Purpose: Comparing anatomic and functional efficacy and safety of primary treatment with either half-dose photodynamic therapy (PDT) or oral eplerenone, or crossover treatment in chronic central... Show morePurpose: Comparing anatomic and functional efficacy and safety of primary treatment with either half-dose photodynamic therapy (PDT) or oral eplerenone, or crossover treatment in chronic central serous chorioretinopathy patients. Methods: After the SPECTRA trial baseline visit, patients were randomized to either half-dose PDT or eplerenone and received crossover treatment if persistent subretinal fluid (SRF) on optical coherence tomography (OCT) was present at first follow-up (at 3 months). Presence of SRF and best-corrected visual acuity (BCVA) was evaluated at 12 months. Results: Out of the 90 patients evaluated at 12 months, complete SRF resolution was present on OCT in 43/48 (89.6%) of patients who were primarily randomized to half-dose PDT and in 37/42 (88.1%) who were primarily randomized to eplerenone. Out of the 42 patients that were primarily randomized to eplerenone, 35 received crossover treatment with halfdose PDT. The BCVA improved significantly more at 12 months in patients who had received primary half-dose PDT as compared to the primary eplerenone group (p = 0.030). Conclusions: Twelve months after baseline visit, most patients treated with half-dose PDT (either primary or crossover treatment) still had complete SRF resolution. The long-term BCVA in patients who receive primary half-dose PDT is better than in patients in whom PDT is delayed due to initial eplerenone treatment with persistent SRF. Show less
This thesis involves the eye disease central serous chorioretinopathy. This disease is characterized by an accumulation of subretinal fluid, which can lead to a reduction in vision, changes in... Show moreThis thesis involves the eye disease central serous chorioretinopathy. This disease is characterized by an accumulation of subretinal fluid, which can lead to a reduction in vision, changes in contrast vision and sometimes distortions in the visual field. Central serous chorioretinopathy mainly occurs in men between 40 and 50 years old. In case of prolonged persistence of subretinal fluid, irreversible vision loss may occur. The most common treatments are photodynamic therapy, eplerenone, and micropulse laser, but there is no consensus on the best treatment. The research in this thesis evaluates the effects and comparisons of photodynamic therapy with micropulse laser and also compared to eplerenone. Patients were enrolled in prospective studies and differences in outcomes (including vision, contrast vision) between the treated groups were evaluated. The results of these studies allow us to improve patient counseling and also to provide the right treatment. The studies presented in this thesis, combined with the available scientific literature, indicate that half-dose therapy is currently the preferred option for the treatment of central serous chorioretinopathy. Show less
Central serous chorioretinopathy (CSC) is a common form of vision loss, typically seen in working-age men. The pathophysiology behind CSC still eludes us, however significant advances have been... Show moreCentral serous chorioretinopathy (CSC) is a common form of vision loss, typically seen in working-age men. The pathophysiology behind CSC still eludes us, however significant advances have been made in understanding this disease over the last decade using information from genetic and cell-based studies and imaging modalities. This review aims to give an overview of the current pathophysiology hypotheses surrounding CSC in addition to future directions in cellular work from human induced pluripotent stem cell derived choroidal endothelial cells from CSC patients. Furthermore, this review will provide the reader with an update on the clinical aspects of CSC including risk factors, diagnostic challenges and findings from multimodal imaging. Show less
