1) The study assessed the efficacy of half-dose photodynamic therapy (PDT) in treating patients with chronic central serous chorioretinopathy (cCSC) who had subretinal fluid (SRF) accumulation outside the fovea causing visual symptoms.
2) In 47% of patients, PDT led to a reduction in visual symptoms at the first follow-up visit. SRF resolved in 88% of eyes at the first visit and completely resolved in all eyes by the final visit.
3) Choroidal thickness decreased statistically significantly after PDT both under the fovea and at the location of extrafoveal SRF accumulation. No complications from PDT were observed
A Systematic Comparison of Spectral-Domain Optical Coherence Tomography and F...John Redaelli
Ophthalmology - Sept. 2011 - A Systematic Comparison of Spectral-Domain Optical Coherence Tomography and Fundus Autofluorescence in Patients with Geographic Atrophy
Journal of Ophthalmology & Visual Sciences is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Ophthalmology & Visual Sciences.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Ophthalmology & Visual Sciences. Journal of Ophthalmology & Visual Sciences accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Ophthalmology & Visual Sciences.
Journal of Ophthalmology & Visual Sciences strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
A Systematic Comparison of Spectral-Domain Optical Coherence Tomography and F...John Redaelli
Ophthalmology - Sept. 2011 - A Systematic Comparison of Spectral-Domain Optical Coherence Tomography and Fundus Autofluorescence in Patients with Geographic Atrophy
Journal of Ophthalmology & Visual Sciences is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Ophthalmology & Visual Sciences.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Ophthalmology & Visual Sciences. Journal of Ophthalmology & Visual Sciences accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Ophthalmology & Visual Sciences.
Journal of Ophthalmology & Visual Sciences strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Bilateral lens capsule rupture in a patient with previously undiagnosed alpor...Riyad Banayot
Ophthalmologists may be the first to consider the diagnosis of Alport’s Syndrome based on lens changes. Uncontrolled Blood pressure can delay surgery during which time IOP should be monitored closely. Results of lensectomies with foldable IOL implantation are successful. To our knowledge, this is the second report of a case of bilateral lens capsule rupture in a patient with previously undiagnosed Alport’s Syndrome.
FUZZY CLUSTERING BASED GLAUCOMA DETECTION USING THE CDR sipij
Glaucoma is a serious eye disease, overtime it will result in gradual blindness. Early detection of thedisease will help prevent against developing a more serious condition. A vertical cup-to-disc ratio which isthe ratio of the vertical diameter of the optic cup to that of the optic disc, of the fundus eye image is an important clinical indicator for glaucoma diagnosis. This paper presents an automated method for the extraction of optic disc and optic cup using Fuzzy C Means clustering technique combined with
thresholding. Using the extracted optic disc and optic cup the vertical cup-to-disc ratio was calculated.
The validity of this new method has been tested on 365 colour fundus images from two different publicly
available databases DRION, DIARATDB0 and images from an ophthalmologist. The result of the method
seems to be promising and useful for clinical work.
A Comparative Study of Age Related Macular Degeneration In Relation To SD-OCT...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Topical dorzolamide for macular edema in the early phase after vitrectomy and...Avaleks-Kiev
Background: The purpose of this study was to evaluate prospectively the efficacy of a topical carbonic anhydrase inhibitor in macular edema after vitrectomy.
Цель: оценка перспективы использования топического ингибитора карбоангидразы для профилактики развития макулярного отека после витрэктомии.
http://ophthalmolog.kiev.ua/
- An article describes what is the impact of refractive error on a layer of retina ( nerve fiber layer) in myopic subjects, Download its full text from Isra Medical Journal.
Objective: To evaluate myopic impact on thickness of nerve fiber layer of the retina in healthy myopic subjects.
Study Design: Prospective Observational study.
Place and Duration: Investigative Department of Ophthalmology of Al-Ibrahim Eye Hospital, Karachi from 1st May 2018 to 30th October 2018.
Methodology: In this study 80 eyes of myopic subjects (SE -0.5 to -11.0 DS) were enrolled. Each eye underwent through comprehensive ocular examination beginning with visual acuity, refraction, fundoscopy by slit lamp and ending up to optical coherence tomography of Nidek. Mean average peripapillary thickness of nerve fiber layer and thickness in superior, inferior, nasal and temporal quadrants was taken into consideration, calculated by Spectral Domain Optical Coherence Tomography (version 1.5.5.0).
Results: Forty subjects volunteered for study protocol among which 21 were male and 19 were female with a degree of refractive breakdown of 30% mild myopic, 50% moderately myopic and 20% highly myopic. The calculated average age was 25.0 ± 5.0 years (range 16-40 years). The average total nerve fiber layer thickness in myopic respondents was 90.85μm; superiorly 112.37μm; inferiorly 117.52μm; temporally 71.85μm and in nasal quadrant was 61.55μm. Retinal nerve fiber layer thickness was statistically significant in superior and temporal quadrant. In high myopes thickness was clinically significant in inferior quadrant in terms of quantity as compared to mild and moderate myopia
Conclusion: Average retinal nerve fiber layer thickness was significantly decreased in high myopia as compared to mild myopia while moderate group had slightly thicker thickness than high myopic group. Hence impact of dioptric power on nerve fiber layer thickness in myopic patients is significant.
