Association between central serous chorioretinopathy and Helicobacter pylori infection: a systematic review and Meta-analysis

AIM:To investigate the association between central serous chorioretinopathy(CSC)and Helicobacter pylori(Hp)by summarizing all available evidence.METHODS:The Scopus,Embase,EBSCO,PubMed,Web of Science,and Cochrane Library databases for all relevant studies published from inception to October 2022 were searched,and manually searched for relevant reference lists as a supplement.Studies investigating the association between CSC and Hp infection were included.Finally,8 case-control studies were included in the Meta-analysis after study selection.RESULTS:The results showed no significant correlation between Hp infection and CSC[odds ratio(OR)1.89,95%confidential interval(CI)0.58–6.15,I2=96%,P=0.29].After subgroup analysis based on the degree of development of the study(developing/developed countries),it was found that the results of the two subgroups were the same as the whole,and no significant difference between the two subgroups existed.Meta-regression showed that the effect of sample size on heterogeneity among studies was more prominent(P<0.01,adjusted R^(2)=89.72%),which can explain 89.72%of the sources of heterogeneity.CONCLUSION:This Meta-analysis reveals no significant correlation between Hp infection and CSC,which still warrants further well-designed extensive sample studies to reach a more reliable conclusion and promote a better understanding of the treatment of CSC.

Efficacy and safety of subthreshold micropulse laser in the treatment of acute central serous chorioretinopathy

·AIM:To analyze the efficacy and safety of subthreshold micropulse laser(SML)in the treatment of acute central serous chorioretinopathy(CSC).·METHODS:This is a retrospective case analysis study.Totally 58 eyes of 58 patients were enrolled,and they were divided into different groups.And 39 patients were treated with SML(SML group)and 19 patients were only observed(observation group).The follow-up period was 3mo after diagnosis.The best corrected visual acuity(BCVA),central retinal thickness(CRT),superficial retinal vascular density(SRVD),deep retinal vascular density(DRVD),the superficial and deep foveal avascular zone(FAZ)area,retinal light sensitivity(RLS),perfusion area of choroidal capillary layer(CCL),subfoveal choroidal thickness(SFCT)and fundus autofluorescence(FAF)were investigated.·RESULTS:The BCVA,CRT,SRVD,DRVD,the superficial and deep FAZ area,RLS,SFCT of SML group were significantly improved at 3mo(all P<0.05).In the observation group,only CRT,DRVD and SFCT were improved(all P<0.05).Other research items in the observation group were not significantly different from baseline(all P>0.05).At the last follow-up,the BCVA and RLS in the SML group were better than those in the observation group,and CRT was lower,SRVD and DRVD,perfusion area of CCL were larger(all P<0.05).On FAF,no change of treatment spots was found after treatment.No structural laser damage was observed on optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA),and no choroidal neovascularization was observed.·CONCLUSION:SML treatment of acute CSC can improve BCVA,RLS,and perfusion area of CCL,reduce CRT,increase SRVD and DRVD,and is safe.

Detection of macular ganglion cell complex loss and correlation with choroidal thickness in chronic and recurrent central serous chorioretinopathy

AIM:To investigate the association of ganglion cell complex thickness(GCCt),global loss volume percentage(GLV%),and focal loss volume percentage(FLV%)with structural and functional findings among patients with chronic central serous chorioretinopathy(CCSC)and recurrent central serous chorioretinopathy(RCSC)by optical coherence tomography(OCT).METHODS:Among 29 patients with monocular affected central serous chorioretinopathy(CSC),15 had CCSC,and 14 had RCSC.The GCCt,FLV%,GLV%,and subfoveal choroidal thickness(SFCT)and sublesional choroidal thickness(SLCT)values were determined using OCT,and the association of these characteristics with neural structure parameters,choroidal morphology,features and functional alterations were estimated for the CCSC and RCSC patients.RESULTS:In CCSC,the affected eyes had significantly lower GCCt values than the fellow eyes in the macular regions(all P<0.05),with the highest GCCt observed in the inferior area.A significant association was found between the GCCt in different regions and the change in best corrected visual acuity(BCVA;r=-0.696;-0.695;-0.694,P<0.05)in CCSC patients.A statistically significant moderate negative correlation indicated that long-term CCSC was associated with greater differences in the GCCt in different regions between affected and fellow eyes(r=-0.562;r=-0.556;r=0.525,P<0.05).Additionally,observation of thickened SFCT was associated with a worse FLV%(r=0.599;r=0.546,P<0.05)in both groups.Similarly,thickened SLCT was associated with FLV%in RCSC patients(r=0.544,P<0.05).CONCLUSION:The distribution and GCCt are associated with the duration and visual outcomes of CCSC,whereas there is no correlation among RCSC patients.FLV%may be instrumental in differentiating the various outer choroidal vessels(pachyvessels)in long-term CSC.These results suggest that neural structure parameters may aid in estimating and predicting the recovery of altered morphology and function in CCSC and RCSC patients.

