Purpose: To study the potential of dark-field scanning laser ophthalmoscopy (DF-SLO) for the prediction of central serous chorioretinopathy (CSC) responsiveness to laser therapy. Methods: Fifty-two eyes of 52 patients (44 males and 8 females, mean age of 45.4 ± 8.8 years) newly diagnosed with CSC were included in this prospective cohort study. At baseline, all patients received multimodal imaging including DF-SLO and then were observed until resolution of subretinal fluid or, in nonresolving cases, treated with laser therapy. At the end of the follow-up, each case was categorized as either self-resolving, resolving after laser treatment, or nonresolving after laser treatment. Presence of granular retinal pigment epithelium (RPE) changes and lucency of RPE/choroid complex at the leak on DF-SLO images were used by two masked graders to identify cases nonresolving after laser treatment. Results: Using DF-SLO images, the masked grader correctly classified 45 of 52 (86.5%) CSC cases. Kappa value for the classification by two graders was 0.95 (95% confidential interval [CI] 0.85–1.0). The area under the receiver operating curve, sensitivity, and specificity of DF-SLO in identifying nonresolving after laser treatment cases were 0.92 (95% CI: 0.79–0.98), 86.7% (95% CI: 59.5%–98.3%), and 96.6% (95% CI: 82.2%–99.2%), respectively. Conclusion: DF-SLO may be a useful technique in prognostication of response to laser treatment in newly diagnosed CSC.

Purpose To evaluate the follow up and treatment outcome of central serous chorioretinopathy (CSCR) based on the new multimodal imaging-based classification and identify the predictors for anatomic and visual outcome. Methods Retrospective, multicentric study on 95 eyes diagnosed with CSCR and a follow up of at least 12 months were included. Eyes with macular neovascularization, atypical CSCR or any other disease were excluded. Results At the baseline, observation was advised to 70% eyes with simple CSCR whereas photodynamic therapy (PDT) was performed in 49% eyes with complex CSCR. Over the follow up, decrease in CMT was significantly higher in simple CSCR as compared to complex CSCR ( P = 0.008) and the recurrences were significantly more in eyes with lower CMT at baseline ( P = 0.0002). Median time of resolution of SRF was 3 months and 6 months in simple and complex CSCR respectively ( P = 0.09). For the 12 months follow up, the median fluid free period was greater ( P = 0.03) while number of interventions performed was lesser in eyes with simple CSCR as compared to complex CSCR ( P = 0.006). Multiple regression analysis showed baseline best corrected visual acuity (BCVA) and baseline persistent SRF to be significantly predictive of BCVA and persistent SRF at 12 months ( P < 0.0001, 0.04) respectively. Conclusions Complex CSCR more often required PDT, was associated with shorter fluid free interval and longer time for SRF resolution. Baseline BCVA and persistent SRF were predictive of final visual and anatomical outcome. The new multimodal imaging based classification is helpful in establishing objective criteria for planning treatment approaches for CSCR.

AIM: To analyze the anatomical and functional outcomes in the inferior recurrences of rhegmatogenous retinal detachment (RRD) depending on the surgical approach. METHODS: Eighty-one eyes of 81 patients (47 males and 34 females with a mean age of 54.8±14.1y) who demonstrated at least one inferior recurrence of RRD were included in this retrospective study. All patients were categorized as having received either circular scleral buckling (SB), pars plana vitrectomy (PPV), a combination of SB and PPV (SB+PPV), PPV with retinotomy (PPV+RT), or PPV+RT and short-term postoperative perfluorocarbon liquid tamponade (PPV+RT+pPFCL). All cases were followed up until successful retinal reattachment or third recurrence. The primary outcome measures were the achievement of the surgical goal without recurrence of RRD and best-corrected visual acuity (BCVA). RESULTS: After the treatment of the first recurrence, the recurrence rate in the PPV+SB group was statistically significantly lower than that of the PPV (P=0.0012), PPV+RT (P=0.028), or PPV+RT+pPFCL (P=0.047) group. There was no statistically significant difference between PPV+SB, PPV+RT, and PPV+RT+pPFCL groups in the recurrence rate after treatment of the second recurrence (42 eyes). However, there was a statistically significant (P=0.016) trend towards a decrease of recurrence rate after PPV+RT+pPFCL. There was no statistically significant improvement of BCVA in either study group (P>0.05) after both first and second recurrence surgery. The mean time follow-up was 109.0±91.0d before the first recurrence and 210.0±186.6d between previous surgery at second recurrence. CONCLUSION: Patients with first inferior recurrence of RRD may benefit from SB as an adjunct to PPV. RT and short-term pPFCL tamponade in the second recurrence may allow better anatomical outcomes, however, without functional improvement.