Bilateral lens capsule rupture in a patient with previously undiagnosed alpor...Riyad Banayot
Ophthalmologists may be the first to consider the diagnosis of Alport’s Syndrome based on lens changes. Uncontrolled Blood pressure can delay surgery during which time IOP should be monitored closely. Results of lensectomies with foldable IOL implantation are successful. To our knowledge, this is the second report of a case of bilateral lens capsule rupture in a patient with previously undiagnosed Alport’s Syndrome.
FUZZY CLUSTERING BASED GLAUCOMA DETECTION USING THE CDR sipij
Glaucoma is a serious eye disease, overtime it will result in gradual blindness. Early detection of thedisease will help prevent against developing a more serious condition. A vertical cup-to-disc ratio which isthe ratio of the vertical diameter of the optic cup to that of the optic disc, of the fundus eye image is an important clinical indicator for glaucoma diagnosis. This paper presents an automated method for the extraction of optic disc and optic cup using Fuzzy C Means clustering technique combined with
thresholding. Using the extracted optic disc and optic cup the vertical cup-to-disc ratio was calculated.
The validity of this new method has been tested on 365 colour fundus images from two different publicly
available databases DRION, DIARATDB0 and images from an ophthalmologist. The result of the method
seems to be promising and useful for clinical work.
A Comparative Study of Age Related Macular Degeneration In Relation To SD-OCT...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Topical dorzolamide for macular edema in the early phase after vitrectomy and...Avaleks-Kiev
Background: The purpose of this study was to evaluate prospectively the efficacy of a topical carbonic anhydrase inhibitor in macular edema after vitrectomy.
Цель: оценка перспективы использования топического ингибитора карбоангидразы для профилактики развития макулярного отека после витрэктомии.
http://ophthalmolog.kiev.ua/
- An article describes what is the impact of refractive error on a layer of retina ( nerve fiber layer) in myopic subjects, Download its full text from Isra Medical Journal.
Objective: To evaluate myopic impact on thickness of nerve fiber layer of the retina in healthy myopic subjects.
Study Design: Prospective Observational study.
Place and Duration: Investigative Department of Ophthalmology of Al-Ibrahim Eye Hospital, Karachi from 1st May 2018 to 30th October 2018.
Methodology: In this study 80 eyes of myopic subjects (SE -0.5 to -11.0 DS) were enrolled. Each eye underwent through comprehensive ocular examination beginning with visual acuity, refraction, fundoscopy by slit lamp and ending up to optical coherence tomography of Nidek. Mean average peripapillary thickness of nerve fiber layer and thickness in superior, inferior, nasal and temporal quadrants was taken into consideration, calculated by Spectral Domain Optical Coherence Tomography (version 1.5.5.0).
Results: Forty subjects volunteered for study protocol among which 21 were male and 19 were female with a degree of refractive breakdown of 30% mild myopic, 50% moderately myopic and 20% highly myopic. The calculated average age was 25.0 ± 5.0 years (range 16-40 years). The average total nerve fiber layer thickness in myopic respondents was 90.85μm; superiorly 112.37μm; inferiorly 117.52μm; temporally 71.85μm and in nasal quadrant was 61.55μm. Retinal nerve fiber layer thickness was statistically significant in superior and temporal quadrant. In high myopes thickness was clinically significant in inferior quadrant in terms of quantity as compared to mild and moderate myopia
Conclusion: Average retinal nerve fiber layer thickness was significantly decreased in high myopia as compared to mild myopia while moderate group had slightly thicker thickness than high myopic group. Hence impact of dioptric power on nerve fiber layer thickness in myopic patients is significant.
Purpose: To evaluate the corneal volume (CV) before and after Ferrara intrastromal corneal ring segments (ICRS) implantation and its influence in clinical outcomes in keratoconus patients.
Novel Development in treatment of Diabetic Macular Edema, by Dr. Fritz Allen, presented at VO, Lecture Series 11, Feb 20, 2011
COPE Course ID: 30657-PS
Comparative Study of Visual Outcome between Femtosecond Lasik with Excimer La...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
AUTOMATED DETECTION OF HARD EXUDATES IN FUNDUS IMAGES USING IMPROVED OTSU THR...IJCSES Journal
One common cause of visual impairment among people of working age in the industrialized countries is
Diabetic Retinopathy (DR). Automatic recognition of hard exudates (EXs) which is one of DR lesions in
fundus images can contribute to the diagnosis and screening of DR.The aim of this paper was to
automatically detect those lesions from fundus images. At first,green channel of each original fundus image
was segmented by improved Otsu thresholding based on minimum inner-cluster variance, and candidate
regions of EXs were obtained. Then, we extracted features of candidate regions and selected a subset which
best discriminates EXs from the retinal background by means of logistic regression (LR). The selected
features were subsequently used as inputs to a SVM to get a final segmentation result of EXs in the image.
Our database was composed of 120 images with variable color, brightness, and quality. 70 of them were
used to train the SVM and the remaining 50 to assess the performance of the method. Using a lesion based
criterion, we achieved a mean sensitivity of 95.05% and a mean positive predictive value of 95.37%. With
an image-based criterion, our approach reached a 100% mean sensitivity, 90.9% mean specificity and
96.0% mean accuracy. Furthermore, the average time cost in processing an image is 8.31 seconds. These
results suggest that the proposed method could be a diagnostic aid for ophthalmologists in the screening
for DR.
Background: Nowadays, ICRS are a step in the treatment of keratoconus. The purpose of this study was to evaluate the refractive effect and the tomographic and biomechanical parameters in keratoconus patients implanted with Ferrara ICRS, and their stability after 18 months.
