Evolution of central serous chorioretinopathy to a severe and chronic disease phenotype

Session Details

Session Title: Free Paper Session 27: AMD VI

Session Date/Time: Sunday 10/09/2017 | 12:00-13:30

Paper Time: 12:00

Venue: Room 117

First Author: : D.Mohabati NETHERLANDS

Co Author(s): :    T. van Rijssen   G. Luyten   T. Missotten   C. Hoyng   S. Yzer   C. Boon              

Abstract Details

Purpose:

To investigate the first presentation and the disease progression in those cases of central serous chorioretinopathy (CSC) with chronic and severe disease characteristics

Setting:

Multicentre retrospective case series

Methods:

The medical records of patients with severe chronic CSC (cCSC) were retrospectively reviewed. A chronic case with persistent complaints for more than 6 months was considered severe when at least one of the following multimodal imaging criteria was present: cumulative areas of diffuse atrophic retinal pigment epithelium (RPE) alterations (DARA) larger than 5 optic disc diameters, at least 2 ‘hot spots’ of leakage or a large area of diffuse leakage on fluorescein angiography, or presence of posterior cystoid retinal degeneration (PCRD). Patients with drusen, signs of choroidal neovascularisations or other retinal abnormalities suggestive of alternative diagnoses were excluded. Outcome measures included multimodal imaging characteristics on optical coherence tomography and fluorescein angiography at first presentation and at final visit, number, and outcome of treatment

Results:

Out of 200 patients, 44 cases with severe cCSC could be included (55 eyes, average age: 50 years, 85% male). In this cohort, the average followed-up time was 37 months (range: 2-103). Best-corrected visual acuity was 69±20 ETDRS letters at disease onset, which increased to 73±22 ETDRS letters at final visit (p=0.118). Patients received on average 2.2 treatments (range: 0-9) (0-5 photodynamic therapy, 0-7 focal thermal laser, 0-5 bevacizumab injections, 0-2 micropulse diode laser), which resulted in a complete resolution of subretinal fluid (SRF) in 84% of the eyes at final visit. Presence of PCRD also reduced in this cohort from 40% to 18% at final visit (p<0.001). In 16 eyes (29%), CSC started with an acute-like episode with no signs of chronicity and with an initial spontaneous recovery. In 32 cases (58%), patients already showed pre-existing features of chronicity at first presentation such as DARA (64%), multiple ‘hot spots’ of leakage (58%), diffuse fluorescein leakage (42%), or PCRD (40%). Information about the first clinical presentation was lacking in 13% of cases

Conclusions:

Most severe cases of cCSC manifest with pre-existing characteristics of chronic retinal abnormalities, without a history of acute CSC or earlier disease episodes. This indicates that severe phenotypes of cCSC may have an alternative pathophysiology, and that there is not necessarily a continuum of CSC starting with a classic acute episode that gradually develops into a chronic and/or severe phenotype. Although multiple treatments were common, the therapeutic outcome was favorable even in this severe cCSC cohort in terms of complete resolution of SRF and PCRD

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