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ABSTRACT Purpose: To assess the effect of continuously covering the sick eye affected with central serous chorioretinopathy for 48 h. Methods: This retrospective, case-control study involved 32 central serous chorioretinopathy patients categorized in the treatment group composed of 17 sick eye that received continuous covering treatment for 48 h with a medical gauze and the observation group composed of 15 of these patients who were followed up. None of the patients received any other treatments or medications. The logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity, macular retinal thickness, and the root mean square value of the amplitude density in the first ring of multifocal electroretinogram were examined before and after the 48-h treatment. Results: After the continuous treatment, the logMAR best-corrected visual acuities were 0.31 ± 0.18 and 0.56 ± 0.37 in the treatment and observation groups, respectively (p=0.019). The macular retinal thicknesses were 461 ± 43 µm and 498 ± 50 µm in the treatment and observation groups, respectively (p=0.032). The root mean square values of the amplitude density in the first ring of multifocal electroretinogram were 32.5 ± 5.3 nV/deg2 and 26.6 ± 4.3 nV/deg2 in the treatment and observation groups, respectively (p=0.002). Conclusions: The continuous application of the covering treatment for 48 h on the sick eye showed positive outcomes with respect to the best-corrected visual acuity, macular retinal thickness, and macular retina functions in the treatment of central serous chorioretinopathy.
RESUMO Objetivo: Este estudo teve como objetivo avaliar o efeito da cobertura contínua do olho doente de pacientes com coriorretinopatia serosa central por 48 horas. Métodos: Este estudo retrospectivo, caso-controle, incluiu 32 pacientes com coriorretinopatia serosa central, dos quais 17 receberam tratamento de cobertura contínua por 48 horas no olho doente com gaze médica como grupo de tratamento e 15 foram acompanhados como grupo de observação. Todos os pacientes não receberam nenhum outro tratamento ou medicamento. O logaritmo do ângulo mínimo de resolução da acuidade visual melhor corrigida (LogMar), a espessura macular da retina e o valor médio da raiz quadrada da densidade da amplitude no primeiro anel do eletroretinograma multifocal foram examinados antes e após o tratamento por 48 horas, respectivamente. Resultados: Após o tratamento contínuo, a acuidade visual melhor corrigida pela escala logMar foi de 0, 31 ± 0, 18 no grupo de tratamento e 0, 56 ± 0, 37 no grupo de observação (p=0, 019). A espessura macular da retina foi de 461 ± 43 µm no grupo de tratamento e 498 ± 50 µm no grupo de observação (p=0,032). O valor médio da raiz quadrada da densidade de amplitude no primeiro anel do eletroretinograma multifocal foi de 32,5 ± 5,3 nV/deg2 no grupo com cobertura e foi de 26,6 ± 4,3 NV/deg2 no grupo de observação (p=0,002). Conclusões: O tratamento de cobertura contínua no olho doente, durante 48 horas, apresentou efeitos positivos na acuidade visual melhor corrigida, na espessura e na função macular da retina no tratamento da coriorretinopatia serosa central.
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The mineralocorticoid receptor (MR) belongs to the nuclear receptor superfamily and is expressed in the retina and choroid. MR antagonist (MRA) has a long history of application in non-ophthalmic clinical practice. Various cellular and animal models indicated that inappropriate activation of MR participated in pathological angiogenesis, oxidative stress, inflammation, disturbance of ion/water homeostasis and neurodegenerative changes, while the application of MRA can reduce or reverse these pathological processes. After using MRA in central serous chorioretinopathy (CSC) patients, improved visual function, less subretinal fluid and reduced sub-foveal choroidal thickness were observed. Single nucleotide polymorphisms in MR and plasma aldosterone levels were significantly different between chronic CSC patients and CSC patients with spontaneous remission. Novel formulation for sustained-release MRA and the mechanisms involving inflammation may become the new focus of MR study. This review summarizes the research status of MR and MRA in order to provide a reference for future basic research and clinical treatment.
