ObjectiveTo observe the alterations of vascular density of superficial or deep retinal vascular plexus and the area of foveal avascular zone (FAZ) in acute central serous chorioretinopathy (CSC) eyes.MethodsThis is a retrospective study including 22 patients with unilateral CSC in acute stages. The patients were divided into group A (22 affected eyes) and B (22 fellow eyes). Twenty eyes of 20 age and gender-matched healthy volunteers (group C) were enrolled in this study. All subjects underwent optical coherence tomography (OCT) angiography examinations. The observation index included signal intensity of blood flow in choroidal capillary, vessel density and FAZ on the superficial capillary plexus (SCP) and deep capillary plexus (DCP).ResultsThe FAZ on DCP in group A was larger than that in group B and C (t=4.28, 5.57; P=0.00、0.00), but there was no significant difference of FAZ on SCP among 3 groups (t=0.28, 0.80; P=0.78, 0.43). The vessel density of SCP and DCP in group A and B were decreased than those in group C (t=−4.40, −2.91; P=0.00, 0.00). The type of choroidal capillaries dilation had two different manifestations by OCTA, which was circumscribed in 12 eyes and diffuse in 10 eyes. The subretinal fluid in macular area which presented dark chamber with weak reflection was observed by en-face OCT.ConclusionsThe vessel density of SCP and DCP in both eyes of acute CSC are lower than those in normal eyes. The FAZ of DCP in affected eyes of acute CSC is larger than that in fellow eyes and normal eyes. The blood flow of dilated choroidal capillary can be manifested as different morphological enhancements.
ObjectiveTo observe the change of retinal microstructures and the association between visual outcome with these microstructures in central serous chorioretinopathy (CSC) after laser treatment.MethodsThis is a retrospective study. From April 2016 to February 2017, a total of 52 eyes from 52 patients who underwent conventional laser treatment (27 eyes) or subthreshold laser treatment (25 eyes) for CSC and the sub-retinal fluid (SRF) absorbed completely were included in this study. The were 46 patients (46 eyes) and 6 males (6 eyes), with the mean age of 43.92±8.62 years. The healthy fellow eyes (49 eyes) were selected as control. All patients were underwent BCVA and SD-OCT examination. According to the OCT images for all patients, the thickness of central foveal (CFT), outer nuclear (ONL), inner segment (IS), outer segment (OS) were measured. The status of ellipsoid zone (EZ), interdigitation zone (IZ) and RPE were also evaluated at fovea. Comparing the change of SD-OCT microstructures in two time points, the first visit after SRF absorbed and the last visit respectively. Spearman correlation analysis was used to analyze the relation between BCVA and ONL, IS, OS.ResultsAt the first visit after SRF absorbed, compared with control eyes, the thickness of CFT (182.55±24.14 μm), ONL (72.86±17.39 μm), IS (41.23±5.14 μm), OS (18.52±10.26 μm) in CSC eyes were decreased (P＜0.001). Meanwhile, the mean BCVA of CSC eyes was 81.27±6.39 letters, which was also significantly decreased comparing with control eyes (P＜0.001). At last visit, the thickness of CFT, ONL, IS, OS were 195.19±22.10, 75.44±16.33, 44.56±4.09, 26.60±11.39 μm, and the mean BCVA was 85.50±5.95 letters. All recovered significantly comparing with first visit (P＜0.05). At first visit, the BCVA of patients with integrate EZ (83.38±5.78 letters) was significantly better than the BCVA of patients with unintegrated EZ (77.90±5.97 letters) (P=0.003). And the BCVA of patients with smooth RPE (82.72±5.95 letter) was also significantly better than the BCVA of patients with rough RPE (78.00±6.31 letters) (P=0.020). The result of Spearman correlation analysis showed that the thickness of OS was positively correlated to BCVA at two time points (r=0.423, 0.416; P=0.002, 0.002).ConclusionsIn CSC, the thickness of ONL, IS, OS were decreased, and the integrality of EZ, IZ, the smooth of RPE were disrupted in different extent. After laser treatment, with retinal reattachment, those microstructures including ONL, IS, OS, EZ, IZ recovered slowly. The thickness of OS, the integrality of EZ and the smooth of RPE were associated with visual acuity.
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.