Oral eplerenone for the management of chronic central serous chorioretinopathy

AIM: To examine eplerenone(Inspra, Pfizer), a mineralocorticoid receptor antagonist, as a treatment option for chronic central serous chorioretinopathy(CSCR).METHODS: A retrospective consecutive case series was conducted for patients receiving oral eplerenone for chronic CSCR. At baseline and each follow-up visit,spectral domain optical coherence tomography(SD-OCT)imaging was performed, including manual measurements of the height and diameter size of subretinal fluid. The primary outcome measure was the reduction in subretinal fluid following initiation of therapy.RESULTS: A total of 17 eyes of 13 patients treated with25 and 50 mg of oral eplerenone per day were identified.Subretinal fluid(SRF) decreased over time following eplerenone therapy(P = 0.007 and P =0.002, diameter and height respectively). Maximum SRF height decreased from a mean of 131.5 μm at baseline to 15.3 μm at day181+. SRF diameter decreased from an average of 2174.4μm at baseline to 46.9 μm at day 181 +. Log MAR visual acuity improved from 0.42(Snellen equivalent: 20/53) at baseline to 0.29(Snellen equivalent: 20/39) at day 181 +(P = 0.024). Central subfield thickness(CST) decreased from 339.5 μm at baseline to 270.3 μm at day 181+(P = 0.029).CONCLUSION: Eplerenone therapy resulted in significant anatomic and visual improvements in eyes with chronic CSCR.

Fundus autofluorescence in central serous chorioretinopathy: association with spectral-domain optical coherence tomography and fluorescein angiography

and FA for identifying pathological abnormalities in CSC. The characteristics of IA AF in CSC were attributable to the modification of melanin in the RPE. IR- AIM: To evaluate the correlation among changes in fundus autofluorescence (AF) measured using infrared fundus AF (IR -AF) and short-wave length fundus AF (SW -AF) with changes in spectral -domain optical coherence tomography (SD -OCT) and fluorescein angiography (FA) in central serous chorioretinopathy (CSC). METHODS: Two hundred and twenty consecutive patients with CSC were included. In addition to AF, patients were assessed by means of SD -OCT and FA. Abnormalities in images of IA -AF, SW -AF, FA were analyzed and correlated with the corresponding outer retinal alterations in SD-OCT findings. RESULTS: Eyes with abnormalities on either IR-AF or SW-AF were found in 256 eyes (58.18%), among them 256 eyes (100%) showed abnormal IR -AF, but SW-AF abnormalities were present only in 213 eyes (83.20%). The hypo-IR-AF corresponded to accumulation of subretinal liquid, collapse of retinal pigment epithelium (APE) or detachment of APE with or without RPE leakage point in the corresponding area. The hyper -IR -AF corresponded to the area with loss of the ellipsoid portion of the inner segments and sub -sensory retinal deposits or focal melanogenesis under sensory retina. The hypo-SW-AF corresponded to accumulation of subretinal liquid or atrophy of RPE. The hyper -SW -AF associated with sub -sensory retinal deposits, detachment of RPE and focal melanogenesis. CONCLUSION: IR-AF was more sensitive than SW-AF AF should be used as a common diagnostic tool for identifying pathological lesion in CSC.