Aim: To compare one Field Of View (1 - FOV) and two Field Of View (2 - FOV) photography for diabetic retinopathy detection by assessing and comparing disease level and outcome.
Methods: A retrospective audit of a random sample of 500 patients with known proliferative diabetic retinopathy (PDR or R3), and 500 non-proliferative diabetic retinopathy (NPDR or R2). Images were re-assessed according to the English program criteria for DR levels using 1-FOV.
— Treatment of nasopharyngeal carcinoma is done by advanced radiotherapy techniques like VMAT (Volumetric Modulated Arc Therapy) where dose to critical organs around tumour is of concern. Present study aimed to describe radiation dose to critical organs in nasopharyngeal cancer patients using VMAT technique. Study was conducted on 10 carcinoma nasopharynx patients treated by VMAT technique at a super-specialty cancer institute in Rajasthan. The structures were contoured using RTOG (Radiation Therapy Oncology Group) guidelines and dose prescription to PTV (Planning Target Volume) was such that 95% iso-dose covered 100% of PTV. Constraints to the OARs (Organs at risk) were as per QUANTEC (Quantitative Analysis of Normal Tissue Effects in the Clinic). VMAT planning was done by double arc using Eclipse (v 10.0.42) treatment planning system. Mean dose to brain stem, spinal cord and optic chiasma were 51.79 Gy, 45.92 Gy and 18.8 Gy respectively. Mean dose to left and right temporal lobes was 22.7Gy and 24.3Gy. Dose to right and left eye were 20.6 Gy and 19.2 Gy while dose to right and left lenses were 5.9Gy and 5.8 Gy respectively. Dose to brain stem, spinal cord, optic chiasma, eyes, lens and temporal lobes were below the dose constraints. VMAT is an effective way to deliver maximum radiation to tumour tissue while providing better sparing of normal tissue and less doses to OARs in carcinoma nasopharynx.
Learning Effect and Test-Retest Variability in Healthy Subjects and Patients ...inventionjournals
Aim: To study learning effect (LE) and test retest variability (TRV) in healthy subjects and patients with primary open angle glaucoma (POAG) using Rarebit perimetry (RBP). To determine normative ranges of RBP. Methods: 61 eyes of 35 subjects underwent visual field testing with standard automated perimetry (SAP) and RBP. TRV and LE were assessed in repeated examinations conducted in 3 different days. First two examinations were conducted within 3 days and the last one within one month. LE was assessed by comparing results from the three sessions. TRV was evaluated by calculating differences between retest for each combination of single tests. To determine normative ranges of RBP were included 34 eyes of 21 healthy subjects and 62 eyes of 47 subjects with preperimetric and early POAG. Cut off value was determined between the two groups using ROC analysis. Results: No significant LE was observed in POAG group. There was a significant LE in the control group but only in the visual field zones with eccentric location. TRV was higher in POAG group and in central visual field zone. The mean MHR in control group was 94.88 (SD 2.21) and 83.56 (SD 6.95) in POAG group. Cut off value for discriminating between healthy subjects and patient with POAG was 91.50% with AUROC 0.985 (p<0.001, ROC analysis). Conclusion: RBP is fast and easy to perform test. RBP testing did not show a significant LE in glaucoma group, however, TRV was consistent. MHR can be successfully used for differentiation of healthy eye from those with early glaucoma changes.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. MEDICAL OPHTHALMOLOGY
Photodynamic therapy in chronic central serous
chorioretinopathy with subretinal fluid outside the fovea
Elon H. C. van Dijk1
& Greet Dijkman1
& Camiel J. F. Boon1,2
Received: 6 April 2017 /Revised: 6 June 2017 /Accepted: 12 June 2017 /Published online: 3 July 2017
# The Author(s) 2017. This article is an open access publication
Abstract
Purpose To assess the efficacy of photodynamic therapy
(PDT) in patients with chronic central serous chorioretinopathy
(cCSC), in whom subretinal fluid (SRF) was solely present
outside the foveal area.
Methods In this retrospective study, 16 eyes of 15 cCSC pa-
tients who received half-dose PDT because of notable subjec-
tive visual complaints due to the presence of extrafoveal SRF,
were included. An ophthalmic examination was performed
before treatment, including Early Treatment Diabetic
Retinopathy Study best-corrected visual acuity measurement,
applanation tonometry, slit-lamp examination, and indirect
ophthalmoscopy, followed by multimodal imaging, including
fundus photography, fundus autofluorescence, spectral-
domain optical coherence tomography (OCT), enhanced-
depth imaging OCT of the choroid, fluorescein angiography,
and indocyanine green angiography.
Results In 7 treated patients (47%), PDT led to a decrease in
visual complaints at the first evaluation visit. At this visit,
extrafoveal SRF on OCT had resolved in 14 eyes (88%),
whereas a complete resolution of extrafoveal SRF had oc-
curred in all eyes at final follow-up visit. At baseline, posterior
cystoid retinal degeneration was also present in 5 eyes (31%)
and this remained present at all evaluation visits in these pa-
tients. Choroidal thickness decreased statistically significantly
in the treated eyes, both foveally and at the location of the
maximum height of extrafoveal SRF. No complications of
PDT were observed.
Conclusions Half-dose PDT treatment of cCSC patients with
visual complaints due to extrafoveal SRF accumulation is a
safe procedure leading to complete SRF resolution, a decrease
in choroidal thickness, and a reduction in visual symptoms.
Keywords Choroidal thickness . Chronic central serous
chorioretinopathy . Extrafoveal . Photodynamic therapy .
