First Author: Y.Kirilova BULGARIA
Co Author(s): P. Vassileva B. Vladimirova
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Chronic central chorioretinopathy (CSC) is a disorder characterized by serous detachment of the neurosensory retina over an area of leakage from the choriocapillaris through the retinal pigment epithelium (RPE). It is usually self–limiting disease but chronic CSC may occur with disfunction of the RPE and visual deterioration. CSC may be complicated by choroidal neovascularisation (CNV). Recent studies have shown a beneficial effect of anti–VEGF treatment in reduction of subretinal fluid and improvement of visual acuity. We demonstrate our results from clinical study of referred patients with chronic CSC treated with intravitreal anti-VEGF drugs at our tertiary hospital.
University Eye Hospital “Prof. Pashev”
All patients underwent routine ophthalmological examination with fluorescein angiography (FA), optic coherent tomography (OCT), standard automated perimetry (SAP) at each visit. Additionally in some patients serology for H. Pylori and herpetic infection was performed. Conservative treatment consisted of systemic Acetazolamide, Spironolactone, Acetylsalicylic acid, non–steroidal anti-inflammatory drugs (NSAID) and anxiolytics. In persistance of subretinal fluid and presence of diffuse damage with acute vascular leakage (suspicious of CNV) intravitreal application of anti-VEGF drugs (bevacizumab and Aflibercept) was undertaken. Both drugs were applied intravitreally: under sterile conditions in operating room were injected in the superior temporal quadrant with a 30-gauge needle (respectively bevacizumab - 1.25 mg (0.05 ml) or 2 mg Aflibercept). After 2-3 loading doses injections were delivered as needed (PRN) based on persistant subretinal fluid on OCT. Follow up period was from 4 years to 4 months. Presence of subretinal fluid and central foveol thickness wre at documented at each visit. Potential causes for CSC development, and risk factors for chronic and recurrent course of disease were evaluated.
Altogether 52 patients with CSC had been examined and treated for a period of 4 years. Male consisted 90% of cases, with age range 24-52 (majority between 30-45). With first attack of CSC were 15 patients referred to us because of prolonged fluid resorbtion (> 8 weeks). The majority were diagnosed with chronic recurrent course of the disease. Main symptoms were blurring of vision, metamorphopsia, chromatopsia, central scotoma, increasing hyperopia. In more than half of patients the recurrence occurred within one year from the initial episode. Main causes for disease were stress: death in the family, divorce, as well as type A personality, excessive smoking, alcohol use, systemic hypertension, strenuous physical activity, etc. Recurrence was provoked in 12 patients after treatment with parabulbar steroids elsewhere. In 27 patients with delayed fluid resorbtion and symptoms of visual distortion anti-VEGF therapy led to fast anatomic improvement with visual gain, maintained for a period of 2-3 months. The average number of injections was five (2 to 8) applications. Recurrences after complete fluid resorbtion post intravitreal therapy were observed in 12 patients during the period of 8-18 months. Re-injections demonstrated fast improvement with vision recovery.
CSC is still mysterious disease with no consensus on pathophysiology and successful treatment. FA and OCT are helpful in reaching to definite diagnosis, and for decision to start anti-VEGF treatment in patient with chronic recurrent CSC. The majority of patients demonstrated rapid visual improvement, and anti-VEGF therapy resulted in significant reduction in macular edema. For timely treatment of recurrent CSC attacks close follow up of visual acuity with OCT imaging of patients is mandatory.