ARVO 2014 Annual Meeting Abstracts 549 Central Serous Chorioretinopathy Thursday, May 08, 2014 12:00 PM–1:45 PM Exhibit/Poster Hall SA Poster Session Program #/Board # Range: 6371–6389/C0148–C0166 Organizing Section: Retina Program Number: 6371 Poster Board Number: C0148 Presentation Time: 12:00 PM–1:45 PM Spectrum of Retinal Pigment Epithelium Abnormalities in Central Serous Chorioretinopathy as Revealed by UltraWidefield Autofluorescence Juliana E. Boneta2, 1, Lawrence A. Yannuzzi4, Sanjeev Nath3, Sherry J. Bass1, Jerome Sherman1, 3. 1SUNY College of Optometry, New York, NY; 2Fromer Eye Centers, New York, NY; 3Eye Institute & Laser Center, New York, NY; 4Vitreous Retina Macula Consultants of New York, New York, NY. Purpose: To document the wide array of ultra-widefield autofluorescence (UWF-AF) presentations in central serous chorioretinopathy (CSCR) and to compare these to clinical exam, standard color and UWF color images, spectral domain OCT and, in select cases, to visual fields (VFs) and UWF fluorescein angiography. Methods: A retrospective review from 3 facilities of 20 eyes from 13 patients diagnosed with CSCR by standard criteria and who had UWF-AF images available to analyze and correlate with other procedures such as SD OCT. Results: Nine of the 13 patients were male and age ranged from the third to the sixth decade. Eleven were symptomatic and two were detected during routine exams. Although a wide spectrum of UWF-AF patterns was discovered, in 11 of the 20 affected eyes, descending “gravitational” tracts were documented. Most often, these gravitational tracts extended to the equator inferiorly and even beyond. In nearly all cases, the tract was hypo AF with a surrounding hyper AF zone. Outer retina involvement (loss of the ellipsoid aka PIL on OCT) corresponded to both hypo and hyper AF lesions. A 41 year old male physician presented with 20/10 VA OD but with a large noticeable superior nasal blind spot (following a motorcycle accident) and was found to have a large, corresponding descending tract without foveal involvement (figure 1). The most profound case in the series was a 45 year old female being treated for 19 years with steroids for SLE with VA of 20/80 OD and FC at 6 ft OS. Both SD OCT and FA confirmed CSCR OD; OS with long standing VA reduction demonstrated total hypo AF in 3 full quadrants extending beyond the equator with only minimal hyper AF in the superior quadrant (figure 2) and only an inferior quadrant of the VF remaining. Conclusions: UWF-AF imaging is quite useful in patients with CSCR to document the extent of RPE damage, often not recognized on clinical exam. SD OCT of lesions revealed by UWF-AF documents loss of photoreceptor integrity and predicts VF defects. UWF-AF is perhaps the preferred non-invasive technology to monitor change in CSCR patients with widespread involvement. Ultra-widefield AF of a 41 year old male physician as discussed in results above. UWF-FA of a 45 year old female as noted in results with profound hypo AF and loss of the photoreceptors in 3 of 4 retinal quadrants OS. Commercial Relationships: Juliana E. Boneta, None; Lawrence A. Yannuzzi, None; Sanjeev Nath, None; Sherry J. Bass, None; Jerome Sherman, Optos (C) Program Number: 6372 Poster Board Number: C0149 Presentation Time: 12:00 PM–1:45 PM Long-Term Impacts of Antioxidant Supplementation and Smoking Cessation on Chronic Central Serous Chorioretinopathy Midori Araki, Tsutomu Yasukawa, Masayuki Ashikari, Aki Kato, Nana Tachi, Yoshio Hirano, Yuichiro Ogura. Nagoya City University, Nagoya, Japan. Purpose: Chronic central serous chorioretinopathy (CSC) has persistent serous retinal detachment (sRD), resulting in gradual vision loss. We have previously reported the potential of antioxidant supplementation and smoking cessation to enhance spontaneous remission of chronic CSC (Tachi et al, ARVO, 2011). The purpose of this study is to evaluate the long-term prognosis of chronic CSC with spontaneous remission under smoking cessation and antioxidant supplementation. ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Methods: Nineteen eyes of 17 patients, who were diagnosed as chronic CSC and guided to stop smoking, if they were a current smoker, and take antioxidant supplements produced on the basis of AREDS formulation (Ocuvite® Lutein or Sante Lutax® 15), were enrolled. Nine patients were a current smoker, 7 an experienced smoker, and 3 a nonsmoker. Averaged age was 59.4 ± 11.5 years. Mean follow-up period was 54 ± 3.9 months. Rate of remission and relapsing of sRD and best-corrected visual acuity (BCVA) were assessed. Results: Spontaneous remission of sRD was observed in 16 of 19 eyes (84%) with mean duration of 4.6 ± 0.53 months. Of these eyes, 7 eyes (37%) had no recurrence during the observation period, while 9 eyes (47%) had remitting and relapsing of chronic CSC. In 2 eyes, relapsing was observed immediately after resuming smoking. At the last visit, 4 eyes of 9 remitting-relapsing cases had no sRD and 5 eyes had recurred sRD. In the other 3 eyes (16%), sRD persisted without remission. Five eyes underwent any interventional treatment 30 ± 10 months after life style guidance in average. Mean BCVA in the LogMAR unit in 14 eyes without any treatments was significantly improved from 0.22 ± 0.10 at baseline to 0.11 ± 0.07 at the last visit (p<0.05). Improvement of BCVA with 0.3 or more LogMAR units was obtained in 3 eyes (21%), while no eyes deteriorated BCVA. Mean BCVA of 5 eyes with interventional treatments was significantly improved from 0.24 ± 0.16 at baseline to 0.07 ± 0.13 at the last visit (P<0.05). Conclusions: The current study suggested that antioxidant supplementation and smoking cessation might enhance spontaneous remission and reduce relapsing rate in eyes