An international collaborative evaluation of central serous chorioretinopathy: different therapeutic approaches and review of literature. The European Vitreoretinal Society central serous chorioretinopathy study

Romano, M. R.; Parolini, B.; Allegrini, D.; Michalewska, Z.; Adelman, R.; Bonovas, S.; Bopp, S.; Citirik, M.; Tekin, K.; Fiser, I.; Boon, C. J. F.; van Dijk, E. C. H.; Donvito, G.; Gungel, H.; Ozdogan Erkul, S.; Unsal, E.; Osmanbasoglu, O.; Dincer, N.; Ercalik, N. Y.; Yenerel, N. M.; Amar, J. -P.; Ennemoser, A.; Besozzi, G.; Sallam, A. A. B.; Ellabban, A. A.; Chang, W.; Eandi, C. M.; Demir, M.; Lee, J.; Pak, K.; Arrevola, L.; Sloka, A.; Morawski, K.; Kulig - Stochmal, A.; Romanowska - Dixon, B.; Striebe, N. -A.; Feltgen, N.; Hoerauf, H.; Inan, U. U.; Tanev, I.; Dyrda, A.; Schuler, A.; Lucke, K.; Brix, A.; Pape, S.; Kusserow-Napp, C.; Loo, P. A.; Kanra, A. Y.; Ardagil Akcakaya, A.; Ari Yaylali, S.; Bae, S. H.; Kim, H. K.; Kim, S. J.; Han, J. R.; Nam, W. H.; Odrobina, D.; Lavaque, E.; Bertelli, E.; Coser, S.; Ziemssen, F.; Forlini, M.; Benatti, C.; Cavallini, G. M.; Stefanickova, J.; Berrod, J. -P.; Saksonov, S.; Lytvinchuk, L.; Moussa, M.; Stefaniotou, M.; Christodoulou, E.; Zayed, M. A.; Oz, O.; Tassinari, P.; Koch, P.; Declercq, C.; Johnston, R.; Rusnak, S.; Penas, S.; Ozdek, S.; Ucgul, Y.; Cisiecki, S.; Dziegielewski, K.; Klimczak, D.; Michalewska, Z.; Michalewski, J.; Nawrocka, Z.; Nawrocki, J.; Ornafel, K.; Pikulski, Z.; Maciej, M.; Acar, N.; Elshafei, M. M.; Hamon, F.; Soyeur, R.; Badat, I.; Brousseau, B.; Hermouet, E.; Peiretti, E.; Lee, J. -H.; Ferreira, N.; Yoon, H. -S.; Alkhars, W. I.; Dudani, A.; Minu, R.; Telang, O.; Morepatil, V. G.; Furtado, M. J.; Y. -J., Jo; Piccolino, F. C.; Finzi, A.

doi:10.1111/aos.14319

Purpose: To study and compare the efficacy of different therapeutic options for the treatment of central serous chorioretinopathy (CSCR). Methods: This is a nonrandomized, international multicentre study on 1719 patients (1861 eyes) diagnosed with CSCR, from 63 centres (24 countries). Reported data included different methods of treatment and both results of diagnostic examinations [fluorescein angiography and/or optical coherent tomography (OCT)] and best-corrected visual acuity (BCVA) before and after therapy. The duration of observation had a mean of 11 months but was extended in a minority of cases up to 7 years. The aim of this study is to evaluate the efficacy of the different therapeutic options of CSCR in terms of both visual (BCVA) and anatomic (OCT) improvement. Results: One thousand seven hundred nineteen patients (1861 eyes) diagnosed with CSCR were included. Treatments performed were nonsteroidal anti-inflammatory eye drops, laser photocoagulation, micropulse diode laser photocoagulation, photodynamic therapy (PDT; Standard PDT, Reduced-dose PDT, Reduced-fluence PDT), intravitreal (IVT) antivascular endothelial growth factor injection (VEGF), observation and other treatments. The list of the OTHERS included both combinations of the main proposed treatments or a variety of other treatments such as eplerenone, spironolactone, acetazolamide, beta-blockers, anti-anxiety drugs, aspirin, folic acid, methotrexate, statins, vitis vinifera extract medication and pars plana vitrectomy. The majority of the patients were men with a prevalence of 77%. The odds ratio (OR) showed a partial or complete resolution of fluid on OCT with any treatment as compared with observation. In univariate analysis, the anatomical result (improvement in subretinal fluid using OCT at 1 month) was favoured by age <60 years (p < 0.005), no previous observation (p < 0.0002), duration less than 3 months (p < 0.0001), absence of CSCR in the fellow eye (p = 0.04), leakage outside of the arcade (p = 0.05) and fluid height >500 μm (p = 0.03). The OR for obtaining partial or complete resolution showed that anti-VEGF and eyedrops were not statistically significant; whereas PDT (8.5), thermal laser (11.3) and micropulse laser (8.9) lead to better anatomical results with less variability. In univariate analysis, the functional result at 1 month was favoured by first episode (p = 0.04), height of subretinal fluid >500 μm (p < 0.0001) and short duration of observation (p = 0.02). Finally, there was no statistically significant difference among the treatments at 12 months. Conclusion: Spontaneous resolution has been described in a high percentage of patients. Laser (micropulse and thermal) and PDT seem to lead to significant early anatomical improvement; however, there is little change beyond the first month of treatment. The real visual benefit needs further clarification.