Chronic Central Serous Chorioretinopathy; Signs, Diagnosis and Treatment

Central serous chorioretinopathy (CSCR) is a maculopathy characterized by the separation of the neurosensory layer as a result of fluid accumulation between the retinal pigment epithelium (RPE) and the photoreceptor layer. Classically it is classified as acute and chronic forms. When the disease lasts longer than 4-6 months, it is called a chronic form, and comprises 15% of all CSCR cases. Although the exact etiology is unknown; studies emphasize changes in choroidal circulation causing choroidal ischemia and vascular hyperpermeability as well as subretinal fluid accumulation due to deterioration of pump function of RPEs. Subretinal fluid accumulation can lead to photoreceptor dysfunction and loss of vision. Classical findings in patients are decrease in visual acuity, blurred vision, metamorphopsia, micropsia, disturbance in color vision and dark adaptation, and scotomas. Diagnosis and follow-up depends on fundoscopy as well as imaging. Optical coherence tomography (OCT) is the primary method. Fundus autoflourescense (FAF) is useful in defining RPE changes noninvasively. Fundus flourescein angiography (FFA) shows the source of leakage. In recurrent, unresolved and chronic cases, OCT, FAF, FFA, and indocyanine green angiography can be used all together to manage the disease, to follow-up its extension, and to diagnose possible neovascular as well as polypoidal component. For the treatment of chronic CSCR patients, besides medical treatments such as carbonic anhydrase inhibitors, mineralocorticoid receptor and glucococorticoid antagonists and intravitreal injections of vascular endothelial growth factor antagonists (Anti-VEGF), half-dose photodynamic therapy and subthreshold micropulse laser treatment are used. Prospective, controlled trials with large series are needed for the treatment of chronic CSCR.