Chronic Central Serous Chorioretinopathy; Signs, Diagnosis and Treatment

Chronic Central Serous Chorioretinopathy

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Fluid Accumulation ◽

Fundus Fluorescein Angiography ◽

Blurred Vision ◽

Central serous chorioretinopathy (CSCR) is a maculopathy characterized by the separation of the neurosensory layer as a result of fluid accumulation between the retinal pigment epithelium (RPE) and the photoreceptor layer. Classically it is classified as acute and chronic forms. When the disease lasts longer than 4-6 months, it is called a chronic form and comprises 15% of all CSCR cases. Although the exact etiology is unknown; studies emphasize changes in choroidal circulation causing choroidal ischemia and vascular hyperpermeability as well as subretinal fluid accumulation due to deterioration pump function of RPEs. Subretinal fluid accumulation can lead to photoreceptor dysfunction and loss of vision. Classical findings in patients are a decrease in visual acuity, blurred vision, metamorphopsia, micropsia, disturbance in color vision and dark adaptation, and scotomas. Diagnosis and follow-up depend on fundoscopy as well as imaging. Optical coherent tomography is the primary method. Fundus autofluorescence (FAF) is useful in defining RPE changes noninvasively. Fundus fluorescein angiography (FFA) shows the source of leakage. In recurrent, unresolved and chronic cases, OCT, FAF, FFA, and indocyanine green angiography can be used all together to manage the disease, to follow-up its extension, and to diagnose possible neovascular as well as polypoidal component. For the treatment of chronic CSCR patients, besides medical treatments such as carbonic anhydrase inhibitors, mineralocorticoid receptor, and glucocorticoid antagonists and intravitreal vascular endothelial growth factor antagonist (Anti-VEGF) injections, half-dose photodynamic therapy and subthreshold micropulse laser treatment are used. Prospective, controlled trials with large series for the treatment of chronic CSCR warranted.

Efficacy of oral rifampicin in chronic central serous chorioretinopathy

Therapeutic Advances in Ophthalmology ◽

10.1177/2515841418807130 ◽

2018 ◽

Vol 10 ◽

pp. 251584141880713 ◽

Cited By ~ 2

Author(s):

Ramesh Venkatesh ◽

Manisha Agarwal ◽

Meha Kantha

Keyword(s):

Visual Acuity ◽

Fluorescein Angiography ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Fundus Fluorescein Angiography ◽

Diffuse Retinal Pigment Epitheliopathy

Duration Of Symptoms ◽

Objective: To evaluate the role of oral rifampicin in the management of chronic central serous chorioretinopathy. Methods: Retrospective analysis of patients diagnosed with chronic central serous chorioretinopathy (duration >3 months) and treated with oral rifampicin 600 mg daily for a maximum period of 3 months was carried out. Baseline visual acuity, fundus fluorescein angiography, and optical coherence tomography were recorded and the patients were followed up. Resolution of subretinal fluid and improvement in visual acuity were the main outcome measures. Recurrence of subretinal fluid was noted. Any adverse reaction to the drug was monitored. Results: Nine eyes of eight patients were included in the study. The average age of the patients was 41.90 years (range 32–52 years). Mean duration of symptoms was 16 months (range 3–60 months). Mean duration of follow-up was 10.11 months (range 3–33 months). Fluorescein angiography showed four eyes with subfoveal leaks and five eyes with diffuse retinal pigment epitheliopathy. Complete resolution of subretinal fluid was achieved in four of the nine eyes – two patients at the end of 1 month, one patient each at the end of 2 and 3 months, respectively. Visual acuity improvement was noted in four of the nine eyes. Three patients had one-line improvement and one patient had a two-line visual improvement. None of the patients had severe adverse events for which the drug had to be discontinued. None of the patients had recurrence of subretinal fluid after the discontinuation of the drug. Conclusion: Oral rifampicin could provide a useful, effective, and cost-effective alternative for treatment of patients with chronic central serous choroidopathy and evidence of healthier retinal pigment epithelium, those with focal leakage. It was not effective in eyes with diffuse retinal pigment epitheliopathy.