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Objective To observe the morphologic alterations of retina pigment epithelial around fluorescein leakage site using spectral-domain optical coherence tomography (SD-OCT) in acute central serous chorioretinopathy (CSC) before and after laser coagulation.Methods Twenty-four eyes of 24 consecutive patients with unilateral acute CSC who underwent laser photocoagulation (wave length:561 nm,energy:80-100 mW,spot diamteter:100 μm,exposure time:0.1 s) were enrolled in this retrospective study.The patients included 22 males and 2 females,with an average age of (39.2± 7.2) years and an average duration of (1.1 ± 0.6) months.The fluorescein leakage outside the foveal avascular zone and serous retinal detachment were found in all the eyes by fluorescein fundus angiography (FFA) and SD-OCT.Twenty-six leakage sites were observed in 24 eyes on FFA.There were 5 smoky leakage points (19.2％),21 inky leakage points (80.8 ％).The retinal pigment epithelial (RPE) layer at leakage points were scanned by SD-OCT before and at 2 weeks,2 months after treatment.SD-OCT showed that the RPE abnormalities were detected at all of the fluorescein leakage points,including serous pigment epithelial detachment (PED) in 16 leakage points (64.5％),protruding RPE in 5 leakage points (19.5％),and irregular RPE in 5 leakage points (19.2％).The morphologic alterations of RPE around fluorescein leakage point before and after laser coagulation were observed.Results At 2 weeks after laser photocoagulation,PED existed in 7 leakage points (26.9％),protruding RPE in 3 leakage points (11.5％),and irregular RPE in 16 leakage points (61.5％).At 2 months after laser photocoagulation,protruding RPE existed in 3 leakage points (11.5％),and irregular RPE in 5 leakage points (19.2％),including RPE defect in 2 leakage points.And there were undetectable RPE abnormalities in other 16 leakage points (61.5％).Conclusions In acute CSC,SD-OCT shows that morphologic features of the RPE layer are changed,including PED,protruding RPE,irregular RPE around the leakage point.After laser photocoagulation the abnormalities of RPE can also be altered from PED to irregular RPE,and RPE defect is observed in restricted regions.
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Objective To observe the characteristic variation of the patients' inner and outer retina who had chronic central serous chorioretinopathy (CSC) after being treated of photodynamic therapy (PDT).Methods Nineteen patients with chronic CSC were recruited,including 15 eye of men and 4 eye of women,logMAR BCVA was 0.1-1.0,0.39 ± 0.30.Meanwhile,24 healthy people were located in the control group.All the patients received PDT for the first time.All subjects including 24 healthy people underwent fourier domain optical coherence tomography (FD-OCT).Retinal thickness were investigated before PDT and 1,4,12,20 weeks after PDT respectively.Data were recorded including inner layer and outer layer.Retinal thickness were compared in fovea (1 mm),parafovea (3 mm)and perifovea(5 mm).Paired-samples t test was used to compare retinal thickness before and after PDT.The statistical differences of patients and control group were evaluated by independent-samples t test.The correlations between the best logMAR corrected visual acuity (BCVA) was analyzed by Pearson statistical analyses.Results The inner(F=13.814,10.095,4.689) and outer(F＝ 9.354,5.878,3.978) layer fovea thickness of CSC subjects in 1,4,12 week was thinner,the difference was statistically significant (P＜0.05).The outer layer fovea thickness at P12 (t =-3.725),parafovea of inner and outer retinal (t =-3.198,-2.722) was reduced when compared with control group,and differences have statistical sense,respectively (P＜0.05).There was correlation between logMAR BCVA and outer retinal thickness in fovea and parafovea (r =0.465,-0.728,-0.687; P＜0.05).Conclusion In our study,the inner and outer layer retinal thickness decreased generally after the first time PDT in CSC patients.
