今日の臨床サポート

中心性漿液性脈絡網膜症

著者: 石龍鉄樹 福島県立医科大学医学部眼科学講座

監修: 沖波聡 倉敷中央病院眼科

著者校正/監修レビュー済:2022/08/03
患者向け説明資料

概要・推奨   

  1. 中心性漿液性脈絡網膜症(CSC:central serous chorioretinopathy)の好発年齢は45歳から51歳である。
  1. 高齢者では滲出型加齢黄斑変性(AMD:age-related macular degeneration)、特にポリープ状脈絡膜血管症(PCV:polypoidal choroidal vasculopathy)を含むtype 1黄斑部血管新生(MNV:macular neovascularization)を示す症例との鑑別が必要である(推奨度1)
  1. ステロイド薬使用はCSC発症のリスクファクターである(推奨度1)
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、 著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※同効薬・小児・妊娠および授乳中の注意事項等は、海外の情報も掲載しており、日本の医療事情に適応しない場合があります。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適応の査定において保険適応及び保険適応外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適応の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
石龍鉄樹 : 奨学(奨励)寄付など(参天製薬,福島県厚生農業協同組合連合会)[2022年]
監修:沖波聡 : 特に申告事項無し[2022年]

改訂のポイント:
  1. 閾値下レーザー照射の記述を追加した。
  1. 脈絡膜新生血管の記述を国際的に推奨されている黄斑部新生血管(MNV)の記述に統一した。

病態・疫学・診察

疾患情報  
  1. 中心性漿液性脈絡網膜症(CSC)は、classic CSCとchronic CSCに分類される。
  1. 一般的には6カ月以上続く漿液性網膜剥離がある例や再発症例をchronic CSCとするが、研究者によっては定義が異なることがあるので注意を要する。
  1. Classic CSCは、中心窩またはその近傍の類円形の漿液性網膜剥離が特徴で、網膜色素上皮障害を認めることがある。自然治癒することが多いが、遷延化する症例がある。慢性例では漿液性網膜剥離の形状はさまざまで、広範囲に網膜色素上皮障害がみられ、遷延化、再発をくり返すと網膜の萎縮がみられるようになる。
  1. 漿液性網膜剥離の遷延、再発により網膜色素上皮障害が広範囲に及んでいる例をびまん性網膜色素上皮症(DRPE:diffuse retinal pigment epitheliopathy)と呼ぶ。
  1. インドシアニングリーン蛍光眼底造影による脈絡膜充盈遅延、異常組織染、脈絡膜中大血管の拡張、光干渉断層計(OCT)での観察での脈絡膜肥厚から、何らかの脈絡膜循環障害による組織間液の貯留が原因であると推定されている。
  1. 長期経過でポリープ状脈絡膜血管症(PCV)を生ずる例があること、CSCとPCVがいずれも脈絡膜肥厚を伴うことから、最近、両者をPachychoroid(厚い脈絡膜) diseaseとして一連のスペクトラムとして捉える報告が増えている[1][2][3][4]
  1. アジア人、中高年男性、ステロイド薬使用、精神的ストレス、妊娠などが発症に関与するといわれている。
  1. 再発が多く1年まで30%~50%が再発する。
問診・診察のポイント  
  1. 中年男性に多く発症するといわれているが、高齢者、更年期以降の女性にもみられることも少なくない。高齢者では滲出型加齢黄斑変性との鑑別が大切である。

