ARVO 2014 Annual Meeting Abstracts 549 Central Serous Chorioretinopathy Organizing Section:

ARVO 2014 Annual Meeting Abstracts
549 Central Serous Chorioretinopathy
Thursday, May 08, 2014 12:00 PM–1:45 PM
Exhibit/Poster Hall SA Poster Session
Program #/Board # Range: 6371–6389/C0148–C0166
Organizing Section: Retina
Program Number: 6371 Poster Board Number: C0148
Presentation Time: 12:00 PM–1:45 PM
Spectrum of Retinal Pigment Epithelium Abnormalities in
Central Serous Chorioretinopathy as Revealed by UltraWidefield Autofluorescence
Juliana E. Boneta2, 1, Lawrence A. Yannuzzi4, Sanjeev Nath3, Sherry J.
Bass1, Jerome Sherman1, 3. 1SUNY College of Optometry, New York,
NY; 2Fromer Eye Centers, New York, NY; 3Eye Institute & Laser
Center, New York, NY; 4Vitreous Retina Macula Consultants of New
York, New York, NY.
Purpose: To document the wide array of ultra-widefield
autofluorescence (UWF-AF) presentations in central serous
chorioretinopathy (CSCR) and to compare these to clinical exam,
standard color and UWF color images, spectral domain OCT and, in
select cases, to visual fields (VFs) and UWF fluorescein angiography.
Methods: A retrospective review from 3 facilities of 20 eyes from
13 patients diagnosed with CSCR by standard criteria and who
had UWF-AF images available to analyze and correlate with other
procedures such as SD OCT.
Results: Nine of the 13 patients were male and age ranged from
the third to the sixth decade. Eleven were symptomatic and two
were detected during routine exams. Although a wide spectrum of
UWF-AF patterns was discovered, in 11 of the 20 affected eyes,
descending “gravitational” tracts were documented. Most often,
these gravitational tracts extended to the equator inferiorly and even
beyond. In nearly all cases, the tract was hypo AF with a surrounding
hyper AF zone. Outer retina involvement (loss of the ellipsoid aka
PIL on OCT) corresponded to both hypo and hyper AF lesions. A
41 year old male physician presented with 20/10 VA OD but with a
large noticeable superior nasal blind spot (following a motorcycle
accident) and was found to have a large, corresponding descending
tract without foveal involvement (figure 1). The most profound case
in the series was a 45 year old female being treated for 19 years
with steroids for SLE with VA of 20/80 OD and FC at 6 ft OS. Both
SD OCT and FA confirmed CSCR OD; OS with long standing VA
reduction demonstrated total hypo AF in 3 full quadrants extending
beyond the equator with only minimal hyper AF in the superior
quadrant (figure 2) and only an inferior quadrant of the VF remaining.
Conclusions: UWF-AF imaging is quite useful in patients with
CSCR to document the extent of RPE damage, often not recognized
on clinical exam. SD OCT of lesions revealed by UWF-AF
documents loss of photoreceptor integrity and predicts VF defects.
UWF-AF is perhaps the preferred non-invasive technology to
monitor change in CSCR patients with widespread involvement.
Ultra-widefield AF of a 41 year old male physician as discussed in
results above.
UWF-FA of a 45 year old female as noted in results with profound
hypo AF and loss of the photoreceptors in 3 of 4 retinal quadrants
OS.
Commercial Relationships: Juliana E. Boneta, None; Lawrence
A. Yannuzzi, None; Sanjeev Nath, None; Sherry J. Bass, None;
Jerome Sherman, Optos (C)
Program Number: 6372 Poster Board Number: C0149
Presentation Time: 12:00 PM–1:45 PM
Long-Term Impacts of Antioxidant Supplementation and
Smoking Cessation on Chronic Central Serous Chorioretinopathy
Midori Araki, Tsutomu Yasukawa, Masayuki Ashikari, Aki Kato,
Nana Tachi, Yoshio Hirano, Yuichiro Ogura. Nagoya City University,
Nagoya, Japan.
Purpose: Chronic central serous chorioretinopathy (CSC) has
persistent serous retinal detachment (sRD), resulting in gradual
vision loss. We have previously reported the potential of antioxidant
supplementation and smoking cessation to enhance spontaneous
remission of chronic CSC (Tachi et al, ARVO, 2011). The purpose
of this study is to evaluate the long-term prognosis of chronic CSC
with spontaneous remission under smoking cessation and antioxidant
supplementation.
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected]
ARVO 2014 Annual Meeting Abstracts
Methods: Nineteen eyes of 17 patients, who were diagnosed as
chronic CSC and guided to stop smoking, if they were a current
smoker, and take antioxidant supplements produced on the basis of
AREDS formulation (Ocuvite® Lutein or Sante Lutax® 15), were
enrolled. Nine patients were a current smoker, 7 an experienced
smoker, and 3 a nonsmoker. Averaged age was 59.4 ± 11.5 years.
Mean follow-up period was 54 ± 3.9 months. Rate of remission and
relapsing of sRD and best-corrected visual acuity (BCVA) were
assessed.
Results: Spontaneous remission of sRD was observed in 16 of 19
eyes (84%) with mean duration of 4.6 ± 0.53 months. Of these eyes,
7 eyes (37%) had no recurrence during the observation period, while
9 eyes (47%) had remitting and relapsing of chronic CSC. In 2 eyes,
relapsing was observed immediately after resuming smoking. At the
last visit, 4 eyes of 9 remitting-relapsing cases had no sRD and 5 eyes
had recurred sRD. In the other 3 eyes (16%), sRD persisted without
remission. Five eyes underwent any interventional treatment 30 ±
10 months after life style guidance in average. Mean BCVA in the
LogMAR unit in 14 eyes without any treatments was significantly
improved from 0.22 ± 0.10 at baseline to 0.11 ± 0.07 at the last
visit (p<0.05). Improvement of BCVA with 0.3 or more LogMAR
units was obtained in 3 eyes (21%), while no eyes deteriorated
BCVA. Mean BCVA of 5 eyes with interventional treatments was
significantly improved from 0.24 ± 0.16 at baseline to 0.07 ± 0.13 at
the last visit (P<0.05).
