Central Serous Chorioretinopathy - Diagnosis and Management

The presentation discusses central serous chorioretinopathy and its management.

1. Central Serous Chorioretinopathy

2. Definition An idiopathic chorioretinal disorder characterized by serous detachment of the neural retina in the macular region.

3. Key Features One or more focal areas of subretinal fluid in the macula. One or more focal leaks at the level of the retinal pigment epithelium

4. Associated Features Retinal pigment epithelial detachment. Mottling of the retinal pigment epithelium. Yellowish white subretinal deposits. Unilateral or bilateral involvement. Recurrences. Dependent, bullous retinal detachment.

5. Epidemiology 5 – 6 per 100 000 Age: Typically from 20 – 50 years Male : Female is 6 : 1 (2.6 : 1 above 50 years) More common in Asians and Hispanics

6. Risk Factors

7. Pathophysiology

8. Ocular Manifestations Unilateral metamorphopsia ( esp Micropsia ) Blurred vision (6/5 to 6/60: Av 6/9) Micropsia Impaired dark adaptation Color desaturation Delayed retinal recovery time from bright light Relative scotoma

9. Ocular Manifestations Permanent sequelae : rare Metamorphopsia Decreased brightness sensitivity Altered color perception Chronic CSCR In 5% of cases In older individuals receiving corticosteroid therapy Characterized by diffuse retinal pigment epitheliopathy with persistent or intermittent subretinal fluid. Retinal detachments tend to be shallow and more diffuse.

10. Diagnosis

11. Differential Diagnosis CNV Optic Disc Pit Polypoidal Choroidal Vasculopathy Harada’s Disease

12. Treatment Observation – usually resolves within 3 months Discontinue steroids if possible

13. Laser Therapy No effect on final visual outcome Reduces the duration of detachment Typically, 6–12 laser burns of 50–200 μm spot size at 0.1-second duration and 75–200 mW Indications for treatment Professional requirement Only eye Persistent leakage beyond 6 months Recurrent CSCR with decreased VA from previous attack Fellow eye with decreased VA associated with CSCR

14. PDT Half Fluence PDT Half Dose PDT

15. aVEGF ( Bevacizumab ) Inconsistent results So far, however, the cumulative weight of evidence has failed to show sustained, clinically significant benefits Chung Y-R, Seo EJ, Lew HM, Lee KH. Lack of positive effect of intravitreal bevacizumab in central serous chorioretinopathy : Meta-analysis and review. Eye 2013;27:1339-46

16. Medical Therapy Several small studies have shown mixed results from a variety of systemic medications for CSCR, including: Carbonic anhydrase inhibitors (acetazolamide ) A drenergic receptor antagonists ( metoprolol , propranolol ) Steroid hormone antagonists (ketoconazole, mifeprestone , finasteride , eplerenone ) Rifampicin

17. H Pylori treatment Sleep Apnea treatment

18. Course and Outcome Visual prognosis is good 40-50% chances of recurrence