Central serous chorioretinopathy – CRSC
Central serous chorioretinopathy (CSCR) is the accumulation of fluid in a pocket beneath the central retina: the macula. This fluid pocket distorts vision. The fluid leakage responsible for the disease originates from a layer of tissue located beneath the retina, called the choroid. Central serous chorioretinopathy usually affects only one eye at a time, but both eyes can be affected simultaneously. It is commonly triggered by stress or the use of corticosteroids. CSCR primarily affects young men in their thirties, but can occur at any age. Most often, the disease resolves spontaneously, without treatment, within 1 to 3 months.
What is the CRSC?
Central serous chorioretinopathy (CSCR) corresponds to the formation of a fluid pocket between the retina and the choroid.
The disease is triggered by taking corticosteroids, stress, and certain toxins.
It mainly affects young men, and evolves spontaneously in a favorable way within 1 to 3 months.
Symptoms of central serous chorioretinopathy
The symptoms of central serous chorioretinopathy are as follows:
Metamorphopsia – Central vision is distorted, diminished, or blurred
Scotoma – Presence of a dark area in the center of vision
Aniseikonia – Objects may appear smaller or farther away than they actually are.
Dyschromatopsia – White hues take on a brownish appearance.
Who is affected?
Men aged 30 to 50 are most likely to develop central serous chorioretinopathy.
Stress and the use of corticosteroids are also major risk factors.
Diagnosis
Your ophthalmologist dilates your pupil using dilating eye drops to examine your retina; this is called a fundus examination.
He will then perform an optical coherence tomography (OCT) scan, an examination that produces very precise images of the macula. It reveals a pocket of fluid under the retina, detaching the pigment epithelium.
Finally, a fluorescein angiography may be performed. During the angiography, a dye is injected into a vein in your arm. The dye spreads throughout the body, including to your eyes.
Your doctor takes pictures of your eye as the dye passes into the blood vessels of the retina.
The dye targets the abnormal areas of your eye responsible for the swelling (leakage point).
Treatment of central serous chorioretinopathy
Surveillance
80 to 90% of CRSC flare-ups disappear in one or two months without treatment.
During this period, your ophthalmologist will examine your eye to see if the fluid is decreasing.
Laser – Photodynamic Therapy (PDT)
Sometimes the fluid does not disappear. In these cases, a laser treatment called photodynamic therapy may be used.
Its action allows the permeability of the choroid to be modified and the leak to be resolved.
Less commonly, intravitreal injections of anti-VEGF can reduce edema in cases of subretinal vessels.
This is objectively measured by OCT or OCT-Angiography.
Anti-mineralocorticoid drugs have long been used in the treatment of chronic CRS.
However, recent meta-analyses have not shown their effectiveness compared to a placebo.
Prediction and development
Most people with central serous chorioretinopathy regain good vision even without treatment. Unfortunately, sometimes visual acuity remains slightly lower than before the flare-up, with a slight scotoma persisting.
About half of patients who have had central serous chorioretinopathy will experience another flare-up in their lifetime. Regular follow-up examinations with your ophthalmologist are important.