Navigated micropulse laser for central serous chorioretinopathy: Efficacy, safety, and predictive factors of treatment response

Purpose There is no widely accepted treatment for persistent/chronic central serous chorioretinopathy. The present study aimed to evaluate the efficacy, safety, and factors associated to treatment response to navigated micropulse laser in chorioretinopathy. Methods Retrospective observational case series including consecutive patients presenting with symptomatic persistent and chronic chorioretinopathy. All patients were treated with 5% navigated micropulse laser with the Navilas system (Navilas®, OD-OS GmBH, Teltwo, Germany), by overlying fluorescein angiography, indocyanine green angiography and/or spectral domain-optical coherence tomography images of visible leaking points and/or choroidal hyperpermeability/subretinal fluid to plan the laser treatment. Results Thirty-nine eyes of 36 consecutive patients (29 men and 7 women, with a mean age of 51.87 years) were included. Logarithm of the minimum angle of resolution (LogMar) best-corrected visual acuity increased from 0.39 ± 0.24 at baseline to 0.24 ± 0.22 at 3 months ( p < 0.0001) and to 0.20 ± 0.07 at 6 months ( p < 0.0001). Subretinal fluid decreased from 166.82 ± 111.11 micron at baseline to 52.33 ± 78.97 micron ( p < 0.0001) at 3 months and 34.12 ± 67.56 micron at 6 months ( p < 0.0001). The presence of a hot spot on fluorescein angiography and a focal choroidal hyperpermeability on indocyanine green angiography, but not the duration of symptoms correlated significantly with the resolution of subretinal fluid at month 3 ( p = 0.023 and p = 0.001). Conclusion Navigated micropulse laser laser treatment was found to be effective and safe for the treatment of chorioretinopathy, with significant improvement in visual and anatomical outcomes, unaccompanied by any adverse event at 3 and 6 months follow-up. Factors associated to subretinal fluid resolution may allow a better selection of likely responders to navigated micropulse laser treatment.

Pachychoroid Spectrum Disorder Findings in Patients with Coronavirus Disease 2019

Purpose. To report the occurrence of acute, bilateral, central serous chorioretinopathy (CSC), and pachychoroid spectrum disorder findings in patients with coronavirus disease 2019 (COVID-19). Methods. In recovered cases of COVID-19 with visual disturbances, complete ocular examinations with multimodal retinal and choroidal evaluation, including enhanced depth imaging optical coherence tomography, fluorescein or indocyanine green angiography, and blue autofluorescence, were obtained. Results. Four COVID-19 recovered patients presented with bilateral blurred vision. Ocular examination and imaging revealed pachychoroid and pachyvessels associated with choroidal hyperpermeability without any obvious intraocular inflammation. Bilateral localized serous retinal detachment was obvious in three cases compatible with pachychoroid associated with CSC manifestation and pachychoroid pigment epitheliopathy in one patient. CSC was resolved with treatment by steroidal antimineralocorticoid (Eplerenone) in two patients and by photodynamic therapy in one patient. None of the patients reported emotional stress and history of corticosteroid consumption. Conclusion. Hyperpermeability of the choroid, pachychoroidopathy, or choroidal vessel congestion can be observed or exacerbated in association with COVID-19.

Genetics, Risk Factors and Pathogenesis in the Spectrum of Pachychoroid Diseases

The spectrum of pachychoroid disease was first described by Warrow et al. in 2013. The characteristics of pachyoroid phenotype are dilatation of the vessels in the Haller layer (pachyvessels), thinning of the layers of Sattler, and choriocapillaris. Dilated choroidal vessels, choroidal hyperpermeability, diffuse or focal choroidal thickness and associated with progressive retinal pigment epithelium (RPE) dysfunction are thought to be in the pathogenesis. Angiographic findings such as choroidal vascular hyperpermeability, especially in the region of RPE changes, and delay in choroidal filling suggest that the primary pathology is associated with choroidal vascular disturbance. However, the exact pathophysiological mechanisms of the disease are not fully known. Pakikoroid-related diseases include pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, focal choroidal excavation, and peripapillary pachychoroid syndrome. These diseases are thought to be reveal different manifestations of common pathological mechanisms. This review highlights the current understanding of genetics, risk factors, and pathogenesis in the spectrum of pachychoroid disease based on the current literature.

Acute and Recurrent Central Serous Chorioretinopathy: Signs, Diagnosis, and Treatment

Acute central serous chorioretinopathy is an idiopathic disease characterized by a well-bordered neurosensorial retinal detachment localized mostly to the posterior pole. Though mostly having a benign clinical course, there can be recurrences and chronicity in the long run. Its pathogenesis remains to be obscure but choroidal hyperpermeability and a defect through the retinal pigment epithelium can be the cause.No treatment is generally required in patients with acute type of disease. However, medical therapy, thermal laser, photodynamic therapy, intravitreal injections, and subthreshold laser can be administered in some patients.