Journal List > J Korean Ophthalmol Soc > v.59(4) > 1010884

Choi and Kim: Clinical Manifestations of Steroid-associated Central Serous Chorioretinopathy

Abstract

Purpose

To evaluate the clinical differences between patients with central serous chorioretinopathy (CSC) developed after steroid use and CSC patients without a history of steroid use for short-term periods.

Methods

We retrospectively analyzed the medical records of 47 patients (55 eyes) diagnosed with CSC from January 2011 to August 2017 by categorizing Group 1 (32 patients, 36 eyes) without a history of steroid use and Group 2 (15 patients, 19 eyes) with a history of steroid use within 6 months. We evaluated the differences in best-corrected visual acuity (BCVA), subretinal fluid (SRF) height, subfoveal choroidal thickness (SFCT), and Haller's layer thickness in the two groups. We also analyzed the changes in the BCVA, SRF height, SFCT, and Haller's layer thickness in each group for 1 month and compared them depending on the treatment.

Results

There were no significant differences between the two groups with regard to age, sex, BCVA, bilaterality, number of leakage points, and Haller's layer thickness. Group 2 showed significantly increased SRF height and SFCT than Group 1 (p = 0.002, p = 0.005, respectively). In Group 1, the level of SRF and SFCT were significantly more decreased after 1 month (p = 0.001, 0.015, respectively) in patients with treatment than in those without treatment. In Group 2, the height of the SRF and SFCT were significantly more decreased after 1 month (p = 0.005, 0.002, respectively) in untreated patients compared to treated patients.

Conclusions

CSC patients with a prior history of steroid use have higher serous detachment and a thicker SFCT than those without prior history of steroid use. Therefore, termination of steroid treatment may reduce the SFCT and SRF in steroid-treated CSC patients.

