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Objective:To observe the efficacy of optical coherence tomography angiography (OCTA) guided half-dose photodynamic therapy (PDT) in the treatment of acute central serous chorioretinopathy (CSC).Methods:A prospective randomized controlled trial. A total of 72 patients (72 eyes) with acute CSC in Peking University People's Hospital from April 2019 to April 2020 were included in the study. They were randomly divided into OCTA group (OCTA-guided PDT, 31 eyes of 31 patients) and indocyanine green angiography (ICGA) group (ICGA-guided PDT, 33 eyes of 33 patients). All patients underwent best corrected visual acuity (BCVA), fundus color photography, OCTA and ICGA examinations. International standard visual acuity chart was used for BCVA examination, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity. In OCTA group, the hyper-reflective area on en face OCTA image at choriocapillaris level was identified as treating area. In ICGA group, the area of choroidal vascular hyperpermeability on ICGA which was related to the leakage on fundus fluorescein angiography (FFA) was identified as treating area. The area corresponding to the treating area on FFA or ICGA was outlined on the color fundus photograph to guide PDT laser spot. The complete subretinal fluid (SRF) resolution, BCVA, central retinal thickness (CRT) at 1, 3, 6 months and SRF recurrent rate at 3, 6 months were observed. Continuous variables between the two groups were compared by t-test or Wilcoxon rank sum test. The χ2 test was used to compare the categorical variables. Results:At 1, 3 and 6 months after treatment, the SRF absorption rate in OCTA group and ICGA group was 74.2% (23/31), 63.6% (21/33), 87.1% (27/31) and 84.8% (28/33), 96.8% (30/31), 91.9% (31/33), respectively. OCTA-guided PDT was demonstrated noninferior to ICGA-guided PDT for complete SRF resolution at 1, 3, 6 months [95% confidence interval ( CI) -11.9%-33.1%, P=0.402; 95% CI -14.7%-19.3%, P=0.107; 95% CI-6.3%-16.1%, P=0.226]. There was no significant difference in the recurrence rate of SRF between the two groups at 3 and 6 months after treatment ( χ2=0.009, 0.047; P=0.925, 0.828). The difference of CRT was statistically significant at 6 months ( t=2.017, P=0.047). There was no significant difference in logMAR BCVA at 1, 3 and 6 months after treatment ( t=0.529, 0.762, 1.017; P=0.581, 0.403, 0.243). Conclusions:During 6 months follow-up, OCTA-guided PDT was demonstrated noninferior to ICGA-guided PDT for the SRF absorption rate in patients with acute CSC.
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@#AIM: To investigate the correlation between macular morphology and visual acuity and visual deformation in acute central serous chorioretinopathy(CSC). <p>METHODS: A cross-sectional clinical case-control study was conducted in which 38 patients with acute monocular CSC(CSC group)and 38 normal eyes(control group)were included. The best corrected visual acuity(BCVA), slit lamp microscope, indirect ophthalmoscope, frequency domain optical coherence tomography(OCT), color fundus photography and M-charts were performed in all subjects. The BCVA was converted to the minimum resolution angle LogMAR record when doing statistical. The mean LogMAR, macular retinal thickness(CFT), subretinal fluid thickness(SRF), transverse diameter length of subretinal fluid in macular area and visual deformation(M value)were significantly different between the two groups. The correlation between CFT and SRF, transverse diameter length of subretinal fluid in macular area and M value was analyzed. <p>RESULTS: The mean BCVA in acute CSC group was 0.15±0.15(LogMAR), that in control group was 0.12±0.12(LogMAR); CFT was 418.89 ±134.74μm in CSC group and SRF was 286.95±136.77μm in CSC group. The length of subretinal fluid transverse diameter in macular area was 2926.37±1109.66μm. CFT in control group was 217.58±12.49μm, SRF was 0, and the transverse diameter of subretinal fluid in macular area was 0. The M value of CSC group was 0.86±0.40, MH and MV were 0.99±0.38, 0.73±0.43, respectively. Compared with MV, MH was obviously aggravated, the difference was statistically significant(<i>t</i>=4.564, <i>P</i><0.01). There was no correlation between BCVA and the degree of visual deformation in CSC group(<i>r</i>=-0.124,<i> P</i>>0.05). In CSC group, BCVA had no correlation with SRF or the length of subretinal fluid transverse diameter in macular area(<i>r</i>=-0.059, -0.12; <i>P</i>=0.73, 0.48; respectively.)There was a positive correlation between CFT and M value in CSC group(<i>r</i>=0.91, <i>P</i><0.01). The value of MV was positively correlated with the length of transverse diameter of subretinal fluid in macular area(<i>r</i>=0.934, <i>P</i><0.01), and the value of MH was positively correlated with SRF(<i>r</i>=0.949,<i> P</i><0.01). <p>CONCLUSION: In acute CSC group, BCVA had no correlation with CFT, SRF, macular subretinal fluid transverse length and visual deformability, and visual deformability was positively correlated with CFT, SRF and macular subretinal fluid transverse length; MV was positively correlated with subretinal fluid transverse length, and MH was positively correlated with SRF.
