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

Clinical spectrum of severe chronic central serous chorioretinopathy a | OPTH  Dove Medical Press

Clinical spectrum of severe chronic central serous chorioretinopathy and outcome of photodynamic therapy Danial Mohabati,1,2 Elon HC van Dijk,1 Thomas J ...

BLOG: How do eplerenone and spironolactone treat CSCR?  Healio

Optometry Blogs | Doug Rett, OD, FAAO | In December, Primary Care Optometry News quoted me in an article about central serous chorioretinopathy. The article ...

Half-dose PDT resolves subretinal fluid in chronic central serous chorioretinopathy  Healio

Half-dose photodynamic therapy for the treatment of chronic central serous chorioretinopathy had superior results when compared with high-density ...

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Central serous retinopathy and hand-foot-mouth disease: coincidence or | IMCRJ  Dove Medical Press

Central serous retinopathy and hand-foot-mouth disease: coincidence or causation? Selina Taylor,1 Maureen Khan,2 Shams Zaidi,3 Umair Alvi,4 Yaqoot ...

Predictors of Outcome During Eplerenone Therapy in Chronic Central Serous Chorioretinopathy:A Prospective, Open-Label Pilot Clinical Study  Healio

Ophthalmic Surgery, Lasers and Imaging Retina | BACKGROUND AND OBJECTIVE:To assess the treatment response and predictive factors following ...

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 ...

Clinical characteristics and long-term visual outcome of severe phenot | OPTH  Dove Medical Press

Clinical characteristics and long-term visual outcome of severe phenotypes of chronic central serous chorioretinopathy Danial Mohabati,1,2 Thomas J van ...

Long-term outcomes in half-dose verteporfin photodynamic therapy for c | OPTH  Dove Medical Press

Long-term outcomes in half-dose verteporfin photodynamic therapy for chronic central serous retinopathy Nadeem Ali Dhirani,1 Yelin Yang,2 Sohel Somani2–4 ...

Central Serous Chorioretinopathy: Risk Factors Identified  Medscape

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Characteristics of the Choriocapillaris Layer in Optical Coherence Tomography Angiography of Acute Central Serous Chorioretinopathy  Healio

Ophthalmic Surgery, Lasers and Imaging Retina | BACKGROUND AND OBJECTIVE:To describe the vascular characteristics of the choriocapillaris layer in acute ...

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 ...

Half-dose verteporfin PDT increases visual acuity, reduces recurrence in central serous chorioretinopathy  Healio

COLORADO SPRINGS, Colo. — Photodynamic therapy with half-dose verteporfin significantly increased visual acuity in eyes with central serous ...

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Treating Central Serous Retinopathy: Adjunctive Nutritional Management  Dynamic Chiropractic

Central serous retinopathy (CSR), or central serous chorioretinopathy (CSC), is an eye disease that causes visual impairment. The condition is often temporary, ...

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Proliferative diabetic retinopathy revealed using OCT angiography  Healio

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Elderly man has central vision loss, lipofuscin accumulation  Healio

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1-year results of combined half-dose photodynamic therapy and ranibizumab for polypoidal choroidal vasculopathy  BMC Blogs Network

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Doctor who allowed patient with eye condition to continue driving bus suspended  TODAYonline

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Spotlight on fundus autofluorescence | OPTO  Dove Medical Press

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