Ekzojen Kortikosteroide Bağlı Santral Seröz Koryoretinopatide Retinal ve Koroidal Değişiklikler

Bu çalışmanın amacı ekzojen steroid kullanımına bağlı santral seröz koryoretinopati (SSKR) ile idiyopatik SSKR’li gözlerde retinal ve koroidal bulguları karşılaştırmaktır. Bu retrospektif çalışmada Ocak 2017 – Ocak 2020 tarihleri arasında steroide bağlı SSKR (Grup I) ve idiyopatik SSKR (Grup II) tanısı alan olguların demografik ve klinik özellikleri karşılaştırılmıştır. Tüm hastaların en iyi düzeltilmiş görme keskinlikleri kaydedilmiştir. En fazla 3 ay süreyle semptomu olan ve tanı anında optik koherens tomografi (OKT) yapılmış olan olgular çalışmaya dahil edilmiştir. İki grubun santral makula kalınlığı (SMK), subretinal mayi (SRM) yüksekliği, pigment epitel dekolmanı (PED) yüksekliği ve subfoveal koroid kalınlığı (SFKK) karşılaştırılmıştır. PED varlığı, PED ve SRM ilişkisi, subretinal hiperreflektif materyal varlığı, fotoreseptör uzaması, elipsoid zon hasarı, intraretinal ödem, koroidal ve retinal hiperreflektif noktalar, sığ irregüler PED gibi OKT bulguları kaydedilmiştir. Grup I 17 olgunun 23 gözünü, grup II 22 olgunun 23 gözünü içerdi. Her iki grupta da erkek cinsiyet baskındı (p=0,458). İki grup arasında ortalama yaş açısından farklılık yoktu. Grup I’de bilateral tutulum daha fazlaydı (p=0,030). İki grup arasında SMK, SRM yüksekliği ve PED yüksekliği açısından anlamlı farklılık yoktu ancak ortalama SFKK grup I’de grup II’den daha fazlaydı (p=0,046). PED sayısı grup I’de grup II’den anlamlı olarak daha fazlaydı (p=0,042). Diğer OKT bulguları iki grupta benzer oranlardaydı. Steroide bağlı SSKR’li gözlerde, ortalama subfoveal koroid kalınlığı ve PED sayısı idiyopatik SSKR’li gözlerden daha fazladır. Ekzojen kortikosteroidlerin hem koroid dolaşımını hem de retina pigment epitelini etkileyerek SSKR’ye neden olabilecekleri düşünülmüştür.

Anahtar Kelimeler:

kortikosteroid, optik koherens tomografi, retina pigment epiteli, santral seröz koryoretinopati, subfoveal koroid kalınlığı

Retinal and Choroidal Changes in Exogenous Corticosteroid Associated Central Serous Chorioretinopathy

The aim of this study is to compare retinal and choroidal findings in eyes with exogenous steroid induced central serous chorioretinopathy (CSCR) and idiopathic CSCR. In this retrospective study, demographic and clinical characteristics of patients diagnosed with steroid-induced CSCR (Group I) and idiopathic CSCR (Group II) between January 2017 and January 2020 were compared. Best corrected visual acuity of all patients were recorded. Cases who were symptomatic for up to 3 months and who had optical coherence tomography (OCT) images were included to the study. Central macular thickness (CMT), the heights of subretinal fluid (SRF) and pigment epithelial detachment (PED) and subfoveal choroidal thickness (SFCT) were compared between the two groups. Presence of PED, association between PED and SRF, sub-retinal hyperreflective material, photoreceptor elongation, ellipsoid zone damage, intraretinal edema, choroidal and retinal hyperreflective dots and flat irregular PED were recorded. Group I included 23 eyes of 17 cases and group II included 23 eyes of 22 cases. Male gender was dominant in both groups (p=0,458). There was no significant difference in terms of age between the two groups. Bilaterality was higher in Group I (p=0,030). Although there was no significant difference in CMT and the height of SRF and PED, mean SFCT was higher in group I than group II (p=0,046). Number of PEDs was significantly higher in group I than group II. Other OCT features were similar in two groups. Subfoveal choroidal thickness and number of PEDs is higher in steroid-induced CSCR than idiopathic CSCR. Exogenous steroids may cause CSCR by affecting both choroidal circulation and retinal pigment epithelium.

