A Multicentric Cross-Sectional Observational Study to Analyze the Effects of Moderate High Altitude on Ocular Health.

Objectives: Prolonged exposure to hypoxia at high altitudes can affect the eyes through various mechanisms, culminating in reduced vision. Multiple studies on this subject have focused on the ocular effects of high altitude on intraocular pressure (IOP), corneal thickness, and the retina. However, there is a lack of literature on the effects of 'moderate high altitude (2000-3000 m)' on the eyes. Hence, we designed our study to determine the impact of moderate high altitude on the eyes. Methods: We recruited two age and gender-matched groups of 250 research participants, each at moderate high altitude (Group A) and plains (Group B), respectively, to determine the effects of moderate high altitude on ocular health, if any. Results: We found a statistically significant increase in dry eye in Group A. We also found four cases of central serous retinopathy and one case of central retinal vein occlusion in Group A. There was no statistically significant change in visual acuity, IOP, or central corneal thickness. Conclusion: There is a vast lacuna in the literature on this particular altitude range, and further studies are required to confirm our findings. It is also recommended that lubricant eye drops be advised as a standard prophylactic measure for all individuals traveling and staying at moderate high altitude.

Ayurvedic management central serous retinopathy - A case report.

BACKGROUND: Central Serous Retinopathy (CSR) is an eye disease that causes visual impairment ascribable to fluid accumulation in the retina's macular area. CSR leads to the blurring of vision associated with metamorphopsia. The cause of the disease is unknown. The practitioners of contemporary science offer treatment only after observing for 3-4 months to resolve the fluid. The blurring of vision may persist even after oedema has resolved. If oedema does not resolve, they undertake laser photodynamic therapy or photocoagulation, which results in permanent damage to neuroretina and impaired visual acuity. According to Ayurveda, symptoms of blurred vision and metamorphopsia indicate Vata Dusti in eyes. CASE & INTERVENTION: A 53-year-old man, who sought Ayurvedic treatment for the blurring of vision in the last ten days, was diagnosed with CSR in the right eye. He underwent one course of Ayurvedic management, comprised of oral medication, including Punarnvadi kashaya, Candraprabha Vati, and Tiktaka ghrita, external treatments like Shiropichu (application of medicated oil on the bregma) and Kriyakalpa (eye treatment) like Anjana karma. OUTCOMES: At the end of a month of the Ayurvedic treatment, visual acuity in the right eye improved to 6/6, and Optic Coherence Tomography affirmed complete resolution of CSR (OCT). A one year follow up confirmed the non-recurrence of the disease. CONCLUSION: Ayurvedic treatment effectively resolves oedema within a short time with a marked visual outcome. Patients of CSR would benefit from the same if treated promptly in the early stage itself. Such patients shall be encouraged to opt for Ayurveda as a primary treatment modality.

A Masquerade Case: Choroidal Hemangioma Misdiagnosed As Central Serous Retinopathy.

Purpose: To report a case of misdiagnosed choroidal hemangioma, initially treated as central serous retinopathy (CSR) complicated by choroidal neovascularization (CNV), and to improve the proper identification of this disorder. Observations: Fundus images revealed a subtle, elevated choroidal lesion with an associated exudative detachment and choroidal vascular lesion on indocyanine green (ICG) angiography. Combined treatment with photodynamic therapy (PDT) and anti-VEGF therapy led to resolution of fluid and improvement in VA from 20/50 to 20/25. Conclusion: It is critical to understand the clinical features of choroidal hemangiomas and their physical presentation on retinal testing to diagnose and treat them in a timely and appropriate manner.

Central serous chorioretinopathy: A review.

Central serous chorioretinopathy (CSC) is the fourth most common non-surgical retinopathy associated with fluid leakage. The pathogenesis is not yet completely understood, but changes in the choroid, sclera and RPE have been described associated with venous congestion of choroidal outflow. CSC can be categorised into acute, chronic, and recurrent subtypes with recent classifications of simple and complex based on the area of RPE change seen on fundus autofluorescence. A multimodal imaging approach is helpful in the diagnosis and management of CSC and secondary complications such as type 1 neovascularisation. Although spontaneous resolution with relatively good visual outcomes is common, treatment should be considered in patients with persistent or recurrent SRF. Treatment options include laser, systemic medications, intravitreal therapy, and surgery. Of these, argon laser for focal extramacular fluid leaks and photodynamic therapy of leakage identified by indocyanine-green angiography currently have the greatest supportive evidence.

Choroidal Melanoma Masquerading as Central Serous Chorioretinopathy.

PURPOSE: To determine the clinical features and outcomes of choroidal melanoma initially masquerading as central serous chorioretinopathy (CSCR). DESIGN: Retrospective case series. SUBJECTS: All patients with choroidal melanoma, initially misdiagnosed as CSCR elsewhere and evaluated by the Ocular Oncology Service at Wills Eye Hospital from 2004 to 2022, were included. METHODS: A retrospective detailed review of patient charts and imaging was performed for all patients included in the study. Paired t tests and chi-squared tests were performed for data analysis. MAIN OUTCOME MEASURES: The primary outcome measures included clinical characteristics, ultrasonography, OCT, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography. The secondary outcome measures included treatment results, such as the final visual acuity, tumor control, radiation-related complications, and melanoma-related metastlasis and death. RESULTS: There were 22 patients (mean age, 48 years; 16 men) in this cohort. The mean interval between initial CSCR diagnosis and suspicion of choroidal melanoma was 50 months (median, 50 months; range, 0-242 months). At tumor diagnosis, the melanoma was submacular in 16 (73%) patients and extramacular in 6 (27%) patients. The mean tumor thickness was 3.4 mm (median, 2.5 mm; range, 1.4-10.7 mm), and the mean basal diameter was 9.2 mm (median, 8.0 mm, range, 4.5-22.0 mm). Features enabling differentiation of choroidal melanoma from CSCR (affected versus unaffected eye) included choroidal thickness asymmetry (100% > 300 µm versus 21% > 300 µm; P = 0.005), ipsilateral choroidal surface irregularity (100% versus 0%; P < 0.001), loss of choroidal vascular detail on OCT (100% versus 0%; P < 0.001), presence of multiple pinpoint leaks on angiography (100% versus 0%; P < 0.001), and contralateral lack of autofluoresence abnormalities (75% versus 6%; P = 0.001). Management of the choroidal melanoma included plaque radiotherapy (19, 86%), enucleation (2, 9%), or treatment elsewhere (1, 5%). On follow-up (mean, 6 years), vision loss of ≥ 3 Snellen lines (9 patients, 47%), metastasis (3 patients, 14%), and death (1 patient, 5%) were noted. CONCLUSIONS: Patients with presumed CSCR, especially if chronic, should be evaluated for a possible thin underlying choroidal melanoma with a dilated fundus examination and multimodal imaging.

La tomografía de coherencia óptica en el diagnóstico y evolución de la coroidopatía lúpica. Reporte de caso

El lupus eritematoso sistémico (LES) es una enfermedad autoinmune que afecta múltiples órganos incluidos los ojos. Entre las manifestaciones oculares del LES se encuentra la coroidopatía lúpica (CL), afección poco frecuente, pero de importantes repercusiones visuales si no se trata oportunamente. Se presenta el caso de una paciente de 41 años que desarrolló una CL durante la reducción de su terapia corticoesteroidea para el LES, estudiada con angiofluoresceinografía retiniana y tomografía de coherencia óptica (OCT) para el diagnóstico y seguimiento de su compromiso ocular. Tanto las fugas del colorante como los desprendimientos serosos de retina cedieron con el tratamiento de altas dosis de prednisona, pero recurrieron en dos oportunidades a pesar del control de la enfermedad de fondo. Se enfatizan las características clínicas para permitir su reconocimiento, resaltando el uso de la OCT para su diagnóstico y seguimiento luego del tratamiento.

SUMMARY Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs including the eyes. Among the ocular manifestations of SLE is lupus choroidopathy, a rare condition but with significant visual repercussions if not treated promptly. We present the case of a 41-year-old woman who developed a lupus choroidopathy during the reduction of the dose of corticosteroid therapy for SLE, studied with retinal angiofluoresceinography and OCT for the diagnosis and follow-up of her ocular involvement. Both the dye leaks and the serous retinal detachments resolved with the treatment of high doses of prednisone but recurred twice despite the control of the underlying disease. The clinical characteristics are emphasized to allow its recognition, highlighting the use of optical coherence tomography (OCT) for its diagnosis and follow-up after treatment.

Eplerenone repurposing in management of chorioretinopathy: Mechanism, nanomedicine-based delivery applications and future trends.

Chronic central serous chorioretinopathy (CSCR) is an ocular threatening disease, a common cause of central vision loss, affecting the posterior pole of the eye. Eplerenone (EPL) is a selective mineralocorticoid receptor antagonist that is primarily used to treat hypertension. Recently, it has shown many benefits in modifying the physio-pathological processes occurring upon stimulation of renin-angiotensin-aldosterone system at the ocular level. In CSCR treatment, several clinical studies and case reports prove the efficacy and safety of EPL. However, setbacks for such studies include a relatively small number of participants and short follow-up periods. This review article is intended to describe theories about the nature and classification of CSCR and recapitulate EPL therapeutic benefits as selective mineralocorticoid receptor antagonist in the treatment of CSCR. Furthermore, we survey the literature on clinical studies discussing the results of use of EPL in treatment of CSCR. In addition, EPL therapeutic formulations that have been developed are described, and future potential delivery systems will be suggested.

Focal Laser Photocoagulation for Central Serous Chorioretinopathy in Under-Represented Populations: A Retrospective Case Series.

This case series examines visual and anatomic outcomes of focal laser photocoagulation in the treatment of central serous chorioretinopathy (CSCR) with subretinal fluid (SRF) in under-represented populations. We reviewed records of 25 eyes with CSCR and SRF that underwent focal laser photocoagulation. Visual acuity (VA) and central macular thickness (CMT) were recorded prior to laser, after laser treatment, and at final follow-up and were all compared using Wilcox signed-rank tests after using Shapiro-Wilk tests to determine normality. The racial and ethnic breakdown of our cohort (n = 25) includes 64% Hispanic (n = 16), 20% black (n = 5), 12% Asian (n = 3), 4% other (n = 1). Patients were followed for a median of 15.5 months (range: 5.75-87 months) after treatment. The VA prior to laser compared to best-available VA significantly improved (p = 0.0003). Pre-laser CMT to post-laser CMT (p < 0.0001) and pre-laser CMT to final CMT (p < 0.0001) significantly improved. Excluding the one eye that developed a choroidal neovascular membrane, the pre-laser VA to final VA improved significantly (p = 0.0047) as well as the pre-laser CMT to final CMT (p < 0.0001). Of the 25 eyes, 4 had persistent SRF following laser, and of the 21 eyes with complete resolution of SRF, 2 developed recurrent SRF. Focal laser photocoagulation can significantly improve VA and CMT in CSCR with active SRF in patients who have been under-represented in prior clinical studies.

Acute-onset central serous retinopathy after immunization with COVID-19 mRNA vaccine.

PURPOSE: We report the case of a 33-year-old male who presented with unilateral central serous retinopathy three days after the injection of a COVID-19 vaccine. OBSERVATIONS: A 33-year-old healthy Hispanic male referred to the ophthalmology service due to blurry vision and metamorphopsia in the right eye without any flashes, floaters, eye redness or pain. The patient reported that 69 hours prior to presentation he received the first dose of the Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine. He denied any past ocular history or pertinent medical history. He does not take any medicines and denies stressful factors in his life. The clinical examination and imaging tests were consistent with central serous retinopathy that resolved in three months. CONCLUSIONS AND IMPORTANCE: This is the first report of an ocular complication potentially associated with a COVID-19 vaccination. Our case contributes information of a side effect potentially related to this new vaccine.

Ophthalmological problems in pregnancy - a review.

Pregnancy is associated with numerous changes affecting all organs. Ophthalmological changes in pregnant women are most often physiological and resolve spontaneously after delivery. However, the possibility of progression of previously diagnosed ophthalmic diseases or the occurrence of ophthalmological complications in the course of diseases characteristic for pregnancy should always be considered.

Visual and anatomical outcomes of central serous chorioretinopathy patients presenting to a tertiary unit: a prospective analysis.

AIM: The aim of this study was to prospectively define the characteristics and outcomes of a cohort of central serous chorioretinopathy patients using optical coherence tomography imaging to determine anatomical disease resolution. Much of the literature available on the characteristics of central serous chorioretinopathy patients pre date the advent of OCT imaging, with conclusive epidemiological evidence being scarce. We describe a cohort of patients presenting to a large centre over the course of a year. METHODS: Prospective data collection was undertaken for all patients diagnosed with central serous chorioretinopathy at our unit over the course of 1 year. All patients underwent thorough history taking and optical coherence tomography imaging. RESULTS: In total, 59 eyes from 51 patients were diagnosed with central serous chorioretinopathy between April 2017 and April 2018; 23 (45.1%) patients had optical coherence tomography evidence of complete anatomical resolution within a year, with three (5.88%) patients suffering a worse visual acuity compared with that at presentation at 1-year end point; and three patients developed secondary choroidal neovascular membranes. CONCLUSION: Our study reports much-needed prospective outcomes of patients with central serous chorioretinopathy, which helps to guide clinicians when deciding treatment strategies, as well as better informing patients of their prognosis for visual improvement.

532-nm Subthreshold Micropulse Laser for the Treatment of Chronic Central Serous Retinopathy.

INTRODUCTION: Subthreshold micropulse laser treatment with a 532 nm (532-SML) wavelength has been suggested as a treatment option for the treatment of chronic central serous retinopathy (cCSR). The objective is to present its effects and complications. METHODS: We present a retrospective cohort study of cCSR patients submitted to 532-SML. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) parameters - central macular thickness, subfoveal outer nuclear layer, external limiting membrane, ellipsoid band, interdigitation band, subretinal fluid and choroidal thickness - were evaluated before and 12 weeks after treatment. A power of 50%, a duty cycle of 5%, exposure time of 200 ms and a spot size of 160 µm were the applied laser parameters. RESULTS: We included 26 eyes. Overall there were no significant changes in visual acuity (median 0.20 (IQR 0) logMAR before and after treatment) or SD-OCT parameters. However, visual benefits occurred in 42.3% (n=11) of the patients and in half of the cases, subretinal fluid was completely reabsorbed. There were no complications. CONCLUSION: In this study, 532-SML was overall ineffective on cCSR as it did not lead to significant changes in the overall median visual acuity and SD-OCT parameters. However, some patients may have benefited functionally and anatomically from the treatment; further investigation is necessary to understand the potential of 532-SML.

Central Serous Chorioretinopathy Classification.

Central serous chorioretinopathy is characterized by an idiopathic neurosensory detachment of the retina. This narrative review aims to discuss the classification system used for central serous chorioretinopathy. Based on our current knowledge, there is no universally adopted classification system. This is the result of the unknown aspects related to pathogenesis and clinical spectrum and evolution. The best option could be to aggregate multimodal pieces of information alongside temporal and phenotypic characteristics.

A Novel Method for Detection and Progress Assessment of Visual Distortion Caused by Macular Disorder: A Central Serous Chorioretinopathy (CSR) Case Study.

This paper presents a new mathematical model along with a measurement platform for accurate detection and monitoring of various visual distortions (VD) caused by macular disorders such as central serous chorioretinopathy (CSR) and age-related macular degeneration (AMD). This platform projects a series of graphical patterns on the patient's retina and calculates the severity of VDs accordingly. The accuracy of this technique relies on the accurate detection of distorted lines by the patient. We also propose a simple mathematical model to evaluate the VD created by CSR. The model is used as a control for the test results achieved from the proposed platform. The proposed platform consists of the required hardware and software for the generation and projection of patterns along with the collection and processing of patients against their standard optical coherence tomography (OCT) images. Based on these results, the OCT images agree with the VD test results, and the proposed platform can be used as an alternative home monitoring method for various macular disorders.

Recent Advances of Computerized Graphical Methods for the Detection and Progress Assessment of Visual Distortion Caused by Macular Disorders.

Recent advances of computerized graphical methods have received significant attention for detection and home monitoring of various visual distortions caused by macular disorders such as macular edema, central serous chorioretinopathy, and age-related macular degeneration. After a brief review of macular disorders and their conventional diagnostic methods, this paper reviews such graphical interface methods including computerized Amsler Grid, Preferential Hyperacuity Perimeter, and Three-dimensional Computer-automated Threshold Amsler Grid. Thereafter, the challenges of these computerized methods for accurate and rapid detection of macular disorders are discussed. The early detection and progress assessment of macular disorders can significantly enhance the required clinical procedure for the diagnosis and treatment of macular disorders.

Effect of oral eplerenone in anatomical and functional improvement in patients with chronic central serous chorioretinopathy.

OBJECTIVE: To determine the efficacy of oral eplerenone in anatomical and functional improvement in patients with chronic central serous chorioretinopathy (CSCR). METHODS: This quasi experimental study was performed at PNS Shifa Hospital Karachi from September 2018 to February 2019. Study included 23 patients. Patients were included using consecutive sampling technique and informed consent was taken from all patients before staring treatment. 50 mg of oral eplerenone per day was given for three months. Subretinal fluid (SRF) height and visual acuity (VA) were noted at baseline, one month and three month follow-up. Structured Study performa was used for data collection. Data was analysed and assessed with SPSS version 23. P value of <0.05 was considered statistically significant. RESULTS: Mean age of patients was 40.7±7 years and mean duration of disease before treatment was 3.7±0.76 months. Mean baseline BCVA and SRF height was 0.39±0.02 logMAR and 123±12.5 µm respectively. Sixty-five percent patients responded at one month and 80% at three months with reduction in SRF height. Improvement in visual acuity was also statistically significant at 3 months (p<0.05). CONCLUSION: Use of eplerenone in chronic CSCR resulted in significant improvement in vision and decrease in mean SRF height.

The Effect of Eplerenone in Chronic Central Serous Chorioretinopathy Refractory to Photodynamic Therapy.

Purpose: To evaluate the efficacy and safety of oral eplerenone in cases of central serous chorioretinopathy (CSCR) refractory to photodynamic therapy (PDT). Methods: 19 patients with chronic CSCR and persistent subretinal fluid (SRF) were treated with oral eplerenone for 6 months, starting at a dose of 25 mg/day for 4 weeks and then 50 mg/day for 5 months. All patients underwent visual acuity measurement and optical coherence tomography (OCT), while fluorescein angiography was also performed at baseline, before treatment. Resolution of SRF, changes in retinal thickness and BCVA changes at month 6 and 12 post-treatment initiation were assessed. In addition, creatinine and electrolyte test was done on each patient every month for potential complications. Results: Two out of 19 cases were excluded, since one presented with hyperkaliemia 15 days after eplerenone intake and one with skin rash one day after the treatment initiation. At month 12, 88.2% of patients exhibited visual acuity improvement and 76.4% SRF resolution, while in 11.8% of patients SRF remained stable. Conclusions: This study has shown that eplerenone is safe and effective in cases of chronic CSCR, refractory to previous PDT.

NGRID: A novel platform for detection and progress assessment of visual distortion caused by macular disorders.

