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Jayashree Ramu, Luke Nicholson, Mahdi Muwas, Philip G Hykin, Sobha Sivaprasad; Disease outcome in central serous chorioretinopathy patients with and without treatment. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3727. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The natural history of central serous chorioretinopathy (CSCR) is unpredictable, the effectiveness of current treatment options is unproven and there is no consensus on when to initiate or withhold treatment. This study evaluated the course of CSCR in a clinical setting.
604 electronic health records and medical imaging database of consecutive patients attending Moorfields Eye Hospital with CSCR between April 2013 and March 2014 were retrospectively reviewed for active CSCR as evidenced by the presence of subretinal fluid during this period. Demographics, presenting visual acuity (VA), treatment options and outcomes, and final VA were collected until 30th September 2014, allowing for a minimum of 6 months follow up. All data were analysed using descriptive statistics.
200 eyes of 177 patients were identified. The mean age at presentation was 53.07 ± 12.27 yrs and the patients were predominantly male (71.2%) of Caucasian origin (43.5%) and 22% had history of steroid use before disease onset.<br /> The mean presenting VA for the cohort was 0.28 ± 0.33 logMAR. Of the 200 eyes, 157 (78%) eyes were observed and 43 (22%) treated. The mean presenting VA of the observation group was 0.22 ± 0.29 logMAR which was maintained at the final visit (0.21 ± 0.32). However, the visual acuity of the treated group at onset was 0.47 ± 0.39 logMAR and following treatment, the mean visual acuity loss was 0.14 ± 0.45 logMAR. The treatment options included (N): 11 = PDT; 10 = thermal laser; 9 = Anti-VEGF; 5 = eplerenone, 1 = ketoconazole, 1 = aspirin. 6 patients received more than one type of treatment. 41% of patients in the observation group had complete resolution of fluid compared to 21% in the treated group.
The study showed that treatment was mainly offered to patients with less good initial visual acuity which may have contributed to the worse outcome of the treated group both in terms of visual acuity and subretinal fluid. There is an unmet need for randomised controlled trials comparing different treatment modalities with observation in CSCR.
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