Abstract
Central serous chorioretinopathy (CSC) is a common cause of central vision loss, primarily affecting men 20-60 years of age. To date, no consensus has been reached regarding the classification of CSC, and a wide variety of interventions have been proposed, reflecting the controversy associated with treating this disease. The recent publication of appropriately powered randomised controlled trials such as the PLACE trial, as well as large retrospective, non-randomised treatment studies regarding the treatment of CSC suggest the feasibility of a more evidence-based approach when considering treatment options. The aim of this review is to provide a comprehensive overview of the current rationale and evidence with respect to the variety of interventions available for treating CSC, including pharmacology, laser treatment, and photodynamic therapy. In addition, we describe the complexity of CSC, the challenges associated with treating CSC, and currently ongoing studies. Many treatment strategies such as photodynamic therapy using verteporfin, oral mineralocorticoid antagonists, and micropulse laser treatment have been reported as being effective. Currently, however, the available evidence suggests that half-dose (or half-fluence) photodynamic therapy should be the treatment of choice in chronic CSC, whereas observation may be the preferred approach in acute CSC. Nevertheless, exceptions can be considered based upon patient-specific characteristics.
Highlights
Central serous chorioretinopathy (CSC) is a chorioretinal disease that causes idiopathic serous detachment of the retina, which is associated with one or more areas of leakage from the choroid through a defect in the retinal pigment epithelium (RPE) outer blood-retina barrier
Mean CMT decreased 160 μm BCVA was 20/200 and improved to 20/40 after treatment Mean BCVA improved from 0.42 LogMAR to 0.31 LogMAR, mean BCVA improved from 0.55 LogMAR to 0.32 LogMAR acute CSC (aCSC), acute central serous chorioretinopathy; BCVA, best-corrected visual acuity; chronic CSC (cCSC); chronic central serous chorioretinopathy; CMT, central macular thickness; CSC, central serous chorioretinopathy; ETDRS, Early Treatment of Diabetic Retinopathy Study; FA, fluorescein angiography; LogMAR, logarithm of the minimal angle of resolution; mineralocorticoid receptors (MR), mineralocorticoid receptor; OCT, optical coherence tomography; SFCT, subfoveal choroidal thickness; SRF, subretinal fluid
When treatment is indicated in aCSC, the current evidence suggests that half-dose or half-fluence photodynamic therapy (PDT) guided by either indocyanine green angiography (ICGA) or FA may be the treatment of choice for accelerating SRF resolution, improving vision, and decreasing the risk of recurrence
Summary
Central serous chorioretinopathy (CSC) is a chorioretinal disease that causes idiopathic serous detachment of the retina, which is associated with one or more areas of leakage from the choroid through a defect in the retinal pigment epithelium (RPE) outer blood-retina barrier. Gass outlined many of the modern ideas of what he called idiopathic CSC (Gass, 1967), proposing that increased permeability of the choriocapillaris causes increased hydrostatic pressure in the choroid This increased hydrostatic pressure in the choroid and hyperpermeability of the choriocapillaris gives rise to pigment epithelial detachments (PEDs) and defects in the RPE monolayer, allowing fluid to leak under the neuroretina. This differs from neovascularisation, in which PEDs occur due to leakage from newly formed vessels. The combination of OCT, FA, ICGA, and OCT angiography can be used to detect subretinal neovascularisation, which may be challenging to conclusively confirm (Borrelli et al, 2018)
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