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P. H. Scharper, Jr., R. Morris; The Effect of Intravitreal Triamcinolone on Snellen Acuity, Foveal Thickness and Macular Volume of Patients With Chronic Central Serous Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4149.
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While the acute form of central serous chorioretinopathy (CSCR) usually resolves spontaneously, the chronic form (duration > 6 months) is more problematic, often resulting in permanent loss of vision. Chronic CSCR is generally characterized by multiple pigment epithelial detachments and diffuse leakage on fluorescein angiography. Focal laser treatment is not beneficial in cases with diffuse leakage, and can be associated with scotoma formation and choroidal neovascularization. Varying dosages of verteporfin with photodynamic therapy (PDT) have been successful in resolving choroidal hyperpermeability in some cases of chronic CSCR, though irreversible damage to the choroidal circulation is a potential side effect. Intravitreal trimancinolone acetonide (IVTA) successfully reduces hyperpermeability in conditions like cystoid macular edema, and is often combined with PDT in the treatment of hyperpermeability associated with choroidal neovascularization in age-related macular degeneration (AMD).
To determine the effect of IVTA on Snellen acuity, foveal thickness and macular volume in patients with chronic CSCR.
A prospective study of five patients with chronic CSCR was undertaken. Pre- and post IVTA Snellen visual acuity, OCT macular volume (MV), and foveal thickness measurements were obtained.
Average duration of symptoms prior to treatment was 15 months. Mean pre-injection Snellen acuity was 20/60. Mean final acuity was 20/40. Mean number of injections was 1.8. Mean pre-injection foveal thickness (FT) was 396 microns, while post-injection FT was 263 microns. Macular volume also improved, from 8.4mm3 pre-IVTA to 7.06 mm3 post-IVTA. Three (60%) patients underwent a second IVTA injection, while one (20%) underwent vitrectomy surgery and required a third IVTA in order to achieve complete resolution.
Ironically, while systemic steroids have been associated with the development of CSCR, our study shows that IVTA is beneficial in treating the chronic form, possibly by decreasing choroidal hyperpermeability. There are minimal risks associated with IVTA, including endophthalmitis and ocular hypertension. Since the effect is temporary, multiple injections may be necessary. Based on these results, we suggest that IVTA be considered in cases of chronic CSCR, especially since other effective treatment modalities are limited.
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