Central serous chorioretinopathy:from glucocorticoids to light intensity

Central serous chorioretinopathy （CSC） is characterized by a localized accumulation of subretinal fluid and an idiopathic focal leakage from choroidal vessels. The exact pathogenesis of CSC, however, still remains obscure. In this paper, we hypothesized that CSC may result from a response of choroidal vessels to an acute increase in the environmental light intensity leading to a focal leakage from the choroidal vessels. High levels of glucocorticoids, in our proposed model, may cause persistence rather than initiation of the focal leakage, probably by suppressing the synthesis of collagen and extracellular matrix components and inhibiting fibroblastic activity.

Comparison of autofluorescence and optical coherence tomography findings in acute and chronic central serous chorioretinopathy

AIM:To discuss and compare the fundus autofluorescence(FAF)and optical coherence tomography(OCT)in acute or chronic central serous chorioretinopathy(CSCR).METHODS:Medical records of 100 cases of CSCR were reviewed.Acute and chronic cases were evaluated according to the duration of decreased visual acuity,serous retinal detachment(RD)and focal leakage on fluorescein angiography(FA).Chi-square test was used for statistical analysis.RESULTS:Forty cases had acute and 60 cases had chronic CSCR.FAF showed focal hypo-autofluorescence in 34(85%)and iso-autofluorescence in 6(15%)of acute cases and hypo-autofluorescence in 51(85%),hyperautofluorescence in 6(10%)and iso-autofluorescence in3(5%)of chronic cases.OCT showed serous RD with distinct borders correlated with FAF findings(hypoautofluorescence)in all acute CSCR cases.In chronic CSCR group,OCT showed serous RD with indistinct borders correlated with FAF findings.The differences between the OCT and FAF findings of the two groups were significant(P=0.000).CONCLUSION:OCT and FAF findings can support the clinical observations in differential diagnosis of acute and chronic CSCR and help clinicians to evaluate retinal pigment epithelium,outer segments of photoreceptors and the components of serous RD.

Is myopia a protective factor against central serous chorioretinopathy?

AIM： To evaluate if any association exists between central serous chorioretinopathy （CSCR） and the refractive status of the eye. METHODS： This retrospective, institutional, case control study included 499 patients, wherein 262 patients diagnosed as acute CSCR, were compared with an age and gender matched control group of 237 patients. All patients were evaluated with a detailed systemic and ocular history, objective and subjective refractions for both eyes and complete ocular examination by a retina specialist, at all visits. Optical coherence tomography confirmed the diagnosis of CSCR. ~ RESULTS： The mean age was found to be 40.7y in the study group （Group 1） compared to 38 10y in the control group （Group 2）. Most common refractive status in the study group, was emmetropia seen in 191 patients （72.9%）, followed by hypermetropia seen in 47 patients （17.9%） and astigmatism seen in 21 patients （8.0%）. Only 3 subjects （1.1%） had myopia, which was less than or equal to 1.0 D, compared to 70 subjects （29.5%） in the control group, suggesting a statistically significant lower incidence of CSCR among the myopic patients （P〈 0.0001）. With respect to the systemic factors, 26 （9.9%） patients were using systemic steroids in the study group （Group 1） compared to none in the control group （Group 2） suggesting a statistically significant association of CSCR with systemic steroid use （P〈0.05）. No other significant systemic risk factors were noted. CONCLUSION： Though CSCR is a multifactorial disease, myopia serves as a protective factor for CSCR. Thus, myopic eyes are less likely to develop CSCR. Since both retinal pigment epithelium （RPE） and choriocapillaris are postulated in the pathogenesis of CSCR, chorio-retinal thinning and atrophy seen in myopic eyes are less likely to cause CSCR.

