Abstract
Bullous central serous chorioretinopathy (bCSCR) is a rare variant of the central serous chorioretinopathy, complicated by an exudative retinal detachment with shifting fluid. This systematic review aims to present the epidemiology, the pathogenesis, the clinical presentation, the imaging, the differential diagnosis, and the latest treatments of this disease. A total of 60 studies were identified following a literature search adhering to PRISMA guidelines. After full-text evaluation, 34 studies about bCSCR were included. bCSCR usually affects middle-aged men, and the principal risk factor is corticosteroid medications. Pathogenesis is related to an increased choroidal vessel and choriocapillaris permeability, with subsequent subretinal fluid accumulation, rich in fibrin, which may provoke the exudative retinal detachment. Clinical presentation and imaging are fundamental to distinguish bCSCR from other pathologies, avoiding unappropriated treatment. Corticosteroid withdraws (if assumed) and laser photocoagulation of leakage sites seen at angiography may speed up retinal reattachment. Verteporfin photodynamic therapy, transpupillary thermal therapy, oral eplerenone and scleral thinning surgery are other therapeutic options. An early diagnosis might prevent disease progression due to harmful medications as well as unnecessary surgery.
Highlights
Bullous central serous chorioretinopathy is a rare and atypical form of chronic central serous chorioretinopathy (CSCR) [1]
In the vast majority of patients, it occurs since the beginning; about one-third of cases have a previous history of CSCR (7 months to 9 years before) [4]. Bullous central serous chorioretinopathy (bCSCR) can recur in about half of cases if not treated [4]
Various risk factors have been reported in bCSCR pathophysiology: systemic corticosteroid therapy, organ transplantation, haemodialysis, pituitary adenoma and pregnancy [3,5,7,8,9,10,11,12]
Summary
Bullous central serous chorioretinopathy (bCSCR) is a rare and atypical form of chronic central serous chorioretinopathy (CSCR) [1]. It was firstly described by Gass in 1973 [2]. When a PED evolves into retinal pigment epithelium (RPE) tear, an exudative retinal detachment (ERD) may develop, becoming a clinical challenge [3]. BCSCR can be misdiagnosed as a rhegmatogenous retinal detachment (RRD) or an ERD, secondary to other pathologies such as Harada’s disease [1]. BCSCR epidemiology, aetiopathogenesis and optimum treatment are still unclear. This systematic review aims to analyze data available on bCSCR, focusing on the epidemiology, pathogenesis, clinical presentation, imaging, differential diagnosis and currently available treatments
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