REFERENCES

1). Spitznas M. Pathogenesis of central serous retinopathy: a new working hypothesis. Graefes Arch Clin Exp Ophthalmol. 1986; 224:321–4.
crossref
2). Gass JD. Pathogenesis of disciform detachment of the neuroepithelium. Am J Ophthalmol. 1967; 63(Suppl):1–139.
3). Bouzas EA, Karadimas P, Pournaras CJ. Central serous chorioretinopathy and glucocorticoids. Surv Ophthalmol. 2002; 47:431–48.
crossref
4). Karadimas P, Bouzas EA. Glucocorticoid use represents a risk factor for central serous chorioretinopathy: a prospective, case-control study. Graefes Arch Clin Exp Ophthalmol. 2004; 242:800–2.
crossref
5). Miki A, Ikuno Y, Jo Y, Nishida K. Comparison of enhanced depth imaging and high-penetration optical coherence tomography for imaging deep optic nerve head and parapapillary structures. Clin Ophthalmol. 2013; 7:1995–2001.
crossref
6). Park HY, Shin HY, Park CK. Imaging the posterior segment of the eye using swept-source optical coherence tomography in myopic glaucoma eyes: comparison with enhanced-depth imaging. Am J Ophthalmol. 2014; 157:550–7.
crossref
7). Chung YR, Kim JW, Choi SY, et al. Subfoveal choroidal thickness and vascular diameter in active and resolved cental serous chorioretinopathy. Retina. 2018:38:102–7.
8). Lee WJ, Lee JW, Park SH, Lee BR. En face choroidal vascular feature imaging in acute and chronic central serous chorioretinopathy using swept source optical coherence tomography. Br J Ophthalmol. 2017; 101:580–6.
crossref
9). Bansal P, Agarwal A, Gupta V, et al. Sprectral domain optical coherence tomography changes following intravitreal dexamethasone implant, Ozurdex(R) in patients with uveitic cystoid macular edema. Indian J Ophthalmol. 2015; 63:416–22.
10). Staurenghi G, Sadda S, Chakravarthy U, et al. Proposed lexicon for anatomic landmarks in normal posterior segment spectral-domain optical coherence tomography: the INOCT consensus. Ophthalmology. 2014; 121:1572–8.
11). Branchini LA, Adhi M, Regatieri CV, et al. Analysis of choroidal morphologic features and vasculature in healthy eyes using spectral-domain optical coherence tomography. Ophthalmology. 2013; 120:1901–8.
crossref
12). Gelber GS, Schatz H. Loss of vision due to central serous chorioretinopathy following psychological stress. Am J Psychiatry. 1987; 144:46–50.
13). Quillen DA, Gass DM, Brod RD, et al. Central serous chorioretinopathy in women. Ophthalmology. 1996; 103:72–9.
crossref
14). Loo JL, Lee SY, Ang CL. Can long-term corticosteroids lead to blindness? A case series of central serous chorioretinopathy induced by corticosteroids. Ann Acad Med Singapore. 2006; 35:496–9.
15). Spaide RF, Koizumi H, Pozzoni MC. Enhanced depth imaging spectral-domain optical coherence tomography. Am J Ophthalmol. 2008; 146:496–500.
crossref
16). Margolis R, Spaide RF. A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes. Am J Ophthalmol. 2009; 147:811–5.
crossref
17). Jain IS, Singh K. Maculopathy a corticosteroid side-effect. J All India Ophthalmol Soc. 1966; 14:250–2.
18). Maruko I, Iida T, Sugano Y, et al. Subfoveal choroidal thickness after treatment of central serous chorioretinopathy. Ophthalmology. 2010; 117:1792–9.
crossref
19). Esmaeelpour M, Ansari-Shahrezaei S, Glittenberg C, et al. Choroid, Haller's, and Sattler's layer thickness in intermediate age-related macular degeneration with and without fellow neovascular eyes. Invest Ophthalmol Vis Sci. 2014; 55:5074–80.
crossref
20). Spaide RF, Campeas L, Haas A, et al. Central serous chorioretinopathy in younger and older adults. Ophthalmology. 1996; 103:2070–9. discussion 2079-80.
crossref
21). Ficker L, Vafidis G, While A, Leaver P. Long-term follow-up of a prospective trial of argon laser photocoagulation in the treatment of central serous retinopathy. Br J Ophthalmol. 1988; 72:829–34.
crossref
22). Watzke RC, Burton TC, Woolson RF. Direct and indirect laser photocoagulation of central serous choroidopathy. Am J Ophthalmol. 1979; 88:914–8.
crossref
23). Artunay O, Yuzbasioglu E, Rasier R, et al. Intravitreal bevacizumab in treatment of idiopathic persistent central serous chorioretinopathy: a prospective, controlled clinical study. Curr Eye Res. 2010; 35:91–8.
crossref
24). Seong HK, Bae JH, Kim ES, et al. Intravitreal bevacizumab to treat acute central serous chorioretinopathy: short-term effect. Ophthalmologica. 2009; 223:343–7.
crossref
25). Benson SE, Schlottmann PG, Bunce C, et al. Optical coherence tomography analysis of the macular after scleral buckle surgery for retinal detachment. Ophthalmology. 2007; 114:108–12.
26). Sohn EH, Khanna A, Tucker BA, et al. Structural and biochemical analyses of choroidal thickness in human donor eyes. Invest Ophthalmol Vis Sci. 2014; 55:1352–60.
crossref
27). Imamura Y, Fujiwara T, Margolis R, Spaide RF. Enhanced depth imaging optical coherence tomography ofthe choroid in central serous chorioretinopathy. Retina. 2009; 29:1469–73.
28). Mrejen S, Spaide RF. Optical coherence tomography: imaging of the choroid and beyond. Surv Ophthalmol. 2013; 58:387–429.
crossref
29). Tittl MK, Spaide RF, Wong D, et al. Systemic findings associated with central serous chorioretinopathy. Am J Ophthalmol. 1999; 128:63–8.
crossref
30). Wakakura M, Ishikawa S. Central serous chorioretinopathy complicating systemic corticosteroid treatment. Br J Ophthalmol. 1984; 68:329–31.
crossref
31). Polak BCP, Baarsma GS, Snyers B. Diffuse retinal pigment epitheliopathy complicating systemic corticosteroid treatment. Br J Ophthalmol. 1995; 79:922–5.
crossref