Chorioretinal response to intravitreal aflibercept injection in acute central serous chorioretinopathy

AIM: To evaluate chorioretinal responses to intravitreal aflibercept injection(IAI) in patients with acute central serous chorioretinopathy(CSC). METHODS: Seventy-one eyes from 71 patients with symptomatic CSC for less than six months were included. Thirty-five eyes received a single IAI and 36 eyes were observed without treatment. Best-corrected visual acuity(BCVA), central subfield foveal thickness(CSFT), and subfoveal choroidal thickness(SFCT) were assessed at baseline and at 1, 2, and 3 mo. RESULTS: The mean SFCT in the IAI group decreased at 1 mo, rebounded at 2 mo and remained stable at 3 mo compared to the baseline, while significant change was not noted in the observation group. The mean CSFT decreased significantly during the 3-month study period in both groups, and was significantly lower in the IAI group at 1 mo(P<0.001). A rebound of CSFT between 1 and 2 mo was noted in 14 eyes(40.0%) in the IAI group and in 1 eye(2.8%) in the observation group(P<0.001). The significant visual improvement was achieved from 1 mo in the IAI group, and from 2 mo in the observation group. The rate of complete absorption of subretinal fluid at 3 mo did not differ between the two groups.(45.7% vs 41.7%, P=0.813). CONCLUSION: A single IAI for acute CSC induce a transient decrease in SFCT and CSFT, which implies that IAI may have a pharmacological effect on the underlying hyperpermeable choroid in acute CSC.

Helicobacter pylori as a risk factor for central serous chorioretinopathy:Literature review

Helicobacter pylori(H. pylori), a Gram-negative bacterium, is one of the most frequent causes of gastrointestinal infections worldwide. It has been associated as a pathogen for the human body with many systemic diseases, including different eye diseases. We will focus on a specific eye disease called idiopathic central serous chorioretinopathy(ICSCR). This disease is characterized by a serous detachment of the neurosensory retina in the macular region, which affects the vision to different degrees. Currently, the pathophysiology of ICSCR is not clear and there is no effective treatment. However, several potential risk factors have been elucidated. One of the factors that has more frequently been associated with ICSCR is stress. As H. pylori was identified as a possible etiological factor for occlusive arterial diseases in young people who were particularly stressed, it was thought that H. pylori might also be present in ICSCR. Therefore, some physicians started to test its presence in patents with ICSCR. If H. pylori happened to be associated with ICSCR, the treatment of gastrointestinal infection could also improve visual symptoms and help to remediate this eye disease. Although H. pylori is highly prevalent in the general population, a true cor-relation seems to exist. We present a review on the relationship between ICSCR and H. pylori.

Efficacy of the subthreshold micropulse yellow wavelength laser photostimulation in the treatment of chronic central serous chorioretinopathy

AIM:To evaluate the efficacy and safety of subthreshold micropulse yellow laser(SMYL)in the treatment of chronic central serous chorioretinopathy(CCSC).METHODS:The medical records of 58 eyes of 58 patients with CCSC were reviewed.A 577-nm SMYL system was used for the treatment.Fundus fluorescein angiography was used as the primary method of identifying CCSC,and resolution of subretinal fluid(SRF)evaluated by optical coherence tomography(OCT)and fundus autofluorescence.Central macular thickness(CMT),central macular volume(CMV),total macular volume(TMV),subfoveal choroidal thickness(SFCT),subretinal fluid height(SRFH),and subfoveal fluid basement diameter values were measured by spectral domain-OCT(SD-OCT)for all eyes.RESULTS:The mean age of the patients was 42.4±9.9(range:20-72)y.The mean follow-up was 11.4±8.5(range:6-37)mo.Median BCVA at at the final follow up after treatment was statistically significant from the baseline.Complete SRF resolution was 12.1%of the eyes in the 1^st month,67.2%of the eyes in the 3rd month and 67.2%of the eyes in the last follow up.The initial median CMT,CMV,TMV,and SFCT values before treatment was significantly higher than 3^rd month visit values(P<0.001).In the multivariate analysis performed,age and disease duration were found to be a risk factor for persistent SRF(P=0.017,P=0.016,respectively).CONCLUSION:SMYL treatment provides a significant anatomical and functional improvement and is effective in eliminating SRF in eyes with CCSC.

