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Vascular and structural alterations of the choroid evaluated by optical coherence tomography angiography and optical coherence tomography after half-fluence photodynamic therapy in chronic central serous chorioretinopathy
摘要： Purpose To concurrently evaluate the effect of half-fluence photodynamic therapy (hf PDT) on choriocapillaris (CC) perfusion and choroidal structure in chronic central serous chorioretinopathy (CSC). Methods This prospective study included 48 eyes of 41 patients with chronic CSC. Enhanced depth imaging optical coherence tomography and optical coherence tomography angiography (OCTA) images were analyzed. Choroidal area (CA), luminal area (LA), and stromal area (SA) were computed using Image J software. Results One month after hf-PDT, total CA decreased to 1.312 mm2 from 1.490 mm2 (p < 0.001), LA decreased to 0.981 mm2 from 1.097 mm2 (p < 0.001), and SA decreased to 0.331 mm2 from 0.393 mm2 (p < 0.001). In OCTA, the CC flow in the eyes with CSC (17.75 mm2) was statistically significantly lower than the fellow eyes (18.93 mm2) at the baseline visit (p < 0.001). After hf-PDT, the flow in the choriocapillaris statistically significantly increased to 18.81 mm2 at the first month (p = 0.02). Conclusions OCTA proves that after hf-PDT a significant increase in CC perfusion occurred at first month. The decrease of the luminal areas in enhanced depth imaging optical coherence tomography is mainly due to a decrease in large-caliber vessels, which indicates that hf-PDT has an effect on larger choroidal vessels and spares CC flow.
关键词： Chronic central serous chorioretinopathy,Optical coherence tomography angiography,Half-fluence photodynamic therapy,Choriocapillaris perfusion
更新于2025-09-23 15:23:52
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OCT Angiography of the Choriocapillaris in Central Serous Chorioretinopathy: A Quantitative Subgroup Analysis
摘要： Introduction: To quantify optical coherence tomography angiography (OCTA) signal changes at the level of the choriocapillaris (CC) in patients with different stages of central serous chorioretinopathy (CSC) and to explore any correlation between subretinal fluid (SRF) and retinal pigment epithelium (RPE) alterations and the OCTA CC signal. Methods: One hundred one CSC eyes and 42 healthy control eyes were included in this retrospective study. CSC patients were allocated into four groups: acute, non-resolving, chronic atrophic and inactive CSC. CC OCTA images (AngioPlex?, Zeiss) were automatically quantified using an image-processing algorithm. Spatial correlation analysis of OCTA signals was performed by overlapping macular edema heatmaps and fundus autofluorescence images with corresponding OCTA images. Results: Active CSC subgroups demonstrated significantly more increased and decreased flow pixels in the CC compared with controls (p < 0.0001). No significant OCTA changes were seen within the active CSC groups or between the inactive and healthy subgroup. Spatial correlation analysis revealed a decreased OCTA signal in the SRF area and an increased signal outside the SRF area in acute CSC. Areas of RPE atrophy co-localized with areas of increased choriocapillaris OCTA signal, while areas with RPE alterations exhibited a normal signal compared with unaffected RPE. Conclusion: The decreased OCTA signal in the area of SRF in acute CSC could be evidence of localized CC hypoperfusion or due to shadowing artifacts. The missing CC OCTA changes in altered RPE adjacent to atrophy argues against CC injury. Studies with higher resolution and optimized image acquisition are warranted to further validate our findings.
