Senny Chapagain*

Geta Eye Hospital, Geta, Kailali, Nepal

*Corresponding Author: Senny Chapagain, Geta Eye Hospital, Geta, Kailali, Nepal.

Received: October 13,2021 ; Published: November 23, 2021

Abstract

Purpose: To assess the visual outcome of different types of central serous chorioretinopathy and to evaluate the effect of treatment modalities for acute, chronic and recurrent central serous chorioretinopathy. Also, to quantify macular thickness (MT) changes after observation and follow up for acute central serous chorioretinopathy without any intervention, after treatment with intravitreal bevacizumab or laser for chronic and recurrent cases.

Methods: This Cross sectional, interventional study examined the eyes of patients with central serous chorioretinopathy including the fundus evaluation, Spectral Domain optical coherence tomography, fundus fluorescein Angiography, prior to and 1, 3 and 6 months after treatment. Best corrected visual acuity, intraocular pressure, detail fundus examinations were done. Clinical and tomographic features of the macula were also assessed during the follow-ups.

Results: 55 eyes of 55 patients were enrolled in the study. 100% of acute cases, that is, 61.81% of the total (n = 34) were treated with topical NSAIDS and observation. For chronic cases 16.36% (n = 9) of the cases were treated with focal laser and 20% (n = 11) of the cases were given injection Avastin. At 6 month, 98.18% (n = 54) had visual acuity between 6/6 to 6/18. 1.82% (n = 1) had visual acuity between 6/18-6/60 whereas none of the patients had visual acuity worse than 6/60. The average macular thickness was 435.47 ± 153.55 μm at presentation which improved to 218.36 ± 67.57 μm at the end of 6th month. The difference in CMT at the baseline and at the end of 6 months was statistically significant (p = 0.005). The subretinal fluid was resolved at 1 month in 12.72% (n = 7) whereas SRF resolved in 56.36% (n = 31) of the cases in the 3rd month. In 21.81% (n = 12) of the cases the SRF resolved in the 6th month and in 9.09% (n = 5) of the cases the subretinal fluid remained unresolved at the end of 6th month. The resorption of SRF was in maximum number of cases at the end of 3 months.

Conclusion: In treatment of CSCR, additional benefits from the use of NSAIDS along with observation accentuates the resolution of Subretinal fluid and improvement of visual acuity for the acute cases. The chronic cases accounted for 27.7% and 14.55% cases were recurrent. Intravitreal bevacizumab (avastin) is more effective in the treatment of chronic and recurrent CSCR as compared to the laser therapy. No serious complications were encountered by treatment with any of the modalities. The efficacy of the intravitreal Avastin and its comparison needs to be further studied and evaluated to establish the proper treatment guidelines in cases of chronic and recurrent CSCR.

Keywords: Chorioretinopathy; Chronic Cases; Central Serous Chorioretinopathy (CSCR)

References

1. Von Graefe A. “Ueber central Recidivi Rende retinitis”. Graefe's Archive for Clinical and Experimental Ophthalmology 12 (1866): 211-215.
2. Levine R., et al. “Long-term follow-up of idiopathic central serous chorioretinopathy by fluorescein angiography”. Ophthalmology 96 (1989): 854-859.
3. Spaide RF., et al. “Central serous chorioretinopathy in younger and older adults”. Ophthalmology 12 (1996): 2070-2079.
4. Loo RH., et al. “Factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy”. Retina 22 (2002): 19-24.
5. Cunningham ET Jr., et al. “Central serous chorioretinopathy in patients with systemic lupus erythematosus”. Ophthalmology 12 (1996): 2081-2090.
6. Bouzas EA., et al. “Central serous chorioretinopathy in endogenous hypercortisolism”. Archives of Ophthalmology 9 (1993): 1229-1233.
7. Mansuetta CC., et al. “An association between central serous chorioretinopathy and gastroesophageal reflux disease”. American Journal of Ophthalmology 6 (2004): 1096-1100.
8. Tatham A and Macfarlane A. “The use of propranolol to treat central serous chorioretinopathy: an evaluation by serial OCT”. Journal of Ocular Pharmacology and Therapeutics 2 (2006): 145-149.
9. Nielsen JS., et al. “Mifepristone treatment of chronic central serous chorioretinopathy”. Retina1 (2007): 119-122.
10. Forooghian F., et al. “Finasteride for chronic central serous chorioretinopathy”. Retina 4 (2011): 766-771.
11. Steinle NC., et al. “Oral rifampin utilisation for the treatment of chronic multifocal central serous retinopathy”. British Journal of Ophthalmology 1 (2012): 10-13.
12. Leaver P and Williams C. “Argon laser photocoagulation in the treatment of central serous retinopathy”. British Journal of Ophthalmology 63 (1979): 674-677.
13. Lim JW and Kim MU. “The efficacy of intravitreal bevacizumab for idiopathic central serous chorioretinopathy”. Graefe's Archive for Clinical and Experimental Ophthalmology 7 (2011): 969-974.
14. Jamil AZ., et al. “Features of central serous chorioretinopathy presenting at a tertiary care hospital in Lahore”. Journal of Pakistan Medical Association 4 (2013): 478-482.
15. Anna Elias., et al. “A Ten-Year Study of Central Serous Chorioretinopathy: Recurrence Rate and Factors Affecting Recurrence”. Kerala Journal of Ophthalmology 4 (2011): 352-357.
16. Cassel GH., et al. “Central serous chorioretinopathy a seasonal variation”. British Journal of Ophthalmology 68 (1984): 724-726.
17. Haimovici R., et al. “Risk factors for central serous chorioretinopathy: a case-control study”. Ophthalmology2 (2004):244-249.
18. Youngsub Eom., et al. “Systemic Factors Associated with Central Serous Chorioretinopathy in Koreans”. Korean Journal of Ophthalmology4 (2012): 260-264.
19. Shahid Jamal Siddiqui., et al. “Pattern of Central Serous Chorioretinopathy (CSCR) on Fundus Fluorescein Angiography”. Pakistan Journal of Ophthalmology4 (2008): 171-175.
20. Yun Young Kim and Christina J Flaxel. “Factors Influencing the Visual Acuity of Chronic Central Serous Chorioretinopathy”. Korean Journal of Ophthalmology2 (2011): 90-97.
21. Park sang-UK., et al. “Intravitreal Anti-Vascular Endothelial Growth Factor versus Observation in Acute Central Serous Chorioretinopathy: One-year Results”. Korean Journal of Ophthalmology. Korean Journal of Ophthalmology4 (2014): 306-313.
22. Koss MJ., et al. “Subthreshold diode laser micro pulse photocoagulation versus intravitreal injections of bevacizumab in the treatment of central serous chorioretinopathy”. Eye (London)2 (2012): 307-314.
23. Michael L., et al. “Experience with Nontreatment of Central Serous Choroidopathy”. Archives of Ophthalmology4 247-250.
24. Ahmad Zeeshan Jamil., et al. “Intravitreal bevacizumab in central serous chorioretinopathy”. Journal of the College of Physicians and Surgeons Pakistan6 (2012): 363-366.
25. Lim SJ., et al. “Intravitreal bevacizumab injection for central serous chorioretinopathy”. Retina1 (2010): 100-106.

Citation

Citation: Senny Chapagain. “Treatment Modalities and Outcomes of Acute and Chronic Cases of Central Serous Chorioretinopathy".Acta Scientific Ophthalmology 4.12 (2021): 59-67.

Copyright

Copyright: © 2021 Senny Chapagain. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.