73 - Central serous chorioretinopathy

Abstract

Since the first description by Albrecht Von Graefe more than 100 years ago, central serous chorioretinopathy (CSC) continues to be a puzzling disease entity with an unknown precise etiology. It is the fourth most common retinal disease in which either subretinal or intraretinal fluid occurs and has a male preponderance. Hypercortisolism has been found to be the most pronounced risk factor for CSC. Choroidal abnormalities have been observed to be underlying in this chorioretinal disease, causing damage to the retinal pigment epithelium and subsequent accumulation of subretinal fluid. Although CSC is self-limiting in a noteworthy percentage of cases, especially in acute CSC, chronic CSC may lead to severe and persistent visual dysfunction. For that reason, a careful approach to timing of treatment is essential to prevent vision loss, minimize recurrences, and reduce complications. Multimodal imaging is the key to establishing the CSC diagnosis. Spectral-domain optical coherence tomography, indocyanine green angiography, and fluorescein angiography are indispensable for diagnosing CSC, planning treatment, and monitoring outcomes. Current evidence suggests that verteporfin photodynamic therapy (PDT) with reduced settings is the gold standard treatment for chronic CSC. In acute CSC, observation is often the preferred treatment, but PDT with reduced settings may be performed in specific circumstances, such as a patient with professional reliance on optimal vision.