Risk factors for central serous chorioretinopathy: A case–control study

doi:10.1016/j.ophtha.2003.09.024

Ophthalmology

Volume 111, Issue 2, February 2004, Pages 244-249

Presented at: American Academy of Ophthalmology Annual Meeting, November 12, 2001; New Orleans.

https://doi.org/10.1016/j.ophtha.2003.09.024 Get rights and content

Abstract

Purpose

To identify systemic factors associated with the development of central serous chorioretinopathy (CSCR).

Design

Retrospective, case–control study. Participants and controls: 312 cases and 312 controls.

Results

By use of a multivariate analysis, the previously described risk factors, systemic steroid use (odds ratio [OR], 37.1; 95% confidence interval [CI], 6.2–221.8), and pregnancy (OR, 7.1; 95% CI, 1.0–50.7), were strongly associated with CSCR. Additional risk factors identified by this study include antibiotic use (OR, 6.2; 95% CI, 1.0–37.9), alcohol use (OR, 4.9; 95% CI, 1.5–16.3), untreated hypertension (OR, 3.3; 95% CI, 1.3–8.5), and allergic respiratory disease (OR, 2.5; 95% CI, 1.2–5.1).

Conclusions

A wide variety of systemic factors are associated with CSCR. Prospective studies are warranted to evaluate the nature and significance of these associations further.

Section snippets

Materials and methods

The general study design was multicenter, retrospective, and case–control. The case definitions used in this report are similar to ones used previously.15, 16, 17 All cases included in this study had classic CSCR or chronic CSCR (also called diffuse retinal pigment epitheliopathy). Classic CSCR was defined as a localized neurosensory retinal detachment associated with a focal leak or leaks at the level of the retinal pigment epithelium by fluorescein angiography. Chronic CSCR was defined as a

Results

There were 312 cases with CSCR. The mean age of the cases was 45.02 years (standard deviation [SD], 12.28; range, 8–92 years; median, 44 years). There were 230 men and 82 women in the CSCR group (M/F ratio 2.8:1). Two hundred forty-four patients had first-episode classic CSCR, and 68 had recurrent classic or chronic CSCR. There were 312 controls, with 230 men and 82 women (M/F ratio 2.8:1). The mean age of the control group was 45.34 years (SD, 12.59 years; range, 6–92 years; median, 44 years).

Discussion

This is the largest and only the second case–control study of patients with CSCR. In addition to confirming previously recognized risk factors such as the use of systemic steroids and pregnancy, we also describe antibiotics, antihistamines, multisystem autoimmune diseases, untreated hypertension, alcohol use, and tobacco use as risk factors. These risk factors are wide ranging and include at least 2 classes of medications, a group of systemic disorders that share some pathophysiologic features,