Central Serous Chorioretinopathy Induced by Work Stress: A Case Report

e-CliniC ◽

10.35790/ecl.v8i2.31107 ◽

2020 ◽

Vol 8 (2) ◽

Author(s):

Ade J. Nursalim ◽

Vera Sumual

Keyword(s):

Risk Factors ◽

Work Stress ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Blurred Vision ◽

Reading Text ◽

Neurosensory Retinal Detachment ◽

The Right

Abstrak: Central serous chorioretinopathy (CSC) adalah terkumpulnya cairan serosa di bawah lapisan epitel pigmen retina yang mengakibatkan terlepasnya retina neurosensorik (detachment). Keadaan ini dapat disebabkan oleh berbagai faktor risiko, termasuk stres psikologik. Jenis kelamin laki-laki merupakan salah satu faktor risiko CSC. Terapi kondisi psikologik merupakan pena-nganan utama CSC yang diinduksi oleh stres kerja. Kami melaporkan seorang laki-laki berusia 27 tahun yang datang ke Poliklinik Mata RSUP Prof. Dr. R. D. Kandou Hospital dengan keluhan kekaburan mata kanan yang mendadak sejak seminggu lalu tanpa didahului oleh nyeri pada mata. Pasien juga mengalami kesulitan dalam membaca teks dan mengenali wajah bila hanya menggunakan mata kanannya. Pasien telah pergi ke optik tetapi tidak mendapatkan ukuran kacamata yang sesuai. Pasien bekerja sebagai tenaga administrasi dan akhir-akhir ini mendapatkan beban kerja berlebihan. Pasien mengakui bahwa ia mengalami kesulitan dalam mengatur aktivitasnya, dan merasakan kelelahan sepanjang hari serta kehilangan minat kerja. Hasil pemeriksaan mata mendapatkan visus 6/15 untuk mata kanan dan visus 6/6 untuk mata kiri, dan metamorphopsia sedangkan hasil pemeriksaan oftalmoskopi memperlihatkan adanya edema dengan lingkaran kekuningan dan berbatas tidak jelas pada mata kanan. Pemeriksaan lanjut dengan OCT menunjukkan adanya cairan subretinal pada mata kanan disertai terlepasnya lapisan epitel pigmen. Saat kontrol setelah 36 hari, visus mata kanan telah membaik 6/6F2 dan peme-riksaan OCT menunjukkan penurunan tebal makula dari 289 μm pada kunjugan pertama men-jadi 190 μm, serta tidak tampak adanya cairan subretinal. Simpulan kasus ini ialah central serous chorioretinopathy yang diinduksi oleh stres kerja, dengan penanganan utama ialah terapi psikologik untuk memperbaiki kualitas hidup.Kata kunci: central serous chorioretinopathy (CSC), stres kerja Abstract: Central serous chorioretinopathy (CSC) is a condition where serous fluid builds up in the retinal pigment epithelium layer which causes neurosensory retinal detachment. This condition is affected by many risk factors, including psychological stress. Male gender is one of the risk factors for CSC. Treatment to the patient's psychological condition can be the main therapy in handling CSC induced by work stress. We reported a 27-year-old male came to the eye clinic at Prof. dr. R. D. Kandou Hospital complaining of sudden blurred vision in his right eye a week ago without initial pain in the eye. The patient also experienced difficulty in reading text and recognizing people’s face using the right eye. The patient went to an optic store but he did not find suitable glasses. The patient works as an administrative employee and is currently getting a heavy workload at his workplace. The patient admitted that he had issues in managing his life in a day. Patients felt tired throughout the day and had no interest in making any activities. The results of the eye examination showed vision 6/15 in the right eye and 6/6 in the left eye, metamorphopsia, edema with a yellowish circle with an unclear border on the right eye using ophthalmoscopy examination, and a subretinal fluid image in the patient's right eye with epithelial detachment pigment acquired through the examination with OCT. After 36 days from the first visit, the right eye vision was improved to 6/6 F2 and OCT examination resulted in a decrease in macula thickness from 289 μm at the first visit to 190 μm, and there was no subretinal fluid. In conclusion, this was a CSC case induced by work stress, and the main treatment was psychological therapy in order to improve the quality of life (QoL).Keywords: central serous chorioretinopathy (CSC), work stress

Long-Term Effect of Half-Fluence Photodynamic Therapy on Fundus Autofluorescence in Acute Central Serous Chorioretinopathy

Journal of Ophthalmology ◽

10.1155/2020/8491712 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Martin Stattin ◽

Stefan Hagen ◽

Daniel Ahmed ◽

Eva Smretschnig ◽

Florian Frommlet ◽

...

