Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a peripheral retinal disease characterized by subretinal hemorrhage and/or subretinal pigment epithelial hemorrhage or exudation. It is often misdiagnosed as age-related macular degeneration, polypoidal chorioretinopathy or choroidal melanoma. With the development of multimodal imaging, PEHCR has different features under different examinations, such as B-scan ultrasound, fluorescein fundus angiography, optical coherence tomography and so on, which contributes to differention from other diseases. Clinical treatments for the disease include intravitreal injection of retinal photocoagulation therapy, anti-vascular endothelial growth factor, pars plana vitrectomyand so on, but there is still no universal consensus. In order to gain a deeper understanding of the clinical features, treatment options and prognosis of PEHCR, minimize missed diagnoses and misdiagnoses, and improve treatment efficiency, further research is required.
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 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.
ObjectiveTo observe the choroidal vascularity index (CVI) and the subfoveal choroidal thickness (SFCT) of central serous chorioretinopathy (CSC), and to compare the stability and consistency of the two methods of measurement.MethodsA retrospective study. Thirty-one patients with unilateral acute CSC who visited the Department of Ophthalmology of Beijing Friendship Hospital for the first time during the period from Nov 1st, 2016 to Mar 18th, 2018 were included in the study. Thirty-one healthy age-matched subjects were enrolled as controls. All CSC affected eyes and their fellow eyes and healthy eyes were scanned by single-line enhanced depth imaging of OCT through central fovea of macula to measure their SFCT. The image was binarized and then the CVI of a 1500 μm range below fovea was calculated, i.e. the ratio of vascular (or lumen) area to total choroidal area. CVI and SFCT were compared among CSC eyes, fellow eyes and healthy eyes by variance analysis. Intra-group correlation coefficient (ICC), Bland-Altman curve and coefficient of variation (CV) were used to analyze the repeatability, consistency and stability of CVI and SFCT; and Medcalc18.2.1 software was used to draw the Bland-Altman curve and observe the consistency of the two measurement methods.ResultsThere were statistically significant differences in CVI and SFCT between CSC affected eyes and fellow eyes (t=3.470, 2.844; P=0.001, 0.006), CSC affected eyes and healthy eyes (t=6.977, 6.277; P＜0.001,＜0.001), fellow eyes and healthy eyes (t=3.508, 3.433; P=0.001, 0.001). Relative consistency analysis of CVI and SFCT showed that the ICC of single measurement and average measurement of CVI were 0.967 and 0.983 respectively, and that of single measurement and average measurement of SFCT were 0.937 and 0.967 respectively. The consistency of CVI and of SFCT was very good. The ICC value of CVI was slightly higher than that of SFCT. The results of repeatability analysis of CVI and SFCT showed that the difference between the two CVI measurements was smaller, and the difference between the two SFCT measurements was larger. And CVI and SFCT stability analysis results showed that the CV of CVI and SFCT were 10.5% and 25.3% respectively. CVI has smaller CV than SFCT.ConclusionsCompared with healthy eyes, CVI and SFCT are increased in CSC affected eyes and fellow eyes. And compared with SFCT, CVI has better consistency, repeatability and stability.
ObjectiveTo investigate the difference in microperimetry between acute and chronic central serous chorioretinopathy (CSC). MethodsCross-sectional cases study. A consecutive series of 208 patients (221 eyes) with CSC diagnosed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were enrolled in the study. The patients were divided into acute group (136 patients, 143 eyes) and chronic group (72 patients, 78 eyes) according to the duration and FFA. There were no statistical difference in sex (χ2=0.012, P=0.912) and mean age (t=-1.492, P=0.137) between two groups. All eyes received the examination of microperimetry and minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA). The mean retinal sensitivities (MS) and fixation rate in the central 2°(P1) and 4° (P2) were determined. ResultsThe mean value of logMAR BCVA in acute group and chronic group were 0.32±0.23 and 0.48±0.33, there was significant difference (Z=-3.353, P=0.001). In acute group and chronic group, the MS were (21.25±5.06) and (15.82±7.23) dB, P1 were (76.36±25.78)% and (55.01±32.34)%, P2 were (92.21±13.06)% and (79.83±23.11)%. There were statistical differences in MS (Z=-5.456, P < 0.001), P1 (Z=-4.629, P < 0.001) and P2 (Z=-4.265, P < 0.001) between two groups. In acute group, fixation was stable in 98 eyes (68.5%), relative unstable in 30 eyes (21.0%), unstable in 15 eyes (10.5%). In chronic group, fixation was stable in 30 eyes (38.5%), relative unstable in 22 eyes (28.2%), unstable in 26 eyes (33.3%). The difference of fixation between two groups was statistically significant (χ2=23.196, P < 0.001). ConclusionMS, fixation rate and fixation stability in chronic CSC eyes were all decreased compared with acute CSC eyes.