with chronic CSC over 5 years. Delay of interventional treatments was unlikely to worsen the prognosis of chronic CSC. Lifestyle guidance might be worthwhile for patients with chronic CSC before therapeutic intervention was considered. Commercial Relationships: Midori Araki, None; Tsutomu Yasukawa, None; Masayuki Ashikari, None; Aki Kato, None; Nana Tachi, None; Yoshio Hirano, None; Yuichiro Ogura, None Program Number: 6373 Poster Board Number: C0150 Presentation Time: 12:00 PM–1:45 PM Recurrence of central serous chorioretinopathy in patients who undergo intraocular surgery with subsequent topical steroid therapy Oscar C. Kuruvilla, Neeti Alapati, Hilliary Inger, Zuhair Peracha, Daniel Kim, Paul A. Edwards. Ophthalmology, Henry Ford Hospital, Royal Oak, MI. Purpose: To evaluate characteristics of patients who were diagnosed and treated for central serous chorioretinopathy (CSR) and subsequently undergo intraocular surgery. Methods: This is a retrospective chart review of 103 patients who were diagnosed and treated for central serous chorioretinopathy at Henry Ford Hospital. All patients selected for review were treated between January 2005 and January 2013, although, they may have been initially diagnosed with CSR prior to this time period. Data collected included age, gender, refraction, history of open angle glaucoma, treatment administered, recurrences, intraocular surgeries, steroid drop usage, systemic steroid usage and fluorescein angiography findings. Results: We evaluated 106 eyes from 98 patients whose mean age was 52.7 years. The majority were male (67%) vs. female (33%). Fifty percent of patients were hyperopic, while 38% were myopic and 12% were emmetropic. Only 12% of affected eyes were pseudophakic. The majority of patients had acute disease (77%) while 19% had chronic disease and 4% had atypical disease. On fluorescein angiography, almost all patients (94%) had expansile dot patterns, 2% had smokestack and 2% had inverted smokestack patterns. Overall, 18% of patients experienced a recurrence of CSR. Patients who underwent intraocular surgery had no recurrences post operatively. Almost a third of patients developed recurrences during treatment with nasal steroids. Patients treated with laser, photodynamic therapy or acetazolamide had an overall recurrence rate of 7%. Conclusions: CSR is a relatively common cause of visual loss. Our affected patients were more likely to be male, phakic hyperopes with acute disease and expansile dot seen on fluorescein angiography. In our review, recurrence rate was approximately 18%. None of the patients who had intraocular surgery experienced a recurrence of CSR despite routine use of topical steroids following surgery. In addition, among 14 patients who had initial treatment, only one had recurrence. The results from this retrospective review suggest that it is safe for patients with history of CSR to undergo intraocular surgery without worry for recurrence of disease. Commercial Relationships: Oscar C. Kuruvilla, None; Neeti Alapati, None; Hilliary Inger, None; Zuhair Peracha, None; Daniel Kim, None; Paul A. Edwards, None Program Number: 6374 Poster Board Number: C0151 Presentation Time: 12:00 PM–1:45 PM POTENTIAL THERAPEUTIC BENEFIT OF MELATONIN IN REFRACTORY CENTRAL SEROUS CHORIORETINOPATHY Jose D. Luna Pinto, Ana L. Gramajo, Gabriel Marquez, Victor Torres, Claudio P. Juarez, Ruth E. Rosenstein. Ophthalmology, Ctr Privado de Ojos Romagosa-Fndtn VER, Cordoba, Argentina. Purpose: To evaluate the efficacy and safety of melatonin for the treatment of chronic central serous chorioretinopathy (CSCR). Methods: Prospective comparative case series.A total of 13 patients with chronic CSCR were treated for 1 month: 8 patients were treated orally with 3 mg melatonin t.i.d, and 5 with placebo. All patients had 20/40 or worse Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) in the affected eye or presented an incapacitating scotoma. Most of the patients had previous failed treatments for their condition. Observational procedures included ETDRS BCVA, and complete ophthalmic examination. Optical Coherence Tomography (OCT) was performed at day 1 and week 4. Fluorescein angiography was performed at baseline only for diagnostic purposes. Results: At one month follow-up, BCVA significantly improved in 87.5% of patients treated with melatonin (7 of 8 patients, p<0.05). All patients showed a mean significant reduction (p<0.01) of central macular thickness (CMT) when compared to the baseline, with 3 patients (37.5%) exhibiting complete resolution of subretinal fluid at one month follow-up. No significant side effects were observed. No changes on BCVA or CMT were noted in the control group. Conclusions: These results suggest that melatonin is safe, well tolerated, and effective in the treatment of chronic CSCR, since it significantly improved BCVA and CMT in patients with this pathology. Further evaluations with longer follow-up and a larger patient population are desirable Commercial Relationships: Jose D. Luna Pinto, None; Ana L. Gramajo, None; Gabriel Marquez, None; Victor Torres, None; Claudio P. Juarez, None; Ruth E. Rosenstein, None Program Number: 6375 Poster Board Number: C0152 Presentation Time: 12:00 PM–1:45 PM Retinal Sensitivity Changes After Half-time Reduced-Fluence Photodynamic Therapy for Central Serous Chorioretinopathy Hirotaka Yokouchi, Masayasu Kitahashi, Mariko Kubota, Takayuki Baba, Shuichi Yamamoto. Ophthalmology, Chiba Univ Graduate School of Med, Chiba, Japan. ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Purpose: To determine the effect of half-time reduced-fluence photodynamic therapy (RF-PDT) on macular function in eyes with chronic central serous chorioretinopathy (CSC). Methods: Twenty-one eyes from 21 patients with chronic CSC of 6 months or more duration were studied. The dose and fluence of RF-PDT was administered according to the standard protocol for age-related macular degeneration (AMD), and laser was applied for 42 seconds guided by indocyanine green (ICG) angiographic images. The best-corrected visual acuity (BCVA) and the retinal sensitivity in the central 2- and 10-degrees were determined at the baseline and at 1, 3 and 6 months after the half-time RF-PDT. The retinal sensitivity was determined by Macular Integrity Assessment microperimetry (MAIA, Italy). Changes of the foveal thickness (CFT) and central choroidal thickness (CCT) were determined by optical coherence tomography (OCT). Results: At the baseline, the mean retinal sensitivity was 19.0±4.60 dB in the central 2 degrees and 21.3±3.45 dB in the central 10 degrees. After half-time RF-PDT, the mean retinal sensitivity improved significantly to 22.5±3.54 dB in the central 2 and 24.3±2.48 dB in the central 10 at 1 month (P<0.001), to 24.2±3.26 dB in the central 2 and 24.4±1.98 dB in the central 10 at 3 months (P<0.001), and to 23.8±2.42 dB in the central 2 and 24.9 ± 2.06 dB in the central 10 (P<0.001).The BCVA was significantly improved at 3 months (0.11±0.22 logMAR units, P<0.05) and at 6 months (0.10±0.17 logMAR units, P<0.05) after half-time RF-PDT than at baseline (0.16±0.20 logMAR units). Six months after half-time RF-PDT, the SRF was resolved at all eyes. The CFT was significantly reduced from 289±77.8μm at baseline to 164±41.4μm at 1 month (P<0.001), 161±45.9μm at 3 months (P<0.001), and 172±35.7μm at 6 months (P<0.001). The CCT significantly improved from 405±105 μm at baseline to 332±97.2μm at 1 month (P<0.001), 340±93.2μm at 3 months (P<0.001), and 333±108μm at 6 months (P<0.001). At 6 months, none of the patients had any systematic or local adverse events associated with the half-time RF-PDT. Conclusions: Half-time RF-PDT results in a significant improvement of the central retinal sensitivity over 6 months in eyes with chronic CSC. We conclude that half-time RF-PDT is beneficial for resolving chronic CSC by 6 months. Commercial Relationships: Hirotaka Yokouchi, None; Masayasu Kitahashi, None; Mariko Kubota, None; Takayuki Baba, None; Shuichi Yamamoto, None Program Number: 6376 Poster Board Number: C0153 Presentation Time: 12:00 PM–1:45 PM Half-dose versus half-fluence photodynamic therapy for chronic central serous chorioretinopathy Ryo Matoba, Yusuke Shiode, Tetsuhiro Kawata, Mio Hosokawa, Shuhei Kimura, Yuki Morizane, Fumio Shiraga. Okayama university, Okayama, Japan. Purpose: To compare the efficacy and safety of half-dose verteporfin photodynamic therapy (PDT) and half-fluence PDT in patients with chronic central serous chorioretinopathy (CSC). Methods: The records of 41 eyes of 39 CSC patients treated with PDT between January 2010 and August 2013 were retrospectively reviewed. Thirty eyes (28 patients) received PDT with half-dose (3mg/m2) verteporfin. Eleven eyes (11 patients) received PDT with half-fluence (25J/cm2). All patients were followed up at least 3 months. Outcome measures included the best correct visual acuity (BCVA), the central retinal thickness (CRT) and the proportion of eyes with complete resolution of serous retinal detachment (SRD) in the macula. Results: At baseline, the mean BCVA and CRT of both groups did not differ significantly. At 3 months after treatment, BCVA (logMAR) of both groups improved significantly; from 0.27 to 0.13 (p < 0.05) and 0.20 to 0.09 (p < 0.05) in the half dose PDT group and the halffluence PDT group, respectively. There was no difference in BCVA at 3 months between the 2 groups (p = 0.711). At 3 months, the CRT of both groups decreased significantly, and the CRT in the half-fluence PDT group was significantly thinner than that the half-dose PDT group (158.7 ± 36.4mm vs. 128.5 ± 28.3mm; p = 0.01). The complete resolution of SRD was achieved in 27 eyes (90%) in the half-dose PDT group and 10 eyes (91%) in the half-fluence PDT group. We did not observe any recurrences, secondary choroidal neovascularization and systemic side effects throughout the follow up period. Conclusions: Both half-dose and half-fluence PDTs showed significant efficacy for chronic CSC. Half-dose PDT may less likely to cause the retinal atrophy than half-fluence PDT. Commercial Relationships: Ryo Matoba, None; Yusuke Shiode, None; Tetsuhiro Kawata, None; Mio Hosokawa, None; Shuhei Kimura, None; Yuki Morizane, None; Fumio Shiraga, Alcon Japan (C), Bausch & Lomb Japan (C), Byer (C), Novartis Pharma (C), Santen Pharma (C) Program Number: 6377 Poster Board Number: C0154 Presentation Time: 12:00 PM–1:45 PM QUANTITATVE EVALUATION OF EPLERENONE TREATMENT FOR CENTRAL SEROUS CHORIORETINOPATHY (CSCR) Agustina Palacio1, Niloofar Piri1, Ahmet Ozkok1, Shlomit Schaal1, Tongalp H. Tezel1, 2. 1Ophthalmology and visual Sciences, University of Louisville, Louisville, KY; 2Anatomy and Neurobiology, University of Louisville, Louisville, KY. Purpose: To determine the effect of mineralocorticod receptor antagonist eplerenone (Inspra®; Pfizer, NY) in the treatment for CSCR. Methods: Pre- and serial post treatment HD-OCT scans with EDI cuts were obtained from five CSCR patients treated with 50 mg/ day of eplerenone. OCT scans were analyzed morphometrically to determine the change in the amount of the subretinal serous fluid. Clinical and morphometric data was compared with a control group of five untreated CSCR patients having similar age (55±12 vs. 49±20, p=0.84), gender (p=1.0), initial logMAR visual acuity (0.29±0.16 vs. 0.21±0.16, p=0.42), duration of symptoms (113±111 vs. 80±156 days, p=0.55) and central macular thickness (415±81 vs. 387±84 microns, p=0.55). Also, the impact of eplerenone on choroidal vasculature