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OBJETIVO: Determinar las alteraciones anatómicas y funcionales retinales en pacientes con coriorretinopatía serosa central aguda y su repercusión en los resultados visuales. MÉTODOS: Estudio observacional, transversal de 24 ojos con coriorretinopatía serosa central aguda, unilateral. Se realizó, Snellen, microperimetría y tomografía de coherencia óptica, y se calculó el grosor macular central. RESULTADOS: La agudeza visual mejor corregida media fue 0,5. Se encontró desprendimiento seroso neurosensorial en el 100 por ciento de los casos y desprendimiento del epitelio pigmentario en el 29,8 por ciento. El grosor retinal promedio por tomografía de coherencia óptica, fue 388,2 ± 112 Ám. La sensibilidad macular total promedio de 11,9 ±5,2 dB, con una sensibilidad macular central (2º) de 10,9 ± 4,87 dB, no se encontró diferencias significativas entre ellas (p= 0,23). Existió correlación inversa entre la sensibilidad central y el grosor macular (r = -0,76), lo que estadísticamente es significativo (p < 0,01); no se comportó de la misma manera la sensibilidad macular total y el grosor macular (r = -0,68). La localización de la fijación fue central en 86,9 por ciento y predominantemente central en 13,1 por ciento. El 91,3 por ciento tuvo una fijación estable y el 8,7 por ciento relativamente inestable. CONCLUSIONES: En la coriorretinopatía serosa central aguda la sensibilidad macular se ve afectada, estando relacionada con el grosor retinal. La localización y estabilidad de la fijación por lo general se conserva central y estable
OBJECTIVE: To determine the functional and anatomical alterations of the retina in patients with acute central serous chorioretinopathy. METHODS: Cross-sectional observational study of 24 eyes (24 patients) with acute unilateral central serous chorioretinopathy. Snelle´s chart, microperimetry and optical coherence tomography was used and the central macular thickness was estimated. RESULTS: The best average corrected visual acuity was 0.5. All the cases presented with neurosensoral serous detachment and pigmentary epithelium detachment was found in 29.8 percent. The average retinal thickness according to the optical coherence tomography figures was 388.2 ± 112 Ám. The average total macular sensitivity was 11.9 ± 5.2 dB, with central macular sensitivity (2o) of 10.9 ± 4.87 dB. There were no significant differences between them (p= 0.23). Central sensitivity and macular thickness were inversely correlated (r=-0.76), which is statistically significant; however, this did not occur in the correlation between the total macular sensitivity and the macular thickness (r = -0.68). The location of fixation was central in 86.9 percent and predominantly central in 13,1 percent of patients .Stable fixation was found in 91.3 percent whereas the relatively unstable was present in 8.7 percent. CONCLUSIONS: In central acute serous chorioretinopathy, the macular sensitivity is affected and is related with the retinal thickness. Location and stability of the fixation are central and stable in general
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Humans , Male , Female , Adult , Middle Aged , Retinal Detachment/complications , Retinal Diseases/physiopathology , Tomography, Optical Coherence/methods , Cross-Sectional Studies , Observational Studies as TopicABSTRACT
We performed indocyanine green angiography(ICGA) in 21 eyes of 21 patients with acute central serous chorioretinopathy(CSC) to investigate choroidal cirulatory changes in this disease. Heidelberg retina angiograph (HRA) that using confocal scanning laser ophthalmoscope was used for ICGA. In the very early phase of HRA, 19 eyes(90%) demonstrated focal areas of delayed filling usually followed by distinctively fluorescent, dilated choroidal vessels running through or around these areas. After mid-phase, diffuse intrachoroidal hyperfluorescence surrounding these dilated vessels and suggesting increased leakage from them was seen in 19 eyes(90%). The focal delays of choroidal filling seemed to reveal choroidal ischemia involved in this disease process rather than physiological delays as they were topographically associated with choroidal hyperfluorescence in the later phase of HRA and leaking points on fluoresecein angiogram. Based on these findings, we suggest the choroid as the primary pathologic focus of acute CSC. Also we propose a scenario of pathogenesis, beginning with choroidal ischemia that leads to increased leakage from choroidal vessels, secondary changes of retinal pigment epithelium and passage of fluid in the subretinal space.