Chronic central serous chorioretinopathy: long-term follow-up and vision-related quality of life

Abstract

Purpose: To describe the clinical findings and long-term outcome of patients with chronic central serous chorioretinopathy (cCSC).

Materials and methods: This was a retrospective case series in 52 eyes of 36 patients with a follow-up period of at least 1 year. Extensive ophthalmic examination and a validated questionnaire concerning vision-related quality of life (National Eye Institute Visual Function Questionnaire [NEI-VFQ]-39) were analyzed.

Results: Mean visual acuity showed a significant decline over time of 0.16 logarithm of minimum angle of resolution ([logMAR] range: -0.22 to 1.3; P=0.009) after a mean follow-up period of 10.6 years. Also, patients reported lower vision-related quality of life based on the NEI-VFQ-39 for almost all categories compared to healthy controls. Macular atrophy was diagnosed more often on optical coherence tomography compared to other diagnostic entities. Retinal pigment epithelium detachments in the macula were documented on optical coherence tomography in 56% of the patients. A significant thinning of foveal thickness was measured over time compared to unaffected fellow eyes (P=0.002). On long-term follow-up, 13 eyes (37%) showed an increase in number of hot spots on fluorescein angiography.

Conclusion: This study indicates that cCSC is a progressive disease in many patients, causing a progressive decline in visual acuity, accompanied by lower reported vision-related quality of life. In deciding whether or not to treat, the progressive nature of cCSC should be taken into account in this relatively young and often still professionally active patient group.

Keywords: NEI-VFQ-39; PDT; chronic central serous chorioretinopathy; micropulse laser; vision-related quality of life.

Figure 1

Imaging of two chronic central serous chorioretinopathy (cCSC) patients. Notes: Images demonstrate characteristic findings in long-standing cCSC on optical coherence tomography (OCT) and fluorescein angiography (FA). (A–C) Fluctuating subretinal fluid (SRF) accumulation on OCT in the right eye of a patient, and typical subfoveal retinal pigment epithelium detachments. The time between scans A and B was 1 month, in which a clear decrease in SRF occurred, and between scans B and C another 2 weeks elapsed, showing a spontaneous increase in SRF. No therapeutic interventions had been performed between these visits. (D–G) FA and OCT of the right and left eyes of a cCSC patient suffering from bilateral extensive cCSC. On FA, a large area of hyperfluorescence can be seen, indicating advanced disease (D, E). OCT shows not only serous SRF in the right eye but also bilateral central posterior cystoid degeneration, indicative of long-standing disease (F, G). This central posterior cystoid degeneration resolved spontaneously after a period of approximately 6 months (H, I).

Figure 2

Abnormalities on fluorescein angiography (FA), indocyanine green angiography (ICGA), and fundus autofluorescence in chronic central serous chorioretinopathy. Notes: (A, B) The appearance of “new” hot spots, highlighted by two arrows, on FA during 4 years of follow-up. (C, D) The development of a gravitational tract was observed originating from the initial leakage area after 6 years of follow-up. (E, F) Examples of differences seen in the extent of the hyperfluorescence areas between FA (E) and ICGA (F). The area depicted by the arrow shows clear hyperfluorescence on ICGA, but is not evident on the mid-phase FA. (G, H) ICGA (H) shows small punctiform hyperfluorescent areas in addition to diffuse hyperfluorescence. The corresponding FA (G) of the same patient shows an area of hyperfluorescence that is significantly smaller than the area seen on ICGA.