Subretinal fluid . Resolution . Visual complaints
Introduction
Central serous chorioretinopathy (CSC) is a chorioretinal dis-
ease that can eventually lead to vision loss as a result of irre-
versible retinal damage, mainly affecting middle-aged men.
Despite the fact that the disease has already been described
by Von Graefe in 1866, the exact pathogenetic mechanism of
CSC is still unknown [1]. The disease is characterized by an
accumulation of serous subretinal fluid (SRF). This leakage
results from dysfunction of the retinal pigment epithelium
(RPE) outer blood-retinal barrier, most probably caused by
choroidal congestion, thickening, and hyperpermeability
[2–5]. Compared to a control group, a significant increase in
choroidal thickness (CT) in both affected eyes and non-
affected fellow eyes has been described, supporting the hy-
pothesis that CSC is a bilateral disorder which can present
unilaterally [3, 6, 7].
In chronic CSC (cCSC), treatment is generally initiated in
case of the presence of vision loss due to SRF accumulation
under the fovea [4, 8]. Based on the currently available
Electronic supplementary material The online version of this article
(doi:10.1007/s00417-017-3720-z) contains supplementary material,
which is available to authorized users.
* Camiel J. F. Boon
c.j.f.boon@lumc.nl
1
Department of Ophthalmology, Leiden University Medical Center,
Albinusdreef 2, 2333 ZA Leiden, The Netherlands
2
Department of Ophthalmology, Academic Medical Center,
University of Amsterdam, Amsterdam, The Netherlands
Graefes Arch Clin Exp Ophthalmol (2017) 255:2029–2035
DOI 10.1007/s00417-017-3720-z
2. literature, photodynamic therapy (PDT) and micropulse laser
treatment appear to be the most appropriate treatment modal-
ities for the disease [8]. In up to 73% of cCSC patients, com-
plete resolution of SRF can be achieved after micropulse laser
treatment, whereas this occurs in up to 100% of cases after
PDT [9–11]. However, no results of large randomized con-
trolled treatment trials have been published yet [2].
PDT is thought to induce choroidal changes due to a tem-
porary decrease in the perfusion of the choriocapillary layer and
due to choroidal vascular remodeling, resulting in a reduction
in fluid leakage from the choroid to the subretinal space [12].
However, some patients develop a temporary worsening of
visual complaints in the first 2 weeks after PDT, and very rare
complications such as choroidal ischemia, choroidal neovascu-
larisation, and RPE atrophy have been described after PDT in
cCSC [13–16]. Because of these possible complications and
because of the fact that in cCSC patients extrafoveal SRF less
often causes visual symptoms compared to foveal SRF, PDT is
usually only performed in the cCSC patient group with foveal
SRF. However, some patients without foveal SRF do have
significant visual symptoms that require treatment. No studies
on the use of PDT in cCSC patients with only extrafoveal SRF
have been conducted thus far. In this retrospective study, we
assessed the safety and efficacy of half-dose PDT on both vi-
sual complaints and SRF on optical coherence tomography
(OCT) in cCSC patients with extrafoveal SRF.
Methods
Patients
Sixteen eyes of 15 patients could be included in this study. In
these patients solely extrafoveal SRF could be detected on
OCT prior to treatment. However, subjectively disabling visual
complaints such as metamorphopsia, impaired color vision,
and blurred peripheral vision led to the decision to schedule a
treatment. PDT treatment had been performed between
November 2014 and January 2017. Diagnosis of cCSC was
established by fundoscopy, digital color fundus photography
(Topcon Corp., Tokyo, Japan), fundus autofluorescence
(Spectralis HRA + OCT; Heidelberg Engineering,
Heidelberg, Germany), spectral-domain OCT (Spectralis
HRA + OCT) and enhanced-depth imaging OCTof the choroid
(Spectralis HRA + OCT), fluorescein angiography (FA;
Spectralis HRA + OCT), and indocyanine green angiography
(ICGA; Spectralis HRA + OCT). All of the following had to be
present to set the cCSC diagnosis: disease duration of more
than 4 months, serous SRF on OCT, ≥ one area of a ‘hot spot’
of leakage or diffuse leakage in combination with irregular
RPE window defects on FA, and corresponding
hyperfluorescence on ICGA. Patients in whom evidence of
other diagnoses than cCSC were present, or cases with
evidence of complications such as polypoidal choroidal vascu-
lopathy and/or choroidal neovascularisation, were excluded.
Local ethics committee and institutional review board ap-
proval was obtained. The study followed the tenets of the
Declaration of Helsinki.
Photodynamic therapy treatment
Half-dose intravenous (3 mg/m2
) verteporfin (Visudyne®;
Novartis Europharm Ltd., Horsham, West Sussex, UK) was
administrated over a period of 10 min. At exactly 15 min after
the start of the verteporfin infusion, a contact glass (Volk®
PDT lens) was positioned on the affected eye, and the laser
beam was projected on the area to be treated. The zone to be
treated was chosen based on hyperfluorescent areas on mid-
phase (10′) ICGA, corresponding to SRF on OCT and
hyperfluorescent ‘hot spots’ of leakage on mid-phase (3′)
FA. For the PDT treatment, a fluency of 50 J/cm2
, treatment
duration of 83 s, and a laser wavelength of 689 nm (Carl Zeiss
Meditec, Dublin, CA, USA) were used.
