CENTRAL SEROUS CHORIORETINOPATHY (CSCR)

✍️ usually affecting only one eye .

✍️ the risk factors of CSCR.

☝️ Type A personality.

☝️ Emotional stress

☝️ Untreated or uncontrollable hypertension

☝️ Alcohol use

☝️ SLE

☝️ Organ transplantation

☝️ GERD

☝️ Cushing’s disease

☝️ steroid abuse

☝️ Pregnancy

✍️ Common among young or middle aged men

☝️ 30 to 50 years of age.

☝️ Men typically outnumber women with a ratio of at least 6:1

☝️older than 50 years the ratio is changed to 2:1.

✍️ CSCR classification

☝️ Typical CSCR

• BCVA 6/60 or better.
• Macular detachment greater than 3 DD
• Pin point ink blot, smoke stack leakage in FFA
• Spontaneous resolution.

☝️ Atypical CSCR.

✍️ Histologically CSCR (Spitnaz classification) has been classified as

☝️ Type 1 (Detachment of sensory retina)

☝️ Type 2 (RPE detachment)

✍️ Type 3 (intermediate type both sensory retina and RPE are elevated).

✅CENTRAL SEROUS CHORIORETINOPATHY (CSCR) clinical picture

✍️ symptoms

☝️ Unilateral blurry vision.

☝️ Micropsia

☝️ metamorphopsia

☝️ Loss of color saturation.

✍️ Signs

☝️ A round or oval detachment of the sensory retina is present at the macula.

☝️ Yellowish subretinal deposits forming a spot pattern.

✍️ the FFA findings in CSCR

☝️ Smoke stack pattern

• least common 10 %

• Early phase with small hyperfluorescent spot due to leakage of dye through RPE.

• Late phase with fluorescein passes into the subretinal space and ascends vertically to the upper border of detachment, and then spreads laterally until the entire area is filled with dye.

☝️ Ink–blot pattern

• common 80%

• Early phase with hyperfluorescent spot.

• Late phase with spot gradually enlarges centrifugally until the area is filled with dye.

✅CENTRAL SEROUS CHORIORETINOPATHY (CSCR) treatment options

✍️ observation

☝️ high rate of spontaneous remission.

☝️ lifestyle counselling

☝️ the avoidance of steroids medication.

✍️ laser photocoagulation ( for extrafoveal lesion)

✍️ PDT ( foveal lesion )

☝️ half-dose PDT for those with severe disease not amenable to argon laser (subfoveal)

✅CENTRAL SEROUS CHORIORETINOPATHY (CSCR) indications of treatment

☝️ Unresolving CSCR of 4 months or more duration.

☝️ If spontaneous recovery does not occur within a month in a patient with or without a history of recurrent CSCR in the same eye

☝️ if the other eye associated with visual loss due to previous episodes of CSCR.

☝️ For patients with occupational needs for binocular vision (pilot, surgeons).

✅ the settings for laser therapy in CENTRAL SEROUS CHORIORETINOPATHY (CSCR)✍️ Two or three ( usually < 10 burns ) moderate intensity burns are applied to the leakage sites to produce mild greying of the RPE.

✍️ Spot size of 200 μ for 0.2 sec and power of 80 MW titrated until the blanching signs are seen in RPE.

✅ DD of CENTRAL SEROUS CHORIORETINOPATHY (CSCR)

☝️ Optic disk pit

☝️ PCV

☝️ uveal effusion syndrome)

☝️ autoimmune disease (SLE, PAN)

☝️ vascular disease

• malignant hypertension

• toxaemia of pregnancy

• disseminated intravascular coagulation (DIC)

• choroidal tumours (including lymphoma).

☝️ CNV

☝️ VKH

☝️ sympathetic ophthalmia

☝️ Posterior scleritis

☝️ RRD

✅CENTRAL SEROUS CHORIORETINOPATHY (CSCR) Prognosis

☝️ 80%, spontaneous recovery to near normal VA (≥6/12) within 1 to 6 months .

☝️ Subtle metamorphopsia may persist.

☝️ Chronic (5%)

☝️ recurrent episodes (in up to 45%) may be associated with more significant visual loss.

☝️ A small risk (<2 %) of CNV is reported.

☝️ Pregnancy associated CSR usually resolves 1 to 2 months post-delivery.