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文献 

Ai Kido, Masahiro Miyake, Hiroshi Tamura, Shusuke Hiragi, Takeshi Kimura, Shosuke Ohtera, Ayako Takahashi, Sotaro Ooto, Koji Kawakami, Tomohiro Kuroda, Akitaka Tsujikawa
Incidence of central serous chorioretinopathy (2011-2018): a nationwide population-based cohort study of Japan.
Br J Ophthalmol. 2021 Jul 14;. doi: 10.1136/bjophthalmol-2021-319403. Epub 2021 Jul 14.
Abstract/Text AIMS: The aim of this study was to elucidate the epidemiological background of central serous chorioretinopathy (CSC), including its incidence and treatment pattern.
METHODS: This was a population-based longitudinal cohort study using a nationwide health insurance claims database of the Japan Ministry of Health, Labour and Welfare (MHLW). As Japan employs universal health coverage, the database covers more than 95% of claims issued in Japan. We accessed all data stored in the database with permission from the MHLW. We traced all individuals aged 30 years or older and identified individuals with new onset of CSC between January 2011 and December 2018. CSC cases were categorised by age and sex for each year, and incidence rate was calculated. We also identified major treatments for CSC to elucidate the initial treatment pattern.
RESULTS: During the 8-year period, 247 930 incidences of CSC were identified, among which 75.9% were men. The crude incidence rate (per 100 000 person-years) in the general population aged 30 years or older was 34.0 (95% CI 33.9 to 34.2), in men was 54.2 (95% CI 53.9 to 54.4) and in women was 15.7 (95% CI 15.5 to 15.8). The mean age of onset was lower in men than in women (50.5±12.5 years vs 54.7±13.5 years). Most of the patients with newly diagnosed CSC (86.8%) did not receive major treatment.
CONCLUSIONS: The current study provides the nationwide population-based evidence to clarify the detailed epidemiology of CSC. These results could help to understand the pathogenesis and mechanisms of CSC in the future.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PMID 34261662
Yang Li, Qi Sheng You, Wen Bin Wei, Jie Xu, Chang Xi Chen, Ya Xing Wang, Liang Xu, Jost B Jonas
Prevalence and associations of central serous chorioretinopathy in elderly Chinese. The Beijing Eye Study 2011.
Acta Ophthalmol. 2016 Jun;94(4):386-90. doi: 10.1111/aos.12891. Epub 2016 Mar 1.
Abstract/Text PURPOSE: To determine the prevalence and associations of central serous chorioretinopathy (CSC) in elderly Chinese.
METHODS: The population-based cross-sectional Beijing Eye Study 2011 included 3468 individuals (age: 64.6 ± 9.8 years; range: 50-93 years), who underwent enhanced depth imaging of spectral-domain optical coherence tomography (SD-OCT). CSC was defined as serous detachment of the retina in the macular region without signs of haemorrhages or signs of polypoidal choroidal vasculopathy, exudative age-related macular degeneration or other retinal vascular disorders, both on fundus photographs and on optical coherence tomography (OCT) images.
RESULTS: Central serous chorioretinopathy was diagnosed in 10 eyes (prevalence rate: 0.15 ± 0.05%; 95% confidence interval (CI):0.06%, 0.25%) of 10 subjects (prevalence rate: 0.31 ± 0.10%; 95% CI: 0.12%, 0.50%). In five subjects, CSC was located foveally, and in five subjects, CSC was located extrafoveally. All subjects affected by foveal CSC were men, and three of the five individuals with extrafoveal CSC were men. In univariate analysis, subjects with CSC were significantly younger than the remaining study participants, and foveal CSC showed a significant (p = 0.02) predilection for men. After adjusting for age and gender, individuals with foveal CSC (383 ± 112 μm versus 270 ± 47 μm; p = 0.02) and the whole group of subjects with CSC had a significantly thicker subfoveal choroid. In a parallel manner, eyes contralateral to eyes with foveal CSC showed a significantly thicker subfoveal choroid than the age-adjusted control group (413 ± 74 μm versus 270 ± 47 μm; p = 0.001).
CONCLUSIONS: In Chinese aged 50+ years, the prevalence of CSC was 0.14% per subject. The choroid in the CSC affected eyes and in the contralateral unaffected eyes was significantly thicker than in an age- and gender-adjusted control population-based group.

© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
PMID 26928876
Der-Chong Tsai, Shih-Jen Chen, Chin-Chou Huang, Pesus Chou, Chia-Min Chung, Po-Hsun Huang, Shing-Jong Lin, Jaw-Wen Chen, Tseng-Ji Chen, Hsin-Bang Leu, Wan-Leong Chan
Epidemiology of idiopathic central serous chorioretinopathy in Taiwan, 2001-2006: a population-based study.
PLoS One. 2013;8(6):e66858. doi: 10.1371/journal.pone.0066858. Epub 2013 Jun 24.
Abstract/Text OBJECTIVES: The epidemiology of idiopathic central serous chorioretinopathy (CSCR) is not well understood in an Asian population. The present study aimed to investigate the incidence and risk factors for corticosteroid-unrelated CSCR using Taiwan's National Health Insurance Research Database.
METHODS AND RESULTS: From 2001 to 2006, a total of 786 patients (500 [63.6%] males) who were newly diagnosed with CSCR, aged from 20 to 64 years and had no history of corticosteroid prescription were identified as incident cases of idiopathic CSCR. 3606 age-, gender-, and enrollment time-matched subjects were randomly selected as the control group. The mean annual incidence was 0.21‰ (0.27‰ for males, and 0.15‰ for females; P<0.001), with a male/female ratio of 1.74. The peak incidence was in the 35- to 39-year-old age group (0.30‰), followed by the 40- to 44-year-old age group (0.26‰). Males had a significantly higher mean annual incidence than female only in the middle age groups. Conditional logistic regression was used to estimate the odds ratios (ORs) for potential risk factors of idiopathic CSCR. Only exposure to anti-anxiety drugs (OR, 1.63; 95% confidence interval, 1.09-2.44) was found to be independently associated with idiopathic CSCR among males. No risk factors of idiopathic CSCR were found for females.
CONCLUSIONS: This study provides the nationwide, population-based data on the incidence of idiopathic CSCR in adult Asians, and suggests that exposure to anti-anxiety drugs is an independent risk factor for idiopathic CSCR among males.

PMID 23826160
Takashi Araki, Hiroto Ishikawa, Chiharu Iwahashi, Masanori Niki, Yoshinori Mitamura, Masahiko Sugimoto, Mineo Kondo, Takamasa Kinoshita, Tomo Nishi, Tetsuo Ueda, Aki Kato, Tsutomu Yasukawa, Yoshihiro Takamura, Fumi Gomi
Central serous chorioretinopathy with and without steroids: A multicenter survey.
PLoS One. 2019;14(2):e0213110. doi: 10.1371/journal.pone.0213110. Epub 2019 Feb 28.
Abstract/Text We investigated the rates of the use of steroids in Japanese central serous chorioretinopathy (CSC) cases and differences in the characteristics of CSC with and without steroids. A total of 538 eyes of 477 patients diagnosed with CSC, with 3 months or more of follow-up between April 2013 and June 2017 at 8 institutions. Patients with CSC with more than 3 months of follow-up were identified by OCT and fluorescein angiography at 8 institutions. Data collected included patient demographics, history of corticosteroid medication and smoking, spherical errors, findings of angiography, subfoveal choroidal thickness, and changes through the follow-up period. Differences in these findings were analyzed in cases with and without corticosteroid treatment. Among the 477 patients (344 men,133 women), 74 (15.5%) (39 men, 35 women) underwent current or prior steroid treatment. Cases with steroids were higher age (p = 0.0403) and showed no male prevalence, more bilateral involvement (p < 0.0001), and the affected eyes had multiple pigment epithelial detachment (p <0.0001), more fluorescein leakage sites (p < 0.0001), greater choroidal thickness (p = 0.0287) and a higher recurrence rate (p = 0.0412). Steroids can cause severer CSC through an effect on choroidal vessels and an impairment of retinal pigment epithelium.

PMID 30818363
R F Spaide, L Hall, A Haas, L Campeas, L A Yannuzzi, Y L Fisher, D R Guyer, J S Slakter, J A Sorenson, D A Orlock
Indocyanine green videoangiography of older patients with central serous chorioretinopathy.
Retina. 1996;16(3):203-13.
Abstract/Text PURPOSE: The authors studied the indocyanine green (ICG) videoangiography findings of central serous chorioretinopathy (CSC) in older adults.
BACKGROUND: Central serous chorioretinopathy in older adults may be confused with the exudative forms of age-related macular degeneration (AMD) because the two entities may have similar ophthalmoscopic and fluorescein angiographic findings. Because of its enhanced ability to image the choroidal circulation, ICG videoangiography has been used to describe certain choroidal vascular abnormalities in young adults with CSC, as well as older patients with choroidal neovascularization (CNV). The ICG videoangiography findings in CSC in older adults is largely unknown.
METHODS: The authors performed ICG videoangiography on 36 patients aged 50 years or older with CSC to characterize their findings.
RESULTS: The ICG videoangiography findings of the patients were consistent, revealing choroidal vascular hyperpermeability manifested by areas of hyperfluorescence that were first seen in the midphase of the angiogram. In the later phases of the angiogram, there were dispersion of the hyperfluorescence and a distinctive silhouetting of the larger choroidal vessels.
CONCLUSIONS: Older patients with CSC have a unique temporal and topographic pattern of hyperpermeability that can help establish the proper diagnosis.