关键词： Choriocapillaris,OCT angiography,Central serous chorioretinopathy
更新于2025-09-23 15:23:52
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Genome-Wide Association Study to Identify a New Susceptibility Locus for Central Serous Chorioretinopathy in the Japanese Population
摘要： PURPOSE. Central serous chorioretinopathy (CSC) is a retinal disorder that often affects the vision of middle-aged people yet the molecular mechanisms of CSC remain unknown. This study was conducted to identify genetic factors influencing individual differences in susceptibility to CSC. METHODS. A two-stage genome-wide association study (GWAS) was conducted with a total of 320 unrelated Japanese idiopathic CSC cases and 3245 population-based controls. In a discovery stage, 137 unrelated Japanese idiopathic CSC cases and 1174 population-based controls were subjected to GWAS, followed by a replication study using an additional 183 individuals with idiopathic CSC and 2071 population-based volunteers. The results of the discovery and replication stages were combined to conduct a meta-analysis. RESULTS. In the two-stage GWAS, rs11865049 located at SLC7A5 in chromosome 16q24.2 was identified as a novel disease susceptibility locus for CSC, as evident from the discovery and replication results using meta-analysis (combined P = 9.71 × 10^-9, odds ratio = 2.10). CONCLUSIONS. The results of the present study demonstrated that SLC7A5 might be the potential candidate gene associated with CSC, indicating a previously unidentified molecular mechanism of CSC.
关键词： Japanese,genome-wide association study,central serous chorioretinopathy,SLC7A5
更新于2025-09-23 15:23:52
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Structural and Functional Outcomes in Chronic Central Serous Chorioretinopathy Treated with Photodynamic Therapy
摘要： Purpose: To study the retinal pigment epithelium (RPE) and retinal alterations in chronic central serous chorioretinopathy treated with photodynamic therapy, and its correlation with functional parameters such as best-corrected visual acuity (BCVA) and contrast sensitivity (CS). Methods: Retrospective, noncomparative, consecutive evaluation by optical coherence tomography and its correlation with BCVA and CS in 31 eyes of 26 patients. Results: In all affected patients, 88.5% were male with a mean age of 42.9 years. The right eye was involved in 64.5% of cases, bilateral in 19% and 73.9% were hyperopic (spherical refraction between 0 and +5.0 diopters). Of these cases, 51.5% had peri-RPE abnormalities, 17.3% hyperreflective substances at RPE, 19.4% RPE atrophy, 55.3% foveolar atrophy, 3.1% pigment epithelial detachment, 5.2% subretinal fluid persistence, 8.3% fibrin deposits, 68.4% photoreceptor inner and outer segment line interruption and 31.1% external limiting membrane interruption. Conclusions: Time evolution and number of outbreaks were related to the decrease in foveal and chorodial thickness and in those with worse BCVA and CS. RPE abnormalities and atrophy were related to the age of onset of symptoms. Photoreceptor elongation has been correlated with poor BCVA and inner and outer segment line destructuring and interruption with poor CS.
关键词： Photochemotherapy,Contrast sensitivity,Visual acuity,Central serous chorioretinopathy,Optical coherence tomography
更新于2025-09-23 15:22:29
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Swept-Source Optical Coherence Tomography Angiography in Central Serous Chorioretinopathy
摘要： Purpose: This article aims to evaluate the appearance of central serous chorioretinopathy (CSC) with swept-source optical coherence tomography angiography (SS-OCTA), to discuss whether localization of the leakage spot seen on fluorescein angiography (FA) corresponds to any recognizable spot on SS-OCTA, and to provide subsequent diagnosis of choroidal neovascularization (CNV) in the course of CSC. Methods: A prospective interventional case series was conducted in a private outpatient office on 30 eyes of 27 patients. In addition to ophthalmic examination, FA, spectral-domain OCT, SS-OCT and SS-OCTA were performed at least once. If laser photocoagulation or anti-vascular endothelial growth factor (anti-VEGF) injection was administered, then all examinations were repeated afterward. Following SS-OCTA, morphology features of CSC were analyzed: localization of the leakage spot, presence of feeder vessels, and presence of CNV. Changes after treatment were recorded. Results: In 26 of 30 cases the leakage site on FA corresponded to a highly hyporeflective site on SS-OCTA. In 7 of these cases laser was successfully administered. In 20/30 eyes we additionally observed thickened vessels at the level of choriocapillaris in close proximity to the most hyporeflective spot. CNV was observed in 4 cases. The leakage spot is the most hyporeflective spot on SS-OCTA localized at the level of choriocapillaris. Additionally, choroidal feeder vessels might be visualized at the level of choriocapillaris in 66% of cases. In 4 eyes, CNV in the course of CSC was noted. Conclusions: In CSC, SS-OCTA is a valuable diagnostic tool and its results complement FA. It might add to the treatment process, especially regarding the need to start and to monitor anti-VEGF injections. Anti-VEGF treatment results in fading but not in complete disappearance of CNV in the course of CSC.
