Central Serous Chorioretinopathy in Patients With Preexisting Immune-Mediated Disorders: MICRoN Report 21

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PURPOSE: To assess the clinical course and imaging characteristics of central serous chorioretinopathy (CSCR) in patients with immune-mediated diseases and examine differences based on prior corticosteroid exposure. DESIGN: Retrospective multicenter clinical cohort study from the Macula Society CSCR Study Group (MICRoN). PARTICIPANTS: The study included 287 eyes of 267 patients with a diagnosis of CSCR. METHODS: Baseline and follow-up best-recorded visual acuity (BRVA), along with multimodal imaging features including central macular thickness, subfoveal choroidal thickness, neurosensory detachment height, and extent of retinal pigment epithelium (RPE) alteration, were evaluated across groups defined by immune-mediated disease status and corticosteroid exposure. Multivariable regression models were used to assess the impact of the presence of immune-mediated pathologies and other baseline factors on visual outcomes, as well as disease persistence, recurrence, and resolution. MAIN OUTCOMES: Longitudinal changes in BRVA and multimodal imaging parameters across CSCR subgroups stratified by presence of immune-mediated disease and corticosteroid exposure; factors associated with disease persistence, recurrence, and changes in BRVA. RESULTS: The study included 287 eyes of 267 patients (mean age 48.3 ± 10.8 years; 144 males, 123 females) across four groups: immune-mediated disease with steroids (47 eyes), steroids without immune-mediated disease (69 eyes), immune-mediated disease without steroids (62 eyes), and idiopathic CSCR (109 eyes). Steroid-exposed immune-mediated cases had worse baseline BRVA (0.3 ± 0.4 vs 0.2 ± 0.2 logarithm of the minimum angle of resolution, P = .03), greater neurosensory detachment height, larger RPE alteration, and thinner choroidal parameters. On multivariable analysis, absence of immune-mediated disease predicted greater BRVA improvement (β = 0.22, P = .01) and immune-mediated disease predicted recurrence (OR 2.64, P = .02). Larger RPE alteration predicted worse baseline BRVA (β = 0.34, P = .001), older age predicted lower resolution (OR 0.11, P = .03), and multifocal lesions predicted greater logarithm of the minimum angle of resolution change (β = 0.23, P = .007). At follow-up, central macular thickness and subfoveal choroidal thickness decreased across all groups, though visual improvement and resolution rates remained lower in immune-mediated cohorts. CONCLUSIONS: Immune-mediated CSCR shows distinct structure-function profiles, with immune-mediated disease status independently associated with poorer visual outcomes and higher recurrence, while optical coherence tomography-biomarkers predict functional and anatomic change.

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