Non-resolving, recurrent and chronic central serous chorioretinopathy: available treatment options

Abstract

Central serous chorioretinopathy is one of the most frequent causes of vision reduction among middle-aged men. This disease usually has a self-limiting course, but sometimes it lasts more than 4-6 months or a second episode follows a complete resolution of the first one. Nevertheless, to date no consensus exists about the duration threshold and therapy protocols for these non-resolving central serous chorioretinopathy. Treatment as half-dose and half-fluence photodynamic therapy, subthreshold micropulse laser treatment, mineralocorticoid receptor antagonists, intravitreal anti-angiogenic drugs, transpupillary thermal therapy, anti-androgenic drugs, methotrexate, Rifampicin and melatonin are described in this review. Complications are very uncommon but end-point results like central macular thickness reduction and best-corrected visual acuity improvement are difficult to compare among different therapeutic modalities due to different duration of follow-up and lack of homogeneity in patient recruitment. The aim of this review is focusing on treatment modalities for these chronic forms with comprehensive recent management updates according to latest clinical trial results.

Bullous Central Serous Chorioretinopathy: A Rare and Atypical Form of Central Serous Chorioretinopathy. A Systematic Review

“…Mineralocorticoid receptor antagonists may reduce choroidal vasodilation and SRF accumulation, downregulating the vasodilator potassium channel KCa2.3 [ 34 ].…”

“…TTT delivers heats to pigmented cells of RPE and choroid with low power for a prolonged period, sparing the sensory retina [ 34 ]. Kawamura et al treated eight eyes of eight patients with TTT [ 33 ].…”

Current Choroidal Imaging Findings in Central Serous Chorioretinopathy

“…This study supports the initial observation that there is no benefit on choroidal morphology after early laser photocoagulation in acute CSCR. For patients with non-resolving, recurrent and chronic CSCR, available treatments include; half dose photodynamic therapy, subthreshold micropulse laser, MR antagonist and transpupillary thermal therapy [ 50 ].…”

Imbalance in the Levels of Angiogenic Factors in Patients with Acute and Chronic Central Serous Chorioretinopathy

“…For a long time, a simple classification of CSC into acute and chronic forms has been used; however, it was based solely on the duration of serous neurosensory retinal detachment [ 2 ]. Nowadays, as new pathogenic concepts of CSC emerge and modern multimodal imaging becomes available, various new classifications are being developed, but so far, none of them has fully reflected the complexity of this clinical entity [ 3 , 4 ]. Daruich et al classified CSC as acute, non-resolving, recurrent, chronic, or inactive, which more precisely refers to the course of the disease [ 5 ].…”