Central Serous Retinopathy

Central serous retinopathy causes central vision loss secondary to fluid leaking under the center of the macula.

What is a Central Serous Retinopathy?

Moderate central vision loss in men (90% of these cases are men) aged 40 to 60 is sometimes caused by central serous retinopathy. Central serous retinopathy is caused by excessively leaky blood vessels in the choroid which is the layer of blood vessels under the retina. When these vessels become excessively leaky, fluid builds up in the choroid and some of that fluid can break through the barrier of the retinal pigment epithelium. The retinal pigment epithelium is a single layer of cells under that retina that are water tight. The fluid that breaks through the retinal pigment epithelium builds up under the retina forming a blister of fluid under the retina. This fluid blurs the vision in two ways. First, because the retina is elevated away from the retinal pigment epithelium by the fluid, it does not receive nutrients and oxygen as efficiently as it should and it doesn't work well. Second, because the retina is not where it should be, images become out of focus. Some people with central serous retinopathy will notice if they wear reading glasses, they can see better because the reading glasses can sometimes refocus the image on the elevated retina.

Cause of Central Serous Retinopathy

The animated image shows a classic smokestack on fluorescein angiography in a patient with acute central serous retinopathy. The white trace dye, fluorescein, does not leak out of the pigment epithelium under the retina. In patients with central serous retinopathy, there is leakage in the choroid of fluid that builds up and then pushes through the barrier layer under the retina, the retina pigment epithelium. That shows up as a leaky spot on the fluorescein angiogram. Because of the concentration gradient in the subretinal fluid, the fluorescein dye moves up from the leaky spot and forms a smokestack looking white are under the center of the macula.

Central Serous Retinopathy and Fundus Autofluorescence

There are several tests that can be done to establish the diagnosis of central serous retinopathy and to help guide management. Fundus autofluorescence - in the accompanying photograph, show the area of bright autofluorescence from the serous retinal detachment. The photoreceptor outer segments that accumulate in the serous retinal detachment autofluoresce and show up bright in the image. Also optical coherence tomography can show the choroidal thickening and the subretinal fluid. Fluorescein angiography and indocyaning green angiography will show which areas of the choroid are leaking and can help guide treatment.

Who develops Central Serous Retinopathy

Central serous retinopathy is associated with Type A personality. Ninety percent of cases occur in men. It is also sometimes seen in people taking steroids orally or by nasal spray. It can also be associated with pregnancy. Serous retinal detachments like those seen in central serous retinopathy can also seen in patients with severe high blood pressure, age related macular degeneration, and posterior uveitis.

The diagnosis of central serous retinopathy is usually established with optical coherence tomography, fluorescein angiography, and sometimes indocyanine green angiography.

Visual acuity usually returns to normal within about 6 months (sometimes sooner) in 95 percent of affected patients. The recurrence rate is 25 percent. If vision does not recover in a reasonably amount of time, hot laser, photodynamic therapy (cold laser) can be considered.

What is Chronic Central Serous Retinopathy

There are some patient who develop chronic central serous retinopathy. Those patients have subretinal fluid for more than 6 months. Sometimes subretinal fluid will persist for years. In those situations, the chronic subretinal fluid causes damage to the pigment epithelium and the overlying retina. Vision loss gradually develops. When a patient is treated for chronic subretinal fluid, even when the fluid goes away, there is often residual vision loss. Sometimes, with treatment, the vision loss can be stabilized or slowed. The accompanying image shows gutters where the chronic subretinal fluid tracks down due to gravity and causes damage that is visible with testing.

Central Serous Retinopathy Treatment

Very few patients with central serous retinopathy require treatment. 90% of patients improve without therapy. Sometimes, central serous retinopathy becomes chronic and causes vision loss that does not improve. Focal laser treatment to the leaking spot is usually effective in patients with CSR. More commonly, photodynamic laser with visudyne is used to treat CSR. Photodynamic laser is a very low power laser which is used to activate the visudyne. The visudyne is infused intravenously over 10 minutes then a 5 minute washout period is observed. Then 86 seconds of laser (low enegery) is used to activate the the drug and seal up the leaky areas in the choroid. This treatment is usually effective. It is likely safer than focal laser but does sometimes need to be repeated.

Central Serous Retinopathy NEWS

Below are current articles from a Google News Feed on Central Serous Retinopathy

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BLOG: Retina pathology to consider before cataract surgery
Healio (blog)
Other pathologies that can be identified using OCT include central serous retinopathy, macular edema, transparent epimacular membranes, vitreomacular schisis and early wet AMD with subretinal fluid, a small area of choroidal neovascularization and no ...