Conclusions: The current study suggested that antioxidant
supplementation and smoking cessation might enhance spontaneous
remission and reduce relapsing rate in eyes with chronic CSC over 5
years. Delay of interventional treatments was unlikely to worsen the
prognosis of chronic CSC. Lifestyle guidance might be worthwhile
for patients with chronic CSC before therapeutic intervention was
considered.
Commercial Relationships: Midori Araki, None; Tsutomu
Yasukawa, None; Masayuki Ashikari, None; Aki Kato, None;
Nana Tachi, None; Yoshio Hirano, None; Yuichiro Ogura, None
Program Number: 6373 Poster Board Number: C0150
Presentation Time: 12:00 PM–1:45 PM
Recurrence of central serous chorioretinopathy in patients who
undergo intraocular surgery with subsequent topical steroid
therapy
Oscar C. Kuruvilla, Neeti Alapati, Hilliary Inger, Zuhair Peracha,
Daniel Kim, Paul A. Edwards. Ophthalmology, Henry Ford Hospital,
Royal Oak, MI.
Purpose: To evaluate characteristics of patients who were diagnosed
and treated for central serous chorioretinopathy (CSR) and
subsequently undergo intraocular surgery.
Methods: This is a retrospective chart review of 103 patients who
were diagnosed and treated for central serous chorioretinopathy at
Henry Ford Hospital. All patients selected for review were treated
between January 2005 and January 2013, although, they may
have been initially diagnosed with CSR prior to this time period.
Data collected included age, gender, refraction, history of open
angle glaucoma, treatment administered, recurrences, intraocular
surgeries, steroid drop usage, systemic steroid usage and fluorescein
angiography findings.
Results: We evaluated 106 eyes from 98 patients whose mean age
was 52.7 years. The majority were male (67%) vs. female (33%).
Fifty percent of patients were hyperopic, while 38% were myopic
and 12% were emmetropic. Only 12% of affected eyes were
pseudophakic. The majority of patients had acute disease (77%) while
19% had chronic disease and 4% had atypical disease. On fluorescein
angiography, almost all patients (94%) had expansile dot patterns, 2%
had smokestack and 2% had inverted smokestack patterns. Overall,
18% of patients experienced a recurrence of CSR. Patients who
underwent intraocular surgery had no recurrences post operatively.
Almost a third of patients developed recurrences during treatment
with nasal steroids. Patients treated with laser, photodynamic therapy
or acetazolamide had an overall recurrence rate of 7%.
Conclusions: CSR is a relatively common cause of visual loss. Our
affected patients were more likely to be male, phakic hyperopes with
acute disease and expansile dot seen on fluorescein angiography.
In our review, recurrence rate was approximately 18%. None of the
patients who had intraocular surgery experienced a recurrence of
CSR despite routine use of topical steroids following surgery. In
addition, among 14 patients who had initial treatment, only one had
recurrence. The results from this retrospective review suggest that it
is safe for patients with history of CSR to undergo intraocular surgery
without worry for recurrence of disease.
Commercial Relationships: Oscar C. Kuruvilla, None; Neeti
Alapati, None; Hilliary Inger, None; Zuhair Peracha, None;
Daniel Kim, None; Paul A. Edwards, None
Program Number: 6374 Poster Board Number: C0151
Presentation Time: 12:00 PM–1:45 PM
POTENTIAL THERAPEUTIC BENEFIT OF MELATONIN IN
REFRACTORY CENTRAL SEROUS CHORIORETINOPATHY
Jose D. Luna Pinto, Ana L. Gramajo, Gabriel Marquez, Victor
Torres, Claudio P. Juarez, Ruth E. Rosenstein. Ophthalmology, Ctr
Privado de Ojos Romagosa-Fndtn VER, Cordoba, Argentina.
Purpose: To evaluate the efficacy and safety of melatonin for the
treatment of chronic central serous chorioretinopathy (CSCR).
Methods: Prospective comparative case series.A total of 13 patients
with chronic CSCR were treated for 1 month: 8 patients were
treated orally with 3 mg melatonin t.i.d, and 5 with placebo. All
patients had 20/40 or worse Early Treatment Diabetic Retinopathy
Study (ETDRS) best-corrected visual acuity (BCVA) in the affected
eye or presented an incapacitating scotoma. Most of the patients
had previous failed treatments for their condition. Observational
procedures included ETDRS BCVA, and complete ophthalmic
examination. Optical Coherence Tomography (OCT) was performed
at day 1 and week 4. Fluorescein angiography was performed at
baseline only for diagnostic purposes.
Results: At one month follow-up, BCVA significantly improved in
87.5% of patients treated with melatonin (7 of 8 patients, p<0.05).
All patients showed a mean significant reduction (p<0.01) of central
macular thickness (CMT) when compared to the baseline, with 3
patients (37.5%) exhibiting complete resolution of subretinal fluid at
one month follow-up. No significant side effects were observed. No
changes on BCVA or CMT were noted in the control group.
Conclusions: These results suggest that melatonin is safe, well
tolerated, and effective in the treatment of chronic CSCR, since
it significantly improved BCVA and CMT in patients with this
pathology. Further evaluations with longer follow-up and a larger
patient population are desirable
Commercial Relationships: Jose D. Luna Pinto, None; Ana L.
Gramajo, None; Gabriel Marquez, None; Victor Torres, None;
Claudio P. Juarez, None; Ruth E. Rosenstein, None
Program Number: 6375 Poster Board Number: C0152
Presentation Time: 12:00 PM–1:45 PM
Retinal Sensitivity Changes After Half-time Reduced-Fluence
Photodynamic Therapy for Central Serous Chorioretinopathy
Hirotaka Yokouchi, Masayasu Kitahashi, Mariko Kubota, Takayuki
Baba, Shuichi Yamamoto. Ophthalmology, Chiba Univ Graduate
School of Med, Chiba, Japan.
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected]
ARVO 2014 Annual Meeting Abstracts
Purpose: To determine the effect of half-time reduced-fluence
photodynamic therapy (RF-PDT) on macular function in eyes with
chronic central serous chorioretinopathy (CSC).
