Clinical Manifestations of Steroid-associated Central Serous Chorioretinopathy

Sung Won Choi; Yu Cheol Kim

doi:10.3341/jkos.2018.59.4.338

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

Original Article

J Korean Ophthalmol Soc 2018;59(4):338-346.

Published online: 7 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.4.338

Clinical Manifestations of Steroid-associated Central Serous Chorioretinopathy

Sung Won Choi, MD, Yu Cheol Kim, MD, PhD

Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea

Address reprint requests to Yu Cheol Kim, MD, PhD Department of Ophthalmology, Dongsan Medical Center, #56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: 82-53-250-8026, Fax: 82-53-250-7705, E-mail: eyedr@damc.or.kr

Received 9 November 2017 Revised 13 January 2018 Accepted 29 March 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Central serous chorioretinopathy, Choroidal thickness, Steroid, Subretinal fluid

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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).

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	p-value*
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)	p-value
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.

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