was estimated by calculating “Choroidal Perfusion Index” (CPI) which is defined as the ratio of the choroidal vascular area to the total choroidal area underneath the serous elevation. Results: Eplerenone treatment caused significant regression of the subretinal fluid which reflected itself by a decrease in the central macular thickness (415±80 vs. 271±28 microns, p=0.02) and total serous fluid area (0.77±0.88 vs. 0.14±0.22, p=0.03), in contrast to observation group which remained the same (central macular thickness = 388±84 mm2 vs.339±84 microns, p=0.35; total serous fluid area = 0.60±0.39 vs. 40±0.74 mm2, p=0.7). The resolution rate of the subretinal fluid was three time higher in the eplerenone group (33±16% vs. 10±25%). Resolution of the subretinal fluid was accompanied with a an increase in CPI (1.7±1.3). Despite better anatomical outcome, the impact of eplerenone treatment on logMAR visual acuity was similar in both groups (3 improved and 2 stable vs. 2 improved, 2 stable, 1 worsened, p=0.55). Treatment with eplerenone was well tolerated in all patients without serious adverse effects. Conclusions: Eplerenone speeds up the resolution of the subretinal fluid in CSCR. However, it is not effective to relieve the choroidal congestion, nor has an impact on final visual acuity. ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Commercial Relationships: Agustina Palacio, None; Niloofar Piri, None; Ahmet Ozkok, None; Shlomit Schaal, None; Tongalp H. Tezel, None Support: unrestricted grant from Research to Prevent Blindness, Inc, NYC, NY Program Number: 6378 Poster Board Number: C0155 Presentation Time: 12:00 PM–1:45 PM Eplerenone fails to treat central serous chorioretinopathy Harpal Sandhu, Demetrios G. Vavvas. Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA. Purpose: To evaluate the efficacy of the mineralocorticoid receptor antagonist eplerenone in patients with active central serous chorioretinopathy (CSR). Methods: Retrospective case series of three patients treated with eplerenone for central serous chorioretinopathy. All patients were assessed with a full eye exam and spectral domain optical coherence tomography (SD-OCT) at each visit. Results: Three eyes in three patients were treated with eplerenone 25 mg or 50 mg daily by mouth. All patients had decreased vision secondary to active CSR. Follow up ranged from three to 12 months. Visual acuity (VA) at the beginning of treatment ranged from 20/32 to 20/60 (mean VA 0.42). Visual acuity at one month was not significantly different (mean VA 0.49, p = 0.43), nor at the end of follow up (mean VA 0.43, p = 0.42). Central macular thickness did not change significantly from pre-treatment (mean 474 microns) to month one (mean 429 microns, p = 0.23), nor did it change significantly at the end of the follow-up period (mean 431 microns, p = 0.32). Conclusions: Eplerenone neither reduced central macular thickness nor improved vision in this cohort of patients with central serous chorioretinopathy. More research is needed to evaluate fully the efficacy of eplerenone for this indication. Commercial Relationships: Harpal Sandhu, None; Demetrios G. Vavvas, None Program Number: 6379 Poster Board Number: C0156 Presentation Time: 12:00 PM–1:45 PM Eplerenone for Treatment of Chronic Central Serous Chorioretinopathy: A Retrospective Case Series Margaret Greven1, David Salz1, John D. Pitcher2, Kevin Elliot3, Carl D. Regillo2, Mitchell Fineman2, Jason Hsu2, James F. Vander2, David H. Fischer2, Marc Spirn2. 1Wills Eye Hospital, Philadelphia, PA; 2Retina Service, Wills Eye Hospital, Philadelphia, PA; 3Thomas Jefferson University School of Medicine, Philadelphia, PA. Purpose: To evaluate the effect of oral eplerenone on visual acuity, subretinal fluid, and choroidal thickness in patients with chronic central serous chorioretinopathy (CSCR). Methods: Retrospective review of all patients from a single multiphysician practice with chronic CSCR who were treated with oral eplerenone from January 2013-June 2013. All patients were followed for a minimum of three months and underwent dilated fundoscopic examination and spectral-domain ocular coherence tomography (OCT) with enhanced depth imaging (EDI) at each visit. Measurement of subfoveal fluid (SFF) height and choroidal thickness were performed. Two-tailed paired t-test was used to calculate statistical significance of pre- and post-treatment variables. Results: Fourteen eyes of 14 patients with chronic CSCR were treated with eplerenone over a 6 month period. At 1 month follow-up, 10 out of 14 patients (71%) had decreased SFF height on OCT and 3 (21%) had complete resolution of SFF. Mean SFF height decreased from 123 mm to 61 mm (p=0.05). Mean choroidal thickness decreased from 301 mm to 263 mm (p=0.07). Mean visual acuity improved minimally from logMAR 0.41 (Snellen visual acuity 20/51) to 0.40 (Snellen visual acuity 20/50, p=0.20). At 3 months follow-up, 13 out of 14 (93%) had decreased SFF height on OCT and 9 (64%) had complete resolution of SFF. Mean SFF height decreased to 21 mm (p=0.004). Mean choroidal thickness decreased to 253 mm (p=0.1). Mean visual acuity improved to logMAR 0.28 (Snellen visual acuity 20/38, p=0.02). Conclusions: Oral eplerenone may be an effective treatment for patients with chronic CSCR. A prospective randomized placebocontrolled trial is needed to definitively determine safety and efficacy of the drug in this setting. Commercial Relationships: Margaret Greven, None; David Salz, None; John D. Pitcher, None; Kevin Elliot, None; Carl D. Regillo, None; Mitchell Fineman, None; Jason Hsu, None; James F. Vander, None; David H. Fischer, None; Marc Spirn, None Program Number: 6380 Poster Board Number: C0157 Presentation Time: 12:00 PM–1:45 PM The Sympatholytic Non-selective