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This study aimed to investigate the risk of major retinal diseases including central serous chorioretinopathy, diabetic retinopathy, retinal vein occlusion, retinal artery occlusion, and hypertensive retinopathy in the long-term postpartum stage according to the presence of previous pregnancy-induced hypertension in a large cohort based on the Korean National Health Insurance Database.
On the basis of Korean health data, 909,520 patients who delivered from 2012 to 2013 were analyzed. Among them, patients who had previous ocular diseases or hypertension and multiple births were excluded. Finally, 858,057 mothers were assessed for central serous chorioretinopathy (ICD-10: H35.70), diabetic retinopathy (ICD-10: H36.0, E10.31, E10.32, E11.31, E11.32, E12.31, E13.31, E13.32, E14.31, E14.32), retinal vein occlusion (ICD-10: H34.8), retinal artery occlusion (ICD-10: H34.2), and hypertensive retinopathy (ICD-10: H35.02) for 9 years after delivery. Enrolled patients were divided into 2 groups: 10,808 patients with and 847,249 without pregnancy-induced hypertension. The primary outcomes were the incidence of central serous chorioretinopathy, diabetic retinopathy, retinal vein occlusion, retinal artery occlusion, and hypertensive retinopathy 9 years after delivery. Clinical variables were age, parity, cesarean delivery, gestational diabetes mellitus, and postpartum hemorrhage. In addition, pregestational diabetes mellitus, kidney diseases, cerebrovascular diseases, and cardiovascular diseases were adjusted.
Postpartum retinal disease during the 9 years after delivery and total retinal diseases showed higher rates in patients with pregnancy-induced hypertension. In detail, the rates of central serous chorioretinopathy (0.3% vs 0.1%), diabetic retinopathy (1.79% vs 0.5%), retinal vein occlusion (0.19% vs 0.1%), and hypertensive retinopathy (0.62% vs 0.05%) were higher than those found in patients without pregnancy-induced hypertension. After adjusting for confounding factors, pregnancy-induced hypertension was associated with development of postpartum retinopathy, with a >2-fold increase (hazard ratio, 2.845; 95% confidence interval, 2.54–3.188). Furthermore, pregnancy-induced hypertension affected the development of central serous chorioretinopathy (hazard ratio, 3.681; 95% confidence interval, 2.667–5.082), diabetic retinopathy (hazard ratio, 2.326; 95% confidence interval, 2.013–2.688), retinal vein occlusion (hazard ratio, 2.241; 95% confidence interval, 1.491–3.368), and hypertensive retinopathy (hazard ratio, 11.392; 95% confidence interval, 8.771–14.796) after delivery.
A history of pregnancy-induced hypertension increases the risk of central serous chorioretinopathy, diabetic retinopathy, retinal vein occlusion, and hypertensive retinopathy according to 9-year long-term ophthalmologic follow-up.
Comparing interventions for chronic central serous chorioretinopathy: A network meta-analysis
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We compare efficacy of treatments for chronic central serous chorioretinopathy (CSCR) > 3 months. Four treatment classes were considered: photodynamic therapy (PDT), subthreshold laser therapies (SLT), mineralocorticoid receptor antagonists (MRA) and antivascular endothelial growth factor (anti-VEGF) agents. Pairwise and network meta-analyses (NMA) of the primary outcomes (complete resolution of subretinal fluid (SRF), mean change in best corrected visual acuity (BCVA as logMAR) and mean change in SRF) and secondary outcomes (mean change in central retinal thickness, and central choroidal thickness (μm), recurrence of SRF, and adverse events) at 3, 6, and 12 months were compared. Confidence in Network Meta-Analysis (CINeMA) informed the certainty of NMA evidence.
Eleven RCTs of 458 eyes (450 patients) were included. NMA at 3 months showed that both PDT and SLT were superior to control for resolution of SRF (OR 4.83; 95% CI 1.72–13.55 and 2.27; 1.14–4.49, respectively) and SLT was superior to control for improving BCVA (MD -0.10; -0.17 to -0.04). PDT was superior to SLT for improving CRT (MD -42.88; -75.27 to -10.50). On probability ranking, PDT and SLT were consistently the best-ranked treatments for each outcome at 3 months, but low confidence of evidence and paucity of studies preclude definitive conclusions.
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To evaluate the optical coherence tomography (OCT) biomarkers of patients with central serous chorioretinopathy (CSC) according to the presence or absence of direct anatomical relation to intervortex vein anastomosis (IVA) on indocyanine green angiography.
We reviewed the records of 39 patients with chronic CSC. Patients were categorized in 2 groups: presence of IVA(Group A) or absence of IVA(Group B) in the macular region. Localization of IVA was categorized in 3 areas according to ETDRS grid:inner 1 mm circle (area-1), 1–3 mm middle circle (area-2) and 3–6 mm outer circle (area-3).
There were 31 eyes in Group A,21 eyes in Group B. Mean age of the patients was 52.5 ± 11.3years in Group A,47.2 ± 11years in Group B(p<0.001).Mean initial visual acuity (VA) was 0.38±0.38LogMAR in Group A, 0.19±0.21LogMAR in Group B(p<0.001).Mean subfoveal choroidal thickness(SFCT) was 436.3 ± 134.3µ in Group A,480.2 ± 136.6µ in Group B(p<0.001).Localization of IVA in area-1 was correlated with inner choroidal attenuation (ICA) and leakage on IVA(p = 0.011,p = 0.02). Localization of IVA in area-3 was correlated with irregular lesions on RPE(p = 0.042).Smokestack configuration,intraretinal cysts and ICA were correlated with worse initial VA(p<0.001,p = 0.001 and p = 0.04).Shaggy subtype of photoreceptor disruption was associated with better initial VA(p = 0.003).
We detected older age, worse initial VA and thinner SFCT in patients with chronic CSC and macular region IVA(m-IVA). Long term follow-up of patients with and without m-IVA may exhibit the difference in treatment outcomes and development of neovasculopathy.
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Swept-source optical coherence tomography angiography (SS-OCTA) was used to detect the presence of macular neovascularization (MNV) in eyes with exudative central serous chorioretinopathy (CSCR).
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^☆

Manuscript no. 210543.

Supported by The Macula Foundation, New York; The Richard H. Chartrand Foundation; Research to Prevent Blindness; and The Massachusetts Lions Eye Research Fund.

The authors have no commercial or proprietary interest in any of the materials noted in this article.

^†: The manuscript was prepared and submitted by Dr Robert Haimovici, who passed away October 9, 2002 at age 40 after a 7-year battle with cancer. At the request of Dr Haimovici's family, Dr Sean Koh has become the corresponding author and has completed the final revisions of the manuscript.

^*: *See Appendix for Study Group membership.

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Original articleRisk factors for central serous chorioretinopathy: A case–control study☆

Abstract

Purpose

Design

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Am J Ophthalmol

Consecutive development in daughter and mother. Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Pharmacol Biochem Behav

Brain Res

J Lab Clin Med

Ophthalmology

Alcohol

J Neuroimmunol

Rheum Dis Clin North Am

Central serous retinopathy

Br J Ophthalmol

Pathogenesis of disciform detachment of the neuroepithelium II. Idiopathic central serous choroidopathy

Am J Ophthalmol

Loss of vision due to central serous chorioretinopathy following psychological stress

Am J Psychiatry

Type A behavior and central serous chorioretinopathy

Trans Am Ophthalmol Soc

Maculopathya corticosteroid side-effect

J All India Ophthalmol Soc

Central serous chorioretinopathy complicating systemic corticosteroid treatment

Br J Ophthalmol

Central serous chorioretinopathy in endogenous hypercortisolism

Arch Ophthalmol

Central serous chorioretinopathy associated with a carcinoma of the adrenal cortex

Retina

Multifocal pigment epithelial damages with serous retinal detachment in systemic lupus erythematosus

Ophthalmologica

Serous retinal detachment resembling central serous chorioretinopathy following organ transplantation

Graefes Arch Clin Exp Ophthalmol

Central serous retinopathy in systemic lupus erythematosusa manifestation of the disease or of its treatment?

Br J Ophthalmol

Original article
Risk factors for central serous chorioretinopathy: A case–control study☆