Comprehensive evaluation of intravitreal conbercept versus half-dose photodynamic therapy for chronic central serous chorioretinopathy

AIM:To compare the safety and efficacy of conbercept intravitreal injection and half-dose photodynamic therapy(PDT)in treating chronic central serous chorioretinopathy(CSC).METHODS:This study was retrospective.Thirty-seven patients(37 eyes)with chronic CSC received conbercept injections while 57 patients(57 eyes)were treated with half-dose PDT.All subjects were followed in 6mo.Outcome measures included change in best-corrected visual acuity(BCVA),central macular thickness(CMT),subfoveal choroidal thickness(SFCT),and resolution of subretinal fluid(SRF).RESULTS:There was no adverse event observed in either treatment group.At the 6-month follow-up,26 eyes(70.3%)in the conbercept group and 54 eyes(94.7%)in the half-dose PDT group(P<0.05)reached full resolution of SRF.The mean logarithm of the minimum angle of resolution(log MAR)BCVA significantly improved(P<0.001)in both treatment groups with better outcome at early phase in the half-dose PDT group(2 wk,1,and 2 mo,P<0.05).All subjects experienced significant CMT improvement(P<0.001)with no statistical difference between the two groups(P>0.05).The SFCT also improved in all subjects(P<0.001)with better outcome in the half-dose PDT group(P<0.05).CONCLUSION:Both intravitreal conbercept and halfdose PDT are safe to use in treating chronic CSC.By 6mo,both treatment groups are efficacious in improving BCVA,reducing CMT and SFCT,and resolving SRF in eyes with chronic CSC.Half-dose PDT may show better outcome at initial phase of treatment in chronic CSC.Longer follow-up period is necessary to study for long-term effect and safety.

A novel mutation of SGK-1 gene in central serous chorioretinopathy

AIM: To investigate the association of serum glucocorticoid kinase gene-1(SGK-1) DNA variants with chronic central serous chorioretinopathy(CSC).METHODS: We enrolled 32 eyes of 32 patients who were diagnosed with chronic CSC and composed 32 normal eyes as a control group. Peripheral blood was used for DNA extraction and polymerase chain reaction amplification. SGK1 gene was sequenced by using Big Dye Terminator v3.1 cycle sequencing Kit(Applied Biosystems, Foster City, CA, USA). The SGK-1 gene and its variants were investigated in CSC patient group and control group.RESULTS: We identified a new polymorphism M32 V in two person in the patient group [Minor allele frequency(MAF) =0.009] on the region of 1-60 amino acids. The rs1057293 was located in the encoder region of the SGK- 1 gene but not associated with CSC(P =0.68). An intrinsic rs1743966 is also not associated(P =0.28).CONCLUSION: The new polymorphism M32 V is located on the region of 1-60 amino acids which is necessary for localization to the mitochondria in CSC patient. This mutation is probably important for the energy metabolism and plays an important role in the cellular response to hyperosmotic stress and other stress stimuli. Both rs1057293 and rs1743966 are not associated with CSC.

Long term outcomes for patients treated with half-fluence photodynamic therapy for chronic central serous chorioretinopathy: a case series

A case series was used to evaluate the efficacy of halffluence photodynamic therapy（PDT） for chronic central serous chorioretinopathy（CSCR）. Patients were treated with standard-dose verteporfin and half-fluence PDT. Totally 13 eyes from 11 patients were included. The mean patient age was 52.0 y. There was a mean reduction in central retinal thickness of 107.0 microns. Totally 7/13 eyes（53.8%） achieved resolution of subretinal fluid（SRF） on optical coherence tomography（OCT） scan after 1 treatment with PDT. Four eyes had further treatment with PDT; of these 1 eye achieved resolution of SRF. Seven of the 13 eyes（53.8%） achieved an improvement of more than 5 ETDRS letters. One patient experienced acute macula oedema 1 d post PDT treatment. These results support the hypothesis that half-fluence PDT can have a positive effect in chronic CSCR for a gain in visual acuity and reduction in sub-retinal fluid. Acute macula oedema is a rare but potential adverse effect of half-fluence PDT.

