Central Serous Chorioretinopathy

SALIENT FEATURES

Central serous chorioretinopathy (CSCR or CSR) is associated with corticosteroid use, elevated levels of endogenous steroids, stress, and “type A” personalities.
Acute cases are generally self-limiting with spontaneous fluid resolution (Figure 28.1).
Chronic CSCR with periodic recurrence of subretinal fluid (SRF) may ultimately lead to complications such as retinal and retinal pigment epithelium (RPE) atrophy and choroidal neovascularization (CNV) (Figures 28.2 and 28.3).
Primary mechanisms of disease include choroidal vasodilation and hyperpermeability, which have been demonstrated on indocyanine green (ICG) angiography.¹,²
Fluorescein angiography may show three patterns of leakage: “expanding dot,” “smoke stack,” and a “diffuse” pattern with multiple leakage points.
Fundus autofluorescence may demonstrate increased autofluorescence in acute CSCR corresponding to areas of SRF. In chronic CSCR, autofluorescence may be decreased due to RPE atrophy.

OCT IMAGING

Characterized by presence of pigment epithelium detachment (PED), serous neurosensory retinal detachment, and choroidal thickening with dilated deep choroidal vessels (“pachy vessels”) (Figures 28.1 and 28.4).

Choroidal abnormalities as previously mentioned may also be seen in the unaffected fellow eye.

FIGURE 28.1 Foveal optical coherence tomography (OCT) of a patient with chronic, recurrent central serous chorioretinopathy (CSCR) with multifocal areas of subretinal fluid (SRF) (yellow arrows). An additional characteristic finding is the presence of a small pigment epithelium detachment (PED) (red arrow). Outer retinal changes (green arrow) are consistent with chronicity.

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