At EURETINA 2018, Navigated Retina Laser is Moving into the Next Decade
PR Newswire (press release)
Cases cover a range of applications from Proliferative Diabetic Retinopathy to Central Serous Chorioretinopathy - with a special focus on navigated microsecond pulsing treatment results. Meet the expert presentations will be held Friday through Sunday ...

and more »

Dove Medical Press

Clinical characteristics and long-term visual outcome of severe phenotypes of chronic central serous chorioretinopathy
Dove Medical Press
Best-corrected visual acuity (BCVA) was 70 ± 18 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters at onset and 70 ± 22 ETDRS letters at final visit (p = 0.770). Among all studied cases, 173 eyes (87%) were treated, which resulted in ...


Predictors of Outcome During Eplerenone Therapy in Chronic Central Serous Chorioretinopathy:A Prospective, Open ...
Healio
Clinical examination and angiography showed signs of chronic central serous chorioretinopathy with presence of shallow subretinal fluid and chronic cystoid changes on swept-source optical coherence tomography (SS-OCT) in her right eye and shallow ...


Long-term outcomes in half-dose verteporfin photodynamic therapy for chronic central serous retinopathy
Dove Medical Press
Results: The average follow-up period for treatment was 19.3 months. Best-corrected visual acuity increased from logMAR means of 0.52 to 0.42 (p<0.05). Central retinal thickness and choroidal thickness also significantly decreased at last follow-up (p ...


Characteristics of the Choriocapillaris Layer in Optical Coherence Tomography Angiography of Acute Central Serous ...
Healio
Central serous chorioretinopathy (CSC) is a chorioretinal disease. Diffuse or focal dysfunction of the retinal pigment epithelium (RPE) is led by increased permeability from the choriocapillaris, which in turn causes a detachment of the neurosensory ...


Trelegy Ellipta Receives Positive CHMP Opinion Supporting Expanded COPD Indication in Europe
Watertown Public Opinion
... the patient should be considered for referral to an ophthalmologist for evaluation of possible causes which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR) which have been reported after use of ...

and more »

Salt Lake Tribune

Betrayal comes full circle, says a Salt Lake City gang investigator who developed PTSD, then lost his job
Salt Lake Tribune
The cloud blurring the view from Break Merino's damaged left eye swells and recedes with memories: A drug dealer's kid, covered in feces and unable to speak after years imprisoned in a pen. The limp weight of a drowning victim. The daughter of a man ...


Patients respond differently to central serous retinopathy treatment
Healio
WASHINGTON – A multitude of management options exist for central serous retinopathy, and “if the patient doesn't become better in 3 to 4 months, consider another option,” Roya Attar, OD, MBA, said here at Optometry's Meeting. Attar and Mohammed ...


Medscape

Central Serous Retinopathy Requires Individualized Approach
Medscape
WASHINGTON, DC — One treatment clearly does not fit all patients with central serous retinopathy (CSR). Determining which approach to try on which patient, and getting it paid for, is a challenge for eye care practitioners, researchers reported here ...


Golfweek

Jarrod Lyle going through heartbreaking rough patch in cancer fight
Golfweek
Jarrod Lyle has been so brave in his cancer fights, but it appears he's struggling in his current battle. Lyle's wife, Briony, posted a blog update to jarrodlylegolf.com on Tuesday and the news she relayed was tough to swallow. Jarrod is currently ...


Friday's Hawaiian Eye 2018 speakers of the day named
Healio
Berdahl moderated a panel discussion titled “Redeeming the unhappy patient.” Sophie J. Bakri, MD, was awarded Speaker of the Day for Retina 2018. She presented “Update on proliferative vitreoretinopathy” and “What's new in central serous retinopathy.”.


OCT has important role in everyday optometry practice
Healio
I have become a big proponent of OCT in optometry practices. We as optometrists have the responsibility of being on the front lines of eye care, whether it be in a private or commercial setting, such as mine. In this capacity, we must embrace ...


Questions remain about use of 'nondamaging' retinal laser therapies
Healio
In 2008, we published the first experience of a nonvisible subthreshold micropulse infrared diode laser treatment of central serous chorioretinopathy. We came to similar conclusions as Wood and colleagues, and micropulse laser is our current first-line ...


Medical News Today

How a turmeric compound could treat glaucoma
Medical News Today
A common way to treat certain types of glaucoma is using eye drops, which help prevent further loss of vision by regulating eye pressure. Recent research, conducted at University College London and Imperial College London, both in the United Kingdom, ...

and more »

Half-dose verteporfin PDT increases visual acuity, reduces recurrence in central serous chorioretinopathy
Healio
Photodynamic therapy with half-dose verteporfin significantly increased visual acuity in eyes with central serous chorioretinopathy compared with that in untreated controls, according to a study presented here. Furthermore, recurrence was significantly ...


Oral Rifampin for Central Serous Retinopathy: A Strategic Approach in Three Patients
Healio
The authors present three cases of chronic central serous retinopathy in which rifampin was used for the utility of its oral delivery in remote care and as an alternative to photodynamic therapy when intravenous access was not possible. In each of ...


