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Purpose: To compare the efficacy of oral propranolol, oral rifampicin, and intravitreal anti-VEGF therapies on resolution-time and visual outcome in patients with central serous chorioretinopathy (CSCR). Methods: A total of 30 patients with CSCR were randomized into three groups of 10 patients. Group A was given oral propranolol, Group B was given oral rifampicin 4 weeks each, and Group C was given 0.05 ml intravitreal injection of anti-VEGF. Comparisons of mean BCVA, contrast sensitivity, and central macular thickness (CMT) performed between baseline and follow-up at 4 weeks, 6 weeks, and 3 months. Results: Statistically significant improvement in BCVA and contrast sensitivity was noted among all three groups. Complete resolution of SRF as indicated by CMT was seen at the end of 4 weeks in Group C, whereas there was a steady decline in CMT until 3 months in Groups A and B. Conclusion: Intravitreal anti-VEGF therapy shows a significantly faster SRF resolution. However, oral propranolol and oral rifampicin could prove as a useful, cost-effective treatment of CSCR.

A 37-year-old healthy male presented with sudden loss of vision in the left eye (LE) 1 week following starting oral steroids for COVID-19 complications. Best-corrected visual acuity in the left eye (LE) was 20/80, N12. Clinical and imaging tests led to a diagnosis of central serous chorioretinopathy in the LE. There was gradual resolution of neurosensory detachment following the discontinuation of steroid therapy. Two months following initial presentation, best-corrected visual acuity in the LE had improved to 20/20, N6.

Abstract Introduction Male gender is an important risk factor of central serous chorioretinopathy (CSC), and studies have explored the pathophysiological role of androgens in CSC with conflicting results. In this study, we shed light on this hot topic by exploring the risk of CSC in a large cohort of male androgen abusers. Methods This study included male androgen abusers identified through a nationwide anti-doping test program across Danish fitness centers from January 3 2006 to March 1 2018. For each case, we randomly sampled ten male controls using Danish nationwide registries. These controls were matched in age and date. Cases and controls were followed until May 16 2018. Data on diagnoses were extracted using the Danish National Registry of Patients using ICD-10 codes to identify cases with CSC. Results We included 1189 cases and 11,890 controls. Mean age at the time of doping sentence was 27.4 ± 6.9 years, and mean length of follow-up was 15.8 ± 3.6 years. We identified no cases of CSC in androgen abusers, and five cases of CSC in the control cohort. The difference between groups was not statistically significant (P = 1.0). Conclusions Male androgen abusers were not at increased risk of CSC. Considering the lack of any signal in this large study, we speculate that if male androgen plays any direct role in the pathophysiology of CSC, its role may be subtle at best.

BACKGROUND: The aim of this study was to determine whether anterior scleral thickness (AST) varies significantly between patients with central serous chorioretinopathy (CSCR) versus normal individuals. To validate scleral thickness measurements by ultrasound biomicroscopy (UBM) vis a vis anterior segment optical coherence tomography (ASOCT). METHODS: This case–control study analyzed 50 eyes of 50 patients with CSCR (cases) and compared it with that of 50 eyes of 50 age- and gender-matched controls. In cases, AST was measured at 1 mm and 2 mm temporal to the temporal scleral spur by ASOCT and UBM. In controls, AST was measured only by ASOCT. In all participants, posterior choroidal thickness (CT) was measured subfoveally, 1 mm nasal and 1 mm temporal to fovea by enhanced depth imaging optical coherence tomography. RESULTS: The mean AST, as measured by ASOCT among cases and controls was 703.86 μm and 667.54 μm, respectively (P = 0.006). The mean AST by ASOCT and UBM in cases were 703.86 μm and 657.42 μm, respectively (P = 0.001). AST measurement by ASOCT and UBM showed a positive and statistically significant correlation (r = 0.431, P = 0.000). The mean CT among cases and controls was 443.56 μm and 373.88 μm, respectively (P = 0.000). We found a weak positive correlation (r = 0.11) in cases and weaker positive correlation in controls, between CT and AST measured by ASOCT. CONCLUSIONS: Our findings suggest that AST varies significantly between patients with CSCR versus normal individuals. We found poor agreement of AST when measured by ASOCT and UBM.

This report describes a rare case of spontaneous Grade-4 retinal pigment epithelium (RPE) rip of serous pigment epithelial detachment (PED) in central serous chorioretinopathy (CSC) and RPE aperture in the fellow eye, with favorable long-term outcomes. A 38-year-old man presented with defective vision (20/30) in the left eye (LE) due to bullous CSC associated with a large extramacular RPE rip located temporally and inferior exudative retinal detachment. Optical coherence tomography (OCT) confirmed a subfoveal serous PED with RPE aperture, subretinal fluid (SRF) and fibrinous exudation, and a large extramacular RPE rip temporally. The right eye (RE) had an asymptomatic large serous PED. The LE was treated with low-fluence photodynamic therapy, which resulted in the closure of RPE aperture and complete resolution of PED and SRF. Six-month later, the patient presented with sudden defective vision (20/120) in the RE secondary to a large fovea-involving (Grade-4) RPE rip with SRF as confirmed on OCT. Fluorescein angiography showed two extrafoveal active point leaks, which were treated with focal photocoagulation. He was also started on oral eplerenone. On subsequent serial follow-ups over 1 year, OCT showed SRF resolution and patchy reorganization of the subfoveal RPE-photoreceptor complex with good visual outcome (20/30).

Abstract Background Central serous chorioretinopathy (CSCR) is a potentially blinding choroidal disease. Despite decades of research, the pathological mechanisms of CSCR are still poorly understood. In recent years, there has been a strong emphasis on choroidal dysfunction as a primary cause of CSCR. Main Body The concept of the pachychoroid disease spectrum and pachychoroid-driven processes are central to current theories regarding the pathophysiological underpinnings of CSCR. Choroidal hyperpermeability and subsequent leakage of fluid seen in CSCR may be due to several causes. Among them are venous congestion, inflammation, mineralocorticoid receptor activation, systemic factors including hemodynamic changes, obstructive sleep apnea, phosphodiesterase inhibitor use, pregnancy, and genetic predispositions. Congestion of vortex veins that drain blood from the choroid may contribute to the dilation of Haller vessels and cause fluid leakage. Vortex veins exit the eye through the sclera; thus, increased scleral thickness has been proposed to be a factor in venous congestion. Asymmetric vortex vein drainage may similarly result in congestion of the local venous system. Vortex vein anastomoses may overload the venous system and form secondary to venous congestion. Recent studies suggest inflammation and mineralocorticoid activation may factor into the development of CSCR, though more research in these areas is called for. Systemic conditions and genetics may predispose individuals to develop CSCR. Conclusions By striving to understand the molecular and physiological mechanisms of this disease, we can better diagnose and treat CSCR to improve outcomes for patients.

