Mineralokortikoidrezeptorantagonisten als Therapieoption bei akuter und chronischer Chorioretinopathia centralis serosa

Maier, Mathias; Stumpfe, S.; Feucht, Nikolaus; Strobl, Patrick; Rath, V.; Lohmann, CP

doi:10.1007/s00347-013-3001-0

Cited by 21 publications

(5 citation statements)

References 35 publications

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“…This beneficial effect could be demonstrated by a significant reduction of central macular thickness, SRF level, and an improvement in visual acuity [34]. However, the effect might be difficult to distinguish from the spontaneous course [35]. SRT might have the potential to overcome all described treatment options; however, this needs to be proven in direct comparative trials.…”

Section: Discussionmentioning

confidence: 99%

Selective Retina Therapy in Acute and Chronic-Recurrent Central Serous Chorioretinopathy

Framme¹,

Walter²,

Berger³

et al. 2015

Ophthalmologica

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Purpose: Selective retina therapy (SRT), the confined laser heating and destruction of retinal pigment epithelial cells, has been shown to treat acute types of central serous chorioretinopathy (CSC) successfully without damaging the photoreceptors and thus avoiding laser-induced scotoma. However, a benefit of laser treatment for chronic forms of CSC is questionable. In this study, the efficacy of SRT by means of the previously used 1.7-µs and shorter 300-ns pulse duration was evaluated for both types of CSC, also considering re-treatment for nonresponders. Material and Methods: In a two-center trial, 26 patients were treated with SRT for acute (n = 10) and chronic-recurrent CSC (n = 16). All patients presented with subretinal fluid (SRF) in OCT and leakage in fluorescein angiography (FA). SRT was performed using a prototype SRT laser system (frequency-doubled Q-switched Nd:YLF-laser, wavelength 527 nm) with adjustable pulse duration. The following irradiation settings were used: a train of 30 laser pulses with a repetition rate of 100 Hz and pulse durations of 300 ns and 1.7 µs, pulse energy 120-200 µJ, retinal spot size 200 µm. Because SRT lesions are invisible, FA was always performed 1 h after treatment to demonstrate laser outcome (5-8 single spots in the area of leakage). In cases where energy was too low, as indicated by missing FA leakage, energy was adjusted and the patient re-treated immediately. Observation intervals were after 4 weeks and 3 months. In case of nonimprovement of the disease after 3 months, re-treatment was considered. Results: Of 10 patients with active CSC that presents focal leakage in FA, 5 had completely resolved fluid after 4 weeks and all 10 after 3 months. Mean visual acuity increased from 76.6 ETDRS letters to 85.0 ETDRS letters 3 months after SRT. Chronic-recurrent CSC was characterized by less severe SRF at baseline in OCT and weaker leakage in FA than in acute types. Visual acuity changed from baseline 71.6 to 72.8 ETDRS letters after 3 months. At this time, SRF was absent in 3 out of 16 patients (19%), FA leakage had come to a complete stop in 6 out of 16 patients (38%). In 6 of the remaining chronic CSC patients, repeated SRT with higher pulse energy was considered because of persistent leakage activity. After the re-treatment, SRF resolved completely in 5 patients (83.3%) after only 25 days. Conclusion: SRT showed promising results in treating acute CSC, but was less effective in chronic cases. Interestingly, re-treatment resulted in enhanced fluid resolution and dry conditions after a considerably shorter time in most patients. Therefore, SRT including re-treatment if necessary might be a valuable CSC treatment alternative even in chronic-recurrent cases.