MD Magazine

Safety, Tolerability Increases Post-Bevacizumab Injection in Intraocular Pressure
MD Magazine
The research team looked at 42 patients who received an intravitreal injection of 2.5 mg/0.1 mL bevacizumab to treat central serous chorioretinopathy or diabetic macular edema. Changes in IOP, corneal endothelial cells and corneal thickness were ...


Healio

VIDEO: Role of OCT angiography in central serous chorioretinopathy
Healio
At Retina 2016, Jay S. Duker, MD, discusses the use of OCT angiography in patients with central serous chorioretinopathy. At Retina 2016, Jay S. Duker, MD, discusses the use of OCT angiography in patients with central serous chorioretinopathy.


Medscape

Central Serous Chorioretinopathy: Risk Factors Identified
Medscape
Hypertension, Helicobacter pylori infection, steroid use, sleep disturbances, autoimmune disease, psychopharmacologic medication use, and type A behavior are possible risk factors for central serous chorioretinopathy (CSC), according to a systematic ...


RETINA-AI Releases the First Artificial Intelligence Mobile App for Eye-Care Providers: Fluid Intelligence by RETINA-AI
PR Newswire (press release)
... after cataract surgery, retinal vein occlusion macula edema, central serous chorioretinopathy, uveitic macula edema, and macula-off retinal detachments. Fluid Intelligence by RETINA-AI is therefore an excellent screening tool for any one of these ...

and more »

Challenges of Treating Irregular Astigmatism: Ophthalmology Times
MedPage Today
A recent study discusses how to identify patients at risk for severe chronic central serous chorioretinopathy with epitheliopathy. A new device, worn like glasses, may improve vision in people considered legally blind. This weekly news roundup is ...


Medical News Today

Persistent stress may lead to vision loss, study shows
Medical News Today
As he explains, "There is clear evidence of a psychosomatic component to vision loss, as stress is an important cause — not just a consequence — of progressive vision loss resulting from diseases such as glaucoma, optic neuropathy, diabetic ...

and more »

PDT should be considered for chronic central serous chorioretinopathy
Healio
WAILEA, Hawaii — Retina specialists should consider photodynamic therapy as an adjunctive treatment for chronic central serous chorioretinopathy, according to a study presented here. “PDT has been impressively good,” Rishi P. Singh, MD, said at Retina ...


Choriocapillaris Changes Imaged by OCT Angiography After Half-Dose Photodynamic Therapy for Chronic Central ...
Healio
Chronic central serous chorioretinopathy (CSC) is characterized by widespread alterations in the retinal pigment epithelium (RPE) as a result of persistent or recurrent serous retinal detachment (SRD) involving the macula. In eyes with CSC, the RPE may ...


Vantage

Deepmind's AI works, but making money remains elusive
Vantage
Patients had a range of disorders including central serous retinopathy, diabetic macular oedema and age-related macular degeneration. After a training period using nearly 15,000 scans, Deepmind's software made 55 incorrect referral decisions out of 997 ...


A Central Hyporeflective Subretinal Lucency Correlates With a Region of Focal Leakage on Fluorescein Angiography ...
Healio
Central serous chorioretinopathy (CSC) is characterized by a serous detachment of the neurosensory retina related to underlying choroidal hyperpermeability and vascular congestion. The accumulation of subretinal fluid (SRF) may be observed on both ...


Washington Post

ESPN's Britt McHenry says she feared for her life, had health issues after viral rant
Washington Post
... she started staying up late to read posts about the incident, behavior McHenry described as self-inflicted punishment. McHenry said the vision in her right eye became cloudy and she was diagnosed with Central Serous Retinopathy, which is often ...
ESPN Reporter Britt McHenry Opens Up About the Viral Video That Changed Her LifeComplex
ESPN reporter who was filmed belittling a tow truck employee last year now says the stress of it all has damaged her ...Daily Mail
NJ's Britt McHenry nearly spiraled out of control after angry viral rantNJ.com
MarieClaire.com
all 30 news articles »

Low Fluence Photodynamic Therapy Versus Graded Subthreshold Transpupillary Thermotherapy for Chronic Central ...
Healio
Central serous chorioretinopathy (CSC) is a serous detachment of the neurosensory retina, usually at the posterior pole, which is sometimes also associated with detachment of the retinal pigment epithelium (RPE). It basically occurs due to leakage of ...


The relationship between mitotic rate and depth of invasion in biopsies of malignant melanoma
Dove Medical Press
In patients suffering from idiopathic central serous chorioretinopathy, anxiety scores are higher than in healthy controls, but do not vary according to sex or repeated central serous chorioretinopathy. Nooshin Bazzazi et al., Neuropsychiatric Disease ...

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