关键词： central serous chorioretinopathy,swept-source OCT angiography,anti-VEGF,laser
更新于2025-09-23 15:21:01
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Prospective evaluation of changes in choroidal vascularity index after half-dose photodynamic therapy versus micropulse laser treatment in chronic central serous chorioretinopathy
摘要： Purpose To assess whether treatment of chronic central serous chorioretinopathy (cCSC) with photodynamic therapy (PDT) and high-density subthreshold micropulse laser (HSML) results in choroidal vascularity index (CVI) changes that may account for the treatment effect. Methods Patients with cCSC were prospectively included and analyzed. Patients received either half-dose PDT or HSML treatment. CVI of the affected and unaffected eye was obtained before treatment, 6 to 8 weeks after treatment, and 7 to 8 months after treatment. Results At baseline, 29 eyes (29 patients) were included both in the PDT and in the HSML group. The mean (± standard deviation) CVI change in the HSML group between before PDT and 6 to 8 weeks after PDT was ? 0.009 ± 0.032 (p = 0.127), whereas this was 0.0025 ± 0.037 (p = 0.723) between the visit before PDT and final visit. The patients in the PDT group had a CVI change of ? 0.0025 ± 0.037 (p = 0.723) between the visit before PDT and first visit after PDT, and a mean CVI change of ? 0.013 ± 0.038 (p = 0.080) between the visit before PDT and final visit. There was no significant correlation between CVI and BCVA at the measured time points, in both the HSML group (p = 0.885), and in the PDT group (p = 0.904). Moreover, no significant changes in CVI occurred in the unaffected eye at any time point. Conclusions PDT and HSML do not significantly affect CVI, and therefore a CVI change may not be primarily responsible for the treatment effect. The positive treatment effect of both interventions may rely on other mechanisms, such as an effect on choriocapillaris and/or retinal pigment epithelium function.
关键词： Choroidal vascularity index,Photodynamic therapy,Central serous chorioretinopathy,Micropulse laser
更新于2025-09-23 15:19:57
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Photoreceptor assessment in focal laser-treated central serous chorioretinopathy using adaptive optics and fundus autofluorescence
摘要： This study analyzed cone density, cone mosaic, and fundus autofluorescence (FAF) images in patients with focal laser-treated central serous chorioretinopathy (CSC). Observational case series. Forty-two eyes of 21 patients with unilateral treated CSC and bilateral best-corrected visual acuity of 1.0 (decimal fraction) were included. FAF and cone mosaic images were obtained in all patients with an adaptive optics fundus camera. Densities were recorded at 20 points throughout the macula, and choroidal thicknesses were measured. Mean choroidal thicknesses were 419.95 ± 110.33 mm in normal eyes, 459.09 ± 90.07 mm in eyes with active CSC, and 438.61 ± 107.57 mm in treated eyes. The highest density of cones in healthy eyes was 38146 cones/mm2, with a 5.66-mm intercellular space (IS), at 700 mm temporal to the center. In eyes with treated CSC, the highest density was 32749 cones/mm2, with a 6.13-mm IS, at 500 mm nasal to the center. In all quadrants, median values of maximum cone density were significantly higher in healthy eyes (P = .02, P = .003, P = .0001, and P = .001). Three types of lesions were identified on FAF and were correlated with those on cone mosaic images. Strong correlations were detected between the presence of hypoautofluorescent lesions on the first FAF image and a greater difference between maximum values of photoreceptor density (r2 = 0.46, P = .03), as well as between the presence of hypoautofluorescent lesions and the duration of pathology (r2 = 0.68, P < .001). The presence of hypoautofluorescent lesions and the duration of pathology were negative prognostic factors in CSC. Laser treatment could prevent photoreceptor loss.