Ophthalmological examinations
Ocular complaints were recorded and Early Treatment
Diabetic Retinopathy Study (ETDRS) best-corrected visual
acuity (BCVA) was measured at the last visit before PDT
and at least at one evaluation visit after PDT. When ETDRS
BCVA was not available, a previously described conversion
method was used [17]. The effect of treatment on SRF was
assessed with spectral-domain OCT imaging. Moreover, the
effect on intraretinal cystoid spaces without intraretinal leak-
age (posterior cystoid retinal degeneration) was also studied
on these OCT images [18, 19].
For the treated eyes, the following findings were measured
manually on enhanced-depth imaging (EDI)-OCT with use of
the caliper tool in Heidelberg Eye Explorer (version 1.9.10.0;
Heidelberg Engineering) at the last visit before PDTand at least
at one evaluation visit after PDT: foveal CT (distance from the
outer part of the hyperreflective RPE layer to the
hyperreflective line of the inner surface of the sclera, on EDI-
OCT) and CT at the location of the maximum height of
extrafoveal SRF (distance from the outer part of the external
limiting membrane to the outer part of the RPE layer).
Complete resolution of SRF on OCT was considered to be
the desired anatomical treatment effect. For comparison with
CT in the treated eyes, subfoveal CT was also measured on
EDI-OCT in untreated fellow eyes.
Statistical analysis
For statistical analyses, a dependent t test was used in SPSS
Statistics (version 23; IBM Corp., Armonk, NY, USA) to
compare both ETDRS and CT at evaluation visits with
2030 Graefes Arch Clin Exp Ophthalmol (2017) 255:2029–2035
3. ETDRS and CT before PDT. The level of statistical signifi-
cance was set at p < 0.05.
Results
The 15 cCSC patients (16 eyes; 14 male patients, 1 female
patient) who were included in this study had a mean age of
52 ± 13 years (range, 35–80 years). In the treated eyes, cCSC
had been diagnosed for the first time at 21 ± 21 months (range,
3–83 months) before PDT. Prior to PDT treatment, ETDRS
BCVA in the affected eyes was 78 (Snellen equivalent: 20/
29) ± 18 letters (range, 21–95 letters). Bilateral signs of cCSC
were present in 10 patients (67%). Posterior cystoid retinal de-
generation was present in 5 eyes (31%) at the last visit before
PDT. Nine included eyes (56%) had received previous CSC
treatment because of foveal SRF, including micropulse laser
treatment (7 eyes) and half-dose PDT (2 eyes). All patients
had received this previous treatment within 1 year before the
half-dose PDT performed within this study. The mean PDTspot
size in the treated eyes was 5.0 ± 1.7 mm (range, 2.2–7.2 mm),
and the verteporfin dosage was 2.9 ± 0.4 ml (range, 2.0–3.3 ml).
Two patients were treated with two PDT spots in one session.
Out of 12 treated eyes of 12 patients, for which this information
was available, the fovea was included in the treatment spot in 10
eyes (84%). Patient characteristics are summarized in Table 1.
At the first evaluation visit after a mean of 63 days (range,
7–161 days) after half-dose PDT, a reduction in visual symp-
toms had occurred in 7 patients (47%). At that visit, ETDRS
BCVA was 80 (Snellen equivalent: 20/25) ± 16 letters (range,
35–96 letters), which was not statistically significantly differ-
ent from the last visit before PDT (p = 0.074). At the last
evaluation visit after a mean of 325 days (range, 189–
351 days) after PDT, ETDRS BCVA was 78 (Snellen equiva-
lent: 20/29) ± 20 letters (range, 20–93 letters) as compared to
the last visit before PDT (p = 0.836).
A complete resolution of extrafoveal SRF had occurred in 14
eyes (88%) at the first evaluation visit after PDT, whereas pos-
terior cystoid retinal degeneration had not disappeared in any of
the eyes. In the 9 patients for whom EDI-OCT images of suffi-
cient quality were available both before PDT and at the first
evaluation, the subfoveal CT was 408 ± 93 μm (range, 200–
509 μm) at this first visit after PDT, which was a significant
decrease as compared to before PDT [452 ± 95 μm (range,
238–554 μm); p = 0.043]. CT at the location of the maximum
height of extrafoveal SRF was 407 ± 99 μm (range, 213–
544 μm) before PDT, which was statistically significantly higher
compared to CTat the first evaluation after PDT [351 ± 102 μm
(range, 172–489 μm); p = 0.015]. Before PDT, subfoveal CT in
the untreated fellow eye was 415 ± 91 μm (range, 244–489 μm),
which did not differ from CT at the first evaluation visit
[411 ± 96 μm (range, 224–502 μm); p = 0.711]. At the final
follow-up visit of 6 patients for whom EDI-OCT images of
Table 1 Clinical characteristics of patients with central serous chorioretinopathy who received photodynamic therapy for extrafoveal subretinal fluid
Patient Age Gender Baseline
ETDRS BCVA
Duration of
CSC (days)
Bilateral CSC Recurrent CSC Previous CSC treatment-affected eye
1 50 M 85 352 Y N N
2 51 F 86 488 N N Micropulse laser treatment (2*)
3 70 M 77 421 Y Y N
4 37 M 59 1299 Y Y N
5 80 M 21 129 Y N Half-dose photodynamic therapy
(foveal SRF)
6 72 M 89 725 Y N N
7 35 M 72 474 Y Y Micropulse laser treatment (1*)
8 51 M 90 547 N Y Micropulse laser treatment (2*)
9 47 M 92 1518 Y N Half-dose photodynamic therapy
(foveal SRF)
10 49 M 84 333 N N Micropulse laser treatment (2*)
11 44 M 90 349 N N Micropulse laser treatment (2*)
12 41 M 67 315 Y N Micropulse laser treatment (2*)
13 50 M 76 671 N N Micropulse laser treatment (2*)
14 47 M 95 211 Y N N
15 57 M 81 83 Y N N
57 M 75 2523 NA Y N
BCVA = best-corrected visual acuity, CSC = central serous chorioretinopathy, ETDRS = Early Treatment of Diabetic Retinopathy Study, NA = not
applicable, SRF = subretinal fluid.
