ophthalmology residents

1. CENTRAL SERROUS
CHORIORETINOPATHY
Othman Al-Abbadi, M.D

2. INTRODUCTION
•idiopathic disorder characterized by a localized serous
detachment of the sensory retina at the macula secondary to
leakage from the choriocapillaris through one or more
hyperpermeable RPE sites.
• Usually unilateral
• May be associated with pigment epithelial detachment (PED)
• Relative preservation of visual function despite prolonged separation of
neural retina from the retinal pigment epithelium (RPE)

3. EPIDEMIOLOGY
• Age: 25 – 55 years
• Gender: Male > female
• RACE: white caucasians
• Increased incidence in:
• Emotional stress
• Type A personality
• Physical Strains,
• Pregnancy
• People engaged in visually demanding work

4. RISK FACTORS
• Steroid administration
• Cushing syndrome
• H.pylori infection
• Pregnancy
• Psychological stress
• Obstructive Sleep apnoea syndrome

5. SYMPTOMS
• Unilateral
• Blurring of vision
• Metamorphopsia
• Micropsia
• Mild dyschromatopsia
• Maybe asymptomatic

6. SIGNS
• VA is typically 0.3-0.8
• may improve with a weak convex lens
• Acquired hyperopic shift
• Round or oval detachment of the sensory retina at the
macula
• Absent foveal reflex
• Subretinal fluid may be clear or turbid
• One or more depigmented RPE foci (PED) within the
neurosensory detachment

8. • Small patches of RPE atrophy and hyperplasia elsewhere in
the posterior pole may indicate the site of previous lesions
(seen on FAF)
• Chronic lesions may be associated with substantial underlying
atrophic change
• Gravitational tract which is best shown on FAF
• Optic disc should be examined to exclude a congenital pit as
the cause of a neurosensory detachment

9. COURSE
• Spontaneous resolution
• within 3–6 months in around 80%
• Chronic course
• Lasting more than 12 months
• associated with gradual photoreceptor and RPE degeneration and
permanently reduced vision
• Multiple recurrent attacks may also give a similar clinical picture.
• Bullous CSR
• Characterized by large single or multiple serous retinal and RPE
detachments
• Recurrence is seen in up to 50%

10. INVESTIGATIONS
• Amsler grid
• OCT
• FA
• FAF
• ICGA

11. AMSLER GRID
• confirms metamorphopsia corresponding to the neurosensory
detachment
• Better not to give the patient “take-home Amsler grid”

12. OCT
• Optically empty neurosensory elevation
• One or more smaller RPE detachments
• Precipitates on the posterior surface of detached retina
• Thickened choroid

17. FLUORESCEIN ANGIOGRAPHY
• Ink blot
• Early hyperfluorescent spot that gradually enlarges
• Smokestack appearance
• vertical column followed by diffusion throughout the detached area
• An underlying PED may be demonstrated

20. FUNDUS AUTOFLUORESCENCE
• FAF typically shows hypofluorescence at the leakage point
and over the area of neurosensory detachment due to blockage
by subretinal fluid.
• The subretinal yellow dots observed clinically might
demonstrate hyperfluorescence

23. ICGA
• Demonstrates the choroidal vascular abnormalities and can act
as a guide to treatment
• Shows multi focal areas of hyper fluorescence in the early and
midphases of the study, which then fade in the late phase of
the study
• Subclinical foci are commonly visible

26. MANAGEMENT
• Observation
• Corticosteroid
• should be discontinued if possible
• • Laser.
• • PDT
• • Intravitreal anti-VEGF agents.
• • Others. Case reports show benefit with a variety of agents
• including aspirin, beta-blockers, mifepristone and
• eplerenone, but controlled assessment is limited to date

27. OBSERVATION
• Appropriate in many cases
• 80%–90% of eyes with CSCR undergo spontaneous resorption
of subretinal fluid within 3–4 months
• Recovery of visual acuity usually follows but can take up to 1
year

28. LASER
• Micropulse diode laser to the RPE site of leakage has shown
good results in several studies, and is associated with
significantly less retinal damage on OCT than conventional
photocoagulation.

29. PDT
• Photodynamic therapy (PDT) with verteporfin has been shown
to be effective in the treatment of CSC
• BUT the use of conventional dosage of verteporfin (6 mg/m2)
might be associated with complications
• Iatrogenic choroidal neovascularization
• Diffuse retinal epithelial atrophy
• More severe retinal thinning
• 30–50% of the dose used for CNV in conjunction with 50%
light intensity

35. RESOURCES
• Kanski’s clinical ophthalmology, 8th
edition
• American academy of ophthalmology (Retina and Vitreous),
2015-2016 edition
• Duane’s ophthalmology, 2006 edition
• www.Eyewiki.org/central_serrous_chorioretinopathy