Figure 1.
Optical coherence tomography scan image of a patient. Height of serous retinal detachment was manually measured using calipers on the software as shown by the white line. The dotted line shows subfoveal choroid thickness that represent from outer border of retinal pigment epithelium to inner border of sclera. The white arrow denotes pigment epithelial detachment. The thickness of Haller's layer was measured from the inner border of the choroid-sclera junction to the innermost point of the selected large choroidal vessel at the subfoveal location (white double-headed arrow).
jkos-59-338f1.tif
Table 1.
Clinical demographics in each group
Group 1 (n = 36) Group 2 (n = 19) p-value
Age (years) 55.12 ± 9.00 51.87 ± 11.44 0.368*
Sex (male:female) 26:6 13:2 0.341
Bilaterality 4 4 0.523
SRF height (μm) 122.39 ± 172.42 225.69 ± 123.58 0.002*
Choroidal thickness (μm) 379.64 ± 103.28 477.05 ± 136.08 0.005*
Haller's layer thickness (μm) 215.56 ± 56.07 230.44 ± 112.18 0.453*
Leaking point 1.28 ± 0.62 1.63 ± 1.01 0.080*
Relapse 6 5 0.375
Chronicization 7 2 0.473

Values are presented as mean ± SD unless otherwise indicated.

SD = standard deviation; SRF=subretinal fluid.

* Mann-Whitney U-test;

Fisher-exact test;

Pearson chi-square test.

Table 2.
Clinical features of steroid induced central serous chorioretinopathy (CSC)
Baseline disease Steroid route Symptom develop period after steroid administration OCT findings FAG findings
Case 1 Nephrotic syndrome Oral 15 days Photoreceptor elongation Granular hyperfluorescence
Case 2 Back pain Oral 1 month PED, SRD Granular hyperfluorescence
Case 3 Renal failure Oral 2 years SRD Granular hyperfluorescence
Case 4 Dermatitis Oral 1 month SRD Ink dot
Case 5 Unknown Oral 3 years Photoreceptor elongation Granular hyperfluorescence
Case 6 Arthritis Oral 6 months RPE hump Granular hyperfluorescence, ink dot
Case 7 Ankylosing spondilitis Oral 1 year PED RPE tract
Case 8 Unknown Oral 2 months PED, SRD
Case 9 Thymoma Oral 2 months Photoreceptor elongation RPE tract, Granular hyperfluorescence
Case 10 Unknown Oral 1 month Photoreceptor elongation Granular hyperfluorescence
Case 11 Unknown Oral 1 month Photoreceptor elongation, PED, SRD Ink dot
Case 12 Unknown Injection 3 months SRD Granular hyperfluorescence
Case 13 Back pain Injection 1 month Photoreceptor elongation Granular hyperfluorescence
Case 14 Arthritis Injection Several months Photoreceptor elongation Ink dot
Case 15 Arthritis Injection 14 days SRD Granular hyperfluorescence

OCT = optical coherence tomography; FAG = fluorescence angiography; PED = pigment epithelium detachment; SRD = sensory retinal detachement; RPE = retinal pigment epithelium.

Table 3.
Correlation between subfoveal choroidal thickness and subretinal detachment height in two groups
Choroidal thickness (μm) SRF height (μm) p-value* Correlation coefficient
Group 1 379.64 ± 103.28 122.39 ± 172.42 0.972 −0.006
Group 2 477.05 ± 136.08 225.69 ± 123.58 0.819 −0.056

Values are presented as mean + SD unless otherwise indicated.

SD = standard deviation; SRF = subretinal fluid.

* Spearman's correlation test.

Table 4.
Comparison of visual acuity at baseline and 1 month later in two groups
Group 1 (n = 36)
Group 2 (n = 19)
p-value*
BCVA (logMAR) Improved BCVA BCVA (logMAR) Improved BCVA
Baseline BCVA 0.24 ± 0.25 0.19 ± 0.24 0.482
BCVA after 1 month 0.26 ± 0.25 0.265 0.14 ± 0.13 0.242 0.130

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; logMAR = logarithm of minimal angle of resolution; SD = standard deviation.

* Mann-Whitney U-test;

Wilcoxon signed rank test.

