Sir,
Central serous chorioretinopathy (CSCR) normally occurs in otherwise healthy individuals. It is characterised by the development of a serous detachment of the neurosensory retina at the macula. Bilateral disease has been reported in about 23% of cases.1 The condition is normally self-limiting with good visual recovery. However, up to 30% of cases may develop recurrent episodes and require photocoagulation therapy.2 Stress has been implicated, but not conclusively proven to be an aetiological factor in CSCR.3 The aetiology of CSCR has been the subject of much speculation, but remains unknown.
There is evidence of abnormal perfusion of the choriocapillaris in CSCR.4, 5, 6 There is also evidence of an association between serous retinal detachment and raised serum antiphospholipid antibodies.7 Furthermore, raised antiphospholipid antibodies are seen in 42% of patients with systemic lupus erythematosus (SLE)8 and an association between SLE and CSCR has been observed.7, 9, 10 Antiphospholipid antibodies are associated with thrombophilia11, 12 and could, in theory, lead to localised thrombosis in the choriocapillaris resulting in the perfusion abnormalities found in CSCR. We performed a pilot study to begin to investigate possible evidence for a direct association between CSCR and raised levels of antiphospholipid antibodies (anticardiolipin, and anti-β2 glycoprotein-1). The prevalence of such antibodies in the normal population is reported to be approximately 6%.13
A total of 20 patients (13 M, 7 F) presenting with a clinical diagnosis of CSCR to one unit between September 1999 and December 2000 underwent analysis of their clotting profiles and serum testing for the presence of antiphospholipid antibodies. General health was assessed and any features specific for the primary antiphospholipid syndrome were recorded.
None of the patients who presented had clinical features of the primary antiphospholipid syndrome. Two patients showed minor abnormalities in their clotting profiles. In one patient, this was transient and the other was lost to follow-up. No patients had persistently elevated levels of antiphospholipid antibodies, although IgM anti-β2 glycoprotein-1was transiently elevated in one patient.
In conclusion, this study did not suggest an association between raised antiphospholipid antibodies and central serous chorioretinopathy. It would appear that antiphospholipid antibodies are unlikely to be directly implicated in the aetiology of CSCR.
This paper was presented as a poster at the Royal College of Ophthalmologists Annual Congress, May 2003.
References
Castro-Correia J, Coutinho MF, Rosas V, Maia J . Long-term follow-up of central serous retinopathy in 150 patients. Doc Ophthalmol 1992; 81: 379–386.
Gilbert CM, Owens SL, Smith PD, Fine SL . Long-term follow-up of central serous chorioretinopathy. Br J Ophthalmol 1984; 68: 815–820.
Gelber GS, Schatz H . Loss of vision due to central serous chorioretinopathy following psychological stress. Am J Psychiatry 1987; 144: 46–50.
Guyer DR, Yannuzzi LA, Slakter JS, Sorenson JA, Ho A, Orlock D . Digital indocyanine green videoangiography of central serous chorioretinopathy. Arch Ophthalmol 1994; 112: 1057–1062.
Prunte C, Flammer J . Choroidal capillary and venous congestion in central serous chorioretinopathy. Am J Ophthalmol 1996; 121: 26–34.
Scheider A, Nasemann JE, Lund OE . Fluorescein and indocyanine green angiographies of central serous choroidopathy by scanning laser ophthalmoscopy. Am J Ophthalmol 1993; 115: 50–56.
Castanon C, Amigo MC, Banales JL, Nava A, Reyes PA . Ocular vaso-occlusive disease in primary antiphospholipid syndrome. Ophthalmology 1995; 102: 256–262.
Harris EN, Gharavi AE, Hughes GR . Anti-phospholipid antibodies. Clin Rheum Dis 1985; 11: 591–609.
Cunningham Jr ET, Alfred PR, Irvine AR . Central serous chorioretinopathy in patients with systemic lupus erythematosus. Ophthalmology 1996; 103: 2081–2090.
Khng CG, Yap EY, Au-Eong KG, Lim TH, Leong KH . Central serous retinopathy complicating systemic lupus erythematosus: a case series. Clin Exp Ophthalmol 2000; 28: 309–313.
Greaves M, Cohen H, MacHin SJ, Mackie I . Guidelines on the investigation and management of the antiphospholipid syndrome. Br J Haematol 2000; 109: 704–715.
Mackworth-Young CG, Loizou S, Walport MJ . Primary antiphospholipid syndrome: features of patients with raised anticardiolipin antibodies and no other disorder. Ann Rheum Dis 1989; 48: 362–367.
Shi W, Krilis SA, Chong BH, Gordon S, Chesterman CN . Prevalence of lupus anticoagulant and anticardiolipin antibodies in a healthy population. Aust N Z J Med 1990; 20: 231–236.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Costen, M., Parkin, B., Davison, C. et al. Central serous chorioretinopathy and antiphospholipid antibodies—results of a pilot study. Eye 18, 938 (2004). https://doi.org/10.1038/sj.eye.6701348
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.eye.6701348