Corticosteroids and central serous chorioretinopathy
ABSTRACT The purpose of this study is to investigate the relationship between corticosteroid use and central serous chorioretinopathy (CSC).
A prospective, case-controlled study.
A consecutive series of patients with acute manifestations of CSC and a control group matched for age, race, and gender were recruited between January 2000 and July 2000.
A detailed clinical history was taken, and fundus examination with slit-lamp biomicroscopy was performed on all patients. Fluorescein angiography was obtained on the study patients.
A total of 50 patients was recruited. Twenty-six patients (52%) had a history of exogenous steroid use, including oral, intravenous, intranasal, and intraarticular administration. Two additional patients had a history of endogenous hypercortisolism (Cushing's syndrome). In a matched control group, eight patients (18%) had a history of steroid use. The difference in corticosteroid exposure between study patients and controls was statistically significant (P < 0.0001).
History of corticosteroid use or Cushing's syndrome.
This study is consistent with previous reports associating steroid use with CSC. It identifies corticosteroids as a significant risk factor for the development of acute, exudative macular manifestation and implicates hypercortisolism as a factor in the pathogenesis of this disorder. Several forms of corticosteroid administration were observed to be a risk factor for CSC. Accordingly, susceptible patients in need of corticosteroids should be advised of the risk of developing acute manifestations of CSC.
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ABSTRACT: Central serous chorioretinopathy (CSC) is a serous macular detachment that usually affects young people and leads fortunately to a spontaneous resolution and a good visual prognosis in most patients. Nevertheless, although in a small percentage of subjects only, it may also develop a chronic or progressive disease with widespread decompensation of the retinal pigment epithelium (RPE) and severe vision loss. The aetiopathogenesis of the disease is still not completely understood and no effective treatment is available at this time. However, an interesting association has been recently highlighted between CSC and the Helicobacter pylori infection. In particular, in a first case report recurrences of the disease were always associated with HP-positivity whereas improvements of both retinal findings and visual acuity were significantly correlated with a successful eradication of the bacterium using the conventional antimicrobial triple-therapy. In a second study, the prevalence of HP infection was found to be significantly higher in CSC-affected subjects compared to age- and sex-matched controls from the same country. Much speculation surrounds the role potentially played by HP in determining CSC. In particular, CSC seems not to be more a merely RPE disease but the final result of a general involvement of the choroidal microcirculation. In fact, several vascular abnormalities, such as localized vasoconstriction and impaired fibrinolysis, have been demonstrated during CSC whose "end-points" might be a focal occlusion of the choriocapillaries with decreased foveal choroidal blood flow, secondary RPE defects and serous macular detachment. Moreover, a HP-dependent immune mechanism, based on a "molecular mimicry" between pathogenic antigens expressed on the bacterium and homologous host proteins (e.g., those of the endothelial vascular wall), might also be involved in the pathophysiology of CSC. In this case, a genetically determined susceptibility of the subject could be an important and limiting factor. Although further multicenter, randomized, case-control trials are necessary to confirm the role potentially played by the HP infection in the pathogenesis of CSC, if this hypothesis would be confirmed in the near future, a novel antimicrobial approach to the disease might be possible waiting for a successful vaccine therapy that will surely stimulate the scientific interest of many authors.Medical Hypotheses 02/2004; 63(3):524-7. DOI:10.1016/j.mehy.2004.02.020 · 1.15 Impact Factor
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ABSTRACT: Die Anwendung systemischer Steroide nach vitreoretinalen Eingriffen und Plombenchirurgie zur Reduktion der Entzündungsreaktion und Vermeidung einer proliferativen Vitreoretinopathie ist weit verbreitet. MethodeMittels dieses Literaturüberblicks versuchen wir, den wissenschaftlichen Hintergrund im Sinne einer Evidence-based Medicine zu überprüfen und die Vor- und Nachteile gegeneinander abzuwägen. Im Vordergrund steht hier insbesonders die Frage nach der Sinnhaftigkeit der systemischen Applikation im Vergleich zu anderen Darreichungsformen sowie die in Studien bewiesene Wirksamkeit der Steroidgabe. In den zitierten Arbeiten zeigt sich zwar die unumstrittene antünflammatorische und antiproliferative Wirkung der Steroide, eine einheitliche Linie bezüglich Dauer, Dosierung und Applikationsart der Steroidtherapie fehlt jedoch. Die intravitreale Verabreichung ist wesentlich besser durch Studien belegt als die systemische Applikation. Die subkonjunctivale oder peribulbäre Verabreichung erzielt wesentlich höhere lokale Wirkspiegel als die systemische Gabe. Weiters wurde die systemische Steroidgabe meist durch zusätzliche Medikation oder Erweiterung der chirurgischen Maßnahmen ergänzt, so dass die besseren Ergebnisse nicht allein auf der Steroidwirkung beruhen. SchlussfolgerungNeben den positiven Effekten der Steroidgabe sind die doch zahlreichen möglichen lokalen und systemischen Nebenwirkungen zu beachten. Groß angelegte prospektive Studien bezüglich Applikationsform, Dauer und Dosierung einer perioperativen Steroidtherapie im Sinne einer Evidence-based Medicine wären wünschenswert. To reduce inflammation and lower the risk of proliferative vitreoretinopathy treatment with systemic steroids after vitreoretinal surgery and scierai buckling procedures is widely used. MethodThis literature review tries to verify the scientific background in terms of evidence based medicine and to compare the advantages and disadvantages. Our essential question is to assess the usefulness of systemic application compared to other forms of administration. The anti-inflammatory and anti-proliferative effect of the steroids is shown without controversy in the cited studies, but in terms of dosage, duration and application form of medication there is no consistent line. Intravitreal application is much better proven than systemic application. Subconjunctival and peribulbär injections should be recommend because of the higher local concentration with lower systemic side effects than after systemic administration. In most studies a combined therapy with additional administration of other drugs or additional surgery was used. So the better results cannot be seen as a consequence of steroid effect alone. ConclusionBeside the advantages of the administration of steroids the possible risks should be considered. Prospective studies in respect of the form of administration, duration and dosage of a perioperative steroid management in terms of an evidence based medicine would be desirable.Spektrum der Augenheilkunde 12/2005; 19(6):326-330. DOI:10.1007/BF03163476 · 0.18 Impact Factor
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ABSTRACT: A high-accuracy differential-type current component detection method and test results are described. The method is suited for vector-controlled pulse width-modulated (PWM) VSI-fed adjustable-speed AC drives. Its features include elimination of high-frequency current harmonics and correction of the detection error caused by the lag time of time-sharing processing. Since this method allows current-loop calculations at a slower sampling rate with a conventional microprocessor, it realizes a fully digital speed regulator with a minor current component loop. Simulation results and experimental results are presented.Power Electronics Specialists Conference, 1988. PESC '88 Record., 19th Annual IEEE; 05/1988