PMID 8789858
Robert Haimovici, Sean Koh, David R Gagnon, Todd Lehrfeld, Sarah Wellik, Central Serous Chorioretinopathy Case-Control Study Group
Risk factors for central serous chorioretinopathy: a case-control study.
Ophthalmology. 2004 Feb;111(2):244-9. doi: 10.1016/j.ophtha.2003.09.024.
Abstract/Text PURPOSE: To identify systemic factors associated with the development of central serous chorioretinopathy (CSCR).
DESIGN: Retrospective, case-control study.
PARTICIPANTS AND CONTROLS: 312 cases and 312 controls.
RESULTS: By use of a multivariate analysis, the previously described risk factors, systemic steroid use (odds ratio [OR], 37.1; 95% confidence interval [CI], 6.2-221.8), and pregnancy (OR, 7.1; 95% CI, 1.0-50.7), were strongly associated with CSCR. Additional risk factors identified by this study include antibiotic use (OR, 6.2; 95% CI, 1.0-37.9), alcohol use (OR, 4.9; 95% CI, 1.5-16.3), untreated hypertension (OR, 3.3; 95% CI, 1.3-8.5), and allergic respiratory disease (OR, 2.5; 95% CI, 1.2-5.1).
CONCLUSIONS: A wide variety of systemic factors are associated with CSCR. Prospective studies are warranted to evaluate the nature and significance of these associations further.

PMID 15019370
L A Yannuzzi
Type A behavior and central serous chorioretinopathy.
Trans Am Ophthalmol Soc. 1986;84:799-845.
Abstract/Text
PMID 3590481
M K Tittl, R F Spaide, D Wong, E Pilotto, L A Yannuzzi, Y L Fisher, B Freund, D R Guyer, J S Slakter, J A Sorenson
Systemic findings associated with central serous chorioretinopathy.
Am J Ophthalmol. 1999 Jul;128(1):63-8.
Abstract/Text PURPOSE: To determine systemic factors associated with central serous chorioretinopathy.
METHODS: In a retrospective study, 230 consecutive patients with central serous chorioretinopathy examined in a referral setting were compared with a historical gender-matched and age-matched control group of 230 patients with ocular findings who were examined in the same referral setting.
RESULTS: The median age of the patients was 49.8 years, and of the control subjects, 50.0 years. The male-female ratio for both groups was 2.7:1. Patients with central serous chorioretinopathy were more likely to use psychopharmacologic medications (odds ratio = 2.6; 95% confidence interval = 1.30 to 5.19; P = .0049) and corticosteroids (odds ratio = 3.17; 95% confidence interval = 1.30 to 7.70; P = .0067) and were more likely to have hypertension (odds ratio = 2.25; 95% confidence interval = 1.39 to 3.63; P = .0008) than were the control subjects.
CONCLUSIONS: This study identified psychopharmacologic medication use, corticosteroid use, and hypertension as factors associated with central serous chorioretinopathy. These findings reinforce the concept that stress and adaptations to stress play a role in this disorder. The findings of possible associations between central serous chorioretinopathy and both hypertension and corticosteroid usage suggest that these modifiable factors may influence morbidity of central serous chorioretinopathy.

PMID 10482095
T Harada, K Harada
Six cases of central serous choroidopathy induced by systemic corticosteroid therapy.
Doc Ophthalmol. 1985 Aug 15;60(1):37-44.
Abstract/Text We report 6 cases of central serous choroidopathy (including pigment epithelial detachment in one case) which appeared in the course of systemic corticosteroid administration conducted to cure concurrent general diseases, and in one patient with a steroid-releasing pituitary adenoma. The majority of cases arose within about one month following the administration of more than 200 mg of prednisolon. It is postulated that corticosteroids operate as a kind of stress intervening in the hypophysis-adrenal system, leading eventually to the development of central serous choroidopathy.