Improved thickness measurement method for choroidal hyperpermeability in central serous chorioretinopathy

AIM:To observe choroidal thickness changes in the choroidal hyperpermeability area(CHA)in patients with central serous chorioretinopathy(CSC)after photodynamic therapy(PDT)using indocyanine green angiography(ICGA)combined with optical coherence tomography(OCT).METHODS:This was a cohort study of 17 eyes(17 patients)with CSC.In all patients,the range of CHA was determined by ICGA.The patients were divided into two groups based on CHA covered the fovea(group A)or not(group B).All patients received half-dose verteporfin PDT over CHA in ICGA.Choroidal thickness was measured by OCT before,1,and 3 mo after treatment.The choroidal thickness values of the fovea and CHAs were obtained for each measurement.Secondary outcomes were changes in the best-corrected visual acuity(BCVA)and amount of subretinal fluid(SRF).RESULTS:The differences in center choroidal thickness at baseline and at 1 and 3 mo post-PDT were statistically significant in group A and all patients(both P<0.001).There was no significant difference in group B(P=0.059).The differences of thickness of CHA and BCVA at baseline and1 and 3 mo post-PDT were statistically significant in group A,group B,and all patients(all P<0.01).All patients showed complete SRF absorption at 3 mo post-PDT.CONCLUSION:Center choroidal thickness does not accurately reflect changes in CHA of patients whose CHA does not covered the fovea center.Using CHA as the observation target can make up for this limitation,expand the scope of application,and reduce bias.

Association between endogenous cortisol level and the risk of central serous chorioretinopathy:a Meta-analysis

AIM： To assess the association between endogenous cortisol level and the risk of central serous chorioretinopathy（CSC）.METHODS： Case-control studies were systematically searched on PubM ed, Embase, Cochrane, China National Knowledge Infrastructure（CNKI） for publishes between January 1990 and July 2017 to assess the association between endogenous cortisol level and CSC. The main endpoints were serum cortisol level at 8 a.m. and 24-hour urine 17-hydroxysteroids level. We assessed pooled data using a random-effects model.RESULTS： Of 86 identified studies, 5 were eligible included in our analysis. The 5 studies included a total of 315 participants, of whom 187 had CSC. Statistically significant association was observed between serum cortisol level（summary SMD=0.77, 95%CI=0.55-0.99）, 24-hour urine 17-hydroxysteroids level（summary SMD=0.95, 95%CI=0.61-1.30）, and the risk of CSC.CONCLUSION： Endogenous cortisol level is associated with an increased risk of CSC. Combined treatment targeting the serum cortisol level at 8 a.m. and 24-hour urine 17-hydroxysteroids level can be a potential preventive strategy for individuals who are at risk of CSC and therapeutic strategy for patients with CSC.

External drainage for exudative retinal detachment secondary to central serous chorioretinopathy

Background: To report the outcomes of external drainage of subretinal fluid(SRF) in exudative retinal detachment secondary to central serous chorioretinopathy(CSCR).Methods: Retrospective observational analysis of six eyes with exudative retinal detachment secondary to CSCR who underwent external drainage of SRF between 2004 and 2014 was performed. Collected data included demographics, steroid usage, surgical details, and visual acuity preoperatively and postoperative visual acuity and clinical examination data were collected. Results: Six eyes of six subjects were included with mean age of 45 years(range, 32 to 61 years). All subjects were male. Mean duration of symptoms was 4.6 months(range, 3 to 8 months). The pre-operative bestcorrected visual acuity(BCVA) ranged from perception of light to 20/60. Four eyes were treated with conventional external drainage and two underwent Chandelier-assisted external drainage. Three cases had laser treatment before drainage and one case underwent photodynamic therapy(PDT) after drainage. The BCVA at last follow-up ranged from 20/2,000(counting fingers at 2 feet) to 20/20. No recurrences were noted in any of the cases till the last follow-up. Mean duration of follow-up was 38 months. Conclusions: Our study demonstrates successful management of exudative retinal detachment secondary to CSCR with external SRF drainage without any complications.