Methods: Twenty-one eyes from 21 patients with chronic CSC of
6 months or more duration were studied. The dose and fluence of
RF-PDT was administered according to the standard protocol for
age-related macular degeneration (AMD), and laser was applied for
42 seconds guided by indocyanine green (ICG) angiographic images.
The best-corrected visual acuity (BCVA) and the retinal sensitivity in
the central 2- and 10-degrees were determined at the baseline and at
1, 3 and 6 months after the half-time RF-PDT. The retinal sensitivity
was determined by Macular Integrity Assessment microperimetry
(MAIA, Italy). Changes of the foveal thickness (CFT) and central
choroidal thickness (CCT) were determined by optical coherence
tomography (OCT).
Results: At the baseline, the mean retinal sensitivity was 19.0±4.60
dB in the central 2 degrees and 21.3±3.45 dB in the central 10
degrees. After half-time RF-PDT, the mean retinal sensitivity
improved significantly to 22.5±3.54 dB in the central 2 and 24.3±2.48
dB in the central 10 at 1 month (P<0.001), to 24.2±3.26 dB in the
central 2 and 24.4±1.98 dB in the central 10 at 3 months (P<0.001),
and to 23.8±2.42 dB in the central 2 and 24.9 ± 2.06 dB in the central
10 (P<0.001).The BCVA was significantly improved at 3 months
(0.11±0.22 logMAR units, P<0.05) and at 6 months (0.10±0.17
logMAR units, P<0.05) after half-time RF-PDT than at baseline
(0.16±0.20 logMAR units). Six months after half-time RF-PDT, the
SRF was resolved at all eyes. The CFT was significantly reduced
from 289±77.8μm at baseline to 164±41.4μm at 1 month (P<0.001),
161±45.9μm at 3 months (P<0.001), and 172±35.7μm at 6 months
(P<0.001). The CCT significantly improved from 405±105 μm at
baseline to 332±97.2μm at 1 month (P<0.001), 340±93.2μm at 3
months (P<0.001), and 333±108μm at 6 months (P<0.001). At 6
months, none of the patients had any systematic or local adverse
events associated with the half-time RF-PDT.
Conclusions: Half-time RF-PDT results in a significant improvement
of the central retinal sensitivity over 6 months in eyes with chronic
CSC. We conclude that half-time RF-PDT is beneficial for resolving
chronic CSC by 6 months.
Commercial Relationships: Hirotaka Yokouchi, None; Masayasu
Kitahashi, None; Mariko Kubota, None; Takayuki Baba, None;
Shuichi Yamamoto, None
Program Number: 6376 Poster Board Number: C0153
Presentation Time: 12:00 PM–1:45 PM
Half-dose versus half-fluence photodynamic therapy for chronic
central serous chorioretinopathy
Ryo Matoba, Yusuke Shiode, Tetsuhiro Kawata, Mio Hosokawa,
Shuhei Kimura, Yuki Morizane, Fumio Shiraga. Okayama university,
Okayama, Japan.
Purpose: To compare the efficacy and safety of half-dose verteporfin
photodynamic therapy (PDT) and half-fluence PDT in patients with
chronic central serous chorioretinopathy (CSC).
Methods: The records of 41 eyes of 39 CSC patients treated with
PDT between January 2010 and August 2013 were retrospectively
reviewed. Thirty eyes (28 patients) received PDT with half-dose
(3mg/m2) verteporfin. Eleven eyes (11 patients) received PDT with
half-fluence (25J/cm2). All patients were followed up at least 3
months. Outcome measures included the best correct visual acuity
(BCVA), the central retinal thickness (CRT) and the proportion of
eyes with complete resolution of serous retinal detachment (SRD) in
the macula.
Results: At baseline, the mean BCVA and CRT of both groups did
not differ significantly. At 3 months after treatment, BCVA (logMAR)
of both groups improved significantly; from 0.27 to 0.13 (p < 0.05)
and 0.20 to 0.09 (p < 0.05) in the half dose PDT group and the halffluence PDT group, respectively. There was no difference in BCVA at
3 months between the 2 groups (p = 0.711). At 3 months, the CRT of
both groups decreased significantly, and the CRT in the half-fluence
PDT group was significantly thinner than that the half-dose PDT
group (158.7 ± 36.4mm vs. 128.5 ± 28.3mm; p = 0.01). The complete
resolution of SRD was achieved in 27 eyes (90%) in the half-dose
PDT group and 10 eyes (91%) in the half-fluence PDT group. We did
not observe any recurrences, secondary choroidal neovascularization
and systemic side effects throughout the follow up period.
Conclusions: Both half-dose and half-fluence PDTs showed
significant efficacy for chronic CSC. Half-dose PDT may less likely
to cause the retinal atrophy than half-fluence PDT.
Commercial Relationships: Ryo Matoba, None; Yusuke Shiode,
None; Tetsuhiro Kawata, None; Mio Hosokawa, None; Shuhei
Kimura, None; Yuki Morizane, None; Fumio Shiraga, Alcon Japan
(C), Bausch & Lomb Japan (C), Byer (C), Novartis Pharma (C),
Santen Pharma (C)
Program Number: 6377 Poster Board Number: C0154
Presentation Time: 12:00 PM–1:45 PM
QUANTITATVE EVALUATION OF EPLERENONE
TREATMENT FOR CENTRAL SEROUS
CHORIORETINOPATHY (CSCR)
Agustina Palacio1, Niloofar Piri1, Ahmet Ozkok1, Shlomit Schaal1,
Tongalp H. Tezel1, 2. 1Ophthalmology and visual Sciences, University
of Louisville, Louisville, KY; 2Anatomy and Neurobiology,
University of Louisville, Louisville, KY.
Purpose: To determine the effect of mineralocorticod receptor
antagonist eplerenone (Inspra®; Pfizer, NY) in the treatment for
CSCR.
Methods: Pre- and serial post treatment HD-OCT scans with EDI
cuts were obtained from five CSCR patients treated with 50 mg/
day of eplerenone. OCT scans were analyzed morphometrically to
determine the change in the amount of the subretinal serous fluid.