Background: Central serous chorioretinopathy (CSC) is a common macular disease characterized by serous retinal detachment and leakage spots at the level of the retinal pigment epithelium. While acute CSC is often self-limiting, chronic and recurrent CSC can lead to permanent vision loss. The identification of risk factors associated with recurrent CSC is crucial for preventive measures and appropriate management. This systematic review aims to determine the various risk factors for the recurrence of central serous chorioretinopathy, with a particular focus on the “wait and see” approach and other contributing factors. Methods: The review protocol was registered in PROSPERO (ID: CRD42023413852). A systematic literature search was conducted across four databases (PubMed, Cochrane, Embase, and ScienceDirect) using the keywords “((Central serous chorioretinopathy) AND (Recurrence) AND (Risk))”. Meta-analyses were performed using Review Manager 5.4. Results: A total of five studies met the inclusion criteria for all factors, while three studies were selected for meta-analyses regarding the “wait and see” approach. The analysis revealed four significant risk factors for CSC recurrence: patient’s clinical condition, therapy administration, age and gender, and patient history. Additionally, a meta-analysis based on three studies involving 1025 eyes demonstrated a statistically significant difference between CSC patients who received no therapy (wait and see) and those who underwent specific therapeutic interventions, with a relative risk of 1.82 (95% CI 1.49–2.22, I2 95%, P Conclusions: Early identification of risk factors, including the ‘wait and see’ approach and other factors, is crucial in preventing the recurrence of central serous chorioretinopathy. Patients at high risk of recurrence should receive vigilant treatment and routine monitoring to avoid permanent vision loss. This systematic review provides valuable insights for clinical decision-making and emphasizes the importance of individualized management strategies for CSC patients.

This study investigated the changes in the ganglion cell complex (GCC) of patients with acute central serous chorioretinopathy (CSC) following focal laser photocoagulation (FLP) and sought to determine its correlation with visual acuity (VA). Our retrospective study was conducted on 30 patients diagnosed with acute CSC between January 2015 and April 2022, who underwent FLP within 3 months of symptom onset. The study assessed GCC changes by measuring the thickness of its inner retinal layers—retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) using optical coherence tomography (OCT). GCC thickness was compared between the affected and unaffected eyes and a healthy control group. VA was also assessed at baseline and at 1, 3, and 6 months post-treatment. VA showed significant improvement from 0.20 ± 0.14 at baseline to 0.10 ± 0.12 logMAR at 6 months post-treatment (p = 0.003). There was no significant change in GCC thickness over the 6-month period. No significant differences in GCC thickness were observed when comparing CSC eyes with fellow eyes or with normal controls at any time point. Final VA was significantly related only to baseline VA, with no correlation found with other factors, including RNFL, GCL, and IPL thickness. In summary, for patients with acute CSC undergoing FLP, our findings indicate that there is no significant change in GCC thickness detectable by OCT before and after the resolution of subretinal fluid (SRF), despite improvements in VA post-laser treatment. This suggests that any potential impact of FLP on GCC thickness may be minimal and not discernible with the current measurement methods, such as OCT, emphasizing that VA improvements may be primarily associated with alterations in the outer retina rather than the inner retina. Further studies with extended follow-up durations are warranted to evaluate any potential long-term changes in GCC.

Background and Objectives: This study aims to investigate the potential association between the COVID-19 pandemic and a new presentation of central serous chorioretinopathy (CSCR). Materials and Methods: A retrospective analysis was conducted, comparing the incidence of new-onset CSCR cases among ophthalmology patients in a regional medical facility in southern Israel between two distinct periods: the COVID-19 pandemic era in Israel, which occurred from 27 February 2020 to 20 December 2020, and the non-pandemic period from calendar years 2018 to 2021, excluding the specific epidemic phase mentioned. Disease severity was evaluated based on recovery time, visual acuity loss, and central macular thickness via OCT. Results: Over the four-year period, 35 new cases of CSCR were recorded. During the COVID-19 pandemic, 17 new cases (0.005% per population) were identified, compared with 18 new cases (0.002% per population) in the preceding three years. The odds ratio for acute CSCR during the pandemic was 2.83 (95% CI, 1.46–5.50) with a p-value of 0.02. CSCR cases during the pandemic seemed to exhibit worse clinical characteristics, though not statistically significant. Additionally, 22.2% of the COVID-19 pandemic group had confirmed COVID-19 cases, which was statistically significantly higher than the general population’s reported cases (6%). Conclusion: The study revealed a statistically significant increase of over 2.5 times in acute CSCR incidence during the COVID-19 pandemic compared with non-pandemic periods. The findings suggest that the pandemic’s stressful changes may have unintended consequences on the occurrence of CSCR, highlighting the importance of mental health support and psychoeducation for affected patients.

Purpose: To investigate the association between the 2 acute phase proteins, C-reactive protein (CRP) and pentraxin 3 (PTX3) with central serous chorioretinopathy (CSCR), as PTX3 is a glucocorticoid-induced protein. Design: Cross-sectional multicenter study. Participants: Patients with CSCR compared with age- and sex-matched healthy participants. Methods: Patients with CSCR from 3 centers in Europe were included in the study. The clinical form of CSCR was recorded. Blood samples from patients with CSCR and healthy participants were sampled, and high-sensitivity CRP and PTX3 levels were measured in the serum. Main Outcome Measures: C-reactive protein and PTX3 serum level comparison between patients with CSCR with age- and sex-matched healthy participants. Results: Although CRP levels were higher in patients with CSCR (n = 216) than in age- and sex-matched controls (n = 130) (2.2 ± 3.2 mg/l vs. 1.5 mg/l ± 1.4, respectively, P = 0.037), PTX3 levels were lower in patients with CSCR (10.5 ± 19.9 pg/ml vs. 87.4 ± 73.2 pg/ml, respectively, P < 0.001). There was no significant difference in CRP or PTX3 levels between patients with acute/recurrent and chronic CSCR. Conclusions: In patients with CSCR, high CRP and low PTX3 levels suggest a form of low-grade systemic inflammation together with a lack of glucocorticoid pathway activation, raising new hypotheses on the pathophysiology of CSCR. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Purpose: To examine choroidal angiographic features in the posterior pole associated with resolution or persistency of subretinal fluid (SRF) in eyes with central serous chorioretinopathy (CSC). Design: Observational case series. Methods: Twenty-nine patients with treatment-naïve CSC were divided into two groups based on the presence or absence of SRF 3 months after the initial visit (month 3) without any treatment. Using enhanced depth imaging of widefield swept-source optical coherence tomography, the choroidal thickness (CT), vessel density (VD), and vessel diameter index (VDI) in the superotemporal and inferotemporal subfields on the temporal side of the 18-mm circle from the disc were measured at the initial visit. We calculated the vertical difference in CT and other choroidal angiographic parameters and evaluated their association with the SRF condition at 3 months. Results: The SRF-resolved and SRF-persistent groups included 10 and 19 patients, respectively. At the initial visit, sex, age, axial length, symptom duration, the logarithm of the minimum angle of resolution visual acuity, and foveal thickness were not significantly different between the two groups. The SRF status at month 3 was not associated with the vertical difference in CT and choroidal VD (P = .614, .065, respectively). However, the vertical difference in choroidal VDI was positively associated with the future presence of SRF (P = .017). Conclusions: Vertically asymmetric dilation of choroidal vessels in the posterior pole may be a vasculature feature associated with SRF from CSC and may be a good predictor of future SRF status.

