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Disease
- Predominantly men between 30 to 50 years are affected
- Risk factors: strongly associated with steroids (ask about infiltrations or asthma sprays)
Symptoms/Findings
- Symptoms: Worsening of visual acuity, blurred vision, dyschromatopsia, relative scotomas, metamorphopsia
- OCT: Subretinal fluid , one/multiple mostly small, circumscribed serous pigment epithelial detachments
- Fluorescein angiography: Ink blot appearance , smokestack sign, RPE alterations, leakage, granular hyperfluorescences (chronic stage)
Management
- Stop all steroid therapies
- Initial observation (spontaneous resorption in 90% within 1-6 months)
- If subretinal fluid persists for 3-4 months and is visually relevant:
- Fluorescein angiography (+ICG): hyperfluorescent spots/leakage, smokestack sign?
- if leakeage extrafoveal (at least 500um from fovea): consider focal laser treatment
- if leakage central: consider subthreshold laser
- Note: Data regarding laser therapy not clear, Cave: Risk of secondary CNV
- Evaluate half-dose Photodynamic Therapy (PDT)
- Planning based on ICG, FLA, OCT
- Fluorescein angiography (+ICG): hyperfluorescent spots/leakage, smokestack sign?
- Signs of secondary CNV: anti-VEGF indicated
- Eplerenone therapy no longer recommended
Prognosis
- Recurrence in 50%
Sources
- EyeWiki Central Serous Chorioretinopathy
- Central serous chorioretinopathy: Towards an evidence-based treatment guideline; Thomas van Rijssen et al. Progress in Retinal and Eye Research, https://doi.org/10.1016/j.preteyeres.2019.07.003
- Sadda, S.R. Lack of efficacy of eplerenone for treatment of active central serous chorioretinopathy. Eye (2020)
- Stellungnahme BVA, DOG, Retinologische Gesellschaft zu CRCS
- The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition(2016)
- Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)