Clinical and morphometric data was compared with a control group
of five untreated CSCR patients having similar age (55±12 vs. 49±20,
p=0.84), gender (p=1.0), initial logMAR visual acuity (0.29±0.16 vs.
0.21±0.16, p=0.42), duration of symptoms (113±111 vs. 80±156 days,
p=0.55) and central macular thickness (415±81 vs. 387±84 microns,
p=0.55). Also, the impact of eplerenone on choroidal vasculature
was estimated by calculating “Choroidal Perfusion Index” (CPI)
which is defined as the ratio of the choroidal vascular area to the total
choroidal area underneath the serous elevation.
Results: Eplerenone treatment caused significant regression of the
subretinal fluid which reflected itself by a decrease in the central
macular thickness (415±80 vs. 271±28 microns, p=0.02) and total
serous fluid area (0.77±0.88 vs. 0.14±0.22, p=0.03), in contrast
to observation group which remained the same (central macular
thickness = 388±84 mm2 vs.339±84 microns, p=0.35; total serous
fluid area = 0.60±0.39 vs. 40±0.74 mm2, p=0.7). The resolution
rate of the subretinal fluid was three time higher in the eplerenone
group (33±16% vs. 10±25%). Resolution of the subretinal fluid was
accompanied with a an increase in CPI (1.7±1.3). Despite better
anatomical outcome, the impact of eplerenone treatment on logMAR
visual acuity was similar in both groups (3 improved and 2 stable
vs. 2 improved, 2 stable, 1 worsened, p=0.55). Treatment with
eplerenone was well tolerated in all patients without serious adverse
effects.
Conclusions: Eplerenone speeds up the resolution of the subretinal
fluid in CSCR. However, it is not effective to relieve the choroidal
congestion, nor has an impact on final visual acuity.
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected]
ARVO 2014 Annual Meeting Abstracts
Commercial Relationships: Agustina Palacio, None; Niloofar Piri,
None; Ahmet Ozkok, None; Shlomit Schaal, None; Tongalp H.
Tezel, None
Support: unrestricted grant from Research to Prevent Blindness, Inc,
NYC, NY
Program Number: 6378 Poster Board Number: C0155
Presentation Time: 12:00 PM–1:45 PM
Eplerenone fails to treat central serous chorioretinopathy
Harpal Sandhu, Demetrios G. Vavvas. Ophthalmology, Massachusetts
Eye and Ear Infirmary, Boston, MA.
Purpose: To evaluate the efficacy of the mineralocorticoid receptor
antagonist eplerenone in patients with active central serous
chorioretinopathy (CSR).
Methods: Retrospective case series of three patients treated with
eplerenone for central serous chorioretinopathy. All patients were
assessed with a full eye exam and spectral domain optical coherence
tomography (SD-OCT) at each visit.
Results: Three eyes in three patients were treated with eplerenone
25 mg or 50 mg daily by mouth. All patients had decreased vision
secondary to active CSR. Follow up ranged from three to 12 months.
Visual acuity (VA) at the beginning of treatment ranged from
20/32 to 20/60 (mean VA 0.42). Visual acuity at one month was not
significantly different (mean VA 0.49, p = 0.43), nor at the end of
follow up (mean VA 0.43, p = 0.42). Central macular thickness did
not change significantly from pre-treatment (mean 474 microns)
to month one (mean 429 microns, p = 0.23), nor did it change
significantly at the end of the follow-up period (mean 431 microns, p
= 0.32).
Conclusions: Eplerenone neither reduced central macular thickness
nor improved vision in this cohort of patients with central serous
chorioretinopathy. More research is needed to evaluate fully the
efficacy of eplerenone for this indication.
Commercial Relationships: Harpal Sandhu, None; Demetrios G.
Vavvas, None
Program Number: 6379 Poster Board Number: C0156
Presentation Time: 12:00 PM–1:45 PM
Eplerenone for Treatment of Chronic Central Serous
Chorioretinopathy: A Retrospective Case Series
Margaret Greven1, David Salz1, John D. Pitcher2, Kevin Elliot3,
Carl D. Regillo2, Mitchell Fineman2, Jason Hsu2, James F. Vander2,
David H. Fischer2, Marc Spirn2. 1Wills Eye Hospital, Philadelphia,
PA; 2Retina Service, Wills Eye Hospital, Philadelphia, PA; 3Thomas
Jefferson University School of Medicine, Philadelphia, PA.
Purpose: To evaluate the effect of oral eplerenone on visual acuity,
subretinal fluid, and choroidal thickness in patients with chronic
central serous chorioretinopathy (CSCR).
Methods: Retrospective review of all patients from a single multiphysician practice with chronic CSCR who were treated with
oral eplerenone from January 2013-June 2013. All patients were
followed for a minimum of three months and underwent dilated
fundoscopic examination and spectral-domain ocular coherence
tomography (OCT) with enhanced depth imaging (EDI) at each visit.
Measurement of subfoveal fluid (SFF) height and choroidal thickness
were performed. Two-tailed paired t-test was used to calculate
statistical significance of pre- and post-treatment variables.
Results: Fourteen eyes of 14 patients with chronic CSCR were
treated with eplerenone over a 6 month period. At 1 month follow-up,
10 out of 14 patients (71%) had decreased SFF height on OCT and 3
(21%) had complete resolution of SFF. Mean SFF height decreased
from 123 mm to 61 mm (p=0.05). Mean choroidal thickness decreased
from 301 mm to 263 mm (p=0.07). Mean visual acuity improved
minimally from logMAR 0.41 (Snellen visual acuity 20/51) to 0.40
(Snellen visual acuity 20/50, p=0.20). At 3 months follow-up, 13
out of 14 (93%) had decreased SFF height on OCT and 9 (64%) had
complete resolution of SFF. Mean SFF height decreased to 21 mm
(p=0.004). Mean choroidal thickness decreased to 253 mm (p=0.1).
Mean visual acuity improved to logMAR 0.28 (Snellen visual acuity
20/38, p=0.02).