β-blocker PROPRANOLOL as A Non-invasive Therapeutic Approach for the Treatment of Chronic Central Serous Chorioretinopathy (CSC) Jose A. Cardillo, Murilo W. Rodrigues, Leticia F. Barroso, Rubens C. Siqueira, Rodrigo Jorge. Retina, Ribeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão Preto, Brazil. Purpose: To evaluate the effect of systemically administered β-blocker propranolol on the course of central serous chorioretinopathy. Our goal is to research potential alternative tool for chronic CSC as monotherapy or as adjunct to more invasive laser techniques Methods: Fourteen CSC-patients with a documented-persistent leakage of at least 4 months were treated by oral propranolol 20 mg twice a day and followed up at monthly intervals for 6 months. Best-corrected visual acuity (BCVA), fluorescein angiography (FA), indocyanine green angiography (ICGA), central macular thickness (CMT) quantified by ocular coherence tomography (OCT), were recorded at baseline and follow-up visits Results: At 3 months, BCVA was significantly enhanced in the treatment group (P =.006) compared with baseline. An improvement in central macular thickness and leakage on fluorescein angiography was noted in all treated patients starting as early as 30 days following treatment Conclusions: β-blocker has a plausible mechanism of action in CSC and may characterize a potential alternative to the present standard of care meriting further evaluation. Commercial Relationships: Jose A. Cardillo, None; Murilo W. Rodrigues, None; Leticia F. Barroso, None; Rubens C. Siqueira, None; Rodrigo Jorge, None Program Number: 6381 Poster Board Number: C0158 Presentation Time: 12:00 PM–1:45 PM Central Serous Chorioretinopathy Treated with Mineralocorticoid Antagonists: a Retrospective Study Analyzing the Clinical and Multimodal Imaging Response to Therapy Quraish Ghadiali1, Jesse J. Jung1, 2, Suqin Yu2, 3, Lawrence A. Yannuzzi1, 2. 1Department of Ophthalmology, New York University, New York, NY; 2Vitreous Retina Macula Consultants of New York, New York, NY; 3Department of Ophthalmology, Shanghai First People’s Hospital, Shanghai Jiaotong University, Shanghai, China. Purpose: To evaluate the effect of systemic spironolactone and eplerenone on the eyes of patients with central serous chorioretinopathy (CSCR) and to better understand the role of mineralocorticoid antagonists in the treatment of this disease. ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts Methods: Twenty-six eyes of 16 patients (10 males, 6 females), with a mean age of 57.4 (range 41-74), diagnosed with CSCR were treated with either spironolactone, eplerenone, or a combination of both drugs and were evaluated retrospectively by chart review and multimodal imaging analysis. Spectral domain optical coherence tomography (SD-OCT) was used to measure subretinal fluid (SRF) and central macular thickness (CMT). Furthermore, enhanced depth imaging optical coherence tomography (EDI-OCT) was used to measure subfoveal choroidal thickness (CT). Visual acuity (VA), CMT, CT, and SRF measurements were taken at the initiation of treatment and at 1, 3, and 6 month follow up intervals. Results: The mean change and 95% confidence intervals for VA, CMT, and CT were calculated as compared to pre-treatment values in all eyes. The mean change in logMAR vision at 1, 3, and 6 month follow up intervals was 0.021 ± 0.029, -0.028 ± 0.062, and -0.066 ± 0.090, respectively. The mean change in CMT at these intervals was -4.04 ± 14.12 mm, 4.11 ± 19.73 mm, and 9.23 ± 31.17 mm, respectively. The mean change in CT at these intervals was -48.94 ± 29.53 mm, -44.00 ± 41.58 mm, and -36.80 ± 82.21 mm, respectively. Twelve eyes were found to have SRF prior to treatment. In this subset, the mean change in SRF at 1, 3, and 6 months was -28.70 ± 33.48 mm, -19.89 ± 36.58 mm, and 9.57 ± 56.74 mm, respectively. CT was significantly decreased at 1 month (P<0.01) and at 3 months (P<0.05). All other measurements showed no significant changes. Conclusions: In eyes with CSCR treated with mineralocorticoid antagonists, no significant changes were found in VA or CMT; in eyes with SRF prior to treatment, there were no significant changes in SRF found at any follow up interval. There were, however, significant decreases in CT at 1 and 3 months after treatment initiation, but no significant changes at 6 months. Given these retrospective findings, mineralocorticoid antagonists do not appear to affect the natural course of CSCR based on clinical and multimodal imaging response. Commercial Relationships: Quraish Ghadiali, None; Jesse J. Jung, None; Suqin Yu, None; Lawrence A. Yannuzzi, None Program Number: 6382 Poster Board Number: C0159 Presentation Time: 12:00 PM–1:45 PM Finasteride for Chronic Central Serous Chorioretinopathy Kelly Fujikawa, Amar P. Patel, Lawrence S. Morse. Department of Opthalmology, University of California Davis Eye Center, Sacramento, CA. Purpose: To investigate the efficacy of finasteride in the treatment of chronic central serous chorioretinopathy (CSCR). Methods: A retrospective chart review was performed of seven eyes from six patients with chronic CSCR treated with finasteride 5mg daily. Patients treated with other therapies or taking exogenous steroids were excluded. Main outcome measures were best-corrected visual acuity (BCVA), central macular thickness (CMT), and subfoveal fluid height. Results: Mean age was 55.4 years (4 males, 2 females). Average BCVA was 0.221 (20/33) at baseline and 0.125 (20/27) at discontinuation of therapy (p=0.482). Average CMT was 337.1 um at baseline and 216.6 um at discontinuation of therapy (p=0.060). Average subfoveal fluid height was 114.6 um at baseline and 0 um at discontinuation of therapy (p=0.065). Average duration of therapy was 5.3 months