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Section: Discussionmentioning

confidence: 99%

Selective Retina Therapy in Acute and Chronic-Recurrent Central Serous Chorioretinopathy

Framme¹,

Walter²,

Berger³

et al. 2015

Ophthalmologica

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“…4,5 Possible treatment options include pharmacological interventions with intravitreal anti-vascular endothelial growth factors or mineral corticoid receptor antagonists, as well as photodynamic therapy and laser procedures. [6][7][8][9][10] In addition to a full clinical examination, invasive (fluorescein angiography [FA], indocyanine green angiography [ICGA]) and noninvasive (fundus cameras, optical coherence tomography [OCT], fundus autofluorescence [FAF], OCT angiography [OCTA]) imaging techniques can help to diagnose CSC and monitor the course of the disease during therapy. Recently, a noninvasive OCTA system (AngioVue; Optovue, Fremont, CA) was introduced, enabling en face high-resolution vascular imaging of the ocular fundus depicting retinal and choroidal vessels based on a split-spectrum amplitude-decorrelation angiography algorithm.…”

Section: Introductionmentioning

confidence: 99%

OCT Angiography Findings in Acute Central Serous Chorioretinopathy

Feucht¹,

Maier²,

Lohmann³

et al. 2016

Ophthalmic Surg Lasers Imaging Retina

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“…Several retrospective and prospective studies on the inhibition of mineralocorticoid receptors have been carried out by using oral spironolactone and eplerenone as potential treatment methods for CSCR patients. Most results have shown positive outcomes demonstrating a significant reduction of SRF, decreased central macular thickness (CMT), and improvement in VA [ 57 , 130 , 131 ]. Although oral spironolactone is not a first-line treatment, it is helpful for patients with non-resolving CSCR with SRD [ 132 ].…”

Section: Treatmentmentioning

confidence: 99%

Central serous chorioretinopathy: updates in the pathogenesis, diagnosis and therapeutic strategies

et al. 2023

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Central serous chorioretinopathy (CSCR), first described by Albrecht von Graefe in 1866, is characterized by focal serous detachment of the neural retina and/or retinal pigment epithelium (RPE) in the posterior pole. CSCR is the first ever described pachychoroid disease. Most recently, hypothetical venous overload choroidopathy is also proposed due to its distinguished morphological and pathological characteristics, including choroidal thickening, choriocapillaris hyperpermeability, remodelling, and intervortex venous anastomoses. Identification of genetic variants is necessary to comprehend the pathophysiology of CSCR. The novel multimodality imaging platforms, including the ultra-widefield imaging system, flavoprotein fluorescence, fluorescence lifetime imaging ophthalmoscopy, and multispectral imaging system, have been used for diagnosing and managing CSCR. Half-dose photodynamic therapy (PDT) remains the mainstay of clinical practice, with about 95% of patients with chronic CSCR improving to visual acuity (VA) of 20/30 or better. The use of oral eplerenone for routine clinical care remains controversial, and long-term randomized clinical trials are warranted to investigate its efficacy in acute and chronic CSCR. While CSCR has generally been recognized as a self-limiting disease with good prognosis, the underlying pathogenesis is still not fully understood, and treatments are often not fully effective. With new evidence emerging about pachydrusen being a disease precursor in both CSCR and polypoidal choroidal vasculopathy (PCV), it would be interesting to investigate whether CSCR can be a precursor to PCV. In this review, we highlighted the currently available evidence on the pathogenesis, diagnosis, multimodality imaging features, and management strategies, including recent findings related to CSCR.

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Mineralokortikoidrezeptorantagonisten als Therapieoption bei akuter und chronischer Chorioretinopathia centralis serosa

Abstract: For further assessment of this treatment controlled clinical trials are urgently required as this therapy would offer a new approach for patients with chronic CSCR and no tendency towards recovery.

Cited by 21 publications

References 35 publications

Selective Retina Therapy in Acute and Chronic-Recurrent Central Serous Chorioretinopathy

Selective Retina Therapy in Acute and Chronic-Recurrent Central Serous Chorioretinopathy

OCT Angiography Findings in Acute Central Serous Chorioretinopathy

Central serous chorioretinopathy: updates in the pathogenesis, diagnosis and therapeutic strategies

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