Keyword(s):

Photodynamic Therapy ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Long Term Follow Up ◽

Acute Central Serous Chorioretinopathy ◽

Mean Differences

Purpose. To evaluate normalized short-wavelength fundus autofluorescence (SW-FAF) imaging changes over time as a predictive parameter for the retinal pigment epithelium (RPE) function in eyes compromised by acute central serous chorioretinopathy (CSCR) after indocyanine green angiography-guided verteporfin (Visudyne®, Novartis Pharma, Basel, Switzerland) photodynamic therapy (PDT) with a half-fluence rate (25 J/cm2). Methods. Quantitative data of SW-FAF grey values (SW-FAF GV) from a 350 μm (SW-350) and 1200 μm (SW-1200) diameter circle centered on the fovea and normalized with the level of SW-FAF GV in a 30° image of 20 eyes in 11 patients initially treated for unilateral acute symptomatic CSCR were collected and retrospectively analyzed after 7 years. A 2-sided t-test was calculated to explore the differences of SW-350 and SW-1200 between one month and the long-term follow-up. Results. Mean differences (95% CI) in SW-FAF GV between 1 month and 7 years after half-fluence PDT were 0.07 ± 0.11 for SW-350 ([95% CI: −0.002; 0.14], p=0.06) and 0.11 ± 0.15 for SW-1200 ([95% CI: 0.01; 0.21], p=0.03). Mean differences in SW-FAF GV of the contralateral untreated eye were 0.06 ± 0.14 for SW-350 ([95% CI: −0.04; 0.17], p=0.22) and 0.05 ± 0.13 for SW-1200 ([95% CI: −0.04; 0.15], p=0.22). Conclusion. After 7 years, normalized SW-FAF GV were significantly lower in eyes with resolved acute CSCR treated with reduced-fluence PDT compared to the follow-up after 1 month without correlation to explicit pattern changes or structural damages. Half-fluence PDT remains a safe and considerable treatment option in acute CSCR.

Fingolimod-associated central serous chorioretinopathy in a young girl

BMJ Case Reports ◽

10.1136/bcr-2021-243207 ◽

2021 ◽

Vol 14 (8) ◽

pp. e243207

Author(s):

Gajanan Chavhan Pratima ◽

Doris Benita ◽

Sandip Sarkar ◽

Amit Kumar Deb

Keyword(s):

Complete Resolution ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Corrected Visual Acuity ◽

Sphingosine 1 Phosphate ◽

Eye Examination ◽

The Right

Fingolimod is a sphingosine-1-phosphate analogue used for the treatment of multiple sclerosis. We, hereby, report a rare case of fingolimod-associated central serous chorioretinopathy (CSCR) in a 21-year-old woman who presented with blurring of vision in the right eye 3 weeks after initiation of oral fingolimod. On examination, best-corrected visual acuity was 20/20 in both the eyes. Fundus examination revealed shallow, serous macular neurosensory detachment in the right eye, and it was confirmed with spectral domain optical coherence tomography. Left eye fundus was normal. Fluorescein angiography showed focal retinal pigment epithelium leak inferior to the fovea. A diagnosis of fingolimod-associated CSCR was made. Oral fingolimod was discontinued. Subsequent follow-up visits showed partial resolution of CSCR at 2 weeks and at 1 month and complete resolution of the subretinal fluid at 2 months. CSCR is, therefore, a rare adverse effect of oral fingolimod treatment. Baseline eye examination and subsequent follow-up at regular intervals are recommended for patients on fingolimod.

Retinal pigment epithelium aperture in acute central serous chorioretinopathy: Another novel possible pathological mechanism

European Journal of Ophthalmology ◽

10.1177/11206721211002444 ◽

2021 ◽

pp. 112067212110024

Author(s):

Chunyan Lei ◽

Rui Hua ◽

Jianan Duan ◽

Meixia Zhang

Keyword(s):

Retinal Pigment Epithelium ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Near Infrared Reflectance ◽

Pathological Mechanism ◽

Acute Central Serous Chorioretinopathy ◽

Sd Oct

Purpose: To present retinal pigment epithelium (RPE) aperture related to an avascular pigment epithelium detachment (PED) secondary to acute central serous chorioretinopathy (CSC). Methods: Case report. Results: A 47-year-old man diagnosed as acute CSC presented with RPE aperture in the superonasal area of the macula in his left eye during follow-up. At 2-week follow-up, his decimal best-corrected visual acuity (BCVA) was improved from 0.08 to 0.6 and subretinal fluid was partially absorbed. However, the near-infrared reflectance demonstrated a round mild hyperreflective lesion on the superonasal area of the macula. On spectral-domain optical coherence tomography (SD-OCT), RPE band of the round lesion discontinued but RPE fractured edges without shrinkage and curling. Fundus autofluorescence (FAF) showed RPE aperture appeared as round hypoautofluorescence and hyperautofluorescence outlined its borderline. OCT angiography demonstrated that no evidence of neovascularization within the sub-RPE space. En Face OCT confirmed that the RPE aperture developed at the edge of the PED lesion. At 8-month follow-up, his decimal BCVA was improved to 1.0 and SD-OCT demonstrated spontaneous resolution of subretinal fluid and restoration of RPE structure, with complete flattening of PED. However, FAF revealed hypoautofluorescence mingled with slight hyperautofluorescence within the lesion. Conclusions: To the best of our knowledge, this is the first report of an RPE aperture secondary to acute CSC. Our case indicated another novel possible pathological mechanism that in the relatively healthy RPE, increased hydrostatic pressure simply itself could contribute to RPE aperture.