Graefes Arch Clin Exp Ophthalmol (2017) 255:2029–2035 2031
4. sufficient quality were available, the subfoveal CT was
397 ± 50 μm (range, 341–468 μm) and the extrafoveal CT
was 371 ± 84 μm (range, 245–475 μm), which was significantly
lower than the CT before PDT (p = 0.001 and p = 0.003, re-
spectively). At that moment, the CTof the untreated fellow eyes
was 422 ± 78 μm (range, 303–496 μm), which did not differ
from CT before PDT (p = 0.953). Multimodal imaging of a
patient before and after half-dose PDT is depicted in Fig. 1.
At final evaluation visit, extrafoveal SRF had disappeared in
all patients. The two patients in whom extrafoveal SRF had not
resolved at the first evaluation visit received an additional half-
dose PDT treatment, after which a complete resolution of SRF
occurred. Both patients had previously received treatment for
cCSC, including micropulse laser treatment (one eye) and half-
dose PDT (one eye). Characteristics on OCT before and at the
evaluation visits after half-dose PDT are summarized in Table 2.
Fig. 1 Characteristics on multimodal imaging of a patient with chronic
central serous chorioretinopathy with only extrafoveal subretinal fluid,
who was treated with half-dose photodynamic therapy. (A–D)
Fluorescein angiography (FA; A), fundus autofluorescence (FAF) imag-
ing (B), indocyanine green angiography (ICGA; C), and a foveal optical
coherence tomography (OCT) scan (D) of a 47-year-old male patient with
chronic central serous chorioretinopathy before half-dose photodynamic
therapy (PDT). FA showed hyperfluorescent areas, with a ‘hot spot’ of
leakage inferiorly of the fovea. On FAF, both hyper- and
hypoautofluorescent abnormalities were present. ICGA revealed the pres-
ence of areas of hyperfluorescence, larger compared to the extent of the
abnormalities on FA. On the foveal OCT scan, no subretinal fluid (SRF)
was present. Some subtle retinal pigment epithelium abnormalities could
be detected, and the choroidal thickness (CT) was 472 μm. (E–G) At the
evaluation visit at 6 weeks after half-dose PDT, the subfoveal CTon OCT
(E) had decreased to 420 μm. FAF imaging (F) revealed a slight increase
in the extent of hyperautofluorescent abnormalities, but the extent of
hyperfluorescent abnormalities on ICGA (G) had clearly decreased.
(H–I) On the OCT scan (H), inferiorly of the fovea, obtained before
half-dose PDT, on which the maximum height of extrafoveal SRF could
be detected, the CT was 468 μm. At 6 weeks after treatment, a complete
resolution of SRF on OCT (I) had occurred and the CT had decreased to
396 μm. The complaints of the patient, which mainly consisted of
metamorphopsia, had not changed at the evaluation visit after treatment
2032 Graefes Arch Clin Exp Ophthalmol (2017) 255:2029–2035
5. Discussion
To the best of our knowledge, this is the first study describing
the outcome of PDT treatment in cCSC patients in whom only
extrafoveal SRF was present on OCT. A complete resolution
of SRF occurred in 88% of patients at first evaluation visit,
and in all patients at final follow-up visit. Also, CT in the
treated eyes decreased significantly at the evaluation visits
both at the location of the maximum height of extrafoveal
SRF and in the fovea. A decrease in visual complaints was
reported for 47% of treated patients.
The percentage of patients in whom SRF disappeared after
half-dose PDT is in line with the outcome of other studies that
included patients with foveal SRF, for whom it has been de-
scribed that treatment could prevent the occurrence of perma-
nent photoreceptor damage [9, 20, 21]. This complete resolu-
tion occurred despite the fact that the majority of eyes in our
study had previously received treatment for cCSC. In addition
to a resolution of SRF, treatment resulted in a significant re-
duction in CT, both extrafoveally and foveally. A comparable
subfoveal CT reduction independently from including the fo-
vea in the PDT-treated area has been previously described [11,
22]. Such an effect that is distant from the area that was actu-
ally treated with the PDT spot may be explained by choroidal
remodeling after PDT treatment [12]. Apart from the finding
that SRF and visual symptoms resolved in a noteworthy num-
ber of cCSC patients with extrafoveal SRF included in this
study, these treatment effects in these cCSC patients may also
decrease the likelihood of either recurrence of SRF or progres-
sion to foveal SRF leakage at a later date, which could lead to
irreversible damage [23].
Based on the available, mostly retrospective evidence on the
safety and efficacy of PDT using reduced treatment settings in
cCSC [8, 13], our first-line choice for the treatment of cCSC is
PDT, and this treatment resulted in a complete resolution of
SRF in all the included patients with extrafoveal SRF.
