The mineralocorticoid receptor (MR) belongs to the nuclear receptor superfamily and is expressed in the retina and choroid. MR antagonist (MRA) has a long history of application in non-ophthalmic clinical practice. Various cellular and animal models indicated that inappropriate activation of MR participated in pathological angiogenesis, oxidative stress, inflammation, disturbance of ion/water homeostasis and neurodegenerative changes, while the application of MRA can reduce or reverse these pathological processes. After using MRA in central serous chorioretinopathy (CSC) patients, improved visual function, less subretinal fluid and reduced sub-foveal choroidal thickness were observed. Single nucleotide polymorphisms in MR and plasma aldosterone levels were significantly different between chronic CSC patients and CSC patients with spontaneous remission. Novel formulation for sustained-release MRA and the mechanisms involving inflammation may become the new focus of MR study. This review summarizes the research status of MR and MRA in order to provide a reference for future basic research and clinical treatment.
ObjectiveTo investigate the difference in microperimetry between acute and chronic central serous chorioretinopathy (CSC). MethodsCross-sectional cases study. A consecutive series of 208 patients (221 eyes) with CSC diagnosed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were enrolled in the study. The patients were divided into acute group (136 patients, 143 eyes) and chronic group (72 patients, 78 eyes) according to the duration and FFA. There were no statistical difference in sex (χ2=0.012, P=0.912) and mean age (t=-1.492, P=0.137) between two groups. All eyes received the examination of microperimetry and minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA). The mean retinal sensitivities (MS) and fixation rate in the central 2°(P1) and 4° (P2) were determined. ResultsThe mean value of logMAR BCVA in acute group and chronic group were 0.32±0.23 and 0.48±0.33, there was significant difference (Z=-3.353, P=0.001). In acute group and chronic group, the MS were (21.25±5.06) and (15.82±7.23) dB, P1 were (76.36±25.78)% and (55.01±32.34)%, P2 were (92.21±13.06)% and (79.83±23.11)%. There were statistical differences in MS (Z=-5.456, P < 0.001), P1 (Z=-4.629, P < 0.001) and P2 (Z=-4.265, P < 0.001) between two groups. In acute group, fixation was stable in 98 eyes (68.5%), relative unstable in 30 eyes (21.0%), unstable in 15 eyes (10.5%). In chronic group, fixation was stable in 30 eyes (38.5%), relative unstable in 22 eyes (28.2%), unstable in 26 eyes (33.3%). The difference of fixation between two groups was statistically significant (χ2=23.196, P < 0.001). ConclusionMS, fixation rate and fixation stability in chronic CSC eyes were all decreased compared with acute CSC eyes.
ObjectiveTo investigate the value of pattern reversal visual evoked potential (PRVEP) and sweep pattern visual evoked potential (SPVEP) in evaluating the visual function of patients with central serous chorioretinopathy (CSC).MethodsA retrospective clinical trial. A total of 38 monocular CSC patients were enrolled from March 2016 to December2018 in Heping Hospital Affiliated Changzhi Medical College. There were 34 males and 4 females with the mean age of 40.0±5.2 years. All patients undergo PRVEP detection in both the acute phase (disease course ≤ 3 months) and the clinical cure phase (disease course ≤ 6 months) using the German Roland electrophysiological RETIport system.The stimulation pattern adopted a checkerboard with 1.00° and 0.25° stimulation angles. The P100 peak amplitude and peak time were observed. SPVEP inspection equipment and methods were the same as PRVEP, and the spatial frequency was 1, 2, 4, 6, 8, 12, 16, 22 cpd. The difference between SPVEP vision and subjective vision were compared. The PRVEP peak amplitude, peak time and SPVEP amplitude and phase of the affected eye and the contralateral eye were compared by paired t test; the subjective vision and SPVEP visual acuity of the affected eye and the contralateral eye were compared by Wilcoxon paired rank test; Pearson product-moment correlation analysis was performed on SPVEP vision.ResultsIn the acute phase, the peak amplitude of P100 in the affected eye was lower than that in the contralateral eye (t=30.26, 13.59), and the peak time was prolonged (t=－19.89, －29.41). The difference was statistically significant (P＜0.01); in clinically cured period, the P100 peak amplitude (t=1.49, －0.57) and peak time (t=－1.22, －1.84) of the affected eye and the contralateral eye