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
• 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)