with six of the seven eyes having complete resolution of subretinal fluid. Upon discontinuation of finasteride, three eyes had recurrence of subretinal fluid after an average duration of 4.7 months. No patient had any side effects from finasteride. Conclusions: Finateride may be a useful treatment for CSCR. A larger study is needed to further evaluate the efficacy of finasteride for CSCR. Commercial Relationships: Kelly Fujikawa, None; Amar P. Patel, None; Lawrence S. Morse, None Program Number: 6383 Poster Board Number: C0160 Presentation Time: 12:00 PM–1:45 PM Anti-VEGF treatment of CNVM Secondary to Chronic Central Serous Retinopathy Netan Choudhry. Herzig Eye Institute, Toronto, ON, Canada. Purpose: The purpose of this study was to examine the efficacyof intravitreal Anti-VEGF therapy on the treatment of choroidal neovascular membranes secondary to chronic central serous retinopathy. Methods: A retrospective review of 5 eyes presenting with chronic central serous retinopathy treated with monthly anti-VEGF 0.5mg (bevacizumab or ranibizumab). Patients underwent baseline fluorescein angiography, OCT with clinical examination. At each monthly visit patient BCVA was measured in conjunction with OCT to measure response. Follow-up time ranged from 3-12 months. Results: All patient presented with subretinal hemorrhage and leakage on fluorescein angiography upon presentation. Mean visual acuity improvement after 3 months of treatment was + 10 letters and 12 letters at 6 months. All eyes demonstrated improvement of OCT features with complete resolution of subretinal fluid in all eyes by 6 months. Intraretinal cystic fluid and shallow PED”s were present in 4 eyes at 6 months. Conclusions: Intravitreal Anti-VEGF therapy demonstrated improvement in best-corrected ETDRS visual acuity in all patients and OCT abnormalities, particularly subretinal fluid. Intravitreal AntiVEGF therapy is an effective treatment for choroidal neovascular membranes secondary to Chronic Central Serous Retinopathy. Commercial Relationships: Netan Choudhry, None Program Number: 6384 Poster Board Number: C0161 Presentation Time: 12:00 PM–1:45 PM Systemic Interferon alpha 2a for treatment of chronic relapsing Central Serous Chorioretinopathy Egbert Matthe, Dirk Sandner, Lutz E. Pillunat. Dept of Ophthalmology, University of Dresden, Dresden, Germany. Purpose: Interferons are used systemically for therapy of chronic hepatitis, some forms of cancer and locally for conjunctival melanocyte disorders. They act highly antiexsudative. Central serous chorioretinopathy (CSC) is caused by exsudation from choroidal vessels resulting in detachment of the retinal pigment epithelium or neurosensory retina. We examined the use of systemic interferon alpha 2a for the treatment of chronic relapsing CSC (CRCSC). Methods: Evaluation of data and history of 6 patients with CRCSC who did not respond to (diuretics, aspirin, anti-VEGF intravitreally), could not receive (photocoagulation), or did not wish common treatment (photodynamic therapy, anti-VEGF intravitreally). Duration of CSC was at least 12 month with at least 1 recurrence. Each patient was treated with 3 million International Units of Interferon alpha 2a daily for 4 weeks, and 2 more weeks given the medication every other day. Visual acuity and central foveal thickness measured with spectral domain OCT were obtained. The patients graded the side effects as “none”, “mild” (notable but not irritating), “tolerable” (irritating, but willing to continue because of efficacy) and “not tolerable”, which stopped treatment. Results: All patients had reduction of subretinal and sub-pigmentepithelial fluid, with complete resorption in 4 cases. Depending on the duration of the CSC, visual acuity increased up to four Snellen lines. 2 patients had very small amounts of fluid when treatment was stopped. 2 patients had recurrence of fluid, one of them twice. We saw recurrence after 2 month and 4 month for the 1st patient, ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts and after 4 month for the 2nd. Re-treatment was effective for all recurrences (gain of visual acuity up to 4 Snellen lines). Side effects were graded as “none” by 1 patient, “mild” by 3 patients (flulike, fatigue), which could be overcome by adding Paracetamol, “tolerable” by 2 patients (obstipation, dizziness, nausea). Only 1 patient we had to grade the side effects as “not tolerable” (leucopenia). Conclusions: We present the first case series of systemic Interferon alpha 2a for treating CRCSC. It provides excellent short term results in reducing subretinal and sub-pigment-epithelial fluid in CRCSC. Treatment is repeatable if necessary. Patients have to be examined for side effects, which might require the therapy to be stopped. Commercial Relationships: Egbert Matthe, None; Dirk Sandner, None; Lutz E. Pillunat, None Program Number: 6385 Poster Board Number: C0162 Presentation Time: 12:00 PM–1:45 PM Micropulsed Laser Therapy Outcomes in the Treatment of Chronic Central Serous Choroidopathy Based on Leakage Pattern Alessandro J. Dare1, 2, Renato Peroni1, Fernando Paganelli1, Leonardo C. Castro1. 