Photodynamic Therapy with Verteporfin for Chronic Central Serous Chorioretinopathy: A Review of Data and Efficacy

Pharmaceuticals ◽

10.3390/ph13110349 ◽

2020 ◽

Vol 13 (11) ◽

pp. 349

Author(s):

Pierluigi Iacono ◽

Stefano Da Pozzo ◽

Monica Varano ◽

Mariacristina Parravano

Keyword(s):

Photodynamic Therapy ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Serous Retinal Detachment ◽

Subretinal Fluid ◽

Long Time ◽

Potential Damage ◽

Retinal Disorder

Central serous chorioretinopathy represents the fourth most frequent retinal disorder, occurring especially in young age. Central serous chorioretinopathy is mainly characterized by macular serous retinal detachment and although the clinical course moves frequently toward a spontaneous resolution, the subretinal fluid may persist for a long time, thus evolving to the chronic form, and leading to a potential damage of the retinal pigment epithelium and to photoreceptors. The photodynamic therapy with verteporfin plays an important role in the armamentarium among the many therapeutic options employed in this complex retinal disorder. In this review, the authors aim to summarize data of efficacy and safety of PDT focusing especially on mechanisms of action of the PDT and providing comparative outcomes with the alternative therapeutic approaches, including especially the subthreshold laser treatment.

Increase in Central Retinal Edema after Subthreshold Diode Micropulse Laser Treatment of Chronic Central Serous Chorioretinopathy

Case Reports in Ophthalmological Medicine ◽

10.1155/2015/813414 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Maciej Gawęcki

Keyword(s):

Fundus Autofluorescence ◽

Subretinal Fluid ◽

Intravitreal Bevacizumab ◽

Thermal Reaction ◽

Retinal Edema ◽

Intravitreal Bevacizumab Injection ◽

Micropulse Laser

Purpose. Subthreshold diode micropulse laser (SDM) treatment is believed to be safe method of treating clinical entities involving retinal edema. We present a case of serous edematous reaction of the retina to SDM treatment.Methods. Case report.Results. A patient with chronic central serous chorioretinopathy (CSCR) was treated with SDM Yellow multispot laser. Procedure had been preceded by careful titration of the laser power, which after achieving of the threshold parameter was decreased by 50%. The follow-up visit two days after treatment revealed significant central retinal edema and subretinal fluid. Fundus autofluorescence image showed thermal reaction from the RPE in the form of small spots of hyperfluorescence corresponding to the laser multispot pattern used for treatment. Retinal edema resolved after topical bromfenac and single intravitreal bevacizumab injection. Slight pigmentary reaction from the RPE persisted.Conclusion. In the treatment of CSCR, there is a need to significantly reduce threshold SDM power parameters or simply use very low power without titration.

The morphology of choroidal neovascularization in chronic central serous chorioretinopathy presenting with flat, irregular pigment epithelium detachment

International Ophthalmology ◽

10.1007/s10792-021-01768-3 ◽

2021 ◽

Author(s):

Claudio Azzolini ◽

Jennifer Cattaneo ◽

Laura Premoli ◽

Cristian Metrangolo ◽

Maurizio Chiaravalli ◽

...

