Central Serous Chorioretinopathy (CSCR)

Central Serous Chorioretinopathy (CSCR)
SYMPTOMS Decrease in central vision, Metamorphopsia, Micropsia
SIGNS Typically unilateral
Loss of a foveal reflex, Large neurosensory detachment that appears as a blister which forms an angle of less than 30 degrees from the RPE layer, Small RPE detachments, Pachychoroid
Chronic/Non-Resolving central serous chorioretinopathy can be associated with Yellow subretinal precipitates, Atrophic tracts (called guttering), Choroidal neovascular membranes, Cystic spaces within the ONL, Photoreceptor loss, RPE disruption with proliferation
WORK-UP Full eye exam with dilated retinal exam, OCT analysis of the macula (signs of central serous chorioretinopathy are best seen with an OCT), OCT-Angiography, Fluorescein Angiography, Indocyanine Green Angiography, Fundus Autofluorescence, Fundus photos, Infrared retinal imaging, Watzke-Allen test, Macular photostress test, Amsler grid
TREATMENT Give take home Amsler grid in order to monitor for change
Patient should Reduce stress, Avoid alcohol and smoking, Discontinue any steroid use if possible, and Control any systemic conditions that are associated with central serous chorioretinopathy
If central serous chorioretinopathy is acute, it can be observed as it will typically self-resolve in 4-6 months (refer to a retinal specialist if there is no improvement seen within 1 month, if subretinal fluid persists even after 4-6 months, if patient is highly symptomatic, if central serous chorioretinopathy is recurrent, or if central serous chorioretinopathy is bilateral)
If central serous chorioretinopathy is chronic or non-resolving, patient should be referred to a retinal specialist
Treatment includes Spironolactone (potassium sparing diuretic), Diamox, Intravitreal anti-VEGF injections, and Half dose PDT
FOLLOW-UP If monitoring central serous chorioretinopathy, the patient should be seen back monthly for the first 6 months until resolved
If macula is stable following treatment by retinal specialist, patient should be seen back in 4-6 months
ADDITIONAL LAB | TESTS None unless if recurrent (Sleep apnea, Hypertension, GERD, Autoimmune disorders, and Kidney disease should be ruled out)
ETIOLOGY Thickened choroid with dilated and hyperpermeable vessels (Pachychoroid) leads to Bruch’s membrane and RPE disruption and microtears as the RPE is not able to overcome fluid overload from the choroid
DIFFERENTIAL DX Diabetic macular edema, Cystoid macular edema, Choroidal neovascular membranes
NOTES Patients with central serous chorioretinopathy often times report a hyperopic shift
Central serous chorioretinopathy typically occurs in males between the ages of 25-50 years old
Central serous chorioretinopathy has 40-50% chance of recurring
Risk factors for central serous chorioretinopathy: Endogenous and exogenous steroid use (strongest risk factor), Type A personality, Sleep apnea, Stress, Hypertension, GERD, Pregnancy, Autoimmune disorders, Tobacco use, Alcohol use, H. Pylori infection, Kidney disease (Membranoproliferative glomerulonephritis type II)
Risk factors for chronic/non-resolving central serous chorioretinopathy: A choroidal thickness > 500 microns, The presence of RPE detachments > 50 microns in height, Patients that are 40 years or older, The presence of photoreceptor loss with yellow subretinal precipitates
Central Serous Chorioretinopathy (CSCR): OCT of the macula demonstrating an acute large neurosensory detachment https://retinagallery.com/displayimage.php?pid=5101