PMID 4042815
M Wakakura, S Ishikawa
Central serous chorioretinopathy complicating systemic corticosteroid treatment.
Br J Ophthalmol. 1984 May;68(5):329-31.
Abstract/Text Central serous chorioretinopathy developed in 2 cases of retrobulbar neuritis during systemic treatment with corticosteroids. Fluorescein angiography confirmed leakage surrounded by central serous detachment of the retina. In one case the central serous chorioretinopathy recurred 3 times during 3 separate courses of treatment. Spontaneous recovery accompanied a reduction in steroid treatment to a low level. It is suggested that high dosage corticosteroids may damage the posterior blood-ocular barrier.

PMID 6712911
E A Bouzas, M H Scott, G Mastorakos, G P Chrousos, M I Kaiser-Kupfer
Central serous chorioretinopathy in endogenous hypercortisolism.
Arch Ophthalmol. 1993 Sep;111(9):1229-33.
Abstract/Text OBJECTIVE: To examine the potential association of central serous chorioretinopathy with endogenous hypercortisolism (Cushing's syndrome).
DESIGN: Ophthalmologic survey of consecutively admitted patients with endogenous Cushing's syndrome.
SETTING: An eye clinic of a research center (National Eye Institute, Bethesda, Md).
PATIENTS: Sixty consecutive patients with confirmed endogenous Cushing's syndrome.
MAIN OUTCOME MEASURES: Findings from complete ophthalmologic evaluation.
RESULTS: Three (5%) of 60 patients had one or more episodes of appropriately documented central serous chorioretinopathy. In all cases, the episodes occurred during the period of hypercortisolism.
CONCLUSIONS: Central serous chorioretinopathy is an uncommon manifestation of endogenous Cushing's syndrome. Since central serous chorioretinopathy has been associated with other hypercortisolemic states, we suggest that glucocorticoids may play a role in the development of this disease.

PMID 8363466
Cynthia A Carvalho-Recchia, Lawrence A Yannuzzi, Silvana Negrão, Richard F Spaide, K Bailey Freund, Hanna Rodriguez-Coleman, Marcio Lenharo, Tomohiro Iida
Corticosteroids and central serous chorioretinopathy.
Ophthalmology. 2002 Oct;109(10):1834-7.
Abstract/Text PURPOSE: The purpose of this study is to investigate the relationship between corticosteroid use and central serous chorioretinopathy (CSC).
DESIGN: A prospective, case-controlled study.
PARTICIPANTS AND CONTROLS: A consecutive series of patients with acute manifestations of CSC and a control group matched for age, race, and gender were recruited between January 2000 and July 2000.
METHODS: A detailed clinical history was taken, and fundus examination with slit-lamp biomicroscopy was performed on all patients. Fluorescein angiography was obtained on the study patients.
RESULTS: A total of 50 patients was recruited. Twenty-six patients (52%) had a history of exogenous steroid use, including oral, intravenous, intranasal, and intraarticular administration. Two additional patients had a history of endogenous hypercortisolism (Cushing's syndrome). In a matched control group, eight patients (18%) had a history of steroid use. The difference in corticosteroid exposure between study patients and controls was statistically significant (P < 0.0001).
MAIN OUTCOME MEASURES: History of corticosteroid use or Cushing's syndrome.
CONCLUSIONS: This study is consistent with previous reports associating steroid use with CSC. It identifies corticosteroids as a significant risk factor for the development of acute, exudative macular manifestation and implicates hypercortisolism as a factor in the pathogenesis of this disorder. Several forms of corticosteroid administration were observed to be a risk factor for CSC. Accordingly, susceptible patients in need of corticosteroids should be advised of the risk of developing acute manifestations of CSC.

