what is serous chorioretinopathy treatment

Treatment Strategies for Central Serous Chorioretinopathy

• Laser photocoagulation. Laser photocoagulation is currently not accepted generally as a useful treatment in patients with chronic CSC (including in those patients with extrafoveal leaks).
• Photodynamic therapy with verteporfin. ...
• Subthreshold retinal laser treatment. ...
• Mineralocorticoid antagonism. ...
• Anti-vascular endothelial growth factor agents. ...

Full Answer

What is the treatment for recurrent central serous chorioretinopathy?

The treatment of recurrent central serous chorioretinopathy with intravitreal bevacizumab. J Ocul Pharmacol Ther. 2011;27(6):611–614. [PubMed] [Google Scholar] 106. Torres-Soriano M.E., García-Aguirre G., Kon-Jara V.

What do we know about central serous chorioretinopathy?

Central serous chorioretinopathy is a disease that is partly understood. Novel advancements have led to further understanding of the disease, and have identified choroidal dysfunction as the principal element in CSCR development. New imaging tools have aided in better monitoring disease response to various treatment models.

What type of laser is used to treat central serous chorioretinopathy?

Lanzetta P., Furlan F., Morgante L., Veritti D., Bandello F. Nonvisible subthreshold micropulse diode laser (810 nm) treatment of central serous chorioretinopathy. A pilot study. Eur J Ophthalmol.

How effective is finasteride for the treatment of central serous chorioretinopathy?

Finasteride is effective for the treatment of central serous chorioretinopathy. Eye (Lond) 2016;30:850–6. [PMC free article][PubMed] [Google Scholar]

What causes serous Chorioretinopathy?

Central serous chorioretinopathy is a disease that causes fluid to build up under the retina, the back part of the inner eye that sends sight information to the brain. The fluid leaks from the choroid (the blood vessel layer under the retina). The cause of this condition is unknown but stress can be a risk factor.

Can central serous retinopathy be cured?

For some people, central serous retinopathy can lead to permanent central vision loss if the fluid underneath the macula does not resolve. Some treatments may also cause scarring, which can lead to impaired vision. However, for most people, central serous retinopathy disappears on its own with no medical intervention.

Does CSR go away?

Most people will recover within 4-6 months without any need for treatment. CSR which lasts over 12 months. This is very rare but can lead to further changes such as RPE detachment or bullous retinal detachment.

Is CSR eye serious?

Central serous chorioretinopathy (CSC or CSCR), also known as central serous retinopathy (CSR), is an eye disease that causes visual impairment, often temporary, usually in one eye....Central serous chorioretinopathySpecialtyOphthalmology2 more rows

What is the best treatment for central serous retinopathy?

The most common treatment for central serous retinopathy is called photodynamic therapy. This uses a special laser called a cold laser to treat the fluid build-up under the retina when central serous retinopathy occurs or recurs.

How do you get rid of fluid behind the eye?

Thermal laser treatment can also help seal the tissue that's leaking fluid behind the retina. The risk of scarring or other complications is greater with traditional thermal laser therapy than with photodynamic therapy. Certain medications may also help, though you should consult with your eye doctor first.

How long does Central serous Chorioretinopathy last?

CSR is characterized by avascular focal leakage through the retinal pigment epithelium (RPE), resulting in serous detachment of the neurosensory retina. It is usually selflimiting and in most cases resolves spontaneously within a 3-month period, with visual acuity usually recovering to 20/30 or better.

What is the best treatment for CSR?

In CSR there is ischemic congestion of the choriocapillaris, and therefore a treatment focused at this level is needed. PDT is the best choice to achieve this. Inoue and colleagues7 recently used indocyanine green angiography (ICGA) to investigate which patients with CSR respond best to PDT treatment.

How serious is fluid behind the eye?

Fluid behind the retina can sometimes lead to a retinal detachment, pushing the retina away as it collects. This is known as an exudative retinal detachment. If the detachment is not promptly treated and is extensive enough, this can cause permanent vision loss.

Is CSR caused by stress?

Stress can cause a condition called Central Serous Chorioretinopathy, commonly referred to as the CSC is condition in which fluid accumulates under the retina.

What is the diagnosis of CSCR?

The diagnosis of CSCR can be made clinically but diagnostic tests such as FA and OCT are often performed to rule out other differential diagnoses and guide treatment. Typical fluorescein angiography include the ink blot appearance (31%), smokestack pattern (12%), and minimally enlarging spot (7%).

How old is a CSCR patient?

Most patients who present with CSCR are between the ages of 28 to 68 years with an average age of 43 years. Those who are over 50 years of age are more likely to have bilateral disease (50%) with RPE loss and choroidal neovascularization compared to those less than 50 years of age (28.4%). CSCR tends to affect males (9.9/100,000) about six times more than females (1.7/100,000).3 Similar prevalence of CSCR was noted in Caucasian, African American, and Asian populations. Studies have suggested that there may be a temporal predominance in spring months (March, April, May June) but the results were not statistically significant.

What is PDT for CSCR?

Photodynamic therapy (PDT) with verteporfin, a photosensitizer that accumulates in vessels and helps target therapy, causes endothelial damage and vascular hypoperfusion to inhibit the choroidal hyperpermeability seen in CSCR. Several reports and studies have demonstrated that PDT can be used in chronic CSCR patients to decrease SRF and improve BCVA. Unfavorable side effects, which include choroidal ischemia, RPE atrophy, RPE rip, retinal thinning, and secondary choroidal neovascular membrane (CNVM) have led to the development of safer versions of PDT, which are reduced-dose PDT and reduced-fluence PDT. Bae demonstrated that reduced-fluence PDT was superior to intravitreal ranibizumab in a RCT for improving BCVA and central retinal thickness. Half dose PDT versus half fluence PDT was compared in eyes with chronic CSCR, demonstrating that half dose PDT treatment allowed for faster SRF resolution and decreased recurrence compared to half-fluence PDT. Further studies titrating dosage of verteporfin and laser fluence are needed to more precisely compare safety profiles and efficacy. PDT necessitates the avoidance of physical activity after treatment.

