Central Serous Chorioretinopathy (CSCR or CSR) is a common condition that affects young people between the ages of 20-50. It is more common in males.
Fluid accumulates underneath the retina and if this occurs at the central macular it results in blurred vision. Patients usually present with central distortion or blurred vision in one eye.
In most cases, a cause is never identified. However, stress and use of steroid medications are thought to be associated in certain cases.
Patients will have a dilated examination to diagnose CSCR. In addition extra tests such as an Optical Coherence Tomography (OCT) is performed. This is a scan that confirms the presence of fluid underneath the retina and allows follow up. It gives the thickness of the macular and allows microscopic detail of the retina to be pictured.
A Fluorescein angiography (FA) may also be done. This involves injecting dye into a vein in your hand or arm and taking a series of photographs over 10 minutes to see if there are problems with the retinal vasculature such as leaking. Indocyanine Green (ICG) is another dye test used for diagnosing CSCR and is performed in the same way as a FA test.
In most cases CSCR resolves spontaneously and no treatment is required. Over 90% of patients return to normal or near normal vision within 3-4 months. Occasionally patients continue to have reduced colour vision, night vision or distortion.
A small group of patients have persistent fluid. This can cause chronic visual loss. Treatment in these cases can be considered when there is no spontaneous improvement.
Laser photocoagulation can be considered if there is a small area of leakage identified on either FA or ICG that is away from the central macula. The goal of this treatment is to seal up the leakage point to prevent further leakage of fluid.
Photodynamic therapy (PDT) with Verteporfin is a type of ‘cold’ laser that can be used when the centre of the macular is involved. Again the aim of the treatment is to stop leakage from choroidal vessels.
Other newer treatments that are currently being studied include anti-VEGF agents such as Avastin® or oral medications that block mineralocorticoid receptor such as Spironolactone or Eplerenone.