ObjectiveTo observe the correlation between obstructive sleep apnea syndrome (OSAS) and central serous chorioretinopathy (CSC).MethodsFrom October 2016 to December 2018, 50 cases of CSC patients (CSC group) and 50 healthy people (control group) matched by age and sex who were diagnosed in the ophthalmological examination of Xi’an No.3 Hospital were included in the study. According to the course of the disease, CSC was divided into acute phase and chronic phase, with 20 and 30 cases respectively. The average age (Z=1.125) and body mass index (BMI) (Z=0.937) of the two groups were compared, and the difference was not statistically significant (P＞0.05); the age of patients with different courses of CSC (Z=1.525) and gender composition ratio (χ2=0.397) and BMI (Z=1.781) were compared, the difference was not statistically significant (P＞0.05). The Berlin questionnaire was used to assess the OSAS risk of subjects in the CSC group and the control group; polysomnography was used to monitor the apnea-hypopnea index (AHI) and minimum blood oxygen saturation (MOS) during night sleep. OSAS diagnostic criteria: typical sleep snoring, daytime sleepiness, AHI (times/h) value ≥ 5. The severity of OSAS was classified as mild OSAS: 5≤AHI＜15; moderate OSAS: 15≤AHI＜30; severe OSAS: AHI≥30. Non-normally distributed measurement data were compared by rank sum test; count data were compared by χ2 test. Spearman correlation analysis was performed on the correlation between OSAS and CSC.ResultsThe AHI data in the CSC group and the control group were 17.46±3.18 and 15.72±4.48 times/h, respectively; the MOS were (83.48±4.68)% and (87.40±3.82)%, respectively; those diagnosed with OSAS were respectively 36 (72.00%, 36/50) and 13 (26.00%, 13/50) cases. AHI (Z=0.312), MOS (Z=0.145), and OSAS incidence (χ2=21.17) were compared between the two groups of subjects, and the differences were statistically significant (P=0.028, 0.001,＜0.001). The AHI of acute and chronic CSC patients were 15.95±3.02 and 18.47±2.92 times/h; the MOS were (86.10±11.07)% and (81.73±4.58)%, respectively. There were statistically significant differences in AHI (Z=0.134) and MOS (Z=0.112) in patients with different course of disease (P=0.005, 0.001). The results of Spearman correlation analysis showed that OSAS and CSC were positively correlated (r=0.312, P=0.031).ConclusionOSAS may be a risk factor for the onset of CSC.
Central serous chorioretinopathy (CSC) is one of the main causes of impaired visual function in middle-aged men. CSC is characterized by a thickening of the choroid and hyperpermeability of the choroidal vessels, resulting in serous subretinal fluid. The pathogenesis of CSC is not fully understood. Since the introduction of indocyanine green angiography, the detection of the influence of the vortex veins in CSC, it has been established that the presence of a thick choroid may be caused by congestion of the vortex vein, resulting in new choroidal drainage through a vortex vein anastomosis. The study of vortex venous blood hemodynamics has elucidated the new concept of the pathogenesis of CSC, deepened our understanding of the disease, and provided a theoretical basis for new treatment methods. With a better understanding of the pathogenesis of CSC, we expect to be able to stratify patients at risk in the clinic and evaluate optimized treatment options for patients with CSC
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.
ObjectiveTo observe the effect of micro-pulse laser in the treatment of acute central serous chorioretinopathy (CSC). Methods105 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 (χ2=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. ResultsThe 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 (χ2=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 micro-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). ConclusionIn 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.
Objective To observe the characteristics of spectral-domain optical coherence tomography (SD-OCT) for leakage point in acute central serous chorioretinopathy (CSC). Methods A total of 21 acute CSC patients (21 eyes) were enrolled in this retrospective study, including 17 men (17 eyes) and 4 women (5 eyes). The mean age was (47.3±8.8) years (range 35 - 66 years). The mean duration was (1.6±0.8) months (range 0.5 - 3.0 months). All patients were underwent mydriatic fundus photography, SD-OCT examination and fluorescein fundus angiography (FFA). SD-OCT and FFA images were carefully compared to observe the SD-OCT examination characteristics of fluorescence leakage point. Results 21/21 eyes had one fluorescein leakage point. In addition to serous retinal detachment, leakage point in the SD-OCT examination showed retinal pigment epithelium (RPE) protrusion in 10 eyes (47.6％), RPE detachment in 7 eyes (33.3％), highly reflective areas suggesting fibrinous exudate in the subretinal space in 3 eyes (14.3％), and RPE defect in 1 eye (4.8％). Conclusion The SD-OCT characteristics of acute CSC include RPE protrusion, RPE detachment, highly reflective areas suggesting fibrinous exudate in the subretinal space and RPE defect.