Central serous chorioretinopathy (CSCR) is a chorioretinal disease that is characterized by central vision loss and is usually seen in middle-aged males. It has been associated with the use of various drugs, including corticosteroids and phosphodiesterase inhibitors. We present the case of a 36-year-old male who developed CSCR after a few weeks of irregular use of quetiapine for his sleep problems. The clinical findings of the patient improved shortly after he stopped using the drug, and at the end of the two-month period complete recovery was observed. Quetiapine is an atypical antipsychotic that exerts its effects on dopamine and serotonin receptors. There are studies showing that these neurotransmitters may play a role in the control of choroidal vascular permeability, which is the underlying cause of CSCR. Therefore, we believe that quetiapine may have a causal relationship with CSCR. To our knowledge, this is the first case report documenting full recovery from quetiapine associated CSCR.

The aim of our study was to investigate the clinical features of central serous chorioretinopathy (CSC) with autofluorescence (AF), retromode (RM), and enface imaging. This retrospective study was conducted at Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome (Italy), between September and December 2022. Each patient underwent a complete ophthalmological examination, which included optical coherence tomography (OCT), enface image analysis, AF, and RM imaging. We further evaluated the presence and area of extension of serous retinal detachment and retinal pigment epithelium (RPE) atrophy through AF, RM, and enface imaging. We included 32 eyes from 27 patients (mean age: 52.7 ± 13.3 years). The median AF area was 19.5 mm2 (IQR 6.1–29.3), while the median RM area was 12.3 mm2 (IQR 8.1–30.8), and the median enface area was 9.3 mm2 (IQR 4.8–18.6). RPE atrophy was diagnosed in 26 cases (81.3%) with RM imaging and in 75% of cases with AF. No difference emerged between AF and RM analysis in the detection of central serous detachment in CSC. However, RM imaging showed a high specificity (91.7%) and negative predictive value (84.6%) to detect RPE changes when compared to the AF standard-of-care technique. Thus, RM imaging could be considered an adjunctive imaging method in CSC. [ABSTRACT FROM AUTHOR]

Background: Systematic literature searches are the cornerstone of systematic reviews. In this study, we evaluated database coverage of randomized clinical trials for central serous chorioretinopathy (CSC). Methods: We searched 12 databases (BIOSIS Previews, CINAHL, the Cochrane Central, Current Contents Connect, Data Citation Index, Derwent Innovations Index, EMBASE, KCI-Korean Journal Database, MEDLINE, PubMed, SciELO Citation Index, and Web of Science Core Collection) on 10 April 2023 for randomized clinical trials for CSC. After identifying all eligible studies across all databases, we investigated the coverage of these studies within each database, including the coverage of any combination of two databases. Results: The 12 databases yielded 848 records for screening, of which 76 were randomized clinical trials for CSC. No single database provided full coverage. The most comprehensive coverage was provided by EMBASE (88%), the Cochrane Central (87%), and PubMed (75%). A combined search in the Cochrane Central and PubMed led to complete coverage (100%) while reducing the number of records for screening from 848 to 279. Conclusions: Systematic review search design should include multiple databases. For randomized clinical trials for CSC, the combination of the Cochrane Central and PubMed provides an excellent balance between coverage and workload. [ABSTRACT FROM AUTHOR]

Introduction: Central Serous Chorioretinopathy (CSCR) encompasses the macular area, secondary to the accumulation of subretinal fluid and increased permeability from the choriocapillaris resulting in focal or diffuse dysfunction of the retinal pigment epithelium. Diagnosis of CSCR is done by several procedures like clinical examination, Amsler grid testing, fluorescein angiography, ocular coherence tomography. There are several treatment options including photodynamic therapy, laser photocoagulation, etc., for CSCR. Aim: To study the efficacy and safety of laser photocoagulation in persistent idiopathic CSCR. Materials and Methods: The present prospective interventional study was conducted in the Department of Ophthalmology, BJ Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India, from August 2019 to January 2021. A total of 30 patients (30 eyes) with idiopathic CSCR, persistent for duration of three months or more with worsening of visual symptoms, active leakage on Fundus Fluoresceine Angiography (FFA) were subjected to 532 nm subthreshold green laser photocoagulation treatment after routine investigations. Statistical analysis was done on International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) software version 20.0. Results: In the present study, there was male preponderance (86.7%) for the CSCR cases. The mean±Standard Deviation (SD) age of in the study was 37.7±0.07 years. All the eyes studied had unilateral involvement with 53.35% right eye involvement and 46.7% left eye involvement. The duration of current episode of CSCR in months showed a mean+SD of 5.86±1.40. The distribution of visual acuity in affected eye (before laser treatment) depicts the mean prelaser Best Corrected Visual Acuity (BCVA) of 30 patients at baseline was (0.68±0.20) in LogMAR. About 67% patients experienced central scotoma and 33% patients had metamorphopsia on Amsler chart. Distribution of active leakage site on FFA showed that 43% cases had active leakage in superonasal quadrant, 30% had active leakage in superotemporal, 17% had active leak in inferonasal quadrant and 10% had active leak in inferotemporal quadrant. CSCR associated with or without Retinal Pigment Epithelium (RPE) atrophy showed that 63.3% patients had RPE atrophy suggesting long-standing course of disease with NSD and subretinal fluid collection affecting RPE. Prelaser mean CMT on OCT of affected eye was 445.83±54.79 µm which was reduced to mean CMT of 303.57±48.49 µm at four weeks follow up, which further reduced to mean CMT of 224.9±20 µm at end of 12 weeks was statistically significant with p-value<0.001. The statistical analysis for the macular thickness at four weeks and 12 weeks showed significant probability with paired t-test with p-value<0.001. Conclusion: It can be concluded from the present study that early treatment with laser photocoagulation is efficient in the restoration of vision within a period of 12 weeks. [ABSTRACT FROM AUTHOR]

