Meeting News

Patients respond differently to central serous retinopathy treatment

Attar
Roya Attar

WASHINGTON – A multitude of management options exist for central serous retinopathy, and “if the patient doesn’t become better in 3 to 4 months, consider another option,” Roya Attar, OD, MBA, said here at Optometry’s Meeting.

Attar and Mohammed Rafieetary, OD, FAAO, shared their poster findings in a live presentation.

“The typical patient is a middle-aged male complaining about a spot in his central vision,” Attar said.

Rafieetary
Mohammed Rafieetary

Differential diagnoses include exudative maculopathy, choroidal tumors, choroidal neovascular membrane, inflammatory disease and serous retinal detachment (SRD), she said.

Attar and Rafieetary reported on five cases of central serous retinopathy (CSR) where each patient responded to a different treatment, which included angiography-guided focal laser, angiography-guided photodynamic therapy (PDT), anti-VEGF injection and oral medication. One patient experienced spontaneous resolution.

“One of the best things that’s happened in the past 10 years is the use of OCT,” Rafieetary said. “You see a thicker-than-normal choroid in these patients, especially in patients with a genetic predisposition.”

The classic presentation of CSR on fluorescein angiography, “is the so-called smokestack fluorescein pattern, where fluid starts in the lesion, usually located below the horizon, and as the fluid leads and rises it creates a smokestack,” he said. “The most commonly seen is the ink blot pattern.

“Fundus autofluorescence is the best way to detect this disease,” Rafieetary continued. “You see hypo-autofluorescence of SRD in early disease. In late and chronic disease you see hyper-autofluorescence of SRD and punctate hyperfluorescent lesions.”

Attar said the management options include observation, focal photocoagulation, intravitreous anti-VEGF, PDT and systemic mineralocorticoid antagonists (MRA).

“If you decide to use laser, you have to have an active leaking site,” Rafieetary said. “Focal photocoagulation is one of the oldest techniques to treat this condition, but you have to identify an extrafoveal leaking spot that is very small.”

Anti-VEGF injections are considered safe, “but this is off-label use,” he said. “The theory is it helps reduce the permeability. Some literature suggests that if you find patients with smaller lesions and better vision and treat with anti-VEGF, you get a better response. PDT has been approved as an orphan drug indication.”

Rafieetary said he considered systemic MRA in a patient with bilateral CSR.

“We cleared it with the primary care physician and checked to see what other systemic medications the patient was on,” he said. “We do see a fairly good response with this.”

Rafieetary said treating CSR, “is a bit of hit-and-miss. There’s literature to support all of it, but that’s all blurry, too. At the same time, we have a patient with chronic disease with significant functional change.

“Snellen visual acuity is not vision,” he concluded. “Patients don’t see the world as black letters on a white background. We have to consider these treatment options.” – by Nancy Hemphill, ELS, FAAO

Reference:

Attar R. Management options for central serous retinopathy. Presented at: Optometry’s Meeting; Washington; June 21-25, 2017.

Disclosures: Attar and Rafieetary reported no relevant financial disclosures.

Attar
Roya Attar

WASHINGTON – A multitude of management options exist for central serous retinopathy, and “if the patient doesn’t become better in 3 to 4 months, consider another option,” Roya Attar, OD, MBA, said here at Optometry’s Meeting.

Attar and Mohammed Rafieetary, OD, FAAO, shared their poster findings in a live presentation.

“The typical patient is a middle-aged male complaining about a spot in his central vision,” Attar said.

Rafieetary
Mohammed Rafieetary

Differential diagnoses include exudative maculopathy, choroidal tumors, choroidal neovascular membrane, inflammatory disease and serous retinal detachment (SRD), she said.

Attar and Rafieetary reported on five cases of central serous retinopathy (CSR) where each patient responded to a different treatment, which included angiography-guided focal laser, angiography-guided photodynamic therapy (PDT), anti-VEGF injection and oral medication. One patient experienced spontaneous resolution.

“One of the best things that’s happened in the past 10 years is the use of OCT,” Rafieetary said. “You see a thicker-than-normal choroid in these patients, especially in patients with a genetic predisposition.”

The classic presentation of CSR on fluorescein angiography, “is the so-called smokestack fluorescein pattern, where fluid starts in the lesion, usually located below the horizon, and as the fluid leads and rises it creates a smokestack,” he said. “The most commonly seen is the ink blot pattern.

“Fundus autofluorescence is the best way to detect this disease,” Rafieetary continued. “You see hypo-autofluorescence of SRD in early disease. In late and chronic disease you see hyper-autofluorescence of SRD and punctate hyperfluorescent lesions.”

Attar said the management options include observation, focal photocoagulation, intravitreous anti-VEGF, PDT and systemic mineralocorticoid antagonists (MRA).

“If you decide to use laser, you have to have an active leaking site,” Rafieetary said. “Focal photocoagulation is one of the oldest techniques to treat this condition, but you have to identify an extrafoveal leaking spot that is very small.”

Anti-VEGF injections are considered safe, “but this is off-label use,” he said. “The theory is it helps reduce the permeability. Some literature suggests that if you find patients with smaller lesions and better vision and treat with anti-VEGF, you get a better response. PDT has been approved as an orphan drug indication.”

Rafieetary said he considered systemic MRA in a patient with bilateral CSR.

“We cleared it with the primary care physician and checked to see what other systemic medications the patient was on,” he said. “We do see a fairly good response with this.”

Rafieetary said treating CSR, “is a bit of hit-and-miss. There’s literature to support all of it, but that’s all blurry, too. At the same time, we have a patient with chronic disease with significant functional change.

“Snellen visual acuity is not vision,” he concluded. “Patients don’t see the world as black letters on a white background. We have to consider these treatment options.” – by Nancy Hemphill, ELS, FAAO

Reference:

Attar R. Management options for central serous retinopathy. Presented at: Optometry’s Meeting; Washington; June 21-25, 2017.

Disclosures: Attar and Rafieetary reported no relevant financial disclosures.

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