Intravitreal ranibizumab in the management of acute central serous Chorioretinopathy
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Abstract
Purpose: To evaluate the efficacy of ranibizumab in hastening the recovery of acute CSCR when given immediately at time of diagnosis.
Methods: In This retrospective case series, a total of 72 patients diagnosed with acute CSCR where reviewed, of which 63 received Ranibizumab at presentation. The patients were evaluated using Best corrected visual acuity, Ophthalmic examination, Optical coherence tomography (OCT) and fluorescein angiography, in addition to indocyanine green angiography and OCT angiography in some cases, at presentation, one week, one month and two months’ post injection.
Results: From the total 72 patients diagnosed with acute CSCR, 63 of them received intravitreal ranibizumab and the remaining 9 patients preferred to go for observation. The mean age of patients was 41.2 year old. The ratio of male to female was 8:1. The mean BCVA at presentation was 6/15 on Snellen chart. All patients who received ranibizumab injection showed an improvement after 1 week, with a mean improvement in BCVA of two lines. Of them, 43 patients were back to BCVA of 6/6 after 2 months and showed complete resolution of sub retinal fluid. The remaining 20 patients showed an additional mean of improvement of one line (over the previous two lines) after the 2 months.
Conclusion: Intravitreal ranibizumab hasten the recovery of both the BCVA and central macular thickness on OCT in acute CSCR when given immediately at presentation.
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Copyright (c) 2017 Nawaiseh I, et al.

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Gass JD. Pathogenesis of disciform detachment of neuroepithelium. II. Idiopathic central serous choroidopathy. Am J Ophthalmol. 1967; 63: 587-615. Ref.: https://goo.gl/XRKjVm
Liew G, Quin G, Gillies M, Fraser-Bell S. Central serous chorioretinopathy: a review of epidemiology and pathophysiology. Clin. Exp. Ophthalmol. 2013; 41: 201-214. Ref.: https://goo.gl/hpLwqg
Brancato R, Scialdone A, Pece A, Coscas G, Binaghi M. Eight-year follow-up of central serous chorioretinopathy with and without laser treatment. Graefes Arch Clin Exp Ophthalmol. 1987; 225: 166-168. Ref.: https://goo.gl/UVqrUz
De Laey JJ. Central serous chorioretinopathy: to treat or not to treat?. Doc Ophthalmol. 1986; 61: 367-372. Ref.: https://goo.gl/SpfSyy
Ficker L, Vafidis G, While A, Leaver P. Longterm followup of a prospective trial of argon laser photocoagulation in the treatment of central serous retinopathy. Br J Ophthalmol. 1988; 72: 829-834. Ref.: https://goo.gl/kXUGNL
Spitznas M. Pathogenesis of central serous retinopathy: a new working hypothesis. Graefes Arch Clin Exp Ophthalmol. 1986; 224: 321-324. Ref.: https://goo.gl/qcjFhL
Spaide RF, Hall L, Haas A, lisa MD, laura BS, et al. Indocyanine green videoangiography of older patients with central serous chorioretinopathy. Retina. 1996; 16: 203-213. Ref.: https://goo.gl/RxQU5w
Chan WM, Lai TY, Lai RY, Liu DT, Lam DS. Half-dose verteporfin photodynamic therapy for acute central serous chorioretinopathy: one-year results of a randomized controlled trial. Ophthalmology. 2008; 115: 1756-1765. Ref.: https://goo.gl/jj4eZC
Yannuzzi LA, Slakter JS, Gross NE, Huang, Klancnik, et al. Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study. Retina. 2003; 23: 288-298. Ref.: https://goo.gl/jxcbx2
Burumcek E, Mudun A, Karacorlu S, Arslan MO. Laser photocoagulation for persistent central serous retinopathy: results of longterm follow-up. Ophthalmology. 1997; 104: 616-622. Ref.: https://goo.gl/EDShsv
Loo RH, Scott IU, Flynn HW Jr, Gass JD, Murray TG, et al. Factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy. Retina. 2002; 22: 19-24. Ref.: https://goo.gl/4oNHPd
Wang M, Munch IC, Hasler PW, Pru¨nte C, Larsen M. Central serous chorioretinopathy. Acta Ophthalmol. 2008; 86: 126-145. Ref.: https://goo.gl/u4GGU8
