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      Short Term Presence of Subretinal Fluid in Central Serous Chorioretinopathy Affects Retinal Thickness and Function

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          Abstract

          Background: Acute central serous chorioretinopathy (CSCR), with subretinal fluid (SRF) resolving spontaneously within a few months from disease onset, has been considered as a benign and self-limiting disease for many years. This study sought to discover if a short presence of SRF can result in morphological and functional damage to the retina. Materials and methods: The study included patients treated by subthreshold diode micropulse laser (SDM) application for acute CSCR at the Dobry Wzrok Ophthalmological Clinic between January 2018 and November 2019. Inclusion criteria were: first episode of CSCR; duration of symptoms of two months or less; complete resolution of subretinal fluid (SRF) after a single session of SDM; and a lack of any retinal pathology, previous CSCR episode, significant anisometropia or amblyopia in the collateral eye. Fifteen patients fulfilled the inclusion criteria, including 13 males and two females aged 42.3 ± 9.5 years. The mean duration of symptoms before treatment was 4.7 ± 1.3 weeks on average. Baseline and follow-up examinations were performed in both the affected and collateral eyes and included best-corrected visual acuity (BCVA); spectral-domain optical coherent tomography measurements such as central retinal thickness (CRT) and minimal foveal thickness (MFT) (at the follow-up visit only); fluorescein angiography (at presentation only) and fundus autofluorescence. The first follow-up visit, when the total resolution of SRF was noted, was conducted between 8 and 12 weeks after SDM. Results: Resolved CSCR eyes had significantly poorer BCVA, CRT, and MFT findings in comparison with healthy collateral eyes (respectively, 0.11 +/− 0.1 vs. 0.01 +/− 0.04 logMAR; 238.80 +/− 23.39 vs. 264.87 +/− 21.22 µm and 178.93 +/− 16.88 vs. 199.47 +/− 17.87 µm) despite the short period of CSCR duration (maximum of 14 ± 2.15 weeks on average). Conclusion: Short presence of SRF typical for acute CSCR can affect retinal function and morphology resulting in poorer visual outcome.

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          Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis.

          Central serous chorioretinopathy (CSCR) is a major cause of vision threat among middle-aged male individuals. Multimodal imaging led to the description of a wide range of CSCR manifestations, and highlighted the contribution of the choroid and pigment epithelium in CSCR pathogenesis. However, the exact molecular mechanisms of CSCR have remained uncertain. The aim of this review is to recapitulate the clinical understanding of CSCR, with an emphasis on the most recent findings on epidemiology, risk factors, clinical and imaging diagnosis, and treatments options. It also gives an overview of the novel mineralocorticoid pathway hypothesis, from animal data to clinical evidences of the biological efficacy of oral mineralocorticoid antagonists in acute and chronic CSCR patients. In rodents, activation of the mineralocorticoid pathway in ocular cells either by intravitreous injection of its specific ligand, aldosterone, or by over-expression of the receptor specifically in the vascular endothelium, induced ocular phenotypes carrying many features of acute CSCR. Molecular mechanisms include expression of the calcium-dependent potassium channel (KCa2.3) in the endothelium of choroidal vessels, inducing subsequent vasodilation. Inappropriate or over-activation of the mineralocorticoid receptor in ocular cells and other tissues (such as brain, vessels) could link CSCR with the known co-morbidities observed in CSCR patients, including hypertension, coronary disease and psychological stress.
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            Central serous chorioretinopathy: update on pathophysiology and treatment.

            Recent technological advances--new pathophysiological insights, new imaging techniques for diagnosis and management, and new treatments--have led to an improved understanding of central serous chorioretinopathy (CSC). The primary role of the choroid has become more widely accepted with widespread use of indocyanine green angiography. Optical coherence tomography (OCT), and particularly enhanced depth imaging OCT, demonstrate a thickened and engorged choroid. Adaptive optics, fundus autofluorescence, multifocal electroretinography, microperimetry, and contrast sensitivity testing reveal that patients with even a mild course suffer previously undetected anatomic and functional loss. Although focal laser and photodynamic therapy are the current standard of care for persistent subretinal fluid in CSC, they are not appropriate in all cases, and the optimal timing of intervention remains unclear. Published by Elsevier Inc.
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              Central serous chorioretinopathy: Towards an evidence-based treatment guideline

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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                26 October 2020
                November 2020
                : 9
                : 11
                : 3429
                Affiliations
                [1 ]Dobry Wzrok Ophthalmological Clinic, Kliniczna 1B/2, 80-402 Gdansk, Poland; jaszczuk.amt@ 123456gmail.com
                [2 ]Department of Ophthalmology, University of Warmia and Mazury, 10-719 Olsztyn, Poland; ae.grzybowski@ 123456gmail.com
                [3 ]Institute for Research in Ophthalmology, 60-554 Poznan, Poland
                Author notes
                [* ]Correspondence: maciej@ 123456gawecki.com ; Tel.: +48-501-788-654
                Author information
                https://orcid.org/0000-0003-2901-0248
                https://orcid.org/0000-0002-3724-2391
                Article
                jcm-09-03429
                10.3390/jcm9113429
                7692782
                33114519
                3e1a9c3b-907f-4873-9e89-2906cb53bf4a
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 16 September 2020
                : 23 October 2020
                Categories
                Article

                central serous chorioretinopathy,subthreshold diode micropulse,photodynamic therapy,spectral-domain optical coherence tomography

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