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Background Subthreshold microsecond pulsing laser is an increasingly common treatment approach for central serous chorioretinopathy. However, there is no literature available on the safety of microsecond laser using different fluence settings in this disease. While many publications can be obtained from conventional microsecond pulsing lasers, few parameter sets are published with the navigated microsecond pulsing laser. Therefore, this study aims to investigate the safety of different parameter sets in subthreshold microsecond pulsing laser treatments. Methods In this retrospective chart review, consecutive patients with central serous chorioretinopathy (> 3 months duration of symptoms) treated with navigated subthreshold microsecond pulsing laser and a follow up of at least five months after microsecond laser application were included. For each patient, the treatment parameters, plan layout, and adverse events related to laser were evaluated. Secondary outcomes included best-corrected visual acuity and anatomical improvements (central retinal thickness). Results One hundred and one eyes were included in the observation and followed for a mean of 10 months (range 5–36). Although a larger range of parameter sets and fluence settings have been used, no patient demonstrated adverse events from navigated microsecond pulsing laser. While 88% of the cases demonstrated stability, 13 cases lost five or more letters due to the persistence of the subretinal fluid. In mean, a best-corrected visual acuity improvement of 0.07logMar (± 0.2) was seen (p = 0.02). In 51% of the patients, a statistically significant improvement of the central retinal thickness was noted at the last follow-up with a mean thickness reduction of 70 µm (± 143) (p < 0.01). Conclusion In conclusion, none of the used parameter sets lead to tissue damage (when using a cautious titration) and, in summary, lead to an improvement in subretinal fluid and improvement in visual acuity. However, further prospective studies are needed to correctly identify the dependency of the treatment strategy on the outcome criteria.

SIGNIFICANCE: This is a case-control study showing changes in accommodation in eyes with acute central serous chorioretinopathy. We found that decreased accommodative amplitude in the affected eyes may indicate suppression of parasympathetic activity in those eyes as one of the pathophysiological mechanisms controlling choroidal thickness and perfusion.PURPOSE: This study aimed to evaluate the changes of accommodation in patients with acute central serous chorioretinopathy.METHODS: Patients with unilateral central serous chorioretinopathy, with and without foveal involvement, as well as patients after resolution of subretinal fluid and healthy age-matched controls were included. Accommodative amplitude was measured and compared between eyes with active or resolved central serous chorioretinopathy, fellow eyes of active central serous chorioretinopathy individuals, and eyes of controls. Correlation between accommodative amplitude and ocular and demographic parameters was calculated.RESULTS: Nineteen acute central serous chorioretinopathy patients (16 males and 3 females, 38.1 ± 5.1 years) and 17 age-matched controls (13 males and 4 females, 37.2 ± 5.4 years) were included. Accommodative amplitude in the study eyes of central serous chorioretinopathy patients was lower than that in the fellow unaffected eyes (1.25 ± 1.0 and 2.54 ± 0.94 D, respectively; P = .002) or in the eyes of healthy controls (2.41 ± 1.38 D, P = .002). In central serous chorioretinopathy eyes, after resolution of subretinal fluid or without foveal involvement, the median accommodative amplitude was lower than that in fellow eyes (1.6 [95% confidence interval, 0.83 to 1.75] and 2.7 D [95% confidence interval, 1.23 to 3.61], respectively; P = .004). No correlation was found between accommodative amplitude in affected central serous chorioretinopathy eyes and different parameters, except for age (r = −0.47, P = .04).CONCLUSIONS: Acute central serous chorioretinopathy is associated with a substantial reduction of accommodative amplitude.