Central Serous Chorioretinopathy: An Update on the Current State of Management

Abstract

Central serous chorioretinopathy (CSCR) is a relatively common retinal disorder that leads to central vision impairment, often with a high recurrence rate. The exact etiology and pathogenetic mechanisms have not been fully elucidated but are likely to be associated with hyperpermeability of the choroidal capillaries and failure of the retinal pigment epithelium (RPE), leading to serous detachment of the neurosensory retina. Multimodal imaging plays a critical role in the diagnostic approach and monitoring of CSCR. Fortunately, the natural course of the disease is usually self-limiting, with spontaneous resolution and total fluid reabsorption. However, some patients may exhibit recurrences or persistent subretinal fluid (chronic CSCR), leading to progressive and irreversible RPE atrophy or photoreceptor damage. Thus, to prevent permanent visual loss, individualized treatment should be considered. Recent developments in the diagnostic and therapeutic approach have contributed to better outcomes in patients with CSCR. More studies are required to improve our understanding of epidemiology, pathogenesis, diagnosis, and treatment, with a significant impact on the management of this challenging clinical entity. The purpose of this review is to summarize the current knowledge about the clinical features, diagnostic workup, and therapeutic approach of CSCR.

Zusammenfassung

Die Chorioretinopathia centralis serosa (CCS) ist eine relativ häufige Netzhauterkrankung, die zu einer Beeinträchtigung des zentralen Sehvermögens führt und häufig eine hohe Rezidivrate aufweist. Die genaue Ätiologie und der pathogenetische Mechanismus sind noch nicht vollständig aufgeklärt, sind aber wahrscheinlich mit einer Hyperpermeabilität der Aderhautkapillaren und einem Versagen des retinalen Pigmentepithels (RPE) verbunden, was zu einer serösen Ablösung der neurosensorischen Netzhaut führt. Die multimodale Bildgebung spielt eine entscheidende Rolle beim diagnostischen Ansatz und der Überwachung von CCS. Glücklicherweise ist der natürliche Krankheitsverlauf i. d. R. selbstlimitierend mit spontaner Auflösung und vollständiger Flüssigkeitsresorption. Einige Patienten können jedoch Rezidive oder anhaltende subretinale Flüssigkeit (chronische CCS) aufweisen, was zu fortschