Risk of Recurrence and Transition to Chronic Disease in Acute Central Serous Chorioretinopathy.

PURPOSE: To study the risk of recurrence in acute central serous chorioretinopathy (aCSC) and to evaluate the risk of transitioning to chronic CSC. PATIENTS AND METHODS: The medical records and multimodal imaging data of 295 aCSC cases were reviewed. Typical aCSC was defined as the presence of serous subretinal fluid (SRF), one focal leakage spot on fluorescein angiography (FA), retinal pigment epithelium (RPE) alterations limited in area to less than one optic disc diameter, and complete recovery from this first CSC episode. An increase in RPE alterations combined with persistent SRF was considered a sign of chronicity, which was determined in cases with >12 months follow-up. The main outcome measures included final visual acuity, percentage of disease recurrence, and percentage of cases moving toward a chronic phenotype. Treatment strategies and their efficacy were also reviewed. RESULTS: A total of 295 eyes in 291 patients with aCSC were included. Spontaneous recovery was awaited in 154 eyes (52%), whereas 141 eyes (48%) recovered following treatment. SRF recurrence occurred in 24% of untreated cases and in 4% of treated cases (p<0.001). An analysis of 61 eyes that underwent an FA after ≥12 months of follow-up revealed increased RPE alterations in 22 eyes (36%), and 14 eyes (23%) had both an increase in RPE alterations and SRF recurrence. CONCLUSION: All aCSC cases recovered from the first disease episode, and none of the cases developed persistent SRF leakage. Among the cases for which long-term follow-up information was available, 36% showed a tendency toward chronicity in terms of increased RPE alterations, whereas 23% showed both an increase in RPE alterations and recurrent SRF. Early photodynamic therapy (PDT) may decrease the risk of recurrences.

Photodynamic Therapy for Chronic Central Serous Chorioretinopathy: Multicenter Study of 65 Cases

PURPOSE: To determine the effect of photodynamic therapy (PDT) on patients with chronic central serous chorioretinopahty (CSC). METHODS: This was a retrospective multicenter study. We collected demographic and ophthalmic data for patients with chronic CSC who were treated with PDT from 16 institutions in Korea. The best corrected visual acuity (BCVA), ophthalmoscopic finding and optical coherence tomography at baseline and follow-up visits were compared longitudinally. RESULTS: Sixty-five eyes of 65 patients were recruited. Males (51 patients, 78.5%) outnumbered females (14 patients, 21.5%). The mean age was 46.4+/-10.0 years of age (28~69). By 1 month, mean BCVA improved from 0.47 to 0.37 (logarithm of the minimum angle of resolution) (P <0.01). This BCVA increased throughout 6 months. Subretinal fluid resolved partially or completely in 89.1% of the patients. Central macular thickness (CMT) decreased from 303.4 to 168.7 micrometer. The amount of change in CMT after PDT was correlated to the female sex and prePDT CMT. At 3 months after PDT, the amount of change in BCVA was significantly related to that of change of CMT (p <0.05). Adverse events were reported in 4 cases, however, most were mild. CONCLUSIONS: PDT was effective and safe for treating chronic CSC.

Choroidal Ne ovascularization in Patients with Chronic Central Serous Chorioretinopathy

Chronic central serous chorioretinopathy[CSC], which also has been termed diffuse retinal pigment epitheliopathy, is defined as a sensory retinal detachment associated with areas of RPE atrophy and pigment mottling. Fluorescein angiographic finding includes areas of granular hyperfluo-rescence and one or many subtle leaks. In older age group, choroidal neo-vascularization[CNV]may develop as a complication. We investigated the clinical features and performed fluorescein angiography[FAG], indocyanine green[ICG]angiography in 10 patients with CNV among 32 patients with chronic CSC. The location of CNV was extrafoveal[3 eyes]and juxtafoveal[7 eyes]. Associated fundus findings were RPE atrophy[8 eyes], PED[5 eyes], serous RD[4 eyes], subretinal hemorrhage[4eyes]. ICG findings were hypo-fluorescence[8 eyes], choroidal hyperpermeability[7 eyes], choroidal delayed filling[5 eyes]. Choroidal neovascularization was identified only with ICG angiography in 6 out of 10 cases. Laser photocoagulation was performed using ICG angiography in 6 cases. Visual acuity was improved in 4 out of 10 cases, and unchanged in 3 out of 10 cases. Therefore, we suggest that ICG angiography may be used as an important device for the diagnosis and management of CNV in patients with chronic CSC. Visual prognosis of CNV in chronic CSC seems to be relatively good.