showed no significant difference (P＞0.05). In the acute phase, the difference in SPVEP amplitude between the affected eye and the contralateral eye with different spatial frequencies was statistically significant (P＜0.01); the phase of the affected eye and the contralateral eye were compared about the spatial frequency 1, 2, 4, 6, 8, 12 cpd, the difference was statistically significant (P＜0.01). During the clinical cure period, the spatial frequency of 6, 8, 12, 16 cpd, the SPVEP amplitude of the affected eye and the contralateral eye, the difference was statistically significant (P＜0.01); on the spatial frequency of 6, 8, 12 cpd, the phase of SPVEP was compared between the affected eye and the contralateral eye, the difference was statistically significant (P＜0.01). During the acute phase and the clinical cure phase, the SPVEP visual acuity of the affected eye was lower than that of the contralateral eye, and the difference was statistically significant (P＜0.01); during the acute phase and clinical cure phase, the SPVEP visual acuity of the affected eye and the contralateral eye were lower than the subjective vision. The difference was statistically significant (acute phase: Z =－5.38, －3.00; P＜0.001, 0.003; clinical cure phase: Z=－5.36, －5.38; P＜0.001,＜0.001). In the acute phase, the subjective visual acuity of the affected eye was positively correlated with SPVEP visual acuity (r=0.847, P＜0.001).ConclusionsPRVEP and SPVEP are useful for objectively assessing the visual function of the patients with CSC. Especially, the slight and potential visual impairment in CSC can been detected by SPVEP.
Central serous chorioretinitis (CSC) is a kind of choroidal retinopathy characterized by choroidal vasodilatation and hyperpermeability, retinal pigment epithelial cell lesions and serous retinal detachment. Various imaging examinations and imaging techniques have been used to describe the characteristics of the retina and choroid. Fundus manifestations of different types of CSC has both generality, and have their respective characteristic. The classification of CSC and its differentiation from other diseases including the choroidal neovascularization and pachychoroidopathy spectrum depending on varieties of fundus imaging techniques. The current study aims to review the various performance characteristics of CSC especially for chronic CSC with multimodal imaging and the current research progress, so as to provide reference for ophthalmologists to more comprehensively and intuitively understand the clinical characteristics and potential pathogenesis of CSC, and also to provide basis for multimodal imaging assisted diagnosis and treatment.
ObjectiveTo compare and observe the fundus imaging characteristics of eyes with glucocorticoid-related central serous chorioretinopathy (CSC). MethodsA retrospective clinical study. A total of 149 CSC patients with 166 eyes diagnosed at Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University from March 2021 to October 2024 were included in the study. The duration of the disease from the appearance of symptoms to treatment was less than 3 months. All affected eyes underwent best-corrected visual acuity (BCVA), fundus color photography, swept-source optical coherence tomography (SS-OCT), and fundus fluorescein angiography (FFA) examinations. BCVA was tested using an international standard vision chart and converted into logarithm of the minimum angle of resolution (logMAR) visual acuity for statistical analysis. The SS-OCT instrument measured subfoveal choroidal thickness (SFCT), central macular thickness (CMT), choroidal vascular volume (CVV), and the width and height of flat irregular pigment epithelial detachment (FIPED). FIPED, subretinal fibrin, and choroidal layer strong reflective spots were identified from SS-OCTA B-scan images; multiple leakages (leak points >3) were identified from FFA images. Based on the presence or absence of a clear history of glucocorticoid administration before the onset, patients were divided into glucocorticoid-related and non-glucocorticoid-related groups, comprising 41 patients with 53 eyes and 108 patients with 113 eyes, respectively. Clinical and fundus imaging characteristics of the two groups were compared. The comparison of quantitative data between the two groups was performed using independent samples t test or non-parametric independent samples Wilcoxon test; the comparison of qualitative data was performed using χ2 test. ResultsCompared with the non-glucocorticoid-related group, the glucocorticoid-related group had a smaller male-to-female ratio and