Keywords:

central serous chorioretinopathy, corticosteroid, optical coherence tomography, retinal pigment epithelium, subfoveal choroidal thickness,

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1. Liu B, Deng T, Zhang J. Risk factors for central serous chorio-retinopathy: A systematic review and meta-analysis. Retina 2016;36(1):9-19.
2. Liegl R, Ulbig MW. Central serous chorioretinopathy. Opht-halmologica 2014;232(2):65-76.
3. Sezer T, Altınışık M, Koytak İA, Özdemir MH. Koroid ve optik koherens tomografi. Turk J Ophthalmol 2016;46:30-7.
4. Han JM, Hwang JM, Kim JS, Park KH, Woo SJ. Changes in choroidal thickness after systemic administration of high-dose corticosteroids: a pilot study. Invest Ophthalmol Vis Sci 2014;55(1):440-5.
5. Ambiya V, Goud A, Rasheed MA, Gangakhedkar S, Vuppara-boina KK, Chhablani J. Retinal and choroidal changes in steroid-associated central serous chorioretinopathy. Int J Retina Vitreous 2018;4:11. doi: 10.1186/s40942-018-0115-1.
6. Araki T, Ishikawa H, Iwahashi C, et al. Central serous choriore-tinopathy with and without steroids: A multicenter survey. PLoS One 2019;14(2):e0213110. doi: 10.1371/ jour-nal.pone.0213110.
7. Honda S, Miki A, Kusuhara S, Imai H, Nakamura M. Choroidal thickness of central serous chorioretinopathy secondary to cor-ticosteroid use. Retina 2017;37(8):1562-7.
8. Karaçorlu M, Özdemir H. Central serous chorioretinopathy after intranasal steroid use. Turk J Ophthalmol 2005;35:72-4.
9. Artunay HÖ, Rasier R, Yüzbaşıoğlu E, Şengül A, Senel A, Bahçecioğlu H. Acute, bilateral central serous chorioretino-pathy associated with topical, periorbital dermal glucocorticoid treatment - case report. Turk J Ophthalmol 2010;40:113-7.
10. Abalem MF, Machado MC, Santos HN, et al. Choroidal and retinal abnormalities by optical coherence tomography in endo-genous Cushing's Syndrome. Front Endocrinol (Lausanne) 2016;7:154. doi: 10.3389/fendo.2016.00154.
11. Kılıç R. Genetics, risk factors and pathogenesis in the spectrum of pachychoroid diseases. Güncel Retina 2020;4(2):62-6.
12. Nicholson BP, Atchison E, Idris AA, Bakri SJ. Central serous chorioretinopathy and glucocorticoids: an update on evidence for association. Surv Ophthalmol 2018;63(1):1-8.
13. Cassel GH, Brown GC, Annesley WH. Central serous choriore-tinopathy: a seasonal variation? Br J Ophthalmol 1984;68(10):724-6.
14. Siaudvytyte L, Diliene V, Miniauskiene G, Balciuniene VJ. Photodynamic therapy and central serous chorioretinopathy. Med Hypothesis Discov Innov Ophthalmol 2012;1(4):67–71.
15. Jampol LM, Weinreb R, Yannuzzi L. Involvement of corticos-teroids and catecholamines in the pathogenesis of central serous chorioretinopathy: a rationale for new treatment strategies. Ophthalmology 2002;109(10):1765–6.
16. Caccavale A, Romanazzi F, Imparato M, Negri A, Morano A, Ferentini F. Central serous chorioretinopathy: a pathogenetic model. Clin Ophthalmol 2011;5:239–43.
17. Yamada R, Yamada S, Ishii A, Tane S. Evaluation of tissue plasminogen activator and plasminogen activator inhibitor-1 in blood obtained from patients of idiopathic central serous chori-oretinopathy. Nippon Ganka Gakkai Zasshi 1993;97(8):955–60.
18. Zhao M, Célérier I, Bousquet E, et al. Mineralocorticoid recep-tor is involved in rat and human ocular chorioretinopathy. J Clin Invest 2012;122(7):2672-9.
19. Golestaneh N, Picaud S, Mirshahi M. The mineralocorticoid receptor in rodent retina: ontogeny and molecular identity. Mol Vis 2002;8:221–5.
20. El Zaoui I, Behar-Cohen F, Torriglia A. Glucocorticoids exert direct toxicity on microvasculature: analysis of cell death mec-hanisms. Toxicol Sci 2015;143:441–53.
21. Manayath GJ, Ranjan R, Shah VS, Karandikar SS, Saravanan VR, Narendran V. Central serous chorioretinopathy: Current update on pathophysiology and multimodal imaging. Oman J Ophthalmol 2018;11(2):103-12.
22. Hanumunthadu D, Matet A, Rasheed MA, Goud A, Vuppurabi-na KK, Chhablani J. Evaluation of choroidal hyperreflective dots in acute and chronic central serous chorioretino-pathy. Indian J Ophthalmol 2019;67(11):1850-4.
23. Yalcinbayir O, Gelisken O, Akova-Budak B, Ozkaya G, Gor-kem Cevik S, Yucel AA. Correlation of spectral domain optical coherence tomography findings and visual acuity in central se-rous chorioretinopathy. Retina 2014 Apr;34(4):705-12.
24. Hwang H, Kim JY, Kim KT, Chae JB, Kim DY. Flat irregular pigment epithelium detachment in central serous chorioretino-pathy: a form of pachychoroid neovasculopathy? Retina 2020;40(9):1724-33.
25. Sahoo NK, Govindhari V, Bedi R, et al. Subretinal hyperreflec-tive material in central serous chorioretinopathy. Indian J Opht-halmol 2020;68(1):126-9.