Purpose: Persistent central serous chorioretinopathy (pCSC) may be treated by laser photocoagulation (PC), selective retina therapy (SRT), or photodynamic therapy (PDT). We conducted retrospective analyses regarding the choice of therapy for pCSC in the best clinical practice and the outcomes of these modalities. Study design: A retrospective interventional study. Methods: The records of 71 eyes of 68 treatment naïve pCSC cases who underwent PC, SRT, or PDT were reviewed. First, the baseline clinical parameters were evaluated to find significant factors associated with the choice of treatment option. Second, the 3 months' visual and anatomical outcomes of each modality were assessed. Results: The PC, SRT, and PDT groups included 7, 22, and 42 eyes, respectively. The leakage pattern in fluorescein angiography (FA) was significantly associated with the choice of treatment (p<0.005). The dry macula ratio at 3 months post-treatment was 29%, 59%, and 81% in the PC, SRT, and PDT groups, respectively, which significantly differed among the groups (p<0.01). The best-corrected visual acuities tended to be improved after the treatments in all groups. Central choroidal thickness (CCT) was significantly decreased in all groups (p<0.05, p<0.01, and p<0.00001, in PC, SRT, and PDT groups, respectively). Logistic regression analysis for dry macula revealed that SRT (p<0.05), PDT (p<0.05), and the changes in CCT (p<0.01)were the significant association factors. Conclusion: The leakage pattern in FA was associated with the choice of treatment option for pCSC. PDT achieved a significantly higher dry macula ratio than PC, 3 months after the treatment. [ABSTRACT FROM AUTHOR]

Central serous chorioretinopathy is often associated with a "classic" presentation of unilateral, macular lesions that result in blur, metamorphopsia and/or scotoma of the affected eye. The condition features serous retinal detachments with or without focal serous retinal pigment epithelium detachments. This report presents two cases of non-macular chronic serous chorioretinopathy. In both cases, the patient was asymptomatic, and the lesions identified incidentally. This report alerts providers to the possibility of chronic serous chorioretinopathy in non-macular locations with subtle or no symptomatology. [ABSTRACT FROM AUTHOR]

Our study evaluated visual function changes after subthreshold micropulse laser (SML) treatment in persistent central serous chorioretinopathy (CSC) and SML safety profile. We conducted a prospective study including 31 fovea-involving CSC patients. The natural course was observed for the first 3 months, SML was performed at 3 months, and SML effectiveness was observed at 6 months. At all three clinical visits, optical coherence tomography (OCT), best corrected visual acuity (BCVA), contrast sensitivity (CS) in five spatial frequencies (1.5, 3.0, 6.0, 12.0, and 18.0 cycles per degree (cpd)), microperimetry (MP), and multifocal electroretinography (mfERG) were performed. The SML safety profile was evaluated with functional and morphological parameters. In the cohort of all CSC patients treated with SML, the statistically significant average improvement was observed in BCVA (p = 0.007), CS-1.5 (p = 0.020), CS-3.0 (p = 0.050), CS-12.0 (p < 0.001), CS-18.0 (p = 0.002), CS (CS-A) (p < 0.001), MP in the central ring (MP-C) (p = 0.020), peripheral ring (MP-P) (p = 0.042), and average retinal sensitivity (MP-A) (p = 0.010). After the SML treatment, mean changes in mfERG amplitudes and implicit times in our cohort were not statistically significant. No morphological or functional adverse effects of SML treatment were observed. SML treatment in persistent CSC episodes leads to significant functional improvement and has an excellent safety profile. [ABSTRACT FROM AUTHOR]

In the pathophysiology of central serous chorioretinopathy (CSC), scleral changes inducing increased venous outflow resistance are hypothesized to be involved. This work aims to investigate anterior scleral thickness (AST) as a risk factor for pachychoroid disorders. A randomized prospective case-control study was performed at the Ludwig Maximilians University, Department of Ophthalmology. In patients with CSC or pachychoroid neovasculopathy (PNV) and in an age- and refraction-matched control group, swept source optical coherence tomography (SS-OCT) was used to measure anterior scleral thickness (AST). Subfoveal choroidal thickness (SFCT) was assessed using enhanced depth imaging OCT (EDI-OCT). In total, 46 eyes of 46 patients were included in this study, with 23 eyes in the CSC/PNV and 23 eyes in the control group. A significantly higher AST was found in the CSC/PNV compared with the control group (403.5 ± 68.6 (278 to 619) vs. 362.5 ± 62.6 (218 to 498) µm; p = 0.028). Moreover, the CSC/PNV group showed a higher SFCT (392.8 ± 92.8 (191–523) vs. 330.95 ± 116.5 (167–609) µm, p = 0.004). Compared with the age- and refraction-matched controls, patients with CSC and PNV showed a significantly thicker anterior sclera. Scleral thickness might contribute to the venous overload hypothesized to induce pachychoroid phenotypes. [ABSTRACT FROM AUTHOR]

Central serous chorioretinopathy is a stress-induced disease and often shows pachychoroid; however, the relationship between stress and choroid remains unlear. The purpose of this study was to investigate, using optical coherence tomography, whether the choroid thickens when rats are subjected to restraint stress. Eight-week-old male F334/Jcl rats were subjected to 30 min of restraint stress, and choroidal thickness was measured before and after stress loading using optical coherence tomography. In addition, salivary corticosterone levels were measured before and after stress loading. Choroidal thickness was significantly increased from 30.1 ± 6.4 µm to 39.7 ± 9.2 µm just after stress loading (p = 0.001). Significant choroidal thickening was not observed on the next day. The salivary corticosterone concentration increased from 1575.3 ± 1040.6 pg/mL before stress loading to 6022.2 ± 6742.6 pg/mL after stress loading, but the difference was not significant (p = 0.10). Choroidal thickness increased when rats were subjected to restraint stress, supporting the hypothesis that stress is one of the causes of pachychoroid spectrum disease, as exemplified by central serous chorioretinopathy. [ABSTRACT FROM AUTHOR]