1Ophthalmology, HOIP - Hospital de Olhos do Interior Paulista, Araraquara, Brazil; 2Ophthalmology, CRV Consultores de Retina e Vítreo, Ribeirao Preto, Brazil. Purpose: Report the functional and anatomic outcomes of a therapeutic possibility using a foveal selective 810-nm micropulsed laser therapy (MLT) technique for chronic idiopathic central serous chorioretinopathy (ICSC) with diffuse or foveal leakage. Methods: Thirty-eight eyes from thirty-six patients with ICSC with symptoms duration longer than 6 months with foveal or juxtafoveal focal leakage (FL), or diffuse retinal pigment epithelial decompensation with multiple (ML) or indeterminate leakage (IL) involving or not the foveal area were treated. High-density focal and macular grids were delivered targeting the angiographic leakage points as well as the adjacent normal retina. Main outcomes were change in ETDRS best correct visual acuity and central macular thickness measured using optical coherence tomography. All patients were followed for at least 6-months. Pre and post-treatment fluorescein angiogram (FA) were accessed. Results: Twenty eyes (53%) were classified as FL, 9 (23,5%) as ML and 9 (23,5%) as IL. All eyes but one (95%) with FL showed complete fluid resolution after the MLT applied just at the leakage point strengthened by more laser in a grid pattern. Eight eyes (28.5%) needed two treatment sessions. Ten eyes gained more than three lines in visual acuity. In ML group 78% of the eyes had complete fluid resolution. The eyes with IL were the most difficult to respond to treatment, 78% needing re-treatments (7 of 9 eyes). Two eyes received one re-treatment, three received two re-treatments and two eyes received four re-treatment. The visual acuity did not change in 5 eyes, increased one line in two eyes and increased two lines in two eyes with IL. No signs of retinal injure were detected even in that eyes receiving 5 treatment sessions. Conclusions: MLT showed to be an effective therapeutic technique in Chronic CSC. IL have the worst outcome in response to MLT, similar to others therapeutic approaches, however re-treatments could be performed as necessary due to the absence of retinal damage, scarring, inflammation, and associated complications, enhancing the final outcomes in this challenging CSC subtype. Commercial Relationships: Alessandro J. Dare, None; Renato Peroni, None; Fernando Paganelli, None; Leonardo C. Castro, None Program Number: 6386 Poster Board Number: C0163 Presentation Time: 12:00 PM–1:45 PM Large choroidal blood vessel sign on optical coherence tomography images in acute central serous chorioretinopathy: locational relationship with angiographic findings. Sung Yong Park, Sang Jin Kim, Don-Il Ham. Ophthalmology, Sung Kyun Kwan University, Seoul, Republic of Korea. Purpose: To evaluate possible association of large choroidal blood vessel changes observed on optical coherence tomography (OCT) images with pathogenesis of central serous chorioretinopathy (CSC), locational relationship between OCT findings and angiographic findings was investigated. Methods: Clinical records of 27 patients with acute CSC who simultaneously underwent enhanced depth imaging (EDI) OCT and fluorescein angiography (FA) using Spectralis HRA+OCT (Heidelberg engineering, Germany) were retrospectively evaluated. 19 patients also underwent indocyanine green angiography (ICGA). The large choroidal blood vessel sign was defined as a round to oval choroidal structure abutting Bruch’s membrane with a diameter larger than 200 μm. Images of EDI OCT raster scan were analyzed for the location of large choroidal blood vessel sign and retinal pigment epithelial (RPE) abnormalities. Infrared (IR) images with position markers corresponding to the boundary of OCT lesions were manually overlaid on FA and ICGA images, and locational relationship was analyzed. Results: Twenty-nine eyes of 27 patients with acute CSC were evaluated. The defined sign on OCT images was identified as a large choroidal blood vessel on ICGA images. Mean frequency of the sign and RPE abnormalities on EDI OCT images was 1.83 ± 1.17 and 1.76 ± 1.02 per eye, respectively. Twenty-seven eyes (93.1 %) had the sign, showing overlapped area with hyperfluorescent area on FA. Of 25 eyes with active leakage point on FA, 23 eyes (92.0 %) showed the defined sign at or closely adjacent to the leakage point and RPE abnormalities on OCT images. In addition, 79.3% (23/29) of the sign showed overlapped area with the area having choroidal vascular hyperpermeablility on ICGA images. Conclusions: Changes of large choroidal blood vessels observed on OCT images might be associated with pathogenesis of RPE and retinal abnormalities in acute CSC. Commercial Relationships: Sung Yong Park, None; Sang Jin Kim, None; Don-Il Ham, None Program Number: 6387 Poster Board Number: C0164 Presentation Time: 12:00 PM–1:45 PM Prevalence of the large choroidal blood vessel sign on optical coherence tomography images in central serous chorioretinopathy. Don-Il Ham1, Sung Min Kim1, Sang Jin Kim1, Yun-Mi Song2, Joohon Sung3, 4, Sung Yong Park1. 1Samsung Medical Center, Ophthal, Sungkyunkwan Univ Sch of Med, Seoul, Republic of Korea; 2Family medicine, Samsung Medical Center, Sungkyunkwan Univ Sch of Med, Seoul, Republic of Korea; 3Epidemiology and Institute of Environment and Health, School of Public Health, Seoul National University, Seoul, Republic of Korea; 44Genomic Medicine Institute (GMI), Medical Research Center, Seoul National University, Seoul, Republic of Korea. Purpose: To investigate the prevalence and clinical significance of the optical coherence tomography (OCT) sign of large choroidal blood vessels in eyes with central serous chorioretinopathy (CSC). Methods: Clinical records of 84 patients with CSC and 84 healthy subjects who underwent EDI OCT were analyzed retrospectively. The large choroidal blood vessel sign was defined as a round to oval choroidal structure abutting Bruch’s membrane with a diameter larger ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2014 Annual Meeting Abstracts than 200 μm on OCT images. Images of EDI OCT raster scan were analyzed for the presence of defined sign and accompanying retinal pigment epithelial (RPE) abnormalities. Results: Ninety-two eyes with CSC and 76 unaffected fellow eyes of 84 patients with CSC and 168 eyes of 84 healthy subjects were evaluated. The defined sign were found