Abstract
Central serous chorioretinopathy (CSCR) is an idiopathic maculopathy characterized by thickened choroid, retinal pigment epithelial detachment, and variable subretinal fluid. CSCR predominantly affects young men, with risk factors including corticosteroid use, the type A behavior pattern, and psychological stress. While usually self-limited with a good visual prognosis, recurrent and persistent CSCR can lead to outer retinal and/or retinal pigment epithelial atrophy, choroidal neovascularization, and visual loss. This article reviews current multimodal imaging and treatment options, which include observation, mineralocorticoid receptor antagonists, thermal laser photocoagulation, and off-label photodynamic therapy with verteporfin.
Highlights
Central serous chorioretinopathy (CSCR) is a macular disorder thought to be due to alterations of the choroidal vasculature that overwhelm the ability of the retinal pigment epithelial (RPE) to dehydrate the subretinal space, with consequent accumulation of subretinal fluid. [1,2,3] Thickened choroid, RPE detachments, and variable subretinal fluid are cardinal features of CSCR
Half-dose photodynamic therapy (PDT) has been reported to reduce subretinal fluid compared to argon laser in CSCR; visual acuity outcomes were similar in both groups [40] (Figures 10–12)
Acute CSCR is often self-limiting, so treatment of CSCR is generally not indicated except when symptoms persist for more than about 3 months
Summary
Central serous chorioretinopathy (CSCR) is a macular disorder thought to be due to alterations of the choroidal vasculature that overwhelm the ability of the retinal pigment epithelial (RPE) to dehydrate the subretinal space, with consequent accumulation of subretinal fluid. [1,2,3] Thickened choroid, RPE detachments, and variable subretinal fluid are cardinal features of CSCR. Central serous chorioretinopathy (CSCR) is a macular disorder thought to be due to alterations of the choroidal vasculature that overwhelm the ability of the retinal pigment epithelial (RPE) to dehydrate the subretinal space, with consequent accumulation of subretinal fluid. [1,2,3] Thickened choroid, RPE detachments, and variable subretinal fluid are cardinal features of CSCR. Patients may be asymptomatic or may complain of central scotoma, metamorphopsia, dyschromatopsia, and micropsia [4,5,6]. CSCR generally affects individuals between ages 30 and 50 years, with a predominance for men [7,8,9,10,11]. CSCR is most commonly seen in Asian and Caucasian patients [8]. Other risk factors include corticosteroid exposure, the type A behavior pattern (including a preponderance of a competitive drive, a sense of urgency, an aggressive nature, and a hostile temperament), psychological stress, Helicobacter pylori infection, use of phosphodiesterase 5 inhibitors, exogenous testosterone supplementation, obstructive sleep apnea, pregnancy, and some endocrine disorders [6, 11,12,13,14,15,16,17,18,19]
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