Interventions for central serous chorioretinopathy: a network meta-analysis

Abstract

Background Central serous chorioretinopathy (CSC) is characterized by serous detachment of the neural retina with dysfunction of the choroid and retinal pigment epithelium (RPE). The effects on the retina are usually self limited, although some people are left with irreversible vision loss due to progressive and permanent photoreceptor damage or RPE atrophy. There have been a variety of interventions used in CSC, including, but not limited to, laser treatment, photodynamic therapy (PDT), and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents. However, it is not known whether these or other treatments offer significant advantages over observation or other interventions. At present there is no evidence-based consensus on the management of CSC. Due in large part to the propensity for CSC to resolve spontaneously or to follow a waxing and waning course, the most common initial approach to treatment is observation. It remains unclear whether this is the best approach with regard to safety and efficacy. Objectives To compare the relative effectiveness of interventions for central serous chorioretinopathy. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2015, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to February 2014), EMBASE (January 1980 to October 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 5 October 2015. Selection criteria Randomized controlled trials (RCTs) that compared any intervention for CSC with any other intervention for CSC or control. Data collection and analysis Two review authors independently selected studies and extracted data. We pooled data from all studies using a fixed-effect model. For interventions applied to the eye (i.e. not systemic interventions), we synthesized direct and indirect evidence in a network meta-analysis model. Main results We included 25 studies with 1098 participants (1098 eyes) and follow-up from 16 weeks to 12 years. Studies were conducted in Europe, North and South America, Middle East, and Asia. The trials were small (most trials enrolled fewer than 50 participants) and poorly reported; often it was unclear whether key aspects of the trial, such as allocation concealment, had been done. A substantial proportion of the trials were not masked. The studies considered a variety of treatments: anti-VEGF (ranibizumab, bevacizumab), PDT (full-dose, half-dose, 30%, low-fluence), laser treatment (argon, krypton and micropulse laser), beta-blockers, carbonic anhydrase inhibitors, Helicobactor pylori treatment, and nutritional supplements (Icaps, lutein); there were only one or two tri...

Review and update for central serous chorioretinopathy

“…Cochrane and authors who performed a systematic review commented that the overall level of evidence of previous published literatures regarding interventions for CSC was low or very low, and there was not enough evidence of which treatments are better [49]. Future research is still warranted to acquire high level of evidence.…”

“…To date, in acute CSC cases, focal photocoagulation can be an optional treatment if patients want rapid recovery for occupational causes, subretinal fluid persists more than 3-4 months, or the leaking site on FA is located more than 500 µm away from the fovea [19,39,49].…”

“…This laser can penetrate deeper tissue and approach within the foveal area. Studies have found the subthreshold diode micropulse laser showed similar therapeutic effect without complications compared to PDT [49,57]. But the set of clinical end points and dose titration are still problems to be solved.…”

“…Potent and longer pharmacologic effects have been expected because aflibercept has some characteristics compared to previous anti-VEGF drugs as followings : more potent VEGF receptor binding effect, the inhibition of additional VEGF subtype (VEGF-A) and placental growth factor (PIGF) as well as VEGF-A. A prospective pilot study suggested that intravitreal aflibercept was tolerated and safe for short-term period (6-month), but large controlled studies are necessary [49].…”

Ranibizumab in the Treatment of Chronic Central Serous Chorio Retinopathy

“…A variety of risk factors have been associated with CSC, including psychological stress, type A personality, hypertension, systemic steroid usage, pregnancy, and genetic susceptibility [3]. The exact pathogenesis of the disease is not fully understood, but abnormalities in the inner choroidal layers, such as venous congestion, ischemia and/or inflammation, lead to choroidal hyper permeability, secondary RPE damage, and serous detachment of the neural retina [3][4][5]. CSC is self-limited in the majority of patients, who usually retain excellent vision.…”