Biomarkers for central serous chorioretinopathy

Abstract

Central serous chorioretinopathy (CSCR) is a common chorioretinal disease characterized by serous retinal detachment that most commonly involves the macular region. Although the natural history of the acute form shows a self-limiting course, a significant number of patients suffer from recurrent episodes leading to chronic disease, often leaving patients with residual visual impairment. Visual morbidity is often worsened by a delay in the diagnosis due to the incorrect understanding of the particular biomarkers of the disease. The aim of this review is to provide clinical understanding of the biomarkers of CSCR with an emphasis on the most recent findings in patient demographics, risk factors, clinical imaging findings, and management options. Patients with these biomarkers, age 30-44 years, male gender, increased stress levels, hypercortisolism (endogenous and exogenous exposures), sleep disturbance, pregnancy, and genetic predisposition have increased susceptibility to CSCR. Also, biomarkers on optical coherence tomography (OCT) such as choroidal thickness (CT) and choroidal vascularity index (CVI) showed good diagnostic and prognostic significance in the management of CSCR. There are nonspecific features of CSCR on OCT and OCT angiography such as choroidal neovascularization, photoreceptor alteration/cone density loss, and flat irregular pigment epithelium detachment. We described rare complications of CSCR such as cystoid macular edema (CME) and cystoid macular degeneration (CMD). Patients with CME recovered some vision when treated with anti-vascular endothelial growth factors (anti-VEGFs). Patients with CMD had irreversible macular damage even after treatment with anti-VEGFs.

Keywords: biomarkers; central serous chorioretinopathy; fluorescein angiography; indocyanine green angiography; optical coherence tomography; optical coherence tomography angiography.

Figure 1.

OCT scan showing neurosensory detachment with demarcation of various layers of choroid (right). Large choroidal vessel thickness is marked, together with the Sattler’s and Haller’s layer (left).

Figure 2.

Choroidal vascularity index (CVI) measurements: Montage showing the process of CVI calculation. Top scan shows neurosensory detachment in an eye with central serous chorioretinopathy; middle scan shows choroidal boundaries using automated algorithm; and bottom scan shows the binarized image of the choroid with CVI of 59.6.

Figure 3.

Fundus photos (upper right) of a 53-year-old man who presented with a 4-year history of gradual vision loss. His best-corrected visual acuity was 20/40. He has no history of steroid use and was currently taking spironolactone 50 mg twice daily. Fundus images (upper left) shows retinal pigment epithelium (RPE) alterations in both eyes. Autofluorescence of both eyes (upper left) show hyper- and hypofluorescence (yellow short arrows) in areas with RPE alterations. Fluorescein angiography (upper right) of both eyes shows focal hyperfluorescence with late leakage along with stipple hyperautofluorescent areas (orange arrows). ICGA (lower left) of both eyes show choroidal hyperpermeability (orange arrows). OCT (lower right) shows neurosensory detachment (orange arrows).

Figure 4.

OCT scan showing choroidal neovascular membrane (left) and pigment epithelium detachment (right).

Figure 5.

OCTA scan (upper images and middle lower image) of a patient with choroidal neovascularity (CNV) associated with central serous chorioretinopathy (CSCR). Choriocapillary scan (upper right) shows choroidal neovascular network. Cross-sectional B-scan (lower left) shows choroidal neovascular membrane (red arrow), subretinal fluid (yellow arrow), and flat irregular pigment epithelium detachment (green arrow).