Robertson DM, Ilstrup D. Direct, indirect, and sham laser photocoagulation in the management of central serous chorioretinopathy. Am J Ophthalmol. 1983; 95: 457-466. Ref.: https://goo.gl/2A8trZ
Leaver P, Williams C. Argon laser photocoagulation in the treatment of central serous retinopathy. Br J Ophthalmol. 1979; 63: 674-677. Ref.: https://goo.gl/ojA3fi
Ficker L, Vafidis G, While A, Leaver P. Long-term follow-up of a prospective trial of argon laser photocoagulation in the treatment of central serous retinopathy. Br J Ophthalmol. 1988; 72: 829-834. Ref.: https://goo.gl/4gJ8H9
Chan WM, Lai TY, Lai RY, Liu DT, Lam DS. Half-dose verteporfin photodynamic therapy for acute central serous chorioretinopathy: one-year results of a randomized controlled trial. Ophthalmology. 2008; 115: 1756-1765. Ref.: https://goo.gl/idr9RM
Schmidt-Erfurth U, Laqua H, Schlötzer-Schrehard U, Viestenz A, Naumann GO. Histopathological changes following photodynamic therapy in human eyes. Arch Ophthalmol. 2002; 120: 835-844. Ref.: https://goo.gl/pEUA14
Maruko I, Iida T, Sugano Y, Ojima A, Ogasawara M, et al. Subfoveal choroidal thickness after treatment of central serous chorioretinopathy. Ophthalmology. 2010; 117: 1792-1799. Ref.: https://goo.gl/od6wv5
Cardillo Piccolino F, Eandi CM, Ventre L, Rigault de la Longrais RC, Grignolo FM. Photodynamic therapy for chronic central serous chorioretinopathy. Retina. 2003; 23: 752-763. Ref.: https://goo.gl/A9TAs4
Chan WM, Lam DS, Lai TY, Tam BS, Liu DT, et al. Choroidal vascular remodelling in central serous chorioretinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level. Br J Ophthalmol. 2003; 87: 1453-1458. Ref.: https://goo.gl/vSk3DX
Jampol LM, Weinreb R, Yannuzzi L. Involvement of corticosteroids and catecholamines in the pathogenesis of central serous chorioretinopathy: a rationale for new treatment strategies. Ophthalmology. 2002; 109: 1765-1766. Ref.: https://goo.gl/s6HKSQ
Golshahi A, Klingmüller D, Holz FG, Eter N. Ketoconazole in the treatment of central serous chorioretinopathy: a pilot study. Acta Ophthalmol. 2010; 88: 576-581. Ref.: https://goo.gl/yyTaZF
Torres-Soriano ME, Garcia-Aguirre G, Kon-Jara V, Ustariz-Gonzáles O, Abraham-Marín M, et al. A pilot study of intravitreal bevacizumab for the treatment of central serous chorioretinopathy (case reports). Graefes Arch Clin Exp Ophthalmol. 2008; 246: 1235-1239. Ref.: https://goo.gl/CdKEPD
Wu L, Martinez-Castellanos MA, Quiroz-Mercado H, Arevalo JF, Berrocal MH, et al. Twelve-month safety of intravitreal injections of bevacizumab (Avastin): results of the Pan-American Collaborative Retina Study Group (PACORES). Graefes Arch Clin Exp Ophthalmol. 2008; 246: 81-87. Ref.: https://goo.gl/k8uh4o
Torres-Soriano ME, Garcia-Aguirre G, Kon-Jara V, Ustariz-Gonzáles O, Abraham-Marín M, et al. A pilot study of intravitreal bevacizumab for the treatment of central serous chorioretinopathy (case reports). Graefes Arch Clin Exp Ophthalmol. 2008; 246: 1235-1239. Ref.: https://goo.gl/YyULAK
Gomi F, Tano Y. Polypoidal choroidal vasculopathy and treatments. Curr Opin Ophthalmol. 2008; 19: 208-212. Ref.: https://goo.gl/Kmx17h
Lantry LE: Ranibizumab, a mAb against VEGF-A for the potential treatment of agerelated macular degeneration and other ocular complications. Curr Opin Mol Ther. 2007; 9: 592-602. Ref.: https://goo.gl/t4EfvY
Brown DM, Campochiaro PA, Singh RP, Li Z, Grav S, et al.Ranibizumab for macular edema following central retinal vein occlusion: sixmonth primary end point results of a phase III study. Ophthalmology. 2010; 117:1124-1133. Ref.: https://goo.gl/sJhHVG
Kim M, Lee SC, Lee SJ. Intravitreal ranibizumab for acute central serous chorioretinopathy. Ophthalmologica. 2013; 229: 152-157. Ref.: https://www.ncbi.nlm.nih.gov/pubmed/23257663
Schaal KB, Hoeh AE, Scheuerle A, Schuett F, Dithmar S, et al. Intravitreal bevacizumab for treatment of chronic central serous chorioretinopathy. Eur J Ophthalmol. 2009; 19: 613-617. Ref.: https://goo.gl/g832H7