a higher bilateral incidence, and the differences were statistically significant (χ2=4.925, 17.849; P＜0.05). The logMAR BCVA for the glucocorticoid-related and non-glucocorticoid-related groups were 0.45±0.33 and 0.21±0.21, respectively; SFCT were (644.43±131.91) and (507.26±121.79) μm; CMT were (389.51±233.45) and (362.59±140.85) μm; CVV were (4.44±1.07) and (3.67±0.82) mm3; FIPED incidence were 58.49% (31/58) and 20.35% (23/113), respectively; FIPED width and height were (1 122.01±533.98) and (742.90±388.79) μm, and (99.13±92.17) and (33.01±15.99) μm; subretinal fibrin were observed in 24 (45.28%, 24/53) and 15 (13.27%, 15/113) eyes; choroidal strong reflections were found in 38 (71.70%, 38/53) and 45 (39.82%, 45/113) eyes; multiple leak points were identified in 35 (66.03%, 35/53) and 40 (35.40%, 40/113) eyes, respectively. Compared with the non-glucocorticoid-related group, the glucocorticoid-related group had worse BCVA (Z=−4.984), thicker SFCT (t=6.586), larger CVV (t=5.160), higher incidence of FIPED (χ2=23.908), and greater width and height of FIPED (t=2.895, Z=−3.703). The glucocorticoid-related group also had a significantly increased incidence of subretinal fibrin, choroidal strong reflections, and multiple leak points, with all differences being statistically significant (χ2=20.565, 14.663, 13.675; P＜0.05); however, the comparison of CMT showed no statistically significant difference (Z=−0.651, P＞0.05). ConclusionCompared with non-glucocorticoid-related CSC, glucocorticoid-related CSC patients have poorer vision, are more likely to affect both eyes, show no gender bias; choroidal vascular dilation is more significant, and damage to the outer retina and retinal pigment epithelium is more severe.
ObjectiveTo observe the alterations of vascular density of superficial or deep retinal vascular plexus and the area of foveal avascular zone (FAZ) in acute central serous chorioretinopathy (CSC) eyes.MethodsThis is a retrospective study including 22 patients with unilateral CSC in acute stages. The patients were divided into group A (22 affected eyes) and B (22 fellow eyes). Twenty eyes of 20 age and gender-matched healthy volunteers (group C) were enrolled in this study. All subjects underwent optical coherence tomography (OCT) angiography examinations. The observation index included signal intensity of blood flow in choroidal capillary, vessel density and FAZ on the superficial capillary plexus (SCP) and deep capillary plexus (DCP).ResultsThe FAZ on DCP in group A was larger than that in group B and C (t=4.28, 5.57; P=0.00、0.00), but there was no significant difference of FAZ on SCP among 3 groups (t=0.28, 0.80; P=0.78, 0.43). The vessel density of SCP and DCP in group A and B were decreased than those in group C (t=−4.40, −2.91; P=0.00, 0.00). The type of choroidal capillaries dilation had two different manifestations by OCTA, which was circumscribed in 12 eyes and diffuse in 10 eyes. The subretinal fluid in macular area which presented dark chamber with weak reflection was observed by en-face OCT.ConclusionsThe vessel density of SCP and DCP in both eyes of acute CSC are lower than those in normal eyes. The FAZ of DCP in affected eyes of acute CSC is larger than that in fellow eyes and normal eyes. The blood flow of dilated choroidal capillary can be manifested as different morphological enhancements.
Central serous chorioretinopathy (CSC) is a common macular disease, mainly manifested as a plasma detachment of the macula. Photodynamic therapy (PDT) is an effective treatment for CSC, but with the shortage of the photosensitizer Verteporfin, the effective treatment of CSC has become a common concern for ophthalmologists. In this paper, based on the latest research results on the relationship between the changes in the thickness of the outer nuclear layer and the natural course of the disease and PDT therapy, we propose that patients with CSC should receive effective treatment as early as possible to prevent irreversible damage to visual function due to the thinning of the outer nuclear layer. In addition to PDT, it is recommended that laser photocoagulation or subthreshold micropulse laser treatment of the leaking spot should be considered first, depending on the presence of the leaking spot and its location in relation to the macula center. Anti-vascular endothelial growth factor therapy can be considered if there is a combination of choroidal neovascularization and/or polypoidal choroidal vasculopathy. Other treatments that have not been demonstrated to be effective in evidence-based medicine are not recommended.