofluorescence (AF) using white-on-white (WW) and blue-on-yellow (BY) perimetries.MethodsWe examined 20 consecutive eyes with resolved CSC. We calculated the areas of abnormal AF detected by SWAF and NIRAF imaging as SWAF_area and NIRAF_area, respectively, and the number of measurement points within and outside abnormal SWAF and NIRAF regions were counted. The results of WW and BY perimetries were superimposed on the AF images, and the mean overall RS within and outside abnormal SWAF and NIRAF regions were calculated using both WW and BY perimetries (W-RSin_SWAF, W-RSout_SWAF, W-RSin_NIRAF, W-RSout_NIRAF, B-RSin_SWAF, B-RSout_SWAF, B-RSin_NIRAF, and B-RSout_NIRAF, respectively).ResultsThe mean age of the participants was 54.1 years. The SWAF_area was significantly smaller than the NIRAF_area (P < 0.0001, Wilcoxon signed rank test). A χ² test suggested a significant relationship between the number of measurement points within/outside abnormal SWAF and NIRAF regions (P < 0.0001). In the results of measurement by WW perimetry, there was a significant difference between W-RSin_NIRAF and W-RSout_NIRAF (P < 0.0001), but not between W-RSin_SWAF and W-RSout_SWAF (P = 0.060, Wilcoxon rank sum test). In contrast, on BY perimetry, there were significant differences between both B-RSin_SWAF and B-RSout_SWAF and between B-RSin_NIRAF and B-RSout_NIRAF (P < 0.0001).ConclusionsNIRAF was useful for predicting impaired RS in eyes with resolved CSC.     

An Insertion Variant in CRH Confers an Increased Risk of Central Serous Chorioretinopathy

PurposeTo identify a novel corticotropin-releasing hormone (CRH) gene variant relevant in patients with central serous chorioretinopathy (CSC).MethodsWe performed a genetic study of CSC in families and sporadic cases with controls. Using whole-exome sequencing and linkage analysis, we identified a heterozygous insertion variant, Gln52insPro, in the CRH gene that cosegregated in two Chinese families with CSC. This variant was evaluated among an additional 1307 patients with CSC and 1438 ethnicity-matched control individuals from three independent Chinese cohorts.ResultsThe CRH variant was strongly associated with CSC in these cohorts of Chinese patients (P_meta = 1.24 × 10⁻¹¹; odds ratio, 3.01; 95% confidence interval, 2.15–4.21). The risk variant Gln52insPro decreased CRH gene expression.ConclusionsOur results implicate the hypothalamic–pituitary–adrenal stress response system in the pathogenesis of CSC and provide a novel rationale for therapeutic intervention.     

Vision-Related Quality of Life in Patients with Chronic Central Serous Chorioretinopathy

ABSTRACT

Purpose: To evaluate vision-related quality of life in patients with chronic central serous chorioretinopathy (CSCR). Design: Prospective, cross-sectional study. Methods: The interviewer-administered National Eye Institute visual function questionnaire (NEI-VFQ-25) was used in 30 adult consecutive patients with chronic CSCR patients. The controls were 30 gender- and age-matched people with normal visual function who came from the same socioeconomic and educational background as the participants. Results: Patients with CSCR had statistically significant lower scores than controls for all the subscales, except for general health. In the study group, all subscale scores of vision-related quality of life, except general health, showed statistically significant negative correlations with the visual acuity. Conclusions: People with CSCR have worse vision-related quality of life than people without the condition.     

The Effect of Intravitreal Bevacizumab in Patients with Acute Central Serous Chorioretinopathy

Purpose

To evaluate the effect of intravitreal bevacizumab injection (IVBI) in acute central serous chorioretinopathy (CSC) patients.

Methods

Patients with acute CSC received IVBI (1.25 mg/0.05 mL) or observation by randomization. Twelve eyes in each group completed 6 months of regular follow-up and were ultimately included in this study. Each patient was assessed using best corrected visual acuity measurements, fluorescein angiography, and optical coherence tomography at baseline and had regular follow-ups after treatment.

Results

All patients showed improvements in visual acuity and fluorescein angiographic leakage and had resolution of their neurosensory detachment following treatment. There were no significant differences in visual acuity, central retinal thickness, or remission duration between the IVBI group and the control group at baseline or after treatment (p>0.05).

Conclusions

Intravitreal bevacizumab showed no positive effect in acute CSC patients compared to the observation group, and there were no adverse effects of treatment. Further investigation will be helpful to understand this therapy in patients with CSC.     

