Central serous chorioretinopathy

Description

Central serous chorioretinopathy (CSCR) is an eye disease that affects the central part of the retina and is associated with fluid accumulation between the layers of the retina (pigment epithelium and neurosensory layer), consequently causing blurred vision. The fluid builds up from the blood-rich blood vessels rich layer below the retina called choroid, which function changes for some reason, such as under stress or after steroid treatments. The disease belongs to the group of more comprehensive pachychorioidal diseases, an entity created just a few years ago after noticing the similarities of choroidal changes. The condition sometimes is incorrectly diagnosed as macular edema or macular degeneration and if the patient is not referred to a retina specialist the delay of proper treatment might cause irreversible vision impairment.

OCT image of CSCR with subretinal fluid (black dome in the center)

Symptoms of CSCR

  • most often one eye is affected at the time
  • a dimmed or blurred central vision is typical
  • the central dark area does not change with eye movements
  • the objects may appear smaller and further away than they are
  • the straight lines may appear bent, the seen image may be distorted

Causes and risk factors of CSCR

The exact cause of the disease is unclear, but high levels of stress and steroid treatments have been shown to play a role in the process. In addition, nasal sprays for colds (oxymethazoline), drugs used by bodybuilders (ephedra, amphetamines) and male potency enhancers (silfenafil, tadalafil) can also start the disease. The disease is most common in able-bodied men, but women and the elderly are also affected.

The disease is associated with cardiovascular disease, sleep apnea, Cushing’s disease and reflux with Helicobacter pylori infection, so investigations may be warranted.

Natural history of CSCR

Central serous chorioretinopathy shows a very varied course. It often goes away on its own in 2-3 months if the trigger cause has ceased. However, it is not uncommon for the disease to be present for more than 4 months, even years, during which time the vision gradually deteriorates. The accumulation of fluid under the retina causes the separation of two layers which only function properly if adhered to each other. In the presence of subretinal fluid these retinal cells begin to malfunction quite soon, so the initial blurred vision becomes a more severe visual impairment due to the gradual damage of the cells. The turning point for irreversible visual decrease varies from individual to individual, as the extent of subretinal fluid and the absorption time also varies from a few weeks to several months. Months or years after recovery, the disease may recur or appear in the other eye too.

vitreolyse Gergely Robert vitreolysis

Treatment of CSCR

The most important in the treatment of the disease is to eliminate the subretinal fluid as soon as possible. There are currently three treatment options available, unfortunately none of which are perfect in all cases: tablet therapy (eplerenone), soft laser therapy with yellow laser of the retina (micropulse laser), and retinal laser irradiation after intravenous photosensitive drug administration (PDT or photodynamic therapy with verteporfin).

Prior to eplerenone treatment a general medical examination and laboratory test is required. The treatment is administered as a cure for at least 3 months, repeating it for further months if necessary.

Micropulse laser treatment is the most modern treatment for the disease, in which the lesion is treated with short-acting laser beam sequences. The advantage of the Navilas micropulse laser device I use is that the treatment can be planned in advance based on the retina image recorded immediately before the treatment and that the eye tracker of the device excludes any unwanted laser shots. In most cases one treatment will suffice, the effect of which will usually appear after a few weeks.

PDT treatment is quite effective in many cases, but today we commonly use it as a last resort, as retinal atrophy may occur after treatment, accompanied by permanent visual impairment

The CSCR and its treatment is my main area of research (find out more here), my doctoral meeting is being prepared on this topic.