PMID 12359603
Tarun Sharma, Nitant Shah, Madhav Rao, Lingam Gopal, Mahesh P Shanmugam, Mahesh Gopalakrishnan, Pramod Bhende, Muna Bhende, Nitin S Shetty, Sukumar Baluswamy
Visual outcome after discontinuation of corticosteroids in atypical severe central serous chorioretinopathy.
Ophthalmology. 2004 Sep;111(9):1708-14. doi: 10.1016/j.ophtha.2004.03.025.
Abstract/Text PURPOSE: To elucidate the effect of discontinuation of corticosteroids in patients with atypical severe central serous chorioretinopathy (CSC) on retinal reattachment, resolution of retinal pigment epithelium (RPE) leaks, and improvement in visual acuity (VA).
DESIGN: Prospective, noncomparative, observational case series.
PARTICIPANTS: Twenty-four eyes of 17 patients who were being treated with corticosteroids for atypical severe CSC. Of these 17 patients, 16 were treated inappropriately with corticosteroids for their ocular condition; presumably, these patients' conditions were misdiagnosed, and they were thought to have choroiditis, Harada's syndrome, or similar entities, and not central serous chorioretinopathy.
INTERVENTION: Observation or laser photocoagulation.
MAIN OUTCOME MEASURES: Reattachment of the retina, obliteration of RPE leaks on fundus fluorescein angiography, and improvement in Snellen VA.
RESULTS: Discontinuation of corticosteroids resulted in reattachment of the retina in 21 eyes (87.5%), with median time to reattachment of 49 days (range, 32-400); only 3 eyes required laser photocoagulation. Fundus fluorescein angiography showed obliteration of RPE leaks at a median period of 75 days (range, 32-400) in the observed eyes; the median VA improved from 20/80 to 20/30. The mean follow-up was 16.5 months.
CONCLUSIONS: Discontinuation of corticosteroids in atypical CSC helped in obliteration of RPE leaks and retinal reattachment in 87.5% of the eyes without laser treatment, and improvement in VA was observed.

PMID 15350327
D M Robertson
Argon laser photocoagulation treatment in central serous chorioretinopathy.
Ophthalmology. 1986 Jul;93(7):972-4.
Abstract/Text Central serous chorioretinopathy, a sporadic self-limited disease of young adults, is associated with loss of central vision, image distortion, and imparied dark adaptation. The diagnosis is verified with fluorescein angiography, which demonstrates and expanding point of fluorescein dye leakage under a serous detachment of the sensory retina. Treatment should ordinarily be delayed four or more months but may be considered if there is evidence of microarchitectural changes in the macular retina, if the best corrected visual acuity declines to 20/40 or less, or if there have been multiple recurrences. Argon laser photocoagulation should be directed to the leakage site, using spot sizes of 200 mu in diameter, exposure times of 0.2 seconds, and low-power intensities.

PMID 3531957
E Burumcek, A Mudun, S Karacorlu, M O Arslan
Laser photocoagulation for persistent central serous retinopathy: results of long-term follow-up.
Ophthalmology. 1997 Apr;104(4):616-22.
Abstract/Text PURPOSE: The authors evaluated the effect of laser photocoagulation for persistent central serous retinopathy (CSR).
METHODS: The authors evaluated 45 eyes of 38 patients who had been offered laser photocoagulation for CSR that did not resolve after 4 months of observation. Sixteen eyes of 14 patients who did not accept laser photocoagulation were followed as the control group. The remaining 29 eyes of 24 patients comprised the study group. Argon green laser photocoagulation was performed on 9 eyes, dye-yellow laser photocoagulation was performed on 12 eyes, and dye-orange laser photocoagulation was performed on 8 eyes. Mean follow-up was 4.8 years (range, 1-7 years).
RESULTS: In the group that received laser treatment, duration of the serous detachment was shorter (P < 0.0001) and final best-corrected visual acuity (BCVA) was better (P = 0.006) than those of the control group. Although none of the eyes in the laser photocoagulation group had a recurrence, seven eyes in the control group had one or more recurrences during the mean follow-up period of 4.8 years (P = 0.0003). Although the duration of the serous detachment was shorter in the dye-yellow laser photocoagulation subgroup than in the argon green laser treatment subgroup (P = 0.01), there were no other differences between the laser photocoagulation subgroups with respect to the duration of the serous detachments or the final BCVA.
CONCLUSION: Direct laser photocoagulation of the leakage site(s) for CSR that persists for 4 months is safe and effective to shorten the duration of the serous detachment, to improve final BCVA, and to decrease the incidence of recurrence.