Table 5.
Comparison of visual acuity, subfoveal choroidal thickness, Haller's layer thickness, subretinal detachment height at baseline and 1 month after in non steroidal central serous chorioretinopathy (CSC) group
Treated (n = 24) Observation (n = 12) p-value
BCVA Initial 0.27 ± 0.24 0.19 ± 0.28 0.255
1 month later 0.25 ± 0.22 0.27 ± 0.32 0.705
p-value 0.428* 0.102*
Choroidal thickness (μm) Initial 388.08 ± 105.26 362.75 ± 101.53 0.902
1 month later 339.67 ± 91.69 338.25 ± 101.27 0.987
p-value 0.001* 0.557*
Haller's layer thickness (μm) Initial 205.86 ± 54.28 233.33 ± 57.20 0.159
1 month later 181.56 ± 61.73 227.61 ± 65.60 0.125
p-value 0.651* 0.219*
SRF height (μm) Initial 131.25 ± 185.71 77.25 ± 107.08 0.121
1 month later 47.75 ± 50.34 44.92 ± 57.96 0.537
p-value 0.015* 0.102*

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; SRF = subretinal fluid; SD = standard deviation.

* Wilcoxon signed rank test;

Mann-Whitney U-test.

Table 6.
Comparison of treatment modality in two groups
Group 1 (n = 36) Group 2 (n = 19) p-value*
Photocoagulation 9 1 0.011
IVB 5 2 0.602
PDT 3 0 0.545
Combination 7 4 0.636
   IVB/PDT 1 4
   Photocoagulation/PDT 2 0
   Photocoagulation/IVB 3 0
   Photocoagulation/PDT/IVB 1 0
Observation 12 12 0.049
p-value 0.087 1.0 0.011

IVB = intravitreal bevacizumab injection; PDT = photodynamic theraphy.

* Fisher-exact test;

Pearson chi-square test;

Kruskal-Wallis test.

Table 7.
Comparison of visual acuity, subfoveal choroidal thickness, Haller's layer thickness, subretinal detachment height at baseline and 1 month after in steroid induced central serous chorioretinopathy (CSC) group
Treated (n = 7) Observation (n = 12) p-value
BCVA Initial 0.34 ± 0.32 0.11 ± 0.12 0.055
1 month later 0.14 ± 0.11 0.13 ± 0.14 0.789
p-value 0.250* 0.437*
Choroidal thickness (μm) Initial 393.29 ± 101.36 525.92 ± 132.77 0.018
1 month later 352.14 ± 128.82 426.75 ± 144.46 0.261
p-value 0.203* 0.005*
Haller's layer thickness (μm) Initial 197.50 ± 57.85 246.92 ±130.53 0.437
1 month later 172.47 ± 64.48 231.27 ± 53.15 0.251
p-value 0.451* 0.519*
SRF height (μm) Initial 191.71 ± 143.87 172.33 ± 125.03 0.853
1 month later 127.14 ± 125.46 42.25 ± 77.82 0.094
p-value 0.375* 0.002*

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; SRF = subretinal fluid; SD = standard deviation.

* Wilcoxon signed rank test;

Mann-Whitney U-test.

Table 8.
Comparison of baseline demographics following steroid administered in steroid induced central serous chorioretinopathy
Steroid-induced CSC
p-value
Oral intake (n = 15) Injection (n = 4)
Age (years) 52.64 ± 12.27 49.75 ± 10.05 0.551*
Sex (male:female) 11:1 3:1 0.450
Baseline BCVA (logMAR) 0.21 ± 0.25 0.16 ± 0.15 0.250*
1 month later BCVA (logMAR) 0.16 ± 0.15 0.15 ± 0.17 0.515*
SRF height (μm) 264.89 ± 124.00 137.50 ± 71.18 0.099
Bilaterality 5 0 0.181
Leaking point 1.62 ± 1.03 1.50 ± 1.00 0.738
Choroidal thickness (μm) 465.38 ± 123.79 542.50 ± 172.99 0.740
Haller's layer thickness (μm) 245.93 ± 105.67 181.00 ± 123.03 0.203

Values are presented as mean ± SD unless otherwise indicated.

CSC = central serous chorioretinopathy; BCVA = best corrected visual acuity; logMAR = logarithm of minimal angle of resolution; SRF = subretinal fluid; SD = standard deviation.

* Mann-Whitney U-test;

Fisher-exact test;

Kruskal-Wallis test.

TOOLS
Similar articles