Conclusions: Oral eplerenone may be an effective treatment for
patients with chronic CSCR. A prospective randomized placebocontrolled trial is needed to definitively determine safety and efficacy
of the drug in this setting.
Commercial Relationships: Margaret Greven, None; David Salz,
None; John D. Pitcher, None; Kevin Elliot, None; Carl D. Regillo,
None; Mitchell Fineman, None; Jason Hsu, None; James F.
Vander, None; David H. Fischer, None; Marc Spirn, None
Program Number: 6380 Poster Board Number: C0157
Presentation Time: 12:00 PM–1:45 PM
The Sympatholytic Non-selective β-blocker PROPRANOLOL
as A Non-invasive Therapeutic Approach for the Treatment of
Chronic Central Serous Chorioretinopathy (CSC)
Jose A. Cardillo, Murilo W. Rodrigues, Leticia F. Barroso, Rubens
C. Siqueira, Rodrigo Jorge. Retina, Ribeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão Preto, Brazil.
Purpose: To evaluate the effect of systemically administered
β-blocker propranolol on the course of central serous
chorioretinopathy. Our goal is to research potential alternative tool
for chronic CSC as monotherapy or as adjunct to more invasive laser
techniques
Methods: Fourteen CSC-patients with a documented-persistent
leakage of at least 4 months were treated by oral propranolol 20
mg twice a day and followed up at monthly intervals for 6 months.
Best-corrected visual acuity (BCVA), fluorescein angiography (FA),
indocyanine green angiography (ICGA), central macular thickness
(CMT) quantified by ocular coherence tomography (OCT), were
recorded at baseline and follow-up visits
Results: At 3 months, BCVA was significantly enhanced in the
treatment group (P =.006) compared with baseline. An improvement
in central macular thickness and leakage on fluorescein angiography
was noted in all treated patients starting as early as 30 days following
treatment
Conclusions: β-blocker has a plausible mechanism of action in CSC
and may characterize a potential alternative to the present standard of
care meriting further evaluation.
Commercial Relationships: Jose A. Cardillo, None; Murilo W.
Rodrigues, None; Leticia F. Barroso, None; Rubens C. Siqueira,
None; Rodrigo Jorge, None
Program Number: 6381 Poster Board Number: C0158
Presentation Time: 12:00 PM–1:45 PM
Central Serous Chorioretinopathy Treated with
Mineralocorticoid Antagonists: a Retrospective Study Analyzing
the Clinical and Multimodal Imaging Response to Therapy
Quraish Ghadiali1, Jesse J. Jung1, 2, Suqin Yu2, 3, Lawrence A.
Yannuzzi1, 2. 1Department of Ophthalmology, New York University,
New York, NY; 2Vitreous Retina Macula Consultants of New York,
New York, NY; 3Department of Ophthalmology, Shanghai First
People’s Hospital, Shanghai Jiaotong University, Shanghai, China.
Purpose: To evaluate the effect of systemic spironolactone
and eplerenone on the eyes of patients with central serous
chorioretinopathy (CSCR) and to better understand the role of
mineralocorticoid antagonists in the treatment of this disease.
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected]
ARVO 2014 Annual Meeting Abstracts
Methods: Twenty-six eyes of 16 patients (10 males, 6 females),
with a mean age of 57.4 (range 41-74), diagnosed with CSCR were
treated with either spironolactone, eplerenone, or a combination of
both drugs and were evaluated retrospectively by chart review and
multimodal imaging analysis. Spectral domain optical coherence
tomography (SD-OCT) was used to measure subretinal fluid (SRF)
and central macular thickness (CMT). Furthermore, enhanced depth
imaging optical coherence tomography (EDI-OCT) was used to
measure subfoveal choroidal thickness (CT). Visual acuity (VA),
CMT, CT, and SRF measurements were taken at the initiation of
treatment and at 1, 3, and 6 month follow up intervals.
Results: The mean change and 95% confidence intervals for VA,
CMT, and CT were calculated as compared to pre-treatment values
in all eyes. The mean change in logMAR vision at 1, 3, and 6 month
follow up intervals was 0.021 ± 0.029, -0.028 ± 0.062, and -0.066
± 0.090, respectively. The mean change in CMT at these intervals
was -4.04 ± 14.12 mm, 4.11 ± 19.73 mm, and 9.23 ± 31.17 mm,
respectively. The mean change in CT at these intervals was -48.94 ±
29.53 mm, -44.00 ± 41.58 mm, and -36.80 ± 82.21 mm, respectively.
Twelve eyes were found to have SRF prior to treatment. In this
subset, the mean change in SRF at 1, 3, and 6 months was -28.70 ±
33.48 mm, -19.89 ± 36.58 mm, and 9.57 ± 56.74 mm, respectively.
CT was significantly decreased at 1 month (P<0.01) and at 3 months
(P<0.05). All other measurements showed no significant changes.
Conclusions: In eyes with CSCR treated with mineralocorticoid
antagonists, no significant changes were found in VA or CMT; in eyes
with SRF prior to treatment, there were no significant changes in SRF
found at any follow up interval. There were, however, significant
decreases in CT at 1 and 3 months after treatment initiation, but no
significant changes at 6 months. Given these retrospective findings,
mineralocorticoid antagonists do not appear to affect the natural
course of CSCR based on clinical and multimodal imaging response.
Commercial Relationships: Quraish Ghadiali, None; Jesse J.
Jung, None; Suqin Yu, None; Lawrence A. Yannuzzi, None
Program Number: 6382 Poster Board Number: C0159
Presentation Time: 12:00 PM–1:45 PM
Finasteride for Chronic Central Serous Chorioretinopathy
Kelly Fujikawa, Amar P. Patel, Lawrence S. Morse. Department
of Opthalmology, University of California Davis Eye Center,
Sacramento, CA.
Purpose: To investigate the efficacy of finasteride in the treatment of
chronic central serous chorioretinopathy (CSCR).
Methods: A retrospective chart review was performed of seven
eyes from six patients with chronic CSCR treated with finasteride
5mg daily. Patients treated with other therapies or taking exogenous
steroids were excluded. Main outcome measures were best-corrected
visual acuity (BCVA), central macular thickness (CMT), and
subfoveal fluid height.