What is CSCR in medical terms?

Disease. Central serous chorioretinopathy ( CSCR) is the fourth most common retinopathy after age-related macular degeneration, diabetic retinopathy and branch retinal vein occlusion. CSCR typically occurs in males in their 20s to 50s who exhibit acute or sub-acute central vision loss or distortion. Other common complaints include micropsia, ...

How long does it take to recover from CSCR?

Acute CSCR is a self-limited condition with resolution of neurosensory retinal detachment and generally good recovery of visual acuity within three months. Of note, recurrences of CSCR have been documented in up to 50% of patients within one year. Fifteen percent of patients may exhibit symptoms and show persistent sub-retinal fluid for greater than 6 months and thus, are diagnosed with chronic CSCR. Limited studies investigating prognostic markers found that outer nuclear layer thickness at the fovea correlates with BCVA in patients with resolved CSCR and that total foveal thickness correlates with BCVA in patients with chronic CSCR with symptoms for 21.8 (7-36) months.

What is CSR in the eye?

CSR causes unilateral vision loss usually in males due to development of sub-retinal fluid, typically between the ages of 20 and 50 years old. However, females with CSCR usually are older than males. The differential diagnosis for sub-retinal fluid is broad and encompass all disease entities that can cause macular neurosensory detachment. These entities include neovascular age related macular degeneration/polypoidal choroidal vasculopathy, myopic choroidal neovascular membrane, choroidal tumor, hypertensive choroidopathy, leukemic choroidal infiltration, choroidopathy due to multiple myeloma, retinal venous occlusion, unilateral acute idiopathic maculopathy, inflammatory conditions like posterior scleritis or Vogt-Koyanagi-Harada disease, optic nerve pit, and rhegmatogenous retinal detachment. Indeed, cases of bullous CSCR (which is usually seen in patients on systemic steroids), where a significant amount of sub-retinal fluid is found, can be mistaken for rhegmatogenous retinal detachments. In both acute and chronic cases that have resolved, the only clue that may be present on examination is macular retinal pigment epithelium (RPE) mottling. By definition, the patient’s retinal detachment cannot be due to another primary process. If suspected, those diagnoses should be ruled out. A thorough history, detailed exam and appropriate imaging and laboratory tests can help delineate between these diagnoses.

What are the mechanisms of action of steroids on the choroid and RPE?

Some mechanisms of action of steroids on the choroid and RPE include potentiation of adrenergic hormones, hypertension, and altered ion transport in RPE cells. Glucocorticoids regulate the expression of adrenergic hormones and receptors, and therefore, said hormones may contribute to the pathophysiology of CSCR.

Home Remedies and Lifestyle

Most cases of central serous retinopathy do not require treatment as the fluid build-up under the retina (the light-sensitive tissue in the back of the eye) often goes away on its own after a couple of months. 1

Over-the-Counter Therapies

There are no over-the-counter therapies for central serous retinopathy. Eye doctors will use laser or laser-assisted treatments, medications, and monitoring. The majority of people with central serous retinopathy achieve good vision again even without any treatment. 1

Prescriptions

Although laser and laser-assisted treatments are more commonly used for central serous retinopathy, eye doctors sometimes will use prescription medications. Your eye doctor may be more likely to consider treatments if your central serous retinopathy does not resolve after more than two months. 1

Surgeries and Specialist-Driven Procedures

The most common treatment for central serous retinopathy is called photodynamic therapy. This uses a special laser called a cold laser to treat the fluid build-up under the retina when central serous retinopathy occurs or recurs.

Summary

Central serous retinopathy usually goes away on its own after a couple of months. For this reason, doctors will not always treat it. When it does require treatment, photodynamic therapy is the most common treatment used.

A Word From Verywell

Keep track of your symptoms if you know you have central serous retinopathy. Let your eye doctor know of any symptom changes. If your central serous retinopathy gets better but then occurs again, let your doctor know so you can work together to find the best treatment for you.

What is the purpose of corticosteroids?

Corticosteroids are found in allergy nose sprays and anti-inflammatory skin creams available over the counter, and are often prescribed to treat a variety of medical conditions. An association has also been made between CSC and patients with emotional distress and/or “type A” personalities.

Can CSC show symptoms?

Depending on the location and amount of sub-retinal fluid, CSC can show no symptoms, especially if the affected areas fall outside of the macula —the part of the retina used to distinguish fine detail for activities like reading and recognizing faces.

General Information

Causes

Pathogenesis

Symptoms

Diagnostics

Treatment

• Conservative therapy
  Conservative treatment of central serous chorioretinopathy is reduced to dehydration and vasoconstrictive therapy. In order to reduce the swelling of the inner shell of the eye, parabulbar injections of glucocorticosteroids are indicated. Also, this group of drugs has an anti-allergic eff…
• Surgical treatment
  In the absence of the effect of drug treatment or frequent relapses of the disease, laser coagulation of the retina is indicated. Focal coagulation is carried out in the area of the lesion of the pigment epithelium. If the defect is located in the area of the papillomacular bundle or at a di…

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