Purpose: To assess the diagnostic accuracy of individual and combined imaging modalities compared with multimodal imaging for the detection of choroidal neovascularization (CNV) in central serous chorioretinopathy (CSC). Methods: We analyzed patients with CSC with and without CNV who had indocyanine green angiography (ICGA), structural optical coherence tomography (OCT), and OCT angiography (OCTA) obtained on the same day. The presence of CNV was determined using multimodal imaging by a senior retina specialist (i.e., diagnostic reference). Individual and combined (i.e., ICGA + structural OCT) imaging modalities were then graded by two expert readers for the presence of CNV. Sensitivity, specificity, positive (PPV), and negative (NPV) predictive values were computed for individual and combined imaging modalities relative to the diagnostic reference. Results: CNV was detected in 17 eyes in 17 out of 33 CSC patients according to the reference standard. Using ICGA, the identification of CNV had a sensitivity of 66.7%, specificity of 66.7%, PPV of 70.6%, and NPV of 62.5%. Structural OCT had the following diagnostic accuracy values: 83.3% of sensitivity, 53.3% of specificity, 68.1% of PPV, and 72.7% of NPV. Using OCTA, CNV was graded to be present with a sensitivity of 77.8%, specificity of 86.7%, PPV of 87.5%, and NPV of 76.5%. The combination of ICGA and structural OCT granted the identification of CNV with a sensitivity of 83.3%, specificity of 86.7%, PPV of 88.2%, and NPV of 81.3%. Conclusions: OCTA has an elevated diagnostic accuracy in identifying CSC-associated CNV, though a combination of ICGA and structural OCT has a comparable diagnostic efficiency. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Four eyes (three patients) presented with an acute inferior exudative retinal detachment associated with an annular choroidal detachment mimicking uveal effusion syndrome. They had a history of central serous chorioretinopathy in the same eye or in the fellow eye. The role of choroidal venous congestion and scleral thickening is discussed. Purpose: To describe central serous chorioretinopathy cases presenting as uveal effusion syndrome, providing new insights into "pachychoroid spectrum" diseases. Methods: Clinical charts, color fundus photographs, fluorescein angiography, indocyanine green angiography, optical coherence tomography, ultrasound imaging, cerebral magnetic resonance imaging, and biometry of four eyes of three patients were assessed. A literature review was conducted. Results: The three patients had peripheral choroidal detachment and inferior bullous retinal detachment associated with central serous chorioretinopathy features detected using multimodal imaging, including fluorescein and indocyanine green angiography. The choroid was thick in the three patients, and uveal effusion occurred after steroid treatment in all cases. Subretinal fluid drainage and deep sclerectomy with flaps of 4 × 4 mm in both inferior quadrants were performed in three eyes of two patients with good outcomes. One patient was treated with photodynamic therapy. All three patients developed a typical leopard-spot pigmentary pattern in the fundus. Conclusion: A severe presentation of highly exudative central serous chorioretinopathy may occur in rare cases with a peripheral choroidal detachment mimicking uveal effusion syndrome. These severe cases highlighted the role of choroidal thickening and hyperpermeability, choroidal vein dilation, and possible scleral thickening in both entities. [ABSTRACT FROM AUTHOR]

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Central serous chorioretinopathy (CSCR) is characterized by central neurosensory retinal detachment from the retinal pigment epithelium. While the association between CSCR and steroid use is widely recognized, it is difficult to distinguish whether the subretinal fluid (SRF) in ocular inflammatory disease results from steroid use or an inflammation-related uveal effusion. We report the case of a 40-year-old man who presented to our department with intermittent redness and dull pain in both eyes that had persisted for three months. He was diagnosed with scleritis with SRF in both eyes and steroid therapy was started. Inflammation improved with steroid use, but SRF increased. This indicated that the fluid was not caused by the posterior scleritis-related uveal effusion but by steroid use. SRF and clinical symptoms subsided after steroids were discontinued completely and immunomodulatory therapy was initiated. Our study highlights that steroid-associated CSCR must be considered in the differential diagnosis of patients with scleritis, and prompt diagnosis with an immediate shift from steroids to immunomodulatory therapy can resolve SRF and clinical symptoms. [ABSTRACT FROM AUTHOR]

Background: Cortisol plays a role in the pathogenesis of central serous chorioretinopathy (CSC). CSC patients have abnormal time-dependent changes in cortisol levels. Here we report a rare case of a patient with central serous chorioretinopathy whose pigment epithelial detachment (PED) exhibited time-dependent recurrence and resolution. Case presentation: A 47-year-old man presented in 2016 for vision loss in the left eye related to recurrent CSC. During follow-up, his PED was observed to resolve spontaneously while he was still in our clinic and recurred the next morning. Such time-dependent changes of the PED were observed in several next follow-ups without any intervention. After excluding possible external factors, the abnormal diurnal variation of cortisol was considered as the internal factor affecting PED. Conclusions: This is the first article that described the spontaneous time-dependent recurrence and resolution of PED without external interference, where endogenous cortisol may be responsible. Interventions against the abnormal cortisol level might be a potential treatment strategy for CSC. More research is urged to explore the impact of the diurnal change in cortisol levels on eyes with CSC. [ABSTRACT FROM AUTHOR]

This study evaluates the long-term effects of selective retina therapy (SRT) on the retinal pigment epithelium (RPE) and neuroretina in patients with central serous chorioretinopathy. SRT was performed on 36 patients using a Nd:YLF-Laser at 527 nm (R:GEN®, Lutronic, Goyang-Si, Republic of Korea). A total of 994 titration spots were examined using up to three years' multimodal imaging. Leakage in fluorescein angiography (FA) was observed after SRT in 523 lesions and resolved after one month. SRT lesions were not visible clinically, but appeared as brightly reflective areas in infrared and multicolor images. Normal morphology was observed in optical coherence tomography (OCT) immediately after SRT. After one month, thickening of the RPE and interdigitation zone changes were seen and disappeared after 539 ± 308 days. No RPE atrophies occurred during the observation period. Decreased fundus autofluorescence (FAF) was mostly observed directly after SRT followed by increased FAF at one month, which faded over time. A significant decrease in the number of visible lesions in the FA and FAF was observed within the three-year follow-up. OCT findings are consistent with animal studies showing SRT-related defect closure by hypertrophy and migration of neighboring cells without RPE atrophy or photoreceptor damage. This suggests that SRT is a safe treatment option for macular diseases and does not lead to retinal atrophy. [ABSTRACT FROM AUTHOR]