Results: Mean age was 55.4 years (4 males, 2 females). Average
BCVA was 0.221 (20/33) at baseline and 0.125 (20/27) at
discontinuation of therapy (p=0.482). Average CMT was 337.1 um
at baseline and 216.6 um at discontinuation of therapy (p=0.060).
Average subfoveal fluid height was 114.6 um at baseline and 0 um
at discontinuation of therapy (p=0.065). Average duration of therapy
was 5.3 months with six of the seven eyes having complete resolution
of subretinal fluid. Upon discontinuation of finasteride, three eyes had
recurrence of subretinal fluid after an average duration of 4.7 months.
No patient had any side effects from finasteride.
Conclusions: Finateride may be a useful treatment for CSCR. A
larger study is needed to further evaluate the efficacy of finasteride
for CSCR.
Commercial Relationships: Kelly Fujikawa, None; Amar P. Patel,
None; Lawrence S. Morse, None
Program Number: 6383 Poster Board Number: C0160
Presentation Time: 12:00 PM–1:45 PM
Anti-VEGF treatment of CNVM Secondary to Chronic Central
Serous Retinopathy
Netan Choudhry. Herzig Eye Institute, Toronto, ON, Canada.
Purpose: The purpose of this study was to examine the efficacyof
intravitreal Anti-VEGF therapy on the treatment of choroidal
neovascular membranes secondary to chronic central serous
retinopathy.
Methods: A retrospective review of 5 eyes presenting with chronic
central serous retinopathy treated with monthly anti-VEGF 0.5mg
(bevacizumab or ranibizumab). Patients underwent baseline
fluorescein angiography, OCT with clinical examination. At each
monthly visit patient BCVA was measured in conjunction with OCT
to measure response. Follow-up time ranged from 3-12 months.
Results: All patient presented with subretinal hemorrhage and
leakage on fluorescein angiography upon presentation. Mean visual
acuity improvement after 3 months of treatment was + 10 letters and
12 letters at 6 months. All eyes demonstrated improvement of OCT
features with complete resolution of subretinal fluid in all eyes by 6
months. Intraretinal cystic fluid and shallow PED”s were present in 4
eyes at 6 months.
Conclusions: Intravitreal Anti-VEGF therapy demonstrated
improvement in best-corrected ETDRS visual acuity in all patients
and OCT abnormalities, particularly subretinal fluid. Intravitreal AntiVEGF therapy is an effective treatment for choroidal neovascular
membranes secondary to Chronic Central Serous Retinopathy.
Commercial Relationships: Netan Choudhry, None
Program Number: 6384 Poster Board Number: C0161
Presentation Time: 12:00 PM–1:45 PM
Systemic Interferon alpha 2a for treatment of chronic relapsing
Central Serous Chorioretinopathy
Egbert Matthe, Dirk Sandner, Lutz E. Pillunat. Dept of
Ophthalmology, University of Dresden, Dresden, Germany.
Purpose: Interferons are used systemically for therapy of chronic
hepatitis, some forms of cancer and locally for conjunctival
melanocyte disorders. They act highly antiexsudative. Central serous
chorioretinopathy (CSC) is caused by exsudation from choroidal
vessels resulting in detachment of the retinal pigment epithelium
or neurosensory retina. We examined the use of systemic interferon
alpha 2a for the treatment of chronic relapsing CSC (CRCSC).
Methods: Evaluation of data and history of 6 patients with CRCSC
who did not respond to (diuretics, aspirin, anti-VEGF intravitreally),
could not receive (photocoagulation), or did not wish common
treatment (photodynamic therapy, anti-VEGF intravitreally). Duration
of CSC was at least 12 month with at least 1 recurrence. Each patient
was treated with 3 million International Units of Interferon alpha
2a daily for 4 weeks, and 2 more weeks given the medication every
other day. Visual acuity and central foveal thickness measured with
spectral domain OCT were obtained. The patients graded the side
effects as “none”, “mild” (notable but not irritating), “tolerable”
(irritating, but willing to continue because of efficacy) and “not
tolerable”, which stopped treatment.
Results: All patients had reduction of subretinal and sub-pigmentepithelial fluid, with complete resorption in 4 cases. Depending on
the duration of the CSC, visual acuity increased up to four Snellen
lines. 2 patients had very small amounts of fluid when treatment
was stopped. 2 patients had recurrence of fluid, one of them twice.
We saw recurrence after 2 month and 4 month for the 1st patient,
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
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ARVO 2014 Annual Meeting Abstracts
and after 4 month for the 2nd. Re-treatment was effective for all
recurrences (gain of visual acuity up to 4 Snellen lines). Side effects
were graded as “none” by 1 patient, “mild” by 3 patients (flulike, fatigue), which could be overcome by adding Paracetamol,
“tolerable” by 2 patients (obstipation, dizziness, nausea). Only
1 patient we had to grade the side effects as “not tolerable”
(leucopenia).
Conclusions: We present the first case series of systemic Interferon
alpha 2a for treating CRCSC. It provides excellent short term results
in reducing subretinal and sub-pigment-epithelial fluid in CRCSC.
Treatment is repeatable if necessary. Patients have to be examined for
side effects, which might require the therapy to be stopped.
Commercial Relationships: Egbert Matthe, None; Dirk Sandner,
None; Lutz E. Pillunat, None
Program Number: 6385 Poster Board Number: C0162
Presentation Time: 12:00 PM–1:45 PM
Micropulsed Laser Therapy Outcomes in the Treatment of
Chronic Central Serous Choroidopathy Based on Leakage
Pattern
Alessandro J. Dare1, 2, Renato Peroni1, Fernando Paganelli1,
Leonardo C. Castro1. 1Ophthalmology, HOIP - Hospital de Olhos
do Interior Paulista, Araraquara, Brazil; 2Ophthalmology, CRV Consultores de Retina e Vítreo, Ribeirao Preto, Brazil.