A patient misdiagnosed with central serous chorioretinopathy: A case report

BACKGROUND Due to some similarities in the manifestations between central serous chorioretinopathy (CSC) and polypoidal choroidal vasculopathy (PCV),PCV may be misdiagnosed as CSC.More attention should be paid to distinguishing these two disorders.CASE SUMMARY A 52-year-old woman presented to our hospital with blurred vision in her left eye for approximately 1 wk.Anterior segment and intraocular pressure findings were normal in both eyes.Fundus photography of the left eye showed a seemingly normal adult oculus fundus without any obvious hard exudate or hemorrhage.Optical coherence tomography exhibited a hypo-reflective space beneath both the neurosensory retina and the pigment epithelium layer.The late phase of fluorescein angiography revealed increased leakage.The patient was initially diagnosed with CSC.At follow-up,however,the final diagnosis turned out to be PCV.CONCLUSION CSC and PCV are two different retinal entities.Lipid deposition and hemorrhage are the most important elements that lead to confusion between these two entities.Indocyanine green angiography should be performed to make a definitive diagnosis,especially in cases with suspected PCV.

Clinical research of fenofibrate and spironolactone for acute central serous chorioretinopathy

AIM：To compare the effectiveness of combined fenofibrate and spironolactone with fenofibrate alone for treatment of central serous chorioretinopathy（CSCR）.METHODS： Totally 60 patients（60 eyes） with a history of acute CSCR were randomed into two groups： group A with combination of fenofibrate（200 mg） and spironolactone（100 mg）,and group B with only fenofibrate（200 mg）.They were taken half an hour before meals and once per day for 8wk.The changes of the visual acuity,subjective symptom,ocular surface disease index（OSDI）,the tear film and optical coherence tomography were observed at 2,4,6,and 8wk before and after treatment.RESULTS： The best corrected visual acuity（BCVA,log MAR） was improved to 0.22 and 0.27 after treatment from baseline of 0.35 and 0.36 in groups A and B（P 〈0.05）,respectively.After 8wk treatment,the central subfield thickness（CST）,and subretinal fluid volumn（SFV） decreased significantly to 49.5% and 78.8% in group A,37.0% and 57.2% in group B.There were significant differences of CST and SFV in both groups（all P 〈0.05）.CONCLUSION：Fenofibratecombinedwithspironolactone may have more clinical efficacy in the treatment of CSCR than fenofibrate only.

Angiographic characteristics of central serous chorioretinopathy in an Egyptian population

· AIM: To describe and analyze the demographic characteristics and to determine the angiographic features of acute central serous chorioretinopathy(CSCR) in an Egyptian population. ·METHODS: A series of consecutive patients presenting with acute idiopathic CSCR to Mansoura Ophthalmology Center Mansoura University who underwent fluorescein angiography (FA) within a 3 -year -period (between January 1, 2007 and December 31, 2009) was retrospectively studied. Patient demographics and angiographic features were studied. Results were compared to those of other Western and Asian populations. ·RESULTS: Fluorescein angiograms of 86 patients were analyzed. 91% were males. The age range of patients was 24 -49 years, with a mean age of (38±6) years. The right eye was the presenting eye in 47% of patients. Eighty seven percent of eyes showed delayed choroidal filling. Thirty -five percent of patients had more than one point of leakage. The macula was the most common site of fluorescein leakage seen in 79% of patients. Peripheral leakage was seen in 14% of patients while peripapillary leakage was seen in 12% of patients. The inkblot leakage pattern was found in 53% of patients. The presenting eye had RPE atrophic changes in 84% of cases. The other eye was assessed in 44 patients (51%). Fifty-five percent of them had signs of RPE atrophic changes. ·CONCLUSION: In the Egyptian population, CSCR is seen at younger age with higher male -to -female ratio and more frequent smokestack leaks than other populations. Despite younger age group, this series of patient showed higher frequency of bilateral and multifocal disease compared to other studies. Roles of psychological stress and choroidal ischemia in pathogenesis of CSCR need further evaluation. ·