Central serous chorioretinopathy: Treatment

Abstract

Central serous chorioretinopathy (CSC) is a pachychoroid spectrum disease characterized by serous detachment of the neurosensory retina with subretinal fluid in young and middle-aged adults. The pathogenesis of CSC is not yet fully understood. However, it is considered a multifactorial disease that is strongly associated with choroidal dysfunction or vascular engorgement. Although there is no consensus on the treatment of CSC, photodynamic therapy has been effectively used to manage serous retinal detachment (SRD) in CSC. Moreover, micropulse diode laser photocoagulation and focal laser treatment have also been used. Recently, oral medications, including mineralocorticoid receptor antagonists, have been proposed for the management of CSC. Multimodal imaging plays a significant role in the diagnosis and treatment of CSC. Optical coherence tomography angiography (OCTA) has the advantage of detecting vascular flow in the retina and choroid layer, allowing for a better understanding of the pathology, severity, prognosis, and chronicity of CSC. In addition, early detection of choroidal neovascularization in CSC is possible using OCTA. This review article aims to provide a comprehensive and updated understanding of CSC, focusing on treatment.

Keywords: Central serous chorioretinopathy; micropulse diode laser photocoagulation; mineralocorticoid receptor antagonist; photodynamic therapy.

Figure 1

Multimodal imaging of a 46-year-old male patient with CSC. (a) The color fundus photograph shows serous retinal detachment. (b) FAF shows granular hypoautofluorescence in the macula. (c) OCT reveals increased subfoveal choroidal thickness, pachyvessels, and SRF. (d) OCTA of the choriocapillaris layer demonstrates choriocapillary hypoperfusion appearing as a dark spot or dark area related to the SRF. (e) FA shows a focal inkblot leakage pattern in the early phase. (f) ICGA shows dilated choroidal vessels with a focal leakage point in the early phase. (g) FA shows a focal inkblot leakage pattern in the late phase. (h) ICGA demonstrates hyperfluorescence corresponding to the leakage point on FA in the late phase. CSC = Central serous chorioretinopathy, OCTA = Optical coherence tomography angiography, SRF = Subretinal fluid, FA = Fluorescein angiography, ICGA = Indocyanine green angiography, OCT = Optical coherence tomography, FAF = Fundus autofluorescence