Central serous chorioretinopathy

Description

Central serous chorioretinopathy (CSCR) is an eye disease that affects the central part of the retina. It 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 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. If the patient is not referred to a retina specialist the delay of proper treatment might cause irreversible vision impairment.

central serous chorioretinopathy
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 (vasoconstrictors), some of the drugs used by bodybuilders and the drugs used for erectile disfunction can also trigger 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 (selective aldosterone antagonist), soft laser therapy with yellow laser of the retina (micropulse laser), and retinal laser irradiation after intravenous photosensitive drug administration (PDT or photodynamic therapy).

Micropulse laser treatment is the modern treatment of 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 before the treatment and the incorporated eye tracker any unwanted laser shots are avoided. In most cases one treatment will suffice, the effect of which will usually appear after a few weeks.

The tablet treatment is now rarely used, after international studies have shown the advantages of micropulse laser treatment over it. The treatment is used in a course of treatment for at least 3 months, repeated several times if necessary. Before and during therapy, laboratory and general medical examinations are necessary to closely monitor possible side effects.

In rare cases, PDT treatment is considered as an alternative treatment option. During this treatment, a drug is injected into the bloodstream, which is then activated by a laser on the diseased part of the retina. Unfortunately, after the therapy, atrophy of the neuroretina can occur, which causes permanent vision loss. Since the availability of micropulse laser treatment, it is only used in cases of last resort.

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

ophtalmologie moderne
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