Objective: To present clinical findings and multimodal imaging of three patients who developed bacillary layer detachments (BALADs) shortly after half-fluence, half-dose (HFHD) verteporfin photodynamic therapy (PDT). Methods: Retrospective observational case series. Three patients were treated with HFHD-PDT for (1) macular neovascularisation five years after resolved central serous chorioretinopathy (CSC), (2) persistent serous retinal detachment (SRD) from chronic CSC, and (3) neovascular age-related macular degeneration with persistent SRD despite intravitreal anti-VEGF therapy. Results: Each patient developed a BALAD after HFHD-PDT. Acute fulminant exudation caused subretinal fluid expansion into the inner photoreceptor layer, cleaving myoid from ellipsoid zones in the central macula. Subretinal fluid and the BALADs subsequently resolved over 6–8 weeks. Conclusions: The subretinal fluid and BALAD following HFHD-PDT were transient and did not cause photoreceptor damage over a 6-month follow-up period. We speculate that the reduced-impact HFHD protocol decreases direct tissue damage but increases proinflammatory cytokines. The long-term pathophysiological consequences of the resolved BALADs are unknown. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

With the development of optical coherence tomography (optical coherence tomography angiography, OCTA), quantitative study of choriocapillaris (choriocapillaris, CC) has become a novel evaluation method. The occurrence and development of eye diseases, such as retina and choroid are closely related to the morphology and function of choroidal vessels, especially the change of choriocapillaris. The CC flow deficits parameters, such as density, area and number can be obtained after processing and quantitative analysising images of CC layer from OCTA, assess changes in choroid blood capillary perfusion, explore the pathogenesis of related diseases and provide certain help for disease diagnosis and intervention therapy. This paper reviews the clinical application and research progress of choroid capillary flow deficits. [ABSTRACT FROM AUTHOR]

In the COVID-19 pandemic, which causes high mortality and morbidity, promising developments are achieved as a result of the global vaccination campaign. However, there is an increase in reported side effects with widespread vaccination. In this report, we present a 44-yearold female patient who presented with unilateral central serous chorioretinopathy (CSCR) three days after the first injection of the BNT162b2 COVID-19 vaccine. Although the possibility of coincidence cannot be excluded, our case provides support for the few cases of CSCR after COVID-19 vaccination in the literature. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the incidence of Central Serous Chorioretinopathy (CSC), which is thought to be associated with stress, in bank employees and the frequency of its detection in routine outpatient clinic examinations. Material and Methods: In this retrospective study, we reviewed data from 891 active bank employees aged between 26-61 years who presented to our clinic between May 2021 and May 2022. A complete ophthalmological examination including visual acuity, intraocular pressure, anterior and posterior segment examination as well as OCT scan (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany) and FFA (CANON EOS, CF-1) were performed in all cases diagnosed with CSCR. Equal number for age- and gender-matched cases who presented for routine eye controls were determined as the control group. Results: We retrospectively screened 891 (401 women, 490 men) bank employee. Active CSCR was diagnosed in 7 patients. In addition, we retrospectively evaluated data from 891 age- and gender-matched subjects (401 women, 490 men) as controls. Active CSCR was diagnosed in only 1 patient in the control group. The CSCR incidence was calculated as 0.008 in bank employees whereas 0.001 in the control group, indicating a significant difference between the groups. (p<0.001). Conclusion: In this study, the rate of CSCR diagnosis was found to be significantly higher in bank sector employees. This study suggests that it is necessary to be very careful in terms of posterior segment findings in the examination of employees from banking sector. [ABSTRACT FROM AUTHOR]

To investigate the genetic architecture of age-related macular degeneration (AMD) in a Japanese population. Genome-wide association study (GWAS). Three thousand seven hundred seventy-two patients with AMD and 16 770 control participants from the Japanese population were enrolled in the association analyses. We conducted a meta-analysis of 2 independent GWASs that included a total of 2663 patients with AMD and 9471 control participants using the imputation reference panel for genotype imputation specified for the Japanese population (n = 3541). A replication study was performed using an independent set of 1109 patients with AMD and 7299 control participants. Associations of genetic variants with AMD. A meta-analysis of the 2 GWASs identified 6 loci significantly associated with AMD (P < 5.0 × 10–8). Of these loci, 4 were known to be associated with AMD (CFH , C2/FB , TNFRSF10A , and ARMS2), and 2 were novel (rs4147157 near WBP1L and rs76228488 near GATA5). The newly identified associations were confirmed in a replication study (P < 0.01). After the meta-analysis of all datasets, we observed strong associations in these loci (P = 1.88 × 10–12 and P = 1.35 × 10–9 for meta-analysis for rs4147157 and rs76228488, respectively). When we looked up the associations in the reported central serous chorioretinopathy (CSC) GWAS conducted in the Japanese population, both loci were associated significantly with CSC (P = 4.86 × 10–3 and P = 4.28 × 10–3 for rs4147157 and rs76228488, respectively). We performed a genetic colocalization analysis for these loci and estimated that the posterior probabilities of shared causal variants between AMD and CSC were 0.39 and 0.60 for WBP1L and GATA5 , respectively. Genetic correlation analysis focusing on the epidemiologically suggested clinical risk factors implicated shared polygenic architecture between AMD and smoking cessation (r g [the measure of genetic correlation] = –0.33; P = 0.01; false discovery rate, 0.099). Our findings imply shared genetic components conferring the risk of both AMD and CSC. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the choroidal morphological changes in central serous chorioretinopathy (CSC) using ultra-widefield (UWF)-optical coherence tomography (OCT). Methods: This single-center, case–control study included 65 CSC eyes (52 males; age, 55.6 ± 13.0 years) and 65 healthy eyes (50 males; age, 57.1 ± 17.9 years). UWF-OCT (viewing angle, 200°) with real-shape correction was used to create an automated choroidal thickness (CT) map. The CT map had three sub-areas: the central (0–30°), middle (30–60°), and peripheral areas (60–100°), and was divided by vertical and horizontal lines. Differences in the CT and the CT change rate (CTCR) from the central to peripheral areas were examined between the CSC and control groups after adjusting for subjects' demographic and clinical factors. Furthermore, we assessed the vortex veins dilation patterns (VVDP) in the macula and examined the CT and the CTCR differences between CSC patients and controls for each VVDP. Results: CSC patients had greater CT than those of the controls in all sectors (CSC vs. controls, the peripheral area: supratemporal 284.4 ± 71.2 μm vs. 220.4 ± 71.2 μm, infratemporal 263.3 ± 69.2 μm vs. 195.3 ± 52.3 μm, supranasal 251.9 ± 70.3 μm vs. 189.5 ± 58.1 μm, infranasal 193.6 ± 71.2 μm vs. 146.3 ± 48.9 μm, P < 0.0001 for all sectors). The CTCR was apparently larger in CSC eyes than controls only for the upper-dominant type of VVDP (CSC patients vs. controls, supratemporal 32.1 ± 9.9% vs. 4.6 ± 23.1%, infratemporal 44.0 ± 11.2% vs. 25.6 ± 16.8%, supranasal 42.6 ± 9.8% vs. 22.2 ± 19.4%, infranasal 57.6 ± 41.2% vs. 41.2 ± 13.9%, P < 0.0001 for all sectors). Conclusions: CSC has a thicker choroid, even in the peripheral areas, and the macular choroidal thickening was more severe in the upper-dominant type of VVDP. VVDP may affect the location of excessive fluid. [ABSTRACT FROM AUTHOR]