PMID 9111253
Lawrence A Yannuzzi, Jason S Slakter, Nicole E Gross, Richard F Spaide, Danielle L L Costa, Sheau J Huang, James M Klancnik, Alexander Aizman
Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study.
Retina. 2003 Jun;23(3):288-98.
Abstract/Text BACKGROUND: Most patients with central serous chorioretinopathy (CSC) have spontaneous resolution of exudative macular detachments and a good visual prognosis. Patients with CSC have a primary choroidal hyperpermeability problem evident as multifocal areas of hyperpermeability during indocyanine green (ICG) angiography. A small percentage of patients develop chronic or progressive disease with widespread decompensation of the retinal pigment epithelium and severe vision loss. There is no known treatment for this variant of the disorder.
PURPOSE: To study ICG-guided photodynamic therapy (PDT) with verteporfin as a potential treatment for patients with chronic CSC.
METHODS: Twenty eyes of 15 patients were studied with fluorescein angiography, optical coherence tomography, and ICG angiography to diagnose the maculopathy, monitor the detachments, and localize the choroidal hyperpermeability of the disorder. PDT with ICG guidance was applied to areas of choroidal hyperpermeability, and the patients were observed to determine the anatomic and functional outcomes.
RESULTS: Photodynamic therapy guided by ICG was associated with complete resolution of exudative macular detachments in 12 patients and incomplete resolution in the remaining eight eyes. The vision improved in six eyes and remained unchanged in 14 eyes during a mean follow-up of 6.8 months. Six weeks after treatment, the mean visual acuity improved by 0.55 lines, an amount that was marginally significant. There was a significant inverse correlation between the baseline visual acuity and the amount of improvement in acuity at 6 weeks. No patient had any treatment-related side effects.
CONCLUSIONS: Indocyanine green angiography-guided PDT with verteporfin seems to aid in the resolution of exudative detachments in patients with chronic CSC. This treatment was associated with a rapid reduction in subretinal fluid and improvement in visual acuity. Although the follow-up time and number of patients in this pilot study were limited, the encouraging results and lack of complications suggest that further study is indicated.

PMID 12824827
Wai-Man Chan, Timothy Y Y Lai, Ricky Y K Lai, David T L Liu, Dennis S C Lam
Half-dose verteporfin photodynamic therapy for acute central serous chorioretinopathy: one-year results of a randomized controlled trial.
Ophthalmology. 2008 Oct;115(10):1756-65. doi: 10.1016/j.ophtha.2008.04.014. Epub 2008 Jun 5.
Abstract/Text OBJECTIVE: To evaluate the efficacy of photodynamic therapy (PDT) with half-dose verteporfin for treating acute central serous chorioretinopathy (CSC).
DESIGN: Prospective, double-masked, placebo-controlled, randomized clinical trial.
PARTICIPANTS AND CONTROLS: Sixty-three eyes of 63 patients with acute symptomatic CSC of 3 months' duration or less were recruited. Forty-three eyes were randomized to indocyanine green angiography (ICGA)-guided PDT with half-dose (3 mg/m(2)) verteporfin and 21 eyes were randomized to placebo.
INTERVENTION: Patients in the verteporfin group received an infusion of half-dose verteporfin over 8 minutes, followed by ICGA-guided PDT 10 minutes from the start of infusion. Laser was applied for 83 seconds covering the choroidal abnormalities observed in ICGA, with a maximum laser spot size of 4500 mum.
MAIN OUTCOME MEASURES: The primary outcome measure was the proportion of eyes with absence of subretinal fluid at the macula at 12 months. Secondary outcome measures included changes in mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), subjective symptoms, optical coherence tomography (OCT) results, central foveal thickness (CFT), and angiographic findings during the 12-month study period.
RESULTS: Thirty-nine patients in the verteporfin group and 19 patients in the placebo group completed 12 months of follow-up. Thirty-seven (94.9%) eyes in the verteporfin group compared with 11 (57.9%) eyes in the placebo group showed absence of subretinal fluid at the macula at 12 months (P = 0.001). The mean logMAR BCVA at 12 months was significantly better in the verteporfin group compared with the placebo group: -0.05 and 0.05, respectively (P = 0.008). All 39 (100%) verteporfin-treated eyes had stable or improved vision, compared with 15 (78.9%) eyes in the placebo group (P = 0.009). The mean OCT CFT for the verteporfin group also was significantly lower compared with the placebo group at 12 months (P = 0.001). No ocular or systemic adverse event was encountered in the study.
CONCLUSIONS: Photodynamic therapy with half-dose verteporfin is effective in treating acute symptomatic CSC, resulting in a higher proportion of patients with absence of exudative macular detachment and better visual acuity compared with placebo.