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Objective To observe the effect of micro-pulse laser in the treatment of acute central serous chorioretinopathy (CSC).Methods 105 cases (114 eyes) with clinically diagnosed acute CSC were included in the study,including 78 males (86 eyes) and 27 females (28 eyes) with an average age of (40.40±7.80) years,and mean duration of 26 days.All patients were examined for best corrected visual acuity (BCVA),slit lamp microscope and pre-lens,direct ophthalmoscopy,color fundus photography,fluorescein angiography combined with indocyanine green angiography (ICGA),and micro-perimetry.Patients were randomly divided into micro-pulse laser treatment group (treatment group,61 eyes) and control group (51 eyes).The age (Z ＝-0.374),gender ratio (x2=0.010),disease duration (Z=-0.525),BCVA (t=1.885),foveal thickness (CFT) (t=-1.754) and macular light sensitivity (t=1.255) were similar between the two groups.The micro-pluse laser treatment was performed with an 810 nm infrared diode laser at the active leakage site on retinal pigment epithelium guided by ICGA.The exposure time was 0.2 s,effective working time was 15％,the laser spot diameter was 100 μm,and the distance between 2 spots was 100 μm.The control group received pseudo-treatment using the same laser parameters.After 2 weeks,1month,3 months and 6 months of treatment,all patients were examined with BCVA,ocular fundus,optical coherence tomography and micro-perimetry.These parameters were compared between the 2 groups.Results The subretinal fluid of 39 eyes in the micro-pulse laser group and that of 3 eyes in the control group were absorbed completely.The cure rates in the micro-pulse laser group (61.9％) was higher than that in the control group (x2 =38.015,P＜0.01).In the micro-pulse laser group,the mean BCVA was 67.81±11.70 at baseline,which increased significantly to 75±9.91,76.78± 9.43,78.56 ± 8.57 and 78.52 ± 8.60 at 2 weeks,1 month,3 months and 6 months after treatment respectively.In the control group,that was 63.86±10.35,64.20±11.43,63.90±10.88,64.55±11.04,64.10±11.12 at baseline,2 weeks,1 month,3 months,6 months post-treatment respectively.The mean post treatment BCVA at each time point were significantly higher in the micro-pulse laser group than that in the control group (P＜ 0.01).The mean CFT was (380.94 ± 50.73) μm at baseline,which reduced to (268.44±44.20),(242.78±41.31),(235.46±38.44),(235.56±38.71) μm at 2 weeks,1 month,3 months and 6 months post-treatment respectively in the nmicro-pulse laser group.In the control group,that was (397.98±52.61),(334.55±59.15),(316.16±55.25),(314.47±53.27),(321.51±55.74) μm at baseline,2 weeks,1 month,3 months,6 months post-treatment respectively.The mean post-treatment CFT at each time point in the micro-pulse laser group were decreased significantly compared to that in the control group (P＜0.01).The mean central retinal sensitivity was (15.03 ± 2.00) dB at baseline,which enhanced to (17.06 ± 1.71),(17.37 ± 1.61),(17.56 ± 1.58),(17.48 ± 1.53) dB at 2 weeks,1 month,3 months and 6 months post-treatment respectively in the micro-pulse laser group.In the control group,that was (14.54±2.22),(14.80±2.16),(14.88±2.09),(14.82±2.07),(14.69±2.11) dB at baseline,2 weeks,1 month,3 months and 6 months post-treatment respectively.The mean central retinal sensitivity at each time point of post-treatment in the micro-pulse laser group were enhanced significantly compared to that in the controlled group(P＜0.01).Conclusion In the treatment of acute CSC,micro-pulse laser can improve BCVA,reduce the mean CFT and improve the mean central retinal sensitivity.It is an effective and safe method to treat acute CSC.
