Chronic Central Serous Chorioretinopathy

Central serous chorioretinopathy (CSC) is a retinal disease that is often not serious but worrisome for those affected, who tend to be anxious and easy to stress. It mainly affects men between the ages of 30 and 50 and, in women, is often associated with cortisone therapy or conditions that increase blood cortisol. Cortisone can worsen or promote recurrence of CSC.

CSC is characterized by an accumulation of fluid under the macula, with no other associated chorioretinal disease. The fluid comes from congested vessels in the choroid and passes under the retina through lesions of the retinal pigment epithelium. Symptoms include blurred vision, central blurring, and image distortion. The disease can resolve spontaneously in 2-4 months with complete visual recovery, although it tends to recur in 45-50% of cases.

It can become chronic (chronic central serous chorioretinopathy) due to areas of persistent decompensation of the pigmented epithelium.

Systemic hypertension is a factor that promotes chronicity. In chronic cases of CSC, pigment epithelium atrophy, cystoid macular degeneration, lipid exudates, subretinal fibrosis and choroidal neovascularization, multiple pigment epithelium detachments, and gravitational epitheliopathy can be observed.

These changes can cause severe and irreversible damage to central vision. Patients with multiple recurrences, persistent detachments, and extensive retinal pigment epithelium involvement are at higher risk for severe visual impairment.

The use of various imaging techniques is important in diagnosing CSCR.State-of-the-art instruments allow adequate deep scans to investigate the choroid (Enhanced Deph Imaging, Swept-source OCT).

In long-standing cases observed in the elderly and complicated by neovascularization, the detection of choroidal thickening may aid the differential diagnosis with age-related macular degeneration of the neovascular type.

Fig. 1: Retinography

Fig. 2: Autofluorescence

Fig. 3: Fluoroangiography

Fig. 4: OCT Right Eye

Fig. 5: OCT Left Eye

Therapy of Chronic Central Serous Chorioretinopathy

Classical treatment consisted of direct photocoagulation of the leaky spots, and photodynamic therapy. Neovascular forms should be treated with Anti Vegf. Currently the treatment of choice is Micropulsed Yellow Laser.

Source: https://albertobellone.it/la-corioretinopatia-sierosa-centrale-cronica/
Thanks to Dr. Alberto Bellone for the article.