Diagnosed a Patient with Central Serous Chorioretinopathy? Now What?: Management of Central Serous Chorioretinopathy

Abstract

Purpose of review: What is the goal of your paper? What questions did you seek to answer? The goal of this paper is to provide a comprehensive review of the management options for central serous chorioretinopathy (CSCR). Recent findings: Summarize the latest research on your topic The majority of cases of acute CSCR may be managed with observation and cessation of corticosteroids, if possible, as well as life-style modifications including stress reduction and control of hypertension. The management of chronic disease is more challenging and may include either medication or laser-based treatment. Summary: What answers did you find? What are the major takeaways/conclusions of your examination? What’s the impact on future research? Management of CSCR necessitates an individualized and selective treatment approach. There is overall poor evidence for the use of systemic and intravitreal medications. From this class of treatments, mineralocorticoid receptor antagonists appear to have the greatest potential. Although conventional thermal photocoagulation may be used in select cases, the most promising treatment options at this time for chronic CSCR are photodynamic therapy, either half-dose or half-fluence, and non-damaging (subthreshold) retinal laser therapy.

<p>532-nm Subthreshold Micropulse Laser for the Treatment of Chronic Central Serous Retinopathy</p>

“…4,14,19,20 For reference, 12 weeks seems to be enough to test the efficacy of this new wavelength in cCSR; this time frame has been used in other studies to understand the response and to weight other treatment options. 2,4,8,9,14,20 In our study, there were no significant changes in BCVA which seem inferior than the other studies that evaluated micropulse laser for cCSR. Also, our patients did not have a significant change in mean CMT.…”

“…SML has been used as an optional treatment for cCSR. 8,9,13 Advantages over PDT are the availability, less invasive treatment, fewer side effects and economic issues. For example, in our department, SML is always available for treatment whilst PDT requires special approval due to its cost.…”

“…[4][5][6] Other available treatment options include mineralocorticoid antagonist (ie spironolactone and eplerenone), focal laser or anti-vascular endothelial growth factor (VEGF) therapy. [7][8][9] There is overall poor evidence for the use of systemic and intravitreal medications; mineralocorticoid receptor antagonists may have the greatest potential from this class of treatments. Conventional thermal photocoagulation may be used in selected cases.…”

“…Conventional thermal photocoagulation may be used in selected cases. 8 Recently, subthreshold micropulse laser treatment (SML) has been used for cCSR with variable results. 2,7,[10][11][12][13] SML is a laser delivery mode that involves a series of repetitive ultrashort laser pulses that more broadly treat RPE.…”

Maladaptive personality traits, psychological morbidity and coping strategies in chronic central serous chorioretinopathy

“…Using validated measures, we found no evidence for a higher prevalence of maladaptive personality traits such as type A behavioural characteristics in patients with cCSC, nor any clear differences in the generic personality traits as compared to the general population. This finding is of interest, as ophthalmologists often assume and report stress-related and type A behavioural characteristics in patients with cCSC, and therefore, the advice on stress reduction to these patients appears common in their management strategies (Gemenetzi et al 2010;Rouvas et al 2014;Goldhagen & Goldhardt 2017). However, our paper indicates that psychological interventions targeting these personality features in cCSC, as was suggested in previous literature (Yannuzzi 1986;Conrad et al 2014), may not be useful.…”