Diagnosis and interventions for central serous chorioretinopathy: review and update

Abstract

Most acute cases of central serous chorioretinopathy resolve spontaneously with minimal visual impairment. The small percentage of eyes developing chronic or recurrent disease that do warrant treatment is often difficult to control. Emergent investigations and treatments have added to the established options available to manage these cases. Optical coherence tomography has proved valuable for both imaging subtle fundoscopic findings and monitoring disease progression. Fluorescein angiography aids identification of pigment epithelial leaks and targets the use of argon laser treatment if outside the fovea. Fluorescein angiography also assists differentiation from other choroidal pathologies such as choroidal neovascularization and polypoidal choroidal vasculopathy. Where the diagnosis is uncertain, indocyanine green angiography can demonstrate classic midphase hyperpermeability. This is also useful to guide the application of photodynamic therapy. Newer treatments such as intravitreal anti-vascular endothelial growth factor are as yet unproven.

Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis

“…CSCR can occur at later ages, particularly in women and patients affected by atypical chronic forms (Cohen et al, 1983;Kitzmann et al, 2008;Lafaut et al, 1998;Perkins et al, 2002;Quillen et al, 1996). Noteworthy, CSCR has been rarely reported in children .…”

Micropulse diode laser versus bevacizumab in chronic central serous chorioretinopathy: a pilot study

“…10 Thermal laser phocoagulation is the oldest but it has the disadvantage of causing visible scar which can cause collateral damage and predispose to choroidal neovascularisation. 11 PDT has been found effective in various studies but it also can cause retinal pigment epithelium (RPE) damage, choroidal ischemia and scotoma. 12 Sub threshold micropulse laser has been shown to achieve resolution without any visible damage which is a major advantage apart from simplicity of the procedure and less cost as compared to PDT.…”

Mimics and chameleons of optic neuritis

“…Patients develop a circumscribed retinal detachment at the posterior pole, typically involving the macula. The cause is unknown, but active choroidal leakage on indocyanine green angiography suggests the choroid is the site of the primary pathology 63. It is strongly associated with increased serum levels of glucocorticoids (usually due to the use of systemic corticosteroids) and is also more common during pregnancy, following severe psychosocial stressors, and in people with ‘type A’ personalities.…”

“…It is strongly associated with increased serum levels of glucocorticoids (usually due to the use of systemic corticosteroids) and is also more common during pregnancy, following severe psychosocial stressors, and in people with ‘type A’ personalities. It is much more common in men and has a peak age of onset of 40–45 years, though it can occur in children 63 64…”