ObjectiveTo observe the imaging features of short-wave length fundus autofluorescence (SW-AF), near-infrared fundus autofluorescence (NIR-AF)and spectral-domain optical coherence tomograph (SD-OCT) in acute central serous chorioretinopathy (CSC). MethodsThis is a retrospective observational consecutive case series study. Eighty-two eyes with acute CSC from 76 patients were enrolled in this study.There were 50 males (56 eyes) and 26 females (26 eyes), average age was (41.32±7.37) years old, average course of the disease was (0.47±1.73) months. The routine clinical examinations included best corrected visual acuity, slit lamp microscope, indirect ophthalmoscope, fundus fluorescein angiography (FFA), SW-AF, NIR-AF and SD-OCT. The imaging features of NIR-AF, SW-AF, SD-OCT and FFA in same eye with acute CSC were analyzed comparatively. ResultsSD-OCT showed retinal pigment epithelium (RPE) detachment corresponding to RPE leakage point on FFA images in all CSC eyes. RPE leakage points in all eyes corresponding to local hypo-NIR-AF, whereas corresponding to normal SW-AF. NIR-AF demonstrated the area of decreased AF corresponding to serous retinal detachment in all eyes, of which, the area of hypo-SW-AF was consistent with that of sensory retinal detachment in 75 eyes. Except for RPE leaking fluorescein in 82 eyes, FFA showed window defects corresponding to clusters of hypo-NIR-AF in 45 eyes, of which, 27 eyes showed hypo-SW-AF appearing concurrently with the locations of window defects of FFA. In 18 eyes, the extent and amount of hypo-SW-AF were less than that of hypo-NIR-AF. ConclusionsThere was local RPE detachment in all eyes with acute CSC. The locations of sensory retinal detachment, local RPE detachment and RPE depigmentation showed hypo-NIR-AF. The locations of sensory retinal detachment and RPE depigmentation showed hypo-SW-AF in most of acute CSC eyes.
ObjectiveTo observe the characteristics of blue light(BLAF) versus near infrared wavelength (IRAF) fundus autofluorescence in central serous chorioretinopathy (CSC) patients. MethodsSeventy-seven eyes of 81 patients diagnosed with CSC were enrolled in this study. According to the duration of disease, patients were divided into acute CSC group and chronic or recurrent CSC group. All patients were examined with fundus fluorescein angiography, including BLAF and IRAF. There were forty-six patients (47 eyes) with acute, thirty-one patients (34 eyes) with chronic or recurrent CSC. The characteristics of BLAF and IRAF in CSC were compared. ResultsIn acute CSC, there were nineteen eyes (40.4%) showed scattered hyper-fluorescence corresponding to the leaking points, eleven eyes (23.4%) showed mottled hypo-fluorescence in BLAF; while 17 eyes (36.2%) showed normal change corresponding to the leaking points. There were 35 eyes can be observed serous retinal detachments in the BLAF images, 21 eyes (60.0%) showed hypo-fluorescence and 14 eyes (40.0%) showed hyper-fluorescence. In the IRAF images, 25 eyes (53.2%) showed mottled fluorescence corresponding to the leaking points, 11 eyes (23.4%) presented with scattered hyper-fluorescent spots and normal fluorescence. The serous retinal detachments of 26 eyes exhibited hypo-fluorescence in the IRAF images. In chronic or recurrent CSC, 19 eyes (55.9%) showed scattered hyper-fluorescence corresponding to the leakage points; followed by no abnormal change in 10 eyes, accounting for 29.4%; few showed mottled hypo-fluorescence (5 eyes 14.7%). There were 35 eyes (41.2%) can be observed serous retinal detachments in the BLAF images. IRAF mainly displayed mottled hypo-fluorescence (22 eyes, 64.7%), ten eyes (29.4%) presented with scattered hyper-fluorescence and 2 eyes (5.8%) presented without abnormal change. The serous retinal detachments of 3 eyes (8.8%) exhibited hypo-fluorescence in the IRAF images. ConclusionsFor acute CSC, a variety of fluorescence were showed in BLAF images and the proportion of the various fluorescences was similar; hypo-fluorescence was showed in the IRAF images. For chronic CSC, hyper-fluorescence was showed in BLAF while hypo-fluorescence in the IRAF images.