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Posterior Segment
Evaluating Central Serous Chorioretinopathy with Multifocal Electroretinogram
Marilita M Moschos and Michael Moschos
Department of Ophthalmology, University of Athens
Abstract
Purpose: To evaluate central serous chorioretinopathy (CSCR) by multifocal electroretinogram (mf-ERG). Patients and methods:
Twenty-one patients (21 eyes) with unilateral CSCR were examined. Both eyes of each patient underwent complete ophthalmological
examination, including measurement of best corrected visual acuity, fluorescein angiography and mf-ERG recording. Our results were
compared with the corresponding findings of 33 age-matched normal volunteers. Results: At presentation, the mean retinal response
density (RRD) of the affected eyes in area 1 was 50.8% lower compared with normal controls (p<0.001). After CSCR regression, the
mean RRD of the affected eyes was 30.1% lower compared with normal controls (p<0.001). Six fellow unaffected eyes showed a mean
RRD in area 1 equal to 12nV/deg
2
. Conclusion: During the acute phase of CSCR, the mean RRD of the fovea was significantly abnormal.
After its regression, mf-ERG values ameliorate, but they remain significantly abnormal. Abnormal values in area 1 were also found in
the unaffected eyes.
Keywords
Central serous chorioretinopathy (CSCR), multifocal electroretinogram (mf-ERG), fovea, fluorescein angiography, visual acuity
Disclosure: The authors have no conflicts of interest to declare.
Received: 12 July 2009 Accepted: 27 July 2009
Correspondence: Marilita M Moschos, Department of Ophthalmology, University of Athens, 6 Ikarias street, Ekali, 14578 Athens, Greece. E:
moschosmarilita@yahoo.fr
Central serous chorioretinopathy (CSCR) is an idiopathic syndrome of diffuse retinal degeneration or cataract, which may influence the
young to middle-aged adults, with men affected more commonly than mf-ERG recording. CSCR was defined as a serous detachment of
women. CSCR is characterised by serous detachment of the the neurosensory retina on fundus biomicroscopy secondary to
neurosensory retina with focal and multifocal areas of leakage at the leakage at the level of RPE on fluorescein angiography.
level of the retinal pigment epithelium (RPE) predominantly affecting
the macular area. Patients often complain of blurred central vision, At presentation, all patients underwent a complete ophthalmic
image distortion (micropsia) and impaired dark adaptation.
1
examination, including best corrected visual acuity (VA) assessment
(Snellen chart), fundus examination, fluorescein angiography and
Recently, this idiopathic syndrome has been associated with mf-ERG recording. Patients were prospectively followed up for two to
systemic corticosteroid therapy.
2
In most cases, CSCR resolves four months until recovery from CSCR. None received laser
spontaneously with good visual prognosis within a few months; photocoagulation. Clinical recovery from the disease was defined as
however, prolonged and recurrent macular detachment in some the resolution of neurosensory detachment, the disappearance of
cases may cause degenerative changes in subfoveal RPE and leakage in fluorescein angiography and the recovery of VA to initial
neurosensory retina with poor visual outcome.
3
The purpose of this value. Masked evaluators were used to determine initial and final VA.
article is to objectively assess the evolution of CSCR by multifocal The institutional ethical committee approved this study and a relevant
electroretinogram (mf-ERG) recordings at presentation and after the consent form was signed by all patients.
disappearance of ophthalmoscopic and fluoroangiographic evidence
of the disease. Multifocal Electroretinogram Recording
For the recording of the mf-ERG, the Visual Evoked Response Imaging
Patients and Methods System III (VERIS III, Tomey, Nagoya, Japan) was used. The stimulus
The study included 21 consecutive cases (21 eyes) with CSCR matrix consisted of 61 hexagonal elements displayed on a cathode
referred to our departments between December 2000 and November ray tube (CRT) colour monitor driven at a frame of 75Hz. These
2003. The mean age of the patients was 43.43 years (range 35–51, hexagons elicit approximately equal signal amplitude at all locations
standard deviation [SD] 5.44); 18 were males and three were female. on a normal retina. Each hexagon was independently alternated
Inclusion criteria were no previous episodes of CSCR, unilateral between black and white at a rate of 75Hz, and the stimulation
involvement, age less than 55 years and good medical status with no technique allowed a retinal response from each stimulus. The
underlying medical problems or drug abuse relevant to CSCR. None luminance of the stimulus for white was 200cd/m
2
and the contrast
of the patients had any other ocular diseases, such as high myopia, was 99.3%. The radius of the stimulus array subtended approximately
© TOUCH BRIEFINGS 2009 71
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