Introduction: Central serous chorioretinopathy (CSCR) is a common disease that in chronic form can lead to significant visual impairment. Hence, the systemic and local risk factors of CSCR have been analyzed to possibly prevent its onset. The goal of the present study was to find the biometric parameters characteristic for CSCR. Methods: The study included 66 eyes of 60 consecutive patients who were diagnosed with acute or chronic CSCR between January 01 2021 and June 30 2021. There were 46 males and 14 females with a mean age of 48.8 ± 10.0 years in the study cohort. Six patients had symptomatic binocular disease. The axial length and retinal parameters of all patients were measured with spectral domain optical coherence tomography (SD-OCT), and refraction error was tested after cycloplegia. The results of the affected eyes were compared with those of healthy fellow eyes (with exclusion of eyes previously affected by CSCR or with any other ocular disorder) (39 eyes) and the control group (75 eyes), and correlated to the duration of the disease. Results: No significant differences were revealed in axial length between the affected eyes, healthy fellow eyes, and controls (23.31 ± 1.06 mm versus 23.59 ± 1.20 mm versus 23.33 ± 1.19 mm, respectively). The distribution of refraction errors was similar in the three analyzed groups. A hypermetropic shift was noted in the affected eyes versus controls (p = 0.030); however, no difference was noted in refraction error between the healthy fellow CSCR eyes and controls (p = 0.418). Both acute and chronic CSCR cases, as well as their fellow eyes, demonstrated significantly greater choroidal thickness compared with healthy individuals (p < 0.001). Longer disease duration was correlated with a significant deficit in macular volume and average central retinal thickness (p < 0.05). Conclusions: CSCR is a clinical entity that can occur in patients with every type of refraction error. A shorter axial length of the eyeball is not associated with the diagnosis of CSCR; however, increased choroidal thickness is typical of this entity. Longer disease duration is correlated with the loss of retinal thickness and volume. Plain Language Summary: Central serous chorioretinopathy (CSCR) is nowadays classified as a clinical entity belonging to the spectrum of pachychoroid disorders characterized by increased choroidal thickness. Quite often, a shorter axial length and hypermetropia were thought to cause choroidal congestion, and as such, were believed to be associated with the incidence of CSCR. This study aimed to evaluate this relationship in the context of the disease duration. The analysis included comparisons among affected CSCR eyes, healthy fellow eyes, and a control group. The results did not prove a relationship between a shorter eyeball or any specific refraction error and CSCR. Both acute and chronic cases of CSCR presented with significantly greater values of choroidal thickness compared with healthy individuals. A loss of retinal thickness and volume was observed with a longer disease duration. [ABSTRACT FROM AUTHOR]

Introduction: Male gender is an important risk factor of central serous chorioretinopathy (CSC), and studies have explored the pathophysiological role of androgens in CSC with conflicting results. In this study, we shed light on this hot topic by exploring the risk of CSC in a large cohort of male androgen abusers. Methods: This study included male androgen abusers identified through a nationwide anti-doping test program across Danish fitness centers from January 3 2006 to March 1 2018. For each case, we randomly sampled ten male controls using Danish nationwide registries. These controls were matched in age and date. Cases and controls were followed until May 16 2018. Data on diagnoses were extracted using the Danish National Registry of Patients using ICD-10 codes to identify cases with CSC. Results: We included 1189 cases and 11,890 controls. Mean age at the time of doping sentence was 27.4 ± 6.9 years, and mean length of follow-up was 15.8 ± 3.6 years. We identified no cases of CSC in androgen abusers, and five cases of CSC in the control cohort. The difference between groups was not statistically significant (P = 1.0). Conclusions: Male androgen abusers were not at increased risk of CSC. Considering the lack of any signal in this large study, we speculate that if male androgen plays any direct role in the pathophysiology of CSC, its role may be subtle at best. [ABSTRACT FROM AUTHOR]

Pachychoroid disease spectrum is a recent term that has been associated with an increasing number of phenotypes. This review discusses updated findings for each of the typical pachychoroid entities (central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, peripapillary pachychoroid syndrome, and focal choroidal excavation), as well as two relatively new additions (peripapillary pachychoroid neovasculopathy and peripheral exudative hemorrhagic chorioretinopathy). Here, we discuss the potential pathogenic mechanisms for these diseases and relevant imaging updates. Finally, we argue for a consistent classification scheme for these entities. [ABSTRACT FROM AUTHOR]

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.

We report a case of central serous chorioretinopathy (CSCR) associated with tadalafil, a phosphodiesterase 5 inhibitor medication. In this report, we describe a case of a 59-year-old male who presented with blurred vision in the right eye. On examination, he was noted to have serous macular, pigment epithelial detachments, and increased choroidal thickness. The diagnosis of CSCR was made, and the patient was asked to stop the offending agent. Three months after stopping tadalafil, the patient’s visual symptoms and subretinal fluid resolved. In conclusion, prescribing physicians should be aware of tadalafil’s ability to decrease vision and cause CSCR. The addition of CSCR to the list of tadalafil’s side effects should also be considered.

Abstract Background The aim of this study was to report the clinical profile and outcomes of retinal pigment epithelial detachment (PED) in Vogt-Koyanagi-Harada (VKH) disease, and to evaluate the correlation between PED and the subsequent development of central serous chorioretinopathy (CSC) throughout the whole corticosteroid treatment course. Methods The retrospective study enrolled a total of 470 eyes with VKH, and 12 eyes with VKH and PED were recruited. Patients were divided into two groups according to the CSC onset or not throughout the whole course (the CSC group and non-CSC group). Best-corrected visual acuity (BCVA) improvement, and PED angle (PEDA, the angle between the two lines of the vertex of the lifted retinal pigment epithelium to the two edge points of the Bruch membrane) were compared between the two groups. Results CSC developed at the site of the PED in 5 of the 12 eyes with PED, while in the remaining 7 eyes PED gradually resolved following therapy. The prevalence of PED and CSC in VKH was 2.55% (12/470) and 1.06% (5/470), respectively. BCVA improvement in the non-CSC group was greater than that in the CSC group, but without a statistical difference (P = 0.25). PEDA was significantly smaller in the CSC group than in the non-CSC group (P = 0.03). Conclusion PEDA is an ideal parameter to reflect hydrostatic pressure and stretches for RPE. As PED predisposes to the development of CSC in selected VKH eyes, PEDA may be a valuable predictive factor for the development of classic CSC in VKH cases.

