Corticosteroids and central serous chorioretinopathy

Carvalho-Recchia, Cynthia A.; Yannuzzi, Lawrence A.; Negrão, Silvana; Spaide, Richard F.; Freund, K. Bailey; Rodriguez-Coleman, Hanna; Lenharo, Marcio; Iida, Tomohiro

doi:10.1016/s0161-6420(02)01117-x

Cited by 272 publications

(197 citation statements)

References 28 publications

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“…Five patients with chronic CSCR served as a control group. The mean age of control patients was 44 years old (range, [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53], with the woman/man ratio being 1 : 4. The number of right and left eyes studied was also similar (3 right eyes and 2 left eyes).…”

Section: Resultsmentioning

confidence: 99%

“…Several factors have been implicated in the initiation and development of this retinal disorder, including immunological reactions, toxins, infections, and neuronal, hormonal, or circulatory processes. [34][35][36][37][38] One theory suggests that there is a focal increase in the choriocapillaris permeability that causes damage to the overlying RPE, and it is suspected that the disturbance would originate in an alteration of the mechanisms of choroidal blood flow autoregulation. 39 An alternative hypothesis postulates that CSCR is provoked by a dysfunction of the RPE that, in turn, causes a reverse in fluid movement in a chorioretinal direction, leading to subretinal space leakage and retinal detachment.…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic benefit of melatonin in refractory central serous chorioretinopathy

Gramajo

Marquez

Torres

et al. 2015

Eye

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Therapeutic benefit of melatonin in refractory central serous chorioretinopathy

Gramajo

Marquez

Torres

et al. 2015

Eye

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“…There are three theories on CSC pathogenesis: [1][2][3][4][5] (1) Disorder of the outer BRB, which leads to choroidal vascular hyperpermeability. 22 (2) Dysfunction of the RPE with a reversal of liquid transport.…”

Section: Discussionmentioning

confidence: 99%

“…2 CSC may be associated with extraocular conditions, including type A personality, organ transplantation, use of steroids, systemic lupus erythematous, Cushing's disease, and other systemic factors. [3][4][5][6] Blurred vision is perceived typically by patients as a dark spot in the center of the visual field with associated hyperopic shift, micropsia, and metamorphopsia, caused by anterior displacement of the retinal plane because of porous RPE. Typically, CSC resolves spontaneously within 3 months in more than 50% of patients, with recovery of visual acuity (VA) despite some pigment epithelium scarring.…”

Section: Introductionmentioning

confidence: 99%

Subthreshold diode laser micropulse photocoagulation versus intravitreal injections of bevacizumab in the treatment of central serous chorioretinopathy

Koss

Beger

Koch

2011

Eye

100

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Purpose To evaluate the treatment of central serous chorioretinopathy (CSC) with either subthreshold diode laser MicroPulse (SDM) or intravitreal bevacizumab (BCZ). Methods This comparative, controlled, prospective study conducted over a period of 10 months examined 52 eyes of 52 patients with (a) treatment with SDM at the active leakage site guided by fluorescein angiography (FA) (n ¼ 16 eyes), (b) intravitreal injection of 1.25 mg BCZ (n ¼ 10 eyes), or (c) observation (n ¼ 26 eyes). Outcome measures included changes in retinal pigment epithelium (RPE) leakage at FA, central macular thickness (CMT), best-corrected visual acuity (BCVA), and 101 macular perimetry. Results At the end of the study, there was 12.5% persistent leakage in the SDM, compared with 60% in the BCZ and 92% in the control group. Mean CMT decreased by 94 lm in the SDM, 38 lm in the BCZ, and did not change in the control group. Mean BCVA improved more than 6 early treatment of diabetic retinopathy study letters in the SDM, decreased by one letter in the BCZ, and by two letters in the control group. In the SDM group, mean perimetric deficit improved by 1.5 decibels and corrected lost variance by 2.6. In the BCZ, it improved by 0.6, and in the control group by 0.5. Retreatment was required in 7/16 eyes of the SDM group (43.75%), and in 5/10 eyes of the BCZ group (50%). Conclusion SDM photocoagulation was superior to intravitreal injections of 1.25 mg BCZ in the treatment of CSC, which resulted in enhanced visual acuity and macular perimetry.

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“…Notably, CSCR is the only choroiditis that is not only not improved, but actually worsened, by glucocorticoids (8,12). Systemic and/or locoregional glucocorticoids are known risk factors for CSCR, as are endogenous cortisol levels (8).…”

Section: Introductionmentioning

confidence: 99%

Mineralocorticoid receptor is involved in rat and human ocular chorioretinopathy

Zhao

Célérier²,

Bousquet³

et al. 2012

J. Clin. Invest.

335

296

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Central serous chorioretinopathy (CSCR) is a vision-threatening eye disease with no validated treatment and unknown pathogeny. In CSCR, dilation and leakage of choroid vessels underneath the retina cause subretinal fluid accumulation and retinal detachment. Because glucocorticoids induce and aggravate CSCR and are known to bind to the mineralocorticoid receptor (MR), CSCR may be related to inappropriate MR activation. Our aim was to assess the effect of MR activation on rat choroidal vasculature and translate the results to CSCR patients. Intravitreous injection of the glucocorticoid corticosterone in rat eyes induced choroidal enlargement. Aldosterone, a specific MR activator, elicited the same effect, producing choroid vessel dilation -and leakage. We identified an underlying mechanism of this effect: aldosterone upregulated the endothelial vasodilatory K channel KCa2.3. Its blockade prevented aldosterone-induced thickening. To translate these findings, we treated 2 patients with chronic nonresolved CSCR with oral eplerenone, a specific MR antagonist, for 5 weeks, and observed impressive and rapid resolution of retinal detachment and choroidal vasodilation as well as improved visual acuity. The benefit was maintained 5 months after eplerenone withdrawal. Our results identify MR signaling as a pathway controlling choroidal vascular bed relaxation and provide a pathogenic link with human CSCR, which suggests that blockade of MR could be used therapeutically to reverse choroid vasculopathy.

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Corticosteroids and central serous chorioretinopathy

Cited by 272 publications

References 28 publications

Therapeutic benefit of melatonin in refractory central serous chorioretinopathy

Therapeutic benefit of melatonin in refractory central serous chorioretinopathy

Subthreshold diode laser micropulse photocoagulation versus intravitreal injections of bevacizumab in the treatment of central serous chorioretinopathy

Mineralocorticoid receptor is involved in rat and human ocular chorioretinopathy

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