Eplerenone versus observation in the treatment of acute central serous chorioretinopathy: a retrospective controlled study

INTRODUCTION: To investigate the effects of eplerenone compared to observation in the treatment of acute central serous chorioretinopathy (CSC). METHODS: Charts of consecutive patients with a diagnosis of acute CSC (visual symptoms < 12 weeks) were reviewed. Included patients were divided into a treatment group (treated with eplerenone) and a control group (observation). Main outcome measures included changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), height of subretinal fluid (SRF) and subfoveal choroidal thickness (CT) at 1 and 3 months in the two groups. RESULTS: Fifteen eyes of 15 patients (2 female, 13 male) and 12 eyes of 12 patients (1 female, 11 male [p = 1.000]) were included in the treatment and control groups, respectively. The mean age was 44 \ub1 9 (30-65) and 47 \ub1 11 years (28-66 years, p = 0.493), respectively. In the treatment group, BCVA improved significantly at 1 month (p = 0.018) and 3 months of follow-up (p = 0.011), while a non-significant improvement was seen in the control group. At 3 months, 12 of 15 eyes (80%) in the treatment group demonstrated complete SRF resolution, versus 3 of 12 eyes (25%) in the control group (p = 0.007). In the treatment group, SRF and CMT were significantly reduced at the 1-month follow-up (p = 0.014, p = 0.028, respectively) and the 3-month follow-up (p < 0.001 for both analyses), while in the control group the changes were not statistically significant. Eplerenone was well tolerated in all patients. CONCLUSION: Patients affected by acute CSC treated with eplerenone achieved greater and faster resolution of the disease compared to the observation group. Eplerenone may represent an attractive new first-line treatment option for acute CSC

Practical guidance for imaging biomarkers in exudative age-related macular degeneration

: We provide an overview of current macular imaging techniques and identify and describe biomarkers that may be of use in the routine management of macular diseases, particularly exudative age-related macular degeneration (AMD). This perspective includes sections on macular imaging techniques including optical coherence tomography (OCT) and OCT angiography (OCTA), classification of exudative AMD, and biomarkers in structural OCT and OCTA. Fluorescein angiography remains a vital tool for assessing the activity of neovascular lesions, while indocyanine green angiography is the preferred option for choroidal vessel imaging in neovascular AMD. OCT provides a non-invasive three-dimensional visualization of retinal architecture in vivo and is useful in the diagnosis of many imaging biomarkers of AMD-related neovascular lesions, including lesion activity. OCTA is a recent advance in OCT technology that allows accurate visualization of retinal and choroidal vascular flow. OCT and OCTA have led to an updated classification of exudative AMD lesions and provide several biomarkers that help to establish a diagnosis and the disease activity status of neovascular lesions. Individualization of therapy guided by OCT and OCTA biomarkers has the potential to further improve visual outcomes in exudative AMD. Moving forwards, integration of technologically-advanced imaging equipment with AI software will help ophthalmologists to provide patients with the best possible care

Analysis of Functional Dissociations between Best Corrected Visual Acuity and Microperimetric Parameters in Neovascular Age-Related Macular Degeneration Patients Underwent to Three Monthly Ranibizumab Injections

Background: To analyze the sensitivity of best corrected visual acuity and microperimetry to detect significant visual changes after 3 intravitreal ranibizumab in exudative age-related macular degeneration. Design: Prospective, open-label study. Participants: 50 eyes of 50 naïve patients affected by neovascular age-related macular degeneration were enrolled. Methods: Enrolled patients underwent to a loading phase of 3 monthly intravitreal injections of ranibizumab. Best-corrected visual acuity was investigated with the ETDRS chart at 4 m. Central retinal sensitivity was tested with microperimetry using a Goldmann III stimulus to 33 points over the 12° central of the macula with a 4-2 double staircase strategy. Main outcome measures: Comparison of changes in mean 4° central retinal sensitivity and best-corrected visual acuity in “BCVA relatively stable patients” (defined as change ≤ ± 4 ETDRS letters after treatment). Analysis of a possible relationship between changes in best-corrected visual acuity and 4° central retinal sensitivity in “mean 4° central retinal sensitivity relatively stable patients” (defined as change in mean retinal sensitivity ≤ ± 2dB) Results: Mean best-corrected visual acuity improved of 5.90 ± 11.29 ETDRS letters (P=0.0006). Total mean retinal sensitivity improved +1.59 ± 2.12 dB (P<0.0001), while in the 4° central retinal area the increase was +1.36 ± 3.45 dB (P=0.0078). 38% of patients (19 eyes) were considered as “BCVA relatively stable patients”. In this subgroup, Pearson’s correlation analysis showed a direct correlation between changes observed with both methods (r = 0.71; P = 0.002). 48% of patients (24 eyes) were considered as “Mean 4° central retinal sensitivity relatively stable patients”. In this subgroup, Pearson’s correlation analysis didn’t show a relationship between changes observed with both methods (r = 0.11; P = 0.56). Conclusions: Microperimetry central retinal sensitivity seems to be an important to complete the functional evaluation in patients with wet age-related macular degeneration after 3 intravitreal ranibizumab

Standardization of Optical Coherence Tomography Angiography Imaging Biomarkers in Diabetic Retinal Disease

Optical coherence tomography Angiography (OCT-A) represents a revolution in the noninvasive evaluation of retinal and choroidal circulation especially in detecting early clinical signs of diabetic retinal disease (DRD). With appropriate use, OCT-A characteristics and measurements have the potential to become new imaging biomarkers in managing and treating DRD. Major challenges include (a) provision of standardized outputs from different OCT-A instruments providing standardized terminology to correctly interpret data; (b) the presence of artifacts; (c) the absence of standardized grading or interpretation method in the evaluation of DRD, similar to that already established in fundus photography; and (d) establishing how OCT-A might be able to provide surrogate markers to demonstrate blood retinal barrier breakdown and vascular leakage, commonly associated with DRD. In fact, OCT-A guidelines for DRD are still evolving. The outputs of quantitative OCT-A data offer a unique opportunity to develop tools based on artificial intelligence to assist the clinicians in diagnosing, monitoring, and managing patients with diabetes. In addition, OCT-A has the potential to become a useful tool for the evaluation of cardiovascular diseases and different neurological diseases including cognitive impairment. This article written by the members of Diabetic Retinopathy expert committee of the European Vision Clinical Research network will review the available evidence on the use of OCT-A as an imaging biomarker in DRD and discuss the limits and the current application as well as future developments for its use in both clinical practice and research trials of DRD