A Case of Idiopathic Central Serous Chorioretinopathy in a 12-year-old Male Treated with Bevacizumab

A 12-year-old male presented with a chief complaint of a 1-month-history of decreased visual acuity in his right eye. The patient had no past history of steroid use or other systemic diseases. On fundus examination, which included fluorescent angiography (FAG) and optical coherence tomography (OCT), the patient was diagnosed with idiopathic central chorioretinopathy, whose clinical course was monitored without any specific treatments. At the time of admission, the best-corrected visual acuity was 0.5 in the right eye and 1.0 in the left eye. On fundoscopy, a serous detachment of 1 disc diameter in size was observed in the posterior pole. According to the FAG and the OCT, serous neurosensory detachment was present. After two months of monitoring the clinical course, the best corrected visual acuity in the right eye was 0.8, and there was improvement of neurosensory retinal detachment. However, OCT detected recurrence after five months, and the corrected visual acuity was decreased to 0.6. Bevacizumab was then injected into the vitreous cavity. Complete resolution of the subretinal fluid resulted eight months later, and the corrected visual acuity improved to 1.0.     

Comparison of Serum Cortisol and Testosterone Levels in Acute and Chronic Central Serous Chorioretinopathy

PurposeTo compare the levels of serum cortisol and testosterone in acute and chronic central serous chorio-retinopathy (CSC).MethodsSerum cortisol and testosterone levels in 30 patients with either acute or chronic CSC were evaluated using chemiluminescent immunoassay.ResultsThe mean age was 42.43 ± 6.37 years (range, 32 to 56 years). The mean 8:00 to 9.00 a.m. serum cortisol level was 12.61 ± 4.74 µg/dL (range, 6.58 to 27.42 µg/dL). The mean serum testosterone level was 5.88 ± 1.57 ng/dL (range, 2.81 to 9.94 ng/dL). The mean visual acuity was 20 / 65.07 ± 40.56 (range, 20 / 25 to 20 / 200). There was no statistically significant difference in the mean levels of serum cortisol and testosterone between the acute and chronic cases (p > 0.05), but there was a statistically significant difference in the mean presenting visual acuity in the two groups (p < 0.05).ConclusionsAll except one patient in the acute group had normal levels of serum cortisol. Testosterone levels were within the normal range in both the acute and chronic cases of CSC. There is unlikely to be any statistically significant difference in the mean levels of serum cortisol and testosterone between the acute and chronic cases, but there may be a statistically significant difference in the mean presenting visual acuity in these groups.     

Alcohol- and Light-induced Electro-oculographic Responses in Age-related Macular Degeneration & Central Serous Chorioretinopathy

The non-photic electro-oculographic (EOG) response induced by alcohol has been proposed as an indicator of retinal pigment epithelial (RPE) integrity, and reported to be abnormal in age-related macular degeneration (ARMD). To evaluate this proposal, we have measured the alcohol-EOG as well as the ISCEV-standard EOG in patients with ARMD (n=11 patients, 4 eyes with drusen, 8 eyes with ‘dry’ and 7 eyes with ‘wet’ lesions) and central serous chorioretinopathy (CSC, n=11 patients, 7 eyes with active and 6 eyes with inactive lesions), compared with 29 normal controls. We recorded the alcohol-induced EOG response after a single oral administration of ethanol at 160 mg/kg, followed by an ISCEV-standard EOG. Blood alcohol levels were monitored with a breath analyzer. We found that neither the alcohol-EOG nor the light-induced EOG response showed any difference between either ARMD or CSC patients and normal controls. Nor was there difference among eyes of different ARMD or CSC subgroups. In addition, blood alcohol concentrations near the time of the alcohol-EOG peak showed no obvious relationship with peak/baseline ratios. These data suggest that neither the alcohol- nor the light-induced EOG is a sensitive indicator of these diseases.     

Psychological Distress and Poor Quality of Life in Patients with Central Serous Chorioretinopathy

Abstract

Purpose: We aimed to compare the mental health and quality of life (QoL) between central serous chorioretinopathy (CSCR) patients and the control subjects. Methods: Thirty consecutive patients presenting with CSCR and age-gender-matched 30 healthy control subjects filled in the following standardized questionnaires: Symptom Checklist 90-R (SCL 90-R) and Short Form 36 (SF-36). Age, gender, and ocular clinical findings were recorded. Results: According to SCL-90-R, all scores were significantly higher in the CSCR group when compared to the control group. The patients with CSCR reported significantly lower levels of QoL, except bodily pain. Conclusion: Our results indicated that CSCR patients have poorer QoL and more psychological problems. CSCR patients may benefit from psychosocial support and interventions.