Study on antifibrinolytic agents associated with central serous chorioretinopathy

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We performed a clinical study to verify the hypothesis that the central serous chorioretinopathy (CSC) is caused by increased serum level of plasminogen activator inhibitor 1 (PAI1) through the choroidal circulatory disturbance due to vortex Vein thrombosis. Blood sample was collected from 83 patients with acute stage of CSC, in whom fluorescein fundus angiogram and indocyanine green infrared angiogram were obtained. PAI1 level was determined by ELISA. Serum level of PAI1 in the patients with CSC ranged from 11 to 579 ng/ml with the median of 45 ng/ml, which was significantly higher than that in the age-matched normal control ranging from 7 to 84 ng/ml with the median of 36 ng/ml. Serum level of Pal in 40 patients (48%) with CSC was higher than 50 ng/ml that is the upper limit of the normal value.These results indicate that the serum level of PAI1 is elevated in the acute phase of CSC and that the disease may be caused from the procoagulant conditions associated with the elevated serum PAI1 level. We also found that the elevated serum level of PAI1 is maintained for several months to years in some patients, which may be responsible for the high tendency toward the disease recurrence.In combination with the delayed choroidal circulation revealed by the indocyanine green fundus angiegram, the results of the present study may support the hypothesis that CSC results from increased blood coagulation in the choroidal circulation.We also investigated the cross-sectional image obtained by the optical coherent tomography of serous detachment of retinal pigment epithelium frequently seen in eyes with CSC. The dome shaped prominence of the serous RPE detachment was less protrusive than the orange-red nodules observed in eyes with idiopathic polypoidal choroidal vasculopathy.