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Randomized controlled trials in central serous chorioretinopathy: A review

Eye volume 37, pages 3306–3312 (2023)Cite this article

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Abstract

Central serous chorioretinopathy (CSCR), a common chorioretinal disease, presents with a myriad of manifestations. Acute CSCR presents with localized neurosensory detachment whereas chronic CSCR may show widespread retinal pigment epithelium (RPE) changes, chronic shallow subretinal fluid, and choroidal neovascularization (CNV) suggestive of a variable natural history leading to suboptimal visual outcomes. Even though multiple treatment options including laser photocoagulation, photodynamic therapy, micropulse laser, anti-vascular endothelial growth factors, and systemic drugs (spironolactone, eplerenone, melatonin, mifepristone) are available, there is an absence of any standardized treatment protocol or gold standard treatment modality. Moreover, their performance compared to observation especially in acute CSCR is still debatable. Compared to other chorioretinal diseases such as age-related macular degeneration, diabetic retinopathy, diabetic macular oedema, and retinal vein occlusion, there is a relative dearth of randomized controlled trials in CSCR. Multiple inconsistencies including reliance on history of disease duration, variable inclusion criteria/disease descriptors/study endpoints, and availability of multiple treatment modalities lead to difficulties in designing RCTs. A consensus-based treatment protocol, therefore, is still elusive. We reviewed the literature and compiled the list of papers published to date, wherein we analyse and compare the inclusion criteria, imaging modalities, study endpoints, study duration, and study results. Correcting these discrepancies and deficiencies will help standardize future study designs, facilitating a next step toward a standardized treatment protocol.

摘要

中心性浆液性脉络膜视网膜病变 (CSCR) 是一种常见的脉络膜视网膜病变, 临床表现多种多样。急性CSCR表现为局限性神经上皮脱离, 而慢性CSCR可能表现为广泛的视网膜色素上皮 (RPE) 改变、慢性视网膜下液、脉络膜下新生血管 (CNV) 形成导致视力低下。尽管有多种治疗方案可供选择, 包括激光光凝、光动力疗法、微脉冲激光、抗VEGF治疗和全身药物 (螺内酯、依普利酮、褪黑素、米非司酮治疗), 但仍缺乏针对CSCR任何标准化治疗方案或金标准治疗模式。此外, 与对照组相比, 特别是急性CSCR中的表现仍然值得商榷。与其他脉络膜视网膜疾病 (如年龄相关性黄斑变性、糖尿病视网膜病变、糖尿病黄斑水肿和视网膜静脉阻塞) 相比, CSCR缺乏随机对照试验。多种因素的不一致性, 包括发病时间持续、变量纳入标准/疾病描述/研究终点以及治疗的多样, 导致RCT设计困难。因此, 基于共识的治疗方案仍然难以实现。我们回顾了文献并收集了迄今为止发表的论文, 我们分析并比较了纳入标准、成像模式、研究终点、研究持续时间和研究结果。纠正差异性和研究设计的缺陷有助于未来研究设计的标准化, 为标准化治疗方案的实施奠定基础。

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Fig. 1: PRISMA chart and selection protocol of randomized controlled studies.

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  1. Sri Sai Eye Hospital, Kankarbagh, Patna, Bihar, India

    Sumit Randhir Singh

  2. Nilima Sinha Medical College & Hospital, Rampur, Madhepura, Bihar, India

    Sumit Randhir Singh

  3. Eastern Virginia Medical School, Norfolk, VA, USA

    John Thomas Goté

  4. UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA

    Jay Chhablani

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JG and JC were involved in the design of the study. SRS and JG were involved in the collection of data, interpretation, analysis, and literature search. SRS and JG were involved in manuscript writing. SRS, JG, and JC were involved in the review and final editing of the article. All the authors conducted the study and equally contributed to the preparation, review, and approval of the manuscript.

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Singh, S.R., Goté, J.T. & Chhablani, J. Randomized controlled trials in central serous chorioretinopathy: A review. Eye 37, 3306–3312 (2023). https://doi.org/10.1038/s41433-023-02509-9

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