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Objective To evaluate the efficacy and safety of half-dose verteporfin photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC).Methods 35 eyes (35 patients) with chronic (or recurrent) CSC treated with half-dose verteporfin PDT.Best-corrected visual acuity(BCVA),central macular thickness (CMT) were measured before and after treatment (1,3 and 6 months).The mean BCVA was 0.28± 0.22,mean CMT was(384.5 ± 85.0) μm.The situation of subretinal fluids (SRF) absorption was observed.Results In 35 eyes,SRF of 29 eyes (82.9％) completely absorbed and 6 eyes (17.1％) not completely absorbed after one month of treatment.SRF of all eyes (100.0％) completely absorbed after three months of treatment.After 6 months of treatment,SRF of 3 eyes (8.6％) were recurrence,which might be completely absorbed when a half-dose maintenance therapy PDT was used again.The mean BCVA significantly improved to 0.14±0.13 at 1 months,0.05±0.11 at 3 months and 0.05± 0.12 at 6 months after PDT (t=5.410,7.830,7.758; P＜0.05).The mean CMT decreased to (224.3± 61.4) μm at 1 months,(199.6±32.7) μm at 3 months and (205.3±39.6) μm at 6 months after PDT (t=11.856,11.781,11.900; P＜0.05).The mean CMT of controlled 32 eyes after treatment was (198.5± 33.9) μm,much lower than the fellow eyes(232.3 ± 17.5) μm (t =-3.988,P＜0.05).Conclusions Half-dose verteporfin PDT was safe and effective in treating chronic CSC,but may cause thinning of CMT.
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Multicenter randomized controlled studies can recruit more subjects in a relatively short period of time,avoiding the bias of single research institution studies,resulting in reliable conclusions and providing strong guidance to clinical practice.They are the most scientific and most reliable methods to evaluate clinical researches.However,there are few multicenter clinical trials in China as Chinese doctors are often trapped in difficulties in clinical research,including imperfect research system,lack of experience,capital investment deficient,the tension in the doctor-patient relationship and so on.Although the above problems are related to medical system architecture of our country in a certain extent,compared with the overseas,we also have our own advantages,such as resource of our patients,doctors,and diseases type.Pay attention to discovering of new type of diseases,looking for genetics discipline,and exploring new medical technology is an important task of clinical research.We have plenty of high level ophthalmology centers at present,which provide favorable conditions for launching multi-center clinical trial studies.We have good reasons to believe that,if we can effectively exploit the resources in our hands,carefully observe and discover clinical problems,there will be more convincing clinical results present in the world after bring up hypothesis boldly while prove it conscientiously and carefully.
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Background It is thought in recently that photodynamic therapy (PDT) is an effective treatment method for chronic central serous chorioretinopathy (CSC), but the dosage of verteporfin and its long-term efficacy and complications is rarely elucidated ever before.Objective This study was to observe the long-term efficacy and safety of 60％ dose verteporfin PDT for chronic CSC.Methods This is a retrospective study and a self-controlled design was used.The clinical data of 25 eyes of 21 chronic CSC patients who received 60％-dose verteporfin PDT in Henan Eye Institute from January 2009 to May 2010 were reviewed, with the male 18 (85.71％) and female 3 (14.29％) as well as monocular CSC 17 patients and binocular CSC 4 patients.The average ages of the patients were (43±5) years.Fundus fluorescein angiography (FFA) , indocyanine green angiography (ICGA), optical coherence tomography(OCT) and best corrected visual acuity (BCVA) were examined in all the patients before and after treatment.PDT with the 60％-dose verteporfin (3.6 mg/m2) was carried out on the CSC eyes.The treated eyes were examined 2 weeks, 1 month and 3 months after PDT.The BCVA,subfoveal choroid thickness,FFA and ICGA findings before and after PDT were compared.The following-up duration was 5 years or more.Results The BCVA before and 3 months after PDT were 0.5 ±0.1 and 0.9±0.2, respectively, with a statistically significant difference between them (t =19.17,P =0.00).The subfoveal choroidal thickness value 3 months after PDT was (326.56±39.47) μm,which was significantly reduced in comparison with (486.24 ±47.53) μm before PDT (t =25.17, P =0.00).FFA and ICGA showed that the leakage of fluorescein (hyperfluorescence) was disappeared in all the treated eyes.No systemic or local adverse effects and recurrence were observed during the follow-up period.Conclusions On the basis of the results of this study and available information,60％-dose verteporfin PDT seems to have a better long-term efficacy and safety than full-dose verteporfin in treating chronic CSC.