Purpose: Report the functional and anatomic outcomes of a
therapeutic possibility using a foveal selective 810-nm micropulsed
laser therapy (MLT) technique for chronic idiopathic central serous
chorioretinopathy (ICSC) with diffuse or foveal leakage.
Methods: Thirty-eight eyes from thirty-six patients with ICSC
with symptoms duration longer than 6 months with foveal or
juxtafoveal focal leakage (FL), or diffuse retinal pigment epithelial
decompensation with multiple (ML) or indeterminate leakage (IL)
involving or not the foveal area were treated. High-density focal
and macular grids were delivered targeting the angiographic leakage
points as well as the adjacent normal retina. Main outcomes were
change in ETDRS best correct visual acuity and central macular
thickness measured using optical coherence tomography. All
patients were followed for at least 6-months. Pre and post-treatment
fluorescein angiogram (FA) were accessed.
Results: Twenty eyes (53%) were classified as FL, 9 (23,5%) as
ML and 9 (23,5%) as IL. All eyes but one (95%) with FL showed
complete fluid resolution after the MLT applied just at the leakage
point strengthened by more laser in a grid pattern. Eight eyes (28.5%)
needed two treatment sessions. Ten eyes gained more than three
lines in visual acuity. In ML group 78% of the eyes had complete
fluid resolution. The eyes with IL were the most difficult to respond
to treatment, 78% needing re-treatments (7 of 9 eyes). Two eyes
received one re-treatment, three received two re-treatments and two
eyes received four re-treatment. The visual acuity did not change in
5 eyes, increased one line in two eyes and increased two lines in two
eyes with IL. No signs of retinal injure were detected even in that
eyes receiving 5 treatment sessions.
Conclusions: MLT showed to be an effective therapeutic technique
in Chronic CSC. IL have the worst outcome in response to MLT,
similar to others therapeutic approaches, however re-treatments could
be performed as necessary due to the absence of retinal damage,
scarring, inflammation, and associated complications, enhancing the
final outcomes in this challenging CSC subtype.
Commercial Relationships: Alessandro J. Dare, None; Renato
Peroni, None; Fernando Paganelli, None; Leonardo C. Castro,
None
Program Number: 6386 Poster Board Number: C0163
Presentation Time: 12:00 PM–1:45 PM
Large choroidal blood vessel sign on optical coherence
tomography images in acute central serous chorioretinopathy:
locational relationship with angiographic findings.
Sung Yong Park, Sang Jin Kim, Don-Il Ham. Ophthalmology, Sung
Kyun Kwan University, Seoul, Republic of Korea.
Purpose: To evaluate possible association of large choroidal blood
vessel changes observed on optical coherence tomography (OCT)
images with pathogenesis of central serous chorioretinopathy (CSC),
locational relationship between OCT findings and angiographic
findings was investigated.
Methods: Clinical records of 27 patients with acute CSC who
simultaneously underwent enhanced depth imaging (EDI) OCT
and fluorescein angiography (FA) using Spectralis HRA+OCT
(Heidelberg engineering, Germany) were retrospectively evaluated.
19 patients also underwent indocyanine green angiography (ICGA).
The large choroidal blood vessel sign was defined as a round to oval
choroidal structure abutting Bruch’s membrane with a diameter
larger than 200 μm. Images of EDI OCT raster scan were analyzed
for the location of large choroidal blood vessel sign and retinal
pigment epithelial (RPE) abnormalities. Infrared (IR) images with
position markers corresponding to the boundary of OCT lesions
were manually overlaid on FA and ICGA images, and locational
relationship was analyzed.
Results: Twenty-nine eyes of 27 patients with acute CSC were
evaluated. The defined sign on OCT images was identified as a large
choroidal blood vessel on ICGA images. Mean frequency of the sign
and RPE abnormalities on EDI OCT images was 1.83 ± 1.17 and
1.76 ± 1.02 per eye, respectively. Twenty-seven eyes (93.1 %) had
the sign, showing overlapped area with hyperfluorescent area on FA.
Of 25 eyes with active leakage point on FA, 23 eyes (92.0 %) showed
the defined sign at or closely adjacent to the leakage point and RPE
abnormalities on OCT images. In addition, 79.3% (23/29) of the
sign showed overlapped area with the area having choroidal vascular
hyperpermeablility on ICGA images.
Conclusions: Changes of large choroidal blood vessels observed
on OCT images might be associated with pathogenesis of RPE and
retinal abnormalities in acute CSC.
Commercial Relationships: Sung Yong Park, None; Sang Jin
Kim, None; Don-Il Ham, None
Program Number: 6387 Poster Board Number: C0164
Presentation Time: 12:00 PM–1:45 PM
Prevalence of the large choroidal blood vessel sign on
optical coherence tomography images in central serous
chorioretinopathy.
Don-Il Ham1, Sung Min Kim1, Sang Jin Kim1, Yun-Mi Song2, Joohon
Sung3, 4, Sung Yong Park1. 1Samsung Medical Center, Ophthal,
Sungkyunkwan Univ Sch of Med, Seoul, Republic of Korea; 2Family
medicine, Samsung Medical Center, Sungkyunkwan Univ Sch of
Med, Seoul, Republic of Korea; 3Epidemiology and Institute of
Environment and Health, School of Public Health, Seoul National
University, Seoul, Republic of Korea; 44Genomic Medicine Institute
(GMI), Medical Research Center, Seoul National University, Seoul,
Republic of Korea.
Purpose: To investigate the prevalence and clinical significance of
the optical coherence tomography (OCT) sign of large choroidal
blood vessels in eyes with central serous chorioretinopathy (CSC).
Methods: Clinical records of 84 patients with CSC and 84 healthy
subjects who underwent EDI OCT were analyzed retrospectively.
The large choroidal blood vessel sign was defined as a round to oval
choroidal structure abutting Bruch’s membrane with a diameter larger
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected]
ARVO 2014 Annual Meeting Abstracts
than 200 μm on OCT images. Images of EDI OCT raster scan were
analyzed for the presence of defined sign and accompanying retinal
pigment epithelial (RPE) abnormalities.