in 96.9% of acute CSC eye, and 89.1 % of all CSC eyes. The defined sign were also observed with or without the vascular wall hyperreflectivity along the Bruch’s membrane. The hyperreflective sign was observed only in eyes with CSC (57.6%), and more frequently associated with acute than chronic and resolved CSC eyes (81.3%, 50%, and 15%, respectively; P<0.05). Although, the isoreflective sign was also observed more frequently in CSC eyes than in unaffected fellow eyes and healthy eyes (79.3%, 32.9 %, and 12.5 %, respectively), its prevalence did not differ significantly among CSC eyes with various clinical conditions (P>0.05). RPE abnormalities were observed in all OCT images in which the hyperreflective sign was observed. Conclusions: The morphological sign of large choroidal blood vessel distinguished by means of EDI OCT raster scan could be helpful for the diagnosis and evaluation of CSC. Commercial Relationships: Don-Il Ham, None; Sung Min Kim, None; Sang Jin Kim, None; Yun-Mi Song, None; Joohon Sung, None; Sung Yong Park, None Program Number: 6388 Poster Board Number: C0165 Presentation Time: 12:00 PM–1:45 PM Obscuration of the inner choroidal layer in central serous chorioretinopathy Ryo Obata, Youko Nomura, Xue Tan, Keiko Azuma, Yasuo Yanagi. Department of Ophthalmology, Univ of Tokyo School of Medicine, Tokyo, Japan. Purpose: To investigate appearance of the choroidal layer in the patients with central serous chorioretinopathy (CSC) using sweptsource optical coherence tomography (OCT) and to analyze its relationship with other tomographic or angiographic findings. Methods: Twenty-eight eyes of 27 cases underwent a set of radial scans centered on the fovea with swept-source OCT (DRI OCT-1, Topcon Inc., Tokyo). We assessed appearance in the choroidal layer, and focused on the finding that hyporeflective reflex extending from the outer choroidal layer obscured some parts of the inner layer which corresponds to Sattler layer and choriocapillaris. Moreover, we analyzed the relationship between the obscuration and serous retinal detachment (SRD), foveal choroidal thickness, and the ratio of hyper- to hyporeflective area (L/D ratio) in OCT. We also assessed the findings in fluoresceine angiography (FA) and indocyanine-green angiography (ICGA). Results: Fifteen and three of 28 eyes had been treated with photodynamic therapy (PDT) and laser photocoagulation, respectively. Inner choroidal obscuration was observed in 15 (54%) of 28 eyes. Comparing the cases with this finding and those without, 33% and 67% of the cases, respectively, had a history of PDT (p=0.008). A higher proportion of the cases with the obscuration showed SRD (69% vs 17%, p=0.008). Additionally, the cases with the finding revealed greater choroidal thickness (364 micrometer vs 295 micrometer beneath the fovea, p=0.03) and lower L/D ratio (p=0.03). Window defects (93%) in FA and hyperpermeability in ICGA (93%) were observed corresponding to the area with obscuration. Conclusions: We found inner choroidal obscuration in CSC patients using swept-source OCT. The correlation with other findings suggests that inner choroidal obscuration may be associated with exudative changes in the choroid caused by CSC. Commercial Relationships: Ryo Obata, None; Youko Nomura, None; Xue Tan, None; Keiko Azuma, None; Yasuo Yanagi, Bayer (F), Novartis (F), Santen pharmaceutical (F), Wakamoto (F) Support: Grant in Aid for scientific research (B) Number 24791837 from the Ministry of Education, Culture, Sports, Science and Technology of Japan Program Number: 6389 Poster Board Number: C0166 Presentation Time: 12:00 PM–1:45 PM Subfoveal choroidal thickness of smoking and non-smoking patients with central serous chorioretinopathy Yasuki Ito, Ruka Maruko, Yosuke Nagasaka, Kazuhiro Oiwa, Hiroko Terasaki. Ophthalmology, Nagoya Univ School of Medicine, Nagoya, Japan. Purpose: The subfoveal choroidal thickness in eyes with central serous chorioretinopathy (CSC) was reported to be thicker. The purpose of this study is to identify the parameters which are associated with subfoveal choroidal thickness in eyes with CSC. The association between subfoveal choroidal thickness and current smoking habit was also evaluated. Methods: Forty eyes of 40 patients (7 women and 33 men, age: 48.9 ± 8.9 years) of chronic CSC were retrospectively studied. Subfoveal choroidal thickness was measured with spectral domain optical coherence tomography (SD-OCT) and compared between smokers and non-smokers. The multivariate analysis was also performed with subfoveal choroidal thickness as the dependent variable, the axial length, age, sex, and current smoking habit as the independent variable, to find the parameters associated with subfoveal choroidal thickness in eyes with CSC. Results: Overall mean ± average subfoveal choroidal thickness was 422.4 ± 98.0 mm. Among 40 patients, there were 18 smokers and 22 non-smokers. Subfoveal choroidal thickness in current smokers was 454.8 ± 101.3mm and significantly thicker than 393.7 ± 19.7 mm in non-smokers (p<0.05). Multivariate analysis showed that current smoking habit was the only parameter associated with subfoveal choroidal thickness (p<0.05). Conclusions: Current smoking habit is associated with thicker subfoveal choroidal thickness in eyes with CSC. Although current smoking habit was not reported to be the distinct risk factor of CSC, current smoking habit may be the factor that worsen the CSC. Commercial Relationships: Yasuki Ito, None; Ruka Maruko, None; Yosuke Nagasaka, None; Kazuhiro Oiwa, None; Hiroko Terasaki, None Support: Grant-in Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (C2159225, C25462710). ©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected].
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