Keyword(s):

Choroidal Neovascularization ◽

Multimodal Imaging ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Morphological Characteristics ◽

Subretinal Fluid ◽

Cross Sectional ◽

Pigment Epithelium Detachment

Abstract Purpose To evaluate morphological characteristics of choroidal neovascularization in chronic central serous chorioretinopathy (CSC) presenting with flat and irregular pigment epithelium detachment (FIPED) by means of innovative multimodal imaging. Methods In this observational cross-sectional study, we examined 10 consecutive patients affected by chronic CSC and FIPED using fluorescein angiography (FA), indocyanine-green angiography (ICGA) and optical coherence tomography angiography (OCTA). A qualitative analysis of the nature and characteristics of neovascular membrane was performed, combining available multimodal imaging and literature data. Results Multiple areas of retinal pigment epithelium alterations, macular hypo- and hyperpigmentation and atrophic areas were identified. Spectral domain OCT (SD-OCT) showed subretinal fluid in 80% of eyes and the ‘double layer sign’ in all patients. Late FA phases showed staining areas without leakage in all eyes; ICGA showed a hyperfluorescent plaque with surrounding hypofluorescence in 80% of patients. OCTA detected characteristic neovascular networks in the outer retina within the FIPEDs, classified as filamentous vessels with a pruned tree-like pattern in five eyes and a tangled pattern in three eyes. The choriocapillaris network showed dark areas in 80% of eyes and diffuse dark spots in all eyes. Conclusion Multimodal imaging completes clinical characterization of FIPEDs in chronic CSC. This study using OCTA technology describes the phenotype of hidden neovascular lesions in shape and morphology.

Bullous central serous chorioretinopathy and retinal pigment epithelium sequelae postblunt trauma

BMJ Case Reports ◽

10.1136/bcr-2020-235882 ◽

2020 ◽

Vol 13 (9) ◽

pp. e235882

Author(s):

Nithin Teja Gunna ◽

Deepika C Parameswarappa ◽

Padmaja Kumari Rani

Keyword(s):

Visual Acuity ◽

Retinal Pigment Epithelium ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Specific Treatment ◽

Subretinal Fluid ◽

Fundus Fluorescein Angiography ◽

Near Vision ◽

The Right

A 68-year-old man presented with diminution of distance and near vision in the right eye for a duration of 1 month postblunt trauma with a stick. On examination, his visual acuity in the right eye was 20/320 and near vision was <N36. Right eye fundus showed bullous neurosensory retinal detachment at posterior pole and retinal pigment epithelium (RPE) atrophic area temporal to fovea. Optical coherence tomography showed subretinal fluid with pigment epithelial detachment and an area of RPE and photoreceptor loss temporal to fovea. Fundus fluorescein angiography and indocyanine green angiography showed focal leaks and transmitted hyperfluorescence corresponding to the area of RPE loss. Left eye examination was unremarkable except for senile cataract of nuclear opalescence grade 3. A diagnosis of right eye bullous central serous chorioretinopathy (CSCR) and RPE sequelae postblunt trauma was made. Our patient was managed conservatively with no specific treatment for CSCR. One month later, there was improvement in vision with decrease in neurosensory detachment. The area of RPE loss remained the same with photoreceptor loss. Since this area of RPE and photoreceptor loss were temporal to fovea, our patient’s visual acuity was not affected significantly.

Implementation of the new multimodal imaging-based classification of central serous chorioretinopathy

European Journal of Ophthalmology ◽

10.1177/11206721211013651 ◽

2021 ◽

pp. 112067212110136

Author(s):

Supriya Arora ◽

Alexei N Kulikov ◽

Dmitrii S Maltsev

Keyword(s):

Multimodal Imaging ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Perfect Agreement ◽

Data Set ◽

Kappa Value ◽

Versus Complex

Purpose: To study the implementation of the new multimodal imaging-based classification system of central serous chorioretinopathy (CSCR). Methods: Ninety-three eyes with CSCR with available fundus autofluorescence (FAF), optical coherence tomography (OCT), and OCT angiography at presentation were included in this study. An anonymous data set was classified by two masked graders. Each case was classified as per presence of (i) simple versus complex (< or >2 disc diameters of retinal pigment epithelium abnormality) CSCR; (ii) primary versus recurrent versus resolved CSCR; (iii) persistent (presence of subretinal fluid >6 months) or not; (iv) outer retinal atrophy (ORA); (v) foveal involvement; and (vi) macular neovascularization (MNV). Agreement between the graders was calculated. Results: Kappa value was 0.91 (95% CI 0.8–1.0) for the entire classification; 0.84 (95% CI 0.73–0.95) for simple versus complex; 1.0 (95% CI 1.0–1.0) for primary versus recurrent versus resolved CSCR; 1.0 (95% CI 1.0–1.0) for persistent or not; 0.9 (95% CI 0.81–0.99) for ORA or not; 0.95 (95% CI 0.84–1.0) for presence or absence of MNV; 1.0 (95% CI 1.0–1.0) for presence or absence of foveal involvement. Conclusion: The new multimodal imaging based CSCR classification showed “near perfect” agreement between two retinal experts.