Results: Ninety-two eyes with CSC and 76 unaffected fellow eyes
of 84 patients with CSC and 168 eyes of 84 healthy subjects were
evaluated. The defined sign were found in 96.9% of acute CSC eye,
and 89.1 % of all CSC eyes. The defined sign were also observed
with or without the vascular wall hyperreflectivity along the Bruch’s
membrane. The hyperreflective sign was observed only in eyes
with CSC (57.6%), and more frequently associated with acute than
chronic and resolved CSC eyes (81.3%, 50%, and 15%, respectively;
P<0.05). Although, the isoreflective sign was also observed more
frequently in CSC eyes than in unaffected fellow eyes and healthy
eyes (79.3%, 32.9 %, and 12.5 %, respectively), its prevalence
did not differ significantly among CSC eyes with various clinical
conditions (P>0.05). RPE abnormalities were observed in all OCT
images in which the hyperreflective sign was observed.
Conclusions: The morphological sign of large choroidal blood vessel
distinguished by means of EDI OCT raster scan could be helpful for
the diagnosis and evaluation of CSC.
Commercial Relationships: Don-Il Ham, None; Sung Min Kim,
None; Sang Jin Kim, None; Yun-Mi Song, None; Joohon Sung,
None; Sung Yong Park, None
Program Number: 6388 Poster Board Number: C0165
Presentation Time: 12:00 PM–1:45 PM
Obscuration of the inner choroidal layer in central serous
chorioretinopathy
Ryo Obata, Youko Nomura, Xue Tan, Keiko Azuma, Yasuo Yanagi.
Department of Ophthalmology, Univ of Tokyo School of Medicine,
Tokyo, Japan.
Purpose: To investigate appearance of the choroidal layer in the
patients with central serous chorioretinopathy (CSC) using sweptsource optical coherence tomography (OCT) and to analyze its
relationship with other tomographic or angiographic findings.
Methods: Twenty-eight eyes of 27 cases underwent a set of radial
scans centered on the fovea with swept-source OCT (DRI OCT-1,
Topcon Inc., Tokyo). We assessed appearance in the choroidal layer,
and focused on the finding that hyporeflective reflex extending from
the outer choroidal layer obscured some parts of the inner layer
which corresponds to Sattler layer and choriocapillaris. Moreover,
we analyzed the relationship between the obscuration and serous
retinal detachment (SRD), foveal choroidal thickness, and the ratio
of hyper- to hyporeflective area (L/D ratio) in OCT. We also assessed
the findings in fluoresceine angiography (FA) and indocyanine-green
angiography (ICGA).
Results: Fifteen and three of 28 eyes had been treated with
photodynamic therapy (PDT) and laser photocoagulation,
respectively. Inner choroidal obscuration was observed in 15 (54%)
of 28 eyes. Comparing the cases with this finding and those without,
33% and 67% of the cases, respectively, had a history of PDT
(p=0.008). A higher proportion of the cases with the obscuration
showed SRD (69% vs 17%, p=0.008). Additionally, the cases with the
finding revealed greater choroidal thickness (364 micrometer vs 295
micrometer beneath the fovea, p=0.03) and lower L/D ratio (p=0.03).
Window defects (93%) in FA and hyperpermeability in ICGA (93%)
were observed corresponding to the area with obscuration.
Conclusions: We found inner choroidal obscuration in CSC patients
using swept-source OCT. The correlation with other findings suggests
that inner choroidal obscuration may be associated with exudative
changes in the choroid caused by CSC.
Commercial Relationships: Ryo Obata, None; Youko Nomura,
None; Xue Tan, None; Keiko Azuma, None; Yasuo Yanagi, Bayer
(F), Novartis (F), Santen pharmaceutical (F), Wakamoto (F)
Support: Grant in Aid for scientific research (B) Number 24791837
from the Ministry of Education, Culture, Sports, Science and
Technology of Japan
Program Number: 6389 Poster Board Number: C0166
Presentation Time: 12:00 PM–1:45 PM
Subfoveal choroidal thickness of smoking and non-smoking
patients with central serous chorioretinopathy
Yasuki Ito, Ruka Maruko, Yosuke Nagasaka, Kazuhiro Oiwa, Hiroko
Terasaki. Ophthalmology, Nagoya Univ School of Medicine, Nagoya,
Japan.
Purpose: The subfoveal choroidal thickness in eyes with central
serous chorioretinopathy (CSC) was reported to be thicker. The
purpose of this study is to identify the parameters which are
associated with subfoveal choroidal thickness in eyes with CSC.
The association between subfoveal choroidal thickness and current
smoking habit was also evaluated.
Methods: Forty eyes of 40 patients (7 women and 33 men, age: 48.9
± 8.9 years) of chronic CSC were retrospectively studied. Subfoveal
choroidal thickness was measured with spectral domain optical
coherence tomography (SD-OCT) and compared between smokers
and non-smokers. The multivariate analysis was also performed
with subfoveal choroidal thickness as the dependent variable, the
axial length, age, sex, and current smoking habit as the independent
variable, to find the parameters associated with subfoveal choroidal
thickness in eyes with CSC.
Results: Overall mean ± average subfoveal choroidal thickness was
422.4 ± 98.0 mm. Among 40 patients, there were 18 smokers and 22
non-smokers. Subfoveal choroidal thickness in current smokers was
454.8 ± 101.3mm and significantly thicker than 393.7 ± 19.7 mm in
non-smokers (p<0.05). Multivariate analysis showed that current
smoking habit was the only parameter associated with subfoveal
choroidal thickness (p<0.05).
Conclusions: Current smoking habit is associated with thicker
subfoveal choroidal thickness in eyes with CSC. Although current
smoking habit was not reported to be the distinct risk factor of CSC,
current smoking habit may be the factor that worsen the CSC.
Commercial Relationships: Yasuki Ito, None; Ruka Maruko,
None; Yosuke Nagasaka, None; Kazuhiro Oiwa, None; Hiroko
Terasaki, None
Support: Grant-in Aid for Scientific Research from the Ministry
of Education, Culture, Sports, Science, and Technology of Japan
(C2159225, C25462710).
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected]
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