关键词： photoreceptor density,cone mosaic,fundus autofluorescence,laser-treated central serous chorioretinopathy,adaptive optics
更新于2025-09-23 15:19:57
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Statement of the BVA, the DOG, and the RG on treatment of choroidal neovascularization in diseases other than neovascular age-related macular degeneration; Stellungnahme des BVA, der DOG und der RG zur Therapie chorioidaler Neovaskularisationen bei anderen Erkrankungen als der neovaskul?ren altersabh?ngigen Makuladegeneration (Englische Version);
摘要： Choroidal neovascularizations (CNV) occur not only in age-related macular degeneration (AMD), but also in numerous other macular and retinal disorders of varying etiology and, if left untreated, can cause irreversible visual loss. The diagnosis of CNV as well as the indication for treatment should be made in the same way as in neovascular AMD: On initial diagnosis: best-corrected visual acuity, fundus examination, optical coherence tomography (OCT), and fluorescein angiography. At follow-up: best-correct visual acuity, fundus examination, OCT, and, depending on findings, fluorescein angiography. Active CNV should be treated with intravitreal operative medication (IVOM) using vascular endothelial growth factor (VEGF) inhibitors if patients have visual acuity of at least 0.05 or if there is sufficient reason to assume that visual acuity could increase to over 0.05 under treatment. Underlying disorders can include, e.g., high myopia, angioid streaks, central serous chorioretinopathy, active and inactive uveitis of varying etiology, including retinochoroiditis, chorioretinitis, and choroiditis, eye injuries, retinal dystrophies, e.g., best disease and pattern dystrophies, idiopathic CNV, subretinal masses (osteomas, hamartomas, nevi). If CNV is not present as a complication in the above-mentioned disorders, IVOM with VEGF inhibitors should not be performed. Ranibizumab and aflibercept are approved in Germany for the treatment of CNV secondary to pathologic myopia. Ranibizumab has been approved in Germany since 12/2016 for the treatment of CNV in disorders other than neovascular AMD and pathologic myopia irrespective of the underlying disease. The other VEGF inhibitors, aflibercept and bevacizumab, can be used off-label. Due to its overall significantly poorer treatment results, photodynamic therapy (PDT) should only be used in exceptional cases and extrafoveal localization. After one initial intravitreal administration of VEGF inhibitors, further CNV activity should be monitored monthly for the first 6 months (see point 2). In the case of persisting or recurrent activity, repeated IVOM should be performed. Depending on disease course, the follow-up interval might be extended 6 months after the last IVOM. In individual justified cases (e.g., patients requiring frequent re-injections), a different treatment regimen (e.g., treat and extend) can be considered in the further course. If visual acuity drops below 0.05 on anti-VEGF treatment, or no further positive treatment outcome is expected (e.g., in the presence of atrophy and/or fibrosis), treatment should be discontinued, unless there is a clear possibility that visual acuity could increase again to over 0.05 under treatment. If no improvement is seen under therapy with a certain VEGF inhibitor, or if deterioration occurs, one can consider switching to an alternative VEGF inhibitor.