This paper presents a new graphical macular interface system (GMIS) for accurate, rapid, and quantitative measurement of visual distortion (VD) in the central vision of patients suffering from macular disorders. In this system, a series of predefined graphical patterns or multiple grids (NGRID) are randomly selected from a library of patterns and visualized on the screen, then the VDs identified by the patient are recorded as binary codes using various control methods including speech recognition. Scalable Vector Graphics (SVG) is used to generate the patterns and save them into a central library. Based on the projected patterns and the patients' responses, a VD graph or so-called heatmap is generated for eye-care purposes. We demonstrate and discuss the functionality of the proposed system for the detection and progress assessment of a macular condition in patients suffering from Central Serous Chorioretinopathy (CSR). Also, we characterize the proposed technique to evaluate the systematic error and response time on healthy human subjects with normal vision. Based on these results, the voice recognition input method exhibits a lower error but a higher response time compared to other input devices. We run the proposed NGRID VD technique to evaluate the effect of CSR on the visual field of a CSR patient. The generated heatmaps are in agreement with standard Optical Coherence Tomography (OCT) images obtained at different times from both the left and right eyes. These results reveal the applicability of the proposed technique for the detection and assessment of macular disorders. Based on these results, the proposed NGRID platform shows great promise for use as an alternative solution for in-home monitoring of various macular disorders and as a means of forwarding responses to secured cloud facilities for future data analysis.

Risk factors for incident central serous retinopathy: case-control analysis of a US national managed care population.

AIM: To evaluate clinical comorbidities and steroid use as risk factors for central serous retinopathy (CSR). METHODS: Using national insurance databases, we conducted a case-control study of beneficiaries with an incident diagnosis of CSR between 2007 and 2015 (n=35 492) and randomly selected controls matched on age-based and sex-based propensity scores (n=1 77 460). RESULTS: The mean age (SD) of cases was 49.1 (12.2) years, and the majority (69.2%) were male. Cases were more likely to have received steroids in the past year (OR 1.14, 95% CI 1.09 to 1.19, p<0.001) and to have comorbid Cushing's syndrome (OR 2.19, 95% CI 1.33 to 3.59, p=0.002), age-related macular degeneration (OR 5.24, 95% CI 5.00 to 5.49, p<0.001), diabetic macular oedema (OR 2.05, 95% CI 1.71 to 2.47, p<0.001) and diabetes mellitus (OR 1.44, 95% CI 1.33 to 1.56, p<0.001). Glaucoma was associated with lower odds of CSR (OR 0.54, 95% CI 0.51 to 0.56, p<0.001). Patients with other previously hypothesised risk factors (including essential hypertension, pregnancy, other autoimmune disease, sleep disorders, Helicobacter pylori infection and gastro-oesophageal reflux disease) had lower odds of CSR. CONCLUSIONS: Male middle-aged patients with recent steroid exposure were significantly more likely to develop CSR. Other risk factors include diabetes mellitus, diabetic macular oedema and age-related macular degeneration. Other previously hypothesised risk factors did not appear to confer increased risk. More research is needed to confirm and examine underlying pathophysiology.

Central serous retinopathy and hand-foot-mouth disease: coincidence or causation?

INTRODUCTION: The clinical and pathological correlation between hand-foot-mouth disease (HFMD) and ocular complications has not yet been established. However, individual case reports indicate a trend that may be the emergence of a new burden of the previous self-limiting virus. This virus is particularly prevalent in childcare centers and poses an infectious disease risk for this workplace. OBJECTIVES: The primary objective of this case report is to describe an unusual clinical record of a patient who developed central serous retinopathy while unwell with HFMD. Discussion of management strategies for this workplace, its staff, and visitors is also included. METHODS: This was an observational case report that was identified and reported retrospectively. For comparison, a search of the literature to identify similar ocular complications of HFMD was also undertaken. Results from this search, in addition to international data and prevention and management strategies are also provided. RESULTS: A total of 13 individual case reports with ocular associations, including this clinical record, were identified in the literature worldwide. The median age was 33 years, and three patients (23%) were female. No treatment or management guidelines for ocular complications of HFMD have been identified. CONCLUSION: Severe and potentially life-threatening complications of a seemingly harmless childhood illness are represented sporadically in the literature. The requirement for research and evaluation into this emerging occupational hazard area is necessary for improved prevention, management, and treatment strategies to be developed.