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Ophthalmology. 2019 Apr;126(4):576-588. doi: 10.1016/j.ophtha.2018.12.048. Epub 2019 Jan 17.

Long-term Visual Outcomes and Causes of Vision Loss in Chronic Central Serous Chorioretinopathy.

Author information

1
Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Quinze-Vingts Hospital, DHU SightMaintain, INSERM-DHOS CIC 1423, Paris, France. Electronic address: sarahmrejen.uretsky@gmail.com.
2
Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York; Department of Physiology and Pharmacology, Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Australia; Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Australia.
3
Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York; Department of Ophthalmology, Manhattan Eye Ear and Throat Hospital, New York, New York.
4
Department of Ophthalmology, New York University School of Medicine, New York, New York.
5
Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
6
Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Casey Eye Institute, Oregon Health and Science University, Portland, Oregon; Portland VA Healthcare System, Portland, Oregon.
7
Department of Ophthalmology, Bascolm Palmer Eye Institute, Miami, Florida.
8
Department of Ophthalmology, Wills Eye Hospital, Philadelphia, Pennsylvania.
9
Department of Ophthalmology, New York University School of Medicine, New York, New York; Vantage Eye Center, Salinas, California.
10
Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Department of Ophthalmology, Shanghai General Hospital, Shanghai, China.
11
Biostatistics Unit of Feinstein Institute for Medical Research, New York.
12
Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York.
13
Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York.

Abstract

PURPOSE:

To evaluate the long-term visual outcomes and causes of vision loss in chronic central serous chorioretinopathy (CSC).

DESIGN:

Retrospective, longitudinal study.

PARTICIPANTS:

A total of 133 participants (217 eyes) with chronic CSC.

METHODS:

A retrospective review of clinical and multimodal imaging data of patients with chronic CSC managed by 3 of the authors between May 1977 and March 2018. Multimodal imaging comprised color photography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence (FAF), and OCT.

MAIN OUTCOME MEASURES:

Best-corrected visual acuity (BCVA) at the final visit; change in BCVA between first visit and 1-, 5-, and 10-year follow-up visits; and causes of vision loss at final visit.

RESULTS:

Data from 6228 individual clinic visits were analyzed. Mean age of patients at the first visit was 60.7 years, and mean period of follow-up from first to last visit was 11.3 years. The cohort included 101 male patients (75.9%). At the final visit, 106 patients (79.7%) maintained driving-standard vision with BCVA of 20/40 or better in at least 1 eye, and 17 patients (12.8%) were legally blind with BCVA of 20/200 or worse in both eyes. Mean BCVA at first visit was not significantly different from mean BCVA at 1- or 5-year follow-up visits (both P ≥ 0.65) but was significantly better than the mean BCVA at the 10-year follow-up visit (P = 0.04). Seventy-nine percent of eyes with 20/40 or better vision at the first visit maintained the same level of vision at the 10-year follow-up visit. Ninety-two percent of eyes with 20/200 or worse vision at the first visit maintained the same level of vision at the 10-year follow-up visit. Cystoid macular degeneration, choroidal neovascularization (CNV), outer retinal disruption on OCT, and FAF changes were associated with poorer vision at the final visit (all P ≤ 0.001). Multivariable analysis revealed that greater age at first visit was associated with greater BCVA change at the 10-year follow-up visit (P = 0.001).

CONCLUSIONS:

Chronic CSC can be a sight-threatening disease leading to legal blindness. Age at presentation and outer retinal changes on multimodal imaging were associated with long-term BCVA changes and may be predictors of long-term visual outcomes.

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