Polypoidal choroidal vasculopathy (PCV) is considered one of the disease entities in the pachychoroid spectrum sharing the common finding of abnormally thickened choroid with Central serous chorioretinopathy (CSCR). Polypoidal choroidal vasculopathy (PCV) is a vascular malformation of the choroid, comprising a network of branching vessels of varying sizes that produce aneurysmal-like enlargements. This disease is generally observed in the macular area. Central serous chorioretinopathy is a retinal disorder characterized by localized serous detachment of the macula. It is secondary to retinal pigment epithelial decomposition and choroidal vascular changes. Fundus photography, optical coherence tomography (OCT), Fundus fluorescein angiography, and Indocyanine green angiography (ICG) aid in the diagnosis and differentiation between these two entities. Here, we report a case of middle aged female presented initially with clinical features suggestive of CSCR and later turned out to be a case of PCV.

Abstract Background To compare swept-source optical coherence tomography angiography (SS-OCTA) and indocyanine green angiography (ICGA) in patients with central serous chorioretinopathy (CSC). Methods SS-OCTA and ICGA images of 39 eyes with symptomatic CSC were collected and aligned. Spatial overlap of the annotations of the coarse granulated high reflective area on choriocapillary OCTA and the hyperfluorescence area on mid-phase ICGA was calculated according to the Jaccard index (JI). SS-OCTA findings of fellow eyes and changes in SS-OCTA abnormalities during the follow-up were also analyzed. Results Three main types of abnormalities in choriocapillaris SS-OCTA images were found: type A, coarse granulated high reflective area (39 eyes [100%]); type B, roundish dark halo around Type A (32 eyes [82.1%]); and type C, coarse granulated low reflective area (39 eyes [100%]). The mean JI of type A on SS-OCTA and the hyperfluorescence area on ICGA were 0.55 ± 0.15 for grader 1 and 0.49 ± 0.15 for grader 2. The mean area of type A abnormalities on SS-OCTA and hyperfluorescence on ICGA was 3.976 (IQR, 2.139–8.168) and 3.043 (IQR, 1.408–4.909) mm2 (P = 0.199). The areas of type A, B and C abnormalities on SS-OCTA after laser treatment or observation were 3.36mm2 (IQR, 2.399–9.312), 2.9mm2 (IQR, 2.15–3.7), and 0.19mm2 (IQR, 0.08–0.23), respectively, which was smaller than those in the baseline (7.311mm2 (IQR 3.788–11.209), P

Weiming Yan1,2 &ast;, Pan Long3 &ast;, Lei Zhang4 &ast;, Meizhu Chen,1 Zuoming Zhang,2 Tao Chen2 1Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hospital Affiliated to Xiamen University), Fuzhou, People’s Republic of China; 2Department of Clinical Aerospace Medicine, The Air Force Medical University, Xi’an, People’s Republic of China; 3Department of Ophthalmology, The General Hospital of Western Theatre Command, PLA, Chengdu, People’s Republic of China; 4Department of Ophthalmology, The Shaanxi Eye Hospital, Xi’an People’s Hospital (Xi’an Fourth Hospital), Affiliated Guangren Hospital, School of Medicine, Xi’an Jiaotong University, Xi’an, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Meizhu Chen, Email jumychen@126.com Tao Chen Email baiidtf0506@126.comPurpose: To explore the temporal topography of the chorioretinopathy in an animal model of central serous chorioretinopathy (CSC) induced by intravenous injection of adrenalin in the Chinchilla rabbits.Methods: Ten Chinchilla rabbits received a daily intravenous injection of adrenaline at 0.04 mg/kg for 8 weeks. Fluorescence fundus angiography (FFA) and electroretinogram (ERG) were performed every week afterwards to see whether there was fluorescence leakage in the fundus and to evaluate the retinal function. Indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were also conducted to detect the change of choroidal vessels. Finally, the eyes of the rabbits were enucleated to make the retinal sections for histological examination with hematoxylin–eosin (HE) staining.Results: Within 8 weeks of the adrenalin administration, 7 out of the 10 rabbits showed different degrees of fluorescence leakage on FFA. The leakage was more obvious during 2– 3 weeks after the adrenalin administration. With the progress of disease, the leakage subsided gradually and a scar-like lesion formed. ICGA revealed the local choroidal ischemia and the dilated choroidal vessels. An obvious detachment of retina and an increased thickness of the choroid were found on OCT, which was most obvious 2 weeks after the adrenalin administration (P< 0.01). ERG revealed no obvious decline of the b-wave amplitude before and after the adrenalin administration (P> 0.05). A circumscribed retinal detachment, the depigmentation of retinal pigment epithelium and enlarged choroidal vessels were shown by the histological examination.Conclusion: The temporal topography of the chorioretinopathy in the Chinchilla rabbits by intravenous injection of adrenaline somewhat mimicked that of the human CSC, which could enhance its application in the exploration for the pathogenesis and the therapeutic measures for human CSC.Keywords: central serous chorioretinopathy, adrenaline, Chinchilla rabbits, choroid

A 37-year-old man experienced two episodes of central serous chorioretinopathy (CSCR) with the onset within a 7-month period, one in each eye. The diagnosis was made based on spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF), and fluorescein angiography. The presence of subretinal neovascularization and polypoidal choroidal vasculopathy were excluded. Each CSCR episode lasted for approximately 6 months and resolved completely after laser photocoagulation (left eye) and photodynamic therapy (right eye). In the right eye, subthreshold micropulse laser treatment and oral eplerenone were initially administered because of a verteporfin shortage, but they were not effective. Final best-corrected visual acuity was 0.8 logMAR in the left eye and “counting fingers” in the right. SD-OCT revealed significant retinal thinning in both eyes despite FAF, showing no major loss of retinal pigment epithelial cells. A significant reduction of ganglion cell complex thickness occurred in the right eye. Acute CSCR can result in significant visual impairment, even when short-lasting.