However, the optimal treatment and timing of treatment for
cCSC is subject to controversy, due to the lack of large pro-
spective randomized controlled trials. We are currently
performing a large prospective randomized controlled multi-
center treatment trial, the PLACE trial, comparing half-dose
PDTwith high-density subthreshold micropulse laser treatment
for cCSC [24]. In this trial, both anatomical and functional
parameters are taken into account, for a prolonged follow-up
period [24]. However, for patients included in this trial and in
other treatment trials on cCSC, generally, the presence of SRF
in the fovea is mandatory to be eligible for inclusion.
Limitations of the current study include the small number of
included patients, its retrospective nature, and the relatively
short follow-up period. Since PDT treatment can lead to both
a temporary increase in visual complaints and to serious com-
plications, it should be performed with its associated risks in
mind, especially in patients without SRF in the fovea [13–16].
Table2Characteristicsonopticalcoherencetomographyinchroniccentralserouschorioretinopathypatientswhoreceivedhalf-dosephotodynamictherapyforextrafovealsubretinalfluid
PatientReductionof
complaints
afterPDT
Pre-PDT
SCT(μm)
Post1-PDT
SCT(μm)
Post2-PDT
SCT(μm)
Pre-PDT
extrafoveal
CT(μm)
Post1-PDT
extrafoveal
CT(μm)
Post2-PDT
extrafoveal
CT(μm)
Pre-PDTSCT
felloweye(μm)
Post1-PDTSCT
felloweye(μm)
Post2-PDTSCT
felloweye(μm)
1YNANANANANANANANANA
2Y549420430482385365478447496
3NNANANANANANANANANA
4NNANANANANANANANANA
5NNANANANANANANANANA
6NNANANANANANANANANA
7YNANANANANANANANANA
8NNANANANANANANANANA
9N413427NA334348NA489416NA
10N238200NA344268NA244224NA
11Y485372341441294245472475451
12Y416361344382324306348368354
13Y447482NA213172NA465469NA
14N492486385454485410458496492
15Y554509468544489475475502437
Y472420413468396423306299303
CT=choroidalthickness,NA=notavailable,PDT=photodynamictherapy,Post1=firstevaluationvisitafterPDT,Post2=lastevaluationvisitafterPDT,SCT=subfovealchoroidalthickness.
Graefes Arch Clin Exp Ophthalmol (2017) 255:2029–2035 2033
6. In conclusion, half-dose PDT treatment of cCSC patients
with notable visual complaints due to extrafoveal SRF accu-
mulation induces complete SRF resolution and leads to a de-
crease in CT and a reduction in visual symptoms.
Acknowledgements This research was supported by the following
foundations: MaculaFonds, Retina Netherlands, BlindenPenning, and
Landelijke Stichting voor Blinden en Slechtzienden, which contributed
through UitZicht, as well as Rotterdamse Stichting Blindenbelangen,
Haagse Stichting Blindenhulp, ZonMw VENI Grant, and Gisela Thier
Fellowship of Leiden University (CJFB). The funding organizations had
no role in the design or conduct of this research. They provided unre-
stricted grants.
Compliance with ethical standards All procedures performed were in
accordance with the ethical standards of the institutional and/or national
research committee and with the 1964 Helsinki Declaration and its later
amendments or comparable ethical standards.
Informed consent Informed consent was obtained from all individual
participants included in the study.
Conflict of interest All authors certify that they have no affiliations
with or involvement in any organization or entity with any financial
interest (such as honoraria; educational grants; participation in speakers’
bureaus; membership, employment, consultancies, stock ownership, or
other equity interest; and expert testimony or patent-licensing arrange-
ments), or non-financial interest (such as personal or professional rela-
tionships, affiliations, knowledge or beliefs) in the subject matter or ma-
terials discussed in this manuscript.
Open Access This article is distributed under the terms of the Creative
Commons Attribution 4.0 International License (http://
creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided you give
appropriate credit to the original author(s) and the source, provide a link
to the Creative Commons license, and indicate if changes were made.
References
1. Von Graefe A (1866) Ueber Centrale Recidiverende retinitis.
Graefes Arch Clin Exp Ophthalmol 12:211–215
2. Daruich A, Matet A, Dirani A, Bousquet E, Zhao M, Farman N,
Jaisser F, Behar-Cohen F (2015) Central serous Chorioretinopathy:
recent findings and new physiopathology hypothesis. Prog Retin
Eye Res 48:82–118. doi:10.1016/j.preteyeres.2015.05.003
3. Liew G, Quin G, Gillies M, Fraser-Bell S (2013) Central serous
Chorioretinopathy: a review of epidemiology and pathophysiology.
Clin Exp Ophthalmol 41:201–214. doi:10.1111/j.1442-9071.2012.
02848.x
4. Nicholson B, Noble J, Forooghian F, Meyerle C (2013) Central
serous Chorioretinopathy: update on pathophysiology and treat-
ment. Surv Ophthalmol 58:103–126. doi:10.1016/j.survophthal.
2012.07.004
5. Prunte C, Flammer J (1996) Choroidal capillary and venous con-
gestion in central serous Chorioretinopathy. Am J Ophthalmol 121:
26–34
6. Chen G, Tzekov R, Li W, Jiang F, Mao S, Tong Y (2017) Subfoveal
Choroidal thickness in central serous Chorioretinopathy: a meta-
analysis. PLoS One 12:e0169152. doi:10.1371/journal.pone.
0169152
7. Kitzmann AS, Pulido JS, Diehl NN, Hodge DO, Burke JP (2008)
The incidence of central serous Chorioretinopathy in Olmsted
County, Minnesota, 1980-2002. Ophthalmology 115:169–173.
doi:10.1016/j.ophtha.2007.02.032
8. Salehi M, Wenick AS, Law HA, Evans JR, Gehlbach P (2015)
Interventions for central serous Chorioretinopathy: a network me-
ta-analysis. Cochrane Database Syst Rev. doi:10.1002/14651858.
