Central serous chorioretinopathy (CSC) is a common macular disease, mainly manifested as a plasma detachment of the macula. Photodynamic therapy (PDT) is an effective treatment for CSC, but with the shortage of the photosensitizer Verteporfin, the effective treatment of CSC has become a common concern for ophthalmologists. In this paper, based on the latest research results on the relationship between the changes in the thickness of the outer nuclear layer and the natural course of the disease and PDT therapy, we propose that patients with CSC should receive effective treatment as early as possible to prevent irreversible damage to visual function due to the thinning of the outer nuclear layer. In addition to PDT, it is recommended that laser photocoagulation or subthreshold micropulse laser treatment of the leaking spot should be considered first, depending on the presence of the leaking spot and its location in relation to the macula center. Anti-vascular endothelial growth factor therapy can be considered if there is a combination of choroidal neovascularization and/or polypoidal choroidal vasculopathy. Other treatments that have not been demonstrated to be effective in evidence-based medicine are not recommended.
The classical surgical operations for foveoschisis in high myopia are vitrectomy, artificial posterior vitreous detachment, removal of the pre-macular vitreous cortex, removal of the inner limiting membrane (ILM) and intraocular gas tamponade, with some minor variations on those basis, including no removal of the ILM or ILM peeling with preservation of the fovea area; with or without gas filling, long-term silicone oil tamponade, etc. All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees. It is worthwhile to emphasize, the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment. To address the risk of such complications, a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area. For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole, a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.
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.
The concept of treatment of central serous chorioretinopathy (CSC) has evolved dramatically with the understanding of its pathogenesis recently. Initial clinical studies found that CSC is a selflimiting disease, therefore advocated observation or conservative treatment was recommended. Further study by fundus fluorescein angiography indicated that CSC results from barrier dysfunction of retinal pigment epithelium (RPE), which leads to serous RPE and (or) neural retinal detachment; so laser photocoagulation to close RPE leakage points by its thermal effects became a strategy to treat CSC. Recent study by indocyanine green angiography revealed that increased choroidal vascular permeability can induce high hydrostatic pressure and focal RPE detachment, resulting in mechanical breakage of RPE barrier. This is likely the major pathological basis of CSC now. Photodynamic therapy (PDT) can embolize of choroidal capillary network, thereby preventing choroidal leakage caused by increased capillary permeability, and thus cure the CSC. However the search for the pathogenesis and better treatment of CSC is far from over. Further investigation about pathogenesis and improvement of diagnosis and treatment is an urgent need for clinic work, but also major issues challenging the wisdom of an ophthalmologist. We need to work together to promote more and better clinical and basic research of CSC.
The etiology of intraocular inflammatory disease and its diagnosis is complicated. Currently available and newly emerging systemic and ocular examinations are of important to determine etiology of intraocular inflammatory disorders. But there also exists multiple misunderstanding, and the strategy of their application is not well defined, or even exaggerated. Unprincipled or randomly selection of auxiliary examination would not help for etiology determination, but bring unnecessary pain and economic burden to patients. Establishment of diagnosis thinking of intraocular inflammatory disease is helpful to standardize the diagnosis process of the disease, improve the diagnostic efficiency, and relief patients from the pain and financial burden that caused by too many useless examinations.
Objective To investigate the difference of curative effect of various surgical methods for the treatment of idiopathic senile macular hole. Methods A retrospective analysis was made for 86 eyes with stage Ⅱ-Ⅳ idiopathic full-thickness macular hole treated with various modes of operation,ie, single vitrectomy (7 eyes),vitrectomy combined with autologous platelet concentrate (APC) as an adjuvant (40 eyes), vitrectomy with internal limiting membrane (ILM) peeling (14 eyes), vitrectomy with both ILM peeling and APC treatment (25 eyes). The main outcome measures included anatomic reattachment rate，change of visual acuity，findings of optic coherence tomography (OCT), Amsler grid and intra or postoperative complication evaluations. Results (1) In visual acuity improvement, the APC group (80.0%) was significantly better than anyone of the other three groups (P＜0.05). (2) In anatomic success rate, the single vitrectomy group was significantly lower than the vitrectomy with APC treatment group（87.5%）or vitrectomy with both ILM peeling and APC as an adjuvant group(92.0%)(P＜0.05). (3) There was no significant difference in operative complication and improvement of distortion of vision. Conclusion Vitrectomy combined with APC as an adjuvant for the treatment of idiopathic macular hole is helpful to improve both the anatomic success rate and postoperative visual acuity. The usage of ILM peeling technique could improve the anatomic reattachment rate, but the vision prognosis of ILM peeling patients is not as good as the patients of APC as an adjuvant. (Chin J Ocul Fundus Dis, 2002, 18: 196-198)
Central serous chorioretinopathy (CSC) is one of the representative pachychoroid spectrum disease. Although fundus fluorescein angiography and indocyanine green angiography can be used as the gold standard for the diagnosis of CSC, they are invasive examinations, which may bring certain risks in clinical application and cannot help us obtain quantitative parameters. Optical coherence tomography angiography (OCTA), as a non-invasive and quantitative examination, is an important imaging tool for understanding the pathogenesis, diagnosis and treatment of CSC. With the advancement of OCTA, the swept-source OCTA has a satisfying scanning depth, a wider scanning range and a higher resolution. The development of OCTA broadens the horizons of the pathogenesis of CSC, promotes the understanding of the pathophysiology of CSC, and sheds new light for its clinical diagnosis and treatment. Based on OCTA, the choroid and retina in eyes with CSC are presented with qualitative and quantitative changes in vascular system. OCTA-guided CSC treatment and the discovery of prognostic markers based on OCTA challenge the application of traditional imaging techniques in CSC. With the continuous improvement and progress of OCTA technology, traditional angiography combined with OCTA will bring great benefits to the diagnosis and treatment of CSC. This review summarizes the quantitative application of OCTA in the pathogenesis, diagnosis and treatment of CSC.
