Central Serous Chorioretinopathy (CSCR)

An idiopathic cause of acute reduction in central vision due to serous detachment of the neurosensory retina at the macula/posterior pole.

Epidemiology

• 3rd to 4th decade most commonly
• Stress
• Hypertension
• Corticosteroid use
• Adrenergic drug use
• Smoking
• Pregnancy
• M>F
• 1/3rd of patients suffer recurrences

Types

• Acute

  • Blurred vision: 6/9 to 6/60
  • Reduced contrast sensitivity and colour vision
  • Metamorphopsia
  • Hyperopic shift
  • Serous detachment of central retina with yellow deposits
  • Serous RPE detachment in some cases
  • 60% resolve spontaneously within 3 months (unless acute persistent CSR)
  • 80% resolve within 6 months and nearly 100% within 1 year
  • After resolution the retina may become stippled with focal pigmentation
  • 40% recurrence rate

• Chronic

  • CSR beyond 3-6 months
  • Distinct features known as ‘diffuse retinal pigment epitheliopathy’ include: pigment clumps, retinal atrophy, fibrosis
  • Risk of CNV

Pathophysiology

• Suspected RPE dysfunction leading to fluid egress into retina
• Increased permeability of the choroid
• Idiopathic
• Secondary
  • Optic disc pit
  • Optic disc coloboma

Tests

• Serial OCT
• FFA/ICG: ink-blot, smoke-stack signs

Management

• Acute CSCR can be observed for 3-6 months for spontaneous resolution
• If earlier visual rehabilitation is needed (eg. work/fellow eye factors): then PDT can be considered
• Focal argon laser carries risk of CNV, scotomata and burn enlargement
• PDT is also used for chronic cases
• Mineralocorticoids (spironolactone, eplenerone): VICI study found eplenerone was not beneficial

Complications

• Pigmentary retinal changes
• Subretinal fibrosis
• CNVM requiring anti-VEGF