PMID 18538401
Kyoko Fujita, Yutaka Imamura, Kei Shinoda, Celso Soiti Matsumoto, Yoshihiro Mizutani, Kouhei Hashizume, Atsushi Mizota, Mitsuko Yuzawa
One-year outcomes with half-dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy.
Ophthalmology. 2015 Mar;122(3):555-61. doi: 10.1016/j.ophtha.2014.09.034. Epub 2014 Nov 18.
Abstract/Text PURPOSE: To assess the 1-year outcome of half-dose verteporfin photodynamic therapy (PDT) for patients with chronic central serous chorioretinopathy (CSC).
DESIGN: Retrospective, interventional case series with no controls.
PARTICIPANTS: A total of 204 eyes of 204 patients with chronic CSC were studied.
METHODS: Fluorescein angiography (FA) and indocyanine green angiography (ICGA) were performed before PDT. The best-corrected visual acuities (BCVAs) were measured and optical coherence tomography was performed before and 1, 3, 6, 9, and 12 months after PDT.
MAIN OUTCOME MEASURES: The main outcome measures were the resolution of the serous retinal detachment (SRD), changes in BCVA, and ocular and systemic complications at 12 months.
RESULTS: A total of 182 of 204 eyes (89.2%) had complete resolution of the SRD at 12 months after the PDT. Eleven eyes (5.4%) had a persistent SRD throughout the follow-up period, and 12 eyes (5.9%) had a recurrence of the SRD after an earlier resolution. One of the 12 eyes had a spontaneous resolution of the SRD 6 months after PDT. The mean±standard deviation BCVA in logarithm of the minimum angle of resolution (logMAR) units significantly improved from 0.11±0.25 before to 0.07±0.23 at 1 month, 0.02±0.23 at 3 months, 0.01±0.23 at 6 months, 0.00±0.24 at 9 months, and -0.01±0.22 at 12 months (P<0.0001). The eyes with an SRD at 12 months were more likely to have an intermediate hyperfluorescence on ICGA (chi-square test, P<0.001) and poorer BCVA before the half-dose PDT (Student t test, P=0.04) than those without SRD at 12 months. None of the patients developed any systemic complications or experienced any severe visual reduction after the half-dose PDT. However, polypoidal lesion appeared in 1 eye 8 months after the PDT.
CONCLUSIONS: Half-dose PDT is an effective and safe method to treat eyes with chronic CSC with an SRD. The CSC resolved and the BCVA improved significantly after PDT. Half-dose PDT was less effective for cases without intense hyperpermeability on ICGA and those with lower BCVA before the PDT.

Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
PMID 25444637
Ichiro Maruko, Tomohiro Iida, Yukinori Sugano, Minoru Furuta, Tetsuju Sekiryu
One-year choroidal thickness results after photodynamic therapy for central serous chorioretinopathy.
Retina. 2011 Oct;31(9):1921-7. doi: 10.1097/IAE.0b013e31822bf6b1.
Abstract/Text PURPOSE: To retrospectively evaluate choroidal thickness 1 year after photodynamic therapy in eyes with central serous chorioretinopathy using optical coherence tomography.
METHODS: Central serous chorioretinopathy was diagnosed using fluorescein angiography, and indocyanine green angiography was used to evaluate choroidal vascular hyperpermeability. We measured the subfoveal choroidal thickness using enhanced depth imaging optical coherence tomography.
RESULTS: Thirteen eyes (13 patients; average age, 56.8 years) with central serous chorioretinopathy were observed 1 year after half-dose photodynamic therapy with verteporfin. The mean subfoveal choroidal thickness decreased significantly from 397 ± 108 μm at baseline to 323 ± 120 μm at 1 month, 312 ± 117 μm at 3 months, 317 ± 117 μm at 6 months, and 321 ± 122 μm at 1 year (P < 0.01, for each comparison with baseline). However, the subfoveal choroid thickness significantly increased 2 days after photodynamic therapy to 441 ± 120 (P < 0.01) compared with baseline. Central serous chorioretinopathy did not recur in any patient. Indocyanine green angiography images at 3 months showed less choroidal vascular hyperpermeability compared with baseline.
CONCLUSION: Half-dose photodynamic therapy for central serous chorioretinopathy resulted in thinner subfoveal choroidal thickness 1 month after treatment, decreased the choroidal vascular hyperpermeability, and maintained the remission for 1 year. Enhanced depth imaging optical coherence tomography was helpful for monitoring the pathophysiologic choroidal changes in central serous chorioretinopathy.

PMID 21878850

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