Abstract
Central serous chorioretinopathy (CSC) is a common cause of visual impairment in patients generally aged 20 to 60 and it is characterized by acute or chronic neurosensory detachments of the retina. Although CSC resolves spontaneously in most cases, in some patients it may cause permanent visual impairment in the working population; for this reason, several approaches, including photodynamic therapy (PDT), subthreshold micropulse laser treatment and oral mineralocorticoid receptor antagonists, have been studied as first-line treatment options for CSC. To date, half-dose PDT has provided the most encouraging results in this regard, supported by large, multicenter, randomized clinical trials such as the “Prospective Randomized Controlled Treatment Trial for Chronic Central Serous Chorioretinopathy” (PLACE) trial; however, the role of novel possible non-invasive treatment options is attracting interest. This review article aims to discuss the current pharmacological treatment options investigated for the management of CSC, including aspirin, ketoconazole, beta blockers, rifampicin and many others. In particular, further evidence about oral mineralocorticoid receptor antagonists, firstly seen as promising non-invasive alternatives for treating CSC, will be provided and discussed in light of the recent “Eplerenone for chronic central serous chorioretinopathy in patients with active, previously untreated disease for more than 4 months” (VICI) trial results, which have largely resized their role as possible first-line oral treatment options for treating CSC.
Highlights
Central serous chorioretinopathy (CSC) is a common chorioretinal disorder characterized by an idiopathic retinal serous detachment of the retina, associated with one or multiple areas of leakage originating from the choroid through a defect in the retinal pigment epithelium (RPE), the outer blood–retina barrier [1]
Many authors subdivide CSC into two clinical subtypes: the acute form, which typically resolves within 3–4 months without need for being treated, and the chronic form, which is characterized by the presence of persistent serous detachment visible by optical coherence tomography (OCT) for longer than 4–6 months; in some cases, cCSC may lead to permanent structural damage of the RPE and the photoreceptor cell layer, causing irreversible long-term visual impairment [7,8,9]
Central serous chorioretinopathy is a common cause of visual impairment in younger people, typically affecting patients aged 20 to 60 [98]
Summary
Central serous chorioretinopathy (CSC) is a common chorioretinal disorder characterized by an idiopathic retinal serous detachment of the retina, associated with one or multiple areas of leakage originating from the choroid through a defect in the retinal pigment epithelium (RPE), the outer blood–retina barrier [1]. Several treatment options, including photodynamic therapy (PDT) with verteporfin, subthreshold retinal laser treatment, transpupillary thermotherapy (TTT) and pharmacological therapy (in particular, oral mineralocorticoid-receptor antagonists) have been investigated for treating CSC; in this regard, some randomized clinical trials have shown that PDT and subthreshold retinal laser treatment are the most promising treatment options currently available. In this regard, Nicolò et al showed in a multicenter study that the full reabsorption of subretinal fluid (SRF) was achieved in 83.9% and 100% of the eyes treated with half-fluence and half-dose PDT, showing an overall safe and effective profile for this procedure there is growing interest in the role of pharmacological therapy given its more conservative and non-invasive approach [12]. In this review we will discuss the clinical efficacies and safety profiles of the most promising drugs investigated for the management of CSC, and we will analyze the role of PDT, which can be considered a pharmacological treatment option
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