OBJECTIVE:To inwestigate the value of fundus fluorescein angiography in evaluation of idiopathic senile macular hole(ISMH). METHODS:fundus fluorescein angiography(FFA)and other clinical examination were performed in 26 cases (31eyes)of ISMH patients. RESULTS:Full-thickness macular holes were in 17 and lamellar holes were in 14 of the 31 eyes. Hyperfluorescencequot;window defectquot;was found at the base of all the eyes with full-thickness maeular holes and 2 eyes with lamellar holes. The size of hyperfluorescence zone was smaller than that of those seen in redfree film, hyperfluorescence in 6 eyes (19.4%) showed homogenous ancl 10 eyes (32.5%) granular in pattern. The small yellowish dots in macular hole showed blocked fluorescence,while the halo of macular hole showed hyperfluorescence. CONCLUSION:Fundus fluorescein angiography was useful in differentiating lamellar from full-thickness macular hole and understanding the degree of retinal pigment epithelium damages in macular holes. （Chin J Ocul Fundus Dis,1996,12: 208-210 ）
ObjectiveTo analyze the associations between the choroidal vasculature and submacular fluid (SMF) in central serous chorioretinopathy (CSC). MethodsA retrospective study. A total of 29 CSC patients (31 eyes) with complete records who visited the Department of Ophthalmology in Peking University People's Hospital from August 1, 2021 to March 1, 2023 were included in this study. The patients were divided into complete absorption and incomplete absorption groups according to the status of SMF in the last visit. All the patients underwent ultra-widefield swept-source optical coherence tomography angiography (UWF SS-OCTA) with a scanning range of 24 mm × 20 mm. The UWF SS-OCTA images were automatically analyzed in 9 regions (superotemporal, superior, superonasal, temporal, central, nasal, inferotemporal, inferior, and inferonasal). Alterations of choroidal vasculature in the nine subfields after SMF absorption were described, including choroidal thickness (CT), flow density of choriocapillaris layer, vessel density of large choroidal vessel layer, three-dimensional choroidal vascularity index (CVI), the mean choroidal vessel volume (mCVV), and the mean choroidal stroma volume (mCSV). The relevant factors affecting the complete absorption of SMF were additionally evaluated. ResultsAt baseline, CT (Z=2.859, P=0.004), mCVV (t=2.514, P=0.018), and mCSV (Z=2.958, P=0.003) in the superotemporal region of the affected eyes in the incomplete absorption group were significantly higher than those in the complete absorption group. Compared with baseline, at the last visit, the proportion of asymmetric vortex veins in the complete absorption group was significantly decreased (χ2=6.000, P=0.014), CVI in the superotemporal, superonasal, temporal, central, nasal, inferotemporal, and inferonasal regions (t=－4.125, t=－3.247, Z=－3.213, t=－2.994, t=－3.417, t=－3.733, t=－3.795; P=0.001, 0.006, 0.001, 0.010, 0.005, 0.003, 0.002), the mCVV of 9 regions (t=－2.959, t=－2.537, t=－2.235, t=－3.260, t=－3.022, t=－2.796, t=－2.747, Z=－2.107, t=－2.935; P=0.011, 0.025, 0.044, 0.006, 0.010, 0.015, 0.017, 0.035, 0.012) were significantly decreased. Compared to the complete absorption group, the choroidal blood flow changes in the non-complete absorption group were more limited, and CT in the upper region increased significantly at the last follow-up (t=2.272, P=0.037). Multivariate logistic regression analysis revealed that baseline CT in the superotemporal region may be an independent risk factor affecting the complete absorption of SMF (odds ratio=0.981, 95% confidential interval 0.965-0.997, P=0.021). ConclusionsIn the process of SMF absorption in CSC, significant reductions of choroidal blood flow were found in the large choroidal vessel layer, and there may be a locally compensatory increase in CT. In addition, baseline CT in superotemporal region is an independent risk factor affecting SMF absorption.
Purpose To assess the efficacy of pars plana vitrectomy,autologous platelet concentrate and gas tamponade for the treatment of full-thickness idiopathic macular holes. Methods The procedures consisted of pars plana vitrectomy with removal of posterior cortical vitreous，air-fluid exchange, instillation of autologous platelet concentrate onto the posterior pole and 20%～30%SF6 tamponade,were performed in treating 6 eyes of 6 patients with idiopathic macular holes. The patients were instructed to lie in a supine position for l hour after surgery,then adviced to remain in a facedown position for 2 weeks. Results Flattening of the surrounding retina and closure of the hole were achieved postoperatively in all the 6 affected eyes.Visual acuity improved two lines or more in 5 eyes (83.3%).Four eyes(66.7%)reached a postoperative visual acuity of 0.3 or more. Retinal detachment ocurred in one eye owing to peripheral new hole formation. Conclusion Pars plana vitrectomy, autologous platelet concentrate and gas tamponade for the treatment of full-thickness idiopathic macular holes are able to close macular hole and improve the visual acuity. (Chin J Ocul Fundus Dis,1998,14:14-15)