CD011841.pub2
9. Tseng CC, Chen SN (2015) Long-Term efficacy of half-dose pho-
todynamic therapy on chronic central serous Chorioretinopathy. Br
J Ophthalmol 99:1070–1077. doi:10.1136/bjophthalmol-2014-
305353
10. Chen SN, Hwang JF, Tseng LF, Lin CJ (2008) Subthreshold diode
Micropulse photocoagulation for the treatment of chronic central
serous Chorioretinopathy with Juxtafoveal leakage.
Ophthalmology 115:2229–2234. doi:10.1016/j.ophtha.2008.08.
026
11. Pryds A, Larsen M (2012) Choroidal thickness following
Extrafoveal photodynamic treatment with Verteporfin in patients
with central serous Chorioretinopathy. Acta Ophthalmol 90:738–
743. doi:10.1111/j.1755-3768.2011.02157.x
12. Chan WM, Lam DS, Lai TY, Tam BS, Liu DT, Chan CK (2003)
Choroidal vascular Remodelling in central serous
Chorioretinopathy after Indocyanine green guided photodynamic
therapy with Verteporfin: a novel treatment at the primary disease
level. Br J Ophthalmol 87:1453–1458
13. Lim JI, Glassman AR, Aiello LP, Chakravarthy U, Flaxel CJ,
Spaide RF (2014) Collaborative retrospective macula society study
of photodynamic therapy for chronic central serous
Chorioretinopathy. Ophthalmology 121:1073–1078. doi:10.1016/
j.ophtha.2013.11.040
14. Lee PY, Kim KS, Lee WK (2009) Severe Choroidal ischemia fol-
lowing photodynamic therapy for pigment epithelial detachment
and chronic central serous Chorioretinopathy. Jpn J Ophthalmol
53:52–56. doi:10.1007/s10384-008-0613-z
15. van Dijk EH, Dijkman G, Theelen T, Hoyng CB, Boon CJ (2016)
Short-Term findings on optical coherence tomography and
Microperimetry in chronic central serous Chorioretinopathy pa-
tients treated with half-dose photodynamic therapy. Retin Cases
Brief Rep. doi:10.1097/icb.0000000000000498
16. Study Group VIP (2001) Photodynamic therapy of Subfoveal
Choroidal neovascularization in pathologic myopia with
Verteporfin. 1-year results of a randomized clinical trial–Vip report
no. 1. Ophthalmology 108:841–852
17. Gregori NZ, Feuer W, Rosenfeld PJ (2010) Novel method for ana-
lyzing Snellen visual acuity measurements. Retina 30:1046–1050.
doi:10.1097/IAE.0b013e3181d87e04
18. Iida T, Yannuzzi LA, Spaide RF, Borodoker N, Carvalho CA,
Negrao S (2003) Cystoid macular degeneration in chronic central
serous Chorioretinopathy. Retina 23:1–7 quiz 137-138
19. Piccolino FC, De La Longrais RR, Manea M, Cicinelli S (2008)
Posterior cystoid retinal degeneration in central serous
Chorioretinopathy. Retina 28:1008–1012. doi:10.1097/IAE.
0b013e31816b4b86
20. Breukink MB, Mohr JK, Ossewaarde-van Norel A, den Hollander
AI, Keunen JE, Hoyng CB, Boon CJ (2016) Half-dose photody-
namic therapy followed by diode Micropulse laser therapy as treat-
ment for chronic central serous Chorioretinopathy: evaluation of a
prospective treatment protocol. Acta Ophthalmol 94:187–197. doi:
10.1111/aos.12938
21. Nicolo M, Eandi CM, Alovisi C, Grignolo FM, Traverso CE,
Musetti D, Cardillo Piccolino F (2014) Half-Fluence versus half-
dose photodynamic therapy in chronic central serous
Chorioretinopathy. Am J Ophthalmol 157:1033–1037. doi:10.
1016/j.ajo.2014.01.022
2034 Graefes Arch Clin Exp Ophthalmol (2017) 255:2029–2035
7. 22. Maruko I, Iida T, Sugano Y, Ojima A, Ogasawara M, Spaide RF
(2010) Subfoveal Choroidal thickness after treatment of central
serous Chorioretinopathy. Ophthalmology 117:1792–1799. doi:
10.1016/j.ophtha.2010.01.023
23. Breukink MB, Dingemans AJ, den Hollander AI, Keunen JE,
MacLaren RE, Fauser S, Querques G, Hoyng CB, Downes SM,
Boon CJ (2017) Chronic central serous Chorioretinopathy: long-
Term follow-up and vision-related quality of life. Clin Ophthalmol
11:39–46. doi:10.2147/opth.s115685
24. Breukink MB, Downes SM, Querques G, van Dijk EH, den
Hollander AI, Blanco-Garavito R, Keunen JE, Souied EH,
MacLaren RE, Hoyng CB, Fauser S, Boon CJ (2015)
Comparing half-dose photodynamic therapy with high-
density Subthreshold Micropulse laser treatment in patients
with chronic central serous Chorioretinopathy (the Place trial):
study protocol for a randomized controlled trial. Trials 16:419.
doi:10.1186/s13063-015-0939-z
Graefes Arch Clin Exp Ophthalmol (2017) 255:2029–2035 2035