Background: To evaluate risk factors for the recurrence of serous macular detachment in untreated patients with central serous chorioretinopathy (CSC). Methods: Retrospective review of untreated CSC patients with a follow-up of ≧3 years. Patient demographics, visual outcome and risk factors for the recurrence of CSC were analyzed. Results: Seventy-three eyes of 73 patients were included, and the mean age was 44.6 years. At baseline, the mean logMAR best corrected visual acuity (BCVA) was 0.30. After a mean follow-up of 72 months, the mean final logMAR BCVA was 0.32. The difference between the final and baseline BCVAs was not statistically significant (p = 0.79). At the last follow-up, 9 (12.3%) eyes showed improved vision of ≧2 lines, and 12 (16.4%) showed a worsening of ≧2 lines. During follow-up, 38 (52.1%) patients experienced ≧1 episode of CSC recurrence. Multivariate Cox regression analysis showed that patients with a history of psychiatric illness (adjustment disorder and depression) were associated with an increased risk of CSC recurrence (hazard ratio = 3.5, p = 0.011). Conclusions: The long-term visual prognosis of CSC is fair without treatment, and a significant proportion of patients developed recurrence of CSC. A history of psychiatric illness is associated with an increased risk of CSC recurrence.

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Low-dose (2 mg) triamcinolone acetonide intravitreal injection as an adjunct to vitrectomy and silicone oil tamponade in treating proliferative vitreoretinopathy (grade C or D) appears to be effective and safe.

To evaluate the correlation between functional and anatomical assessments with multifocal electroretinography (mfERG) and optical coherence tomography (OCT) in patients with acute central serous chorioretinopathy (CSC). Thirty-four eyes of 34 patients with acute CSC underwent mfERG and OCT examinations. First-order mfERG N1 and P1 response amplitudes and latencies were analyzed.OCT parameters measured included central subretinal fluid (SRF) thickness, central retinal thickness, total central foveal thickness, vertical, and horizontal diameters of SRF, and macular volume. Correlation analyses were performed between best-corrected visual acuity (BCVA), mfERG parameters, and OCT measurements. Correlation analysis showed that logMAR BCVA was significantly correlated with mfERG N1 amplitudes of rings 1 and 2 (P = 0.006), N1 latency of ring 4 (P = 0.012), and P1 latency of ring 1 (P = 0.036). No significant correlation was observed between logMAR BCVA and any of the OCT measurements. For the correlation between mfERG parameters and OCT measurements, mfERG N1 and P1 latencies of the paracentral rings were significantly correlated with the central SRF thickness (P < or = 0.024), diameters of the SRF (P < or = 0.018), and macular volume (P < or = 0.030). MfERG responses but not OCT measurements correlated with logMAR BCVA in patients with acute CSC. The amount of SRF nonetheless correlated with the mfERG N1 and P1 latencies of the paracentral rings, suggesting that impairment in the conduction of electrical responses in the paracentral macula is proportional to the severity of serous macular detachment in CSC. MfERG and OCT can complement each other in the functional and anatomical assessments in CSC.

Purpose: To report a case of choroidal excavation accompanied by Vogt-Koyanagi-Harada disease (VKH). Methods: A 54-year-old Japanese woman who was complaining of bilateral blurring of vision associated with headache underwent optical coherence tomography (OCT), fluorescein angiography, and indocyanine green angiography as well as a routine ophthalmological examination. Results: Fundoscopy showed papilloedema and serous retinal detachment in both eyes. Fluorescein angiography detected bilateral multifocal leakage with pooling of dye in the subretinal space. Indocyanine green angiography showed patches of hyperfluorescence and hypofluorescent spots bilaterally. A diagnosis of VKH was reached soon afterwards. OCT of the left eye revealed the presence of a unilateral choroidal excavation under the fovea and subretinal fibrin over the site of the excavation. Treatment successfully resolved VKH symptoms with gradual resolution of subretinal fibrin and fluid; however, the choroidal excavation remained. Conclusions: This case is the first report of choroidal excavation associated with VKH. Our results suggest that choroidal excavation can be induced by choroidal inflammation caused by VKH.

In eyes with idiopathic macular hole, reductions in first-order mfERG responses are limited to the central macula, while the second-order mfERG response abnormalities involved more of the peripheral macular region. OCT measurement of apical and not the basal diameter of macular hole correlated with the severity of retinal dysfunction assessed by both mfERG and visual acuity.

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We enjoyed reading the article from Guvendag Guven et al.(1) who looked into angle closure glaucoma (ACG) in pregnancy and its relationship with the drug ritodrine. We appreciate their efforts and here we would like to share our alternative ideas regarding the suggestion that ritodrine was one of the causes of ACG. Moreover, we would like to discuss other modalities of managing ACG in pregnant patients.Ritodrine is a selective beta-2-adrenoceptor agonist. In the human eye, beta receptors are mostly located in the ciliary process epithelium, followed by the iris sphincter. The iris dilator muscles contain mainly alpha receptors (2,3). Therefore it might be unlikely that the attack was related to ritodrine alone. Previous reports of ACG related to beta-2adrenergic agonist use, e.g. salbutamol, appeared to require a coexisting administration of a parasympathetic antagonist, such as ipratropium bromide. It was postulated that nebulized salbutamol caused an increase in intraocular pressure (IOP) by corneal absorption, with ciliary body beta-2-adrenergic receptor stimulation promoting aqueous humor secretion. Angle closure was exacerbated by pupil dilation caused by the parasympathetic inhibitory effect of ipratropium (4). We propose that further study would be needed to delineate the magnitude of effect of ritodrine alone on angle configuration.We agree with the authors that stress response and hospitalization in a dark room might cause pupil dilatation. These have been proposed as mechanisms of precipitating an ACG, and may indeed be partly responsible for the ACG attack in this pregnant woman, thus confounding the effects of ritodrine, if any.The authors chose glaucoma medications as their initial tools of management. We believe that one might need to be cautious with their use even though the pregnancy has reached the third trimester. The use of topical timolol has been reported to be associated with fetal cardiac arrhythmia (5). A newborn infant was reported to have developed metabolic acidosis, hypocalcemia, and hypomagnesemia because of maternal use of acetazolamide, pilocarpine, and timolol in pregnancy (6). Increasingly, glaucomatologists are using laser peripheral iridotomy (LPI) and argon laser peripheral iridoplasty (ALPI) as the initial management strategy as an alternative to glaucoma medications. In our experience with ACG attacks, the severity of corneal edema in the first few hours of the attack might not preclude a successful LPI. Even if LPI was not possible initially due to corneal edema, we could consider ALPI as the primary treatment modality, followed by second stage LPI (7). This obviates the need to use glaucoma medications with the potential adverse effects to the fetus.The authors mentioned certain factors that decrease the IOP in advancing pregnancy and ascribed them as protective mechanisms for ACG. However, we think that this might be true only for open angle glaucoma (OAG). ACG is a result of pupil block and angle closure, which has a typical IOP of around 50 Á/ 60 mmHg or above. This wil...