关键词： Choroidal neovascularization,Myopia,Retinal dystrophies,Ranibizumab,VEGF inhibitors,Uveitis,Idiopathic CNV,Central serous chorioretinopathy,Angioid streaks,Photodynamic therapy,Subretinal tumors,Aflibercept,Bevacizumab,Eye injuries
更新于2025-09-19 17:15:36
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Transfoveal Micropulse Laser Treatment of Central Serous Chorioretinopathy within Six Months of Disease Onset
摘要： Background: It has been recommended that any invasive treatment performed in patients with central serous chorioretinopathy (CSCR) not be initiated earlier than four months after disease onset due to the potential for spontaneous remission of symptoms. The goal of this study was to examine the outcome of transfoveal subthreshold micropulse laser treatment (SMPLT) of CSCR performed at six months or less after disease onset. Materials and methods: The study included 32 cases of CSCR lasting between three weeks and six months (mean: 3.4 ± 2.3 months). All patients had transfoveal SMPLT applied and were followed for at least three months after each session of SMPLT. Two sessions of SMPLT in total were planned in case of an insu?cient response to the ?rst instance of treatment. Evaluation parameters included any change in best-corrected visual acuity (BCVA) and retinal morphology. Results: Total resolution of subretinal ?uid (SRF) was noted in 26 cases (81.25%). Final BCVA improved signi?cantly from 0.37 ± 0.22 logMAR to 0.22 ± 0.20 logMAR after treatment. Overall, early SMPLT correlated with better ?nal BCVA (p = 0.0005, Spearman rank correlation). For eyes achieving a total resolution of SRF, BCVA improved from 0.33 ± 0.21 logMAR to 0.17 ± 0.14 logMAR (p = 0.004, Spearman rank correlation). The analysis of SMPLT nonresponders revealed a tendency for poorer baseline visual acuity. Conclusions: Patients with CSCR lasting six months or less treated with transfoveal SMPLT achieve better functional results with early application of this procedure. As baseline BCVA predicts ?nal visual acuity, earlier treatment, permitted by the safety of SMPLT, may improve ?nal visual outcomes.
关键词： central serous chorioretinopathy,photodynamic therapy,subthreshold micropulse laser,subretinal ?uid
更新于2025-09-11 14:15:04
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Nanosekundenlaserbehandlung bei Chorioretinopathia centralis serosa ohne RPE-Defekte: eine retrospektive Fallserie
摘要： Background Chorioretinopathia centralis serosa (CCS) is a uni- or bilateral disease of the macula which is characterized by detachment of the neuro-sensory retina. The spontaneous resolution rate is 68 % after four months and 84 % after six months. Purpose To investigate the efficacy of subthreshold nanopulse laser treatment for central serous chorioretinopathy (CCS) in the absence of any atrophy in the retinal pigment epithelium (RPE). Methods This retrospective study comprised 23 eyes of 23 patients without previous treatment. Patients were followed up to 12 months. Laser treatment was performed with the 2RT? nanolaser using a grid stimulation. Changes in corrected visual acuity (VA), microperimetry and subretinal fluid height in optical coherence tomographic images were measured. Saliences in autofluorescence images and angiographic images were observed. All results were documented 1, 3, 6 and 12 months after the first treatment. Patients did not receive any supplementary treatment. Results Two months after the first treatment, 74 % of the patients showed complete SRF resolution and 91 % of the patients within 6 months had complete resorption of the SRF. Central visual acuity and macula sensitivity significantly improved from 0.18 ± 0.16 logMAR to 0.09 ± 0.17 logMAR and 24.19 ± 3.96 dB to 27.59 ± 2.89 dB. The SRF decreased within one month significantly. No CNV was documented during the observation time. The baseline subretinal fluid height is a predictive factor of faster resolution. Conclusion The evaluation of our treatment results shows that the therapy is a safe and promising method. Patients with a CCS without existing RPE defects benefit from the treatment with the 2RT? nanolaser, which is associated with an improvement of the macula function.
关键词： Retina,central serous chorioretinopathy,Nanolaser,microperimetry,retinal pigment epithelium,Subthreshold?Laser,Chorioretinopathia centralis serosa,subthreshold nanopulse laser,subretinal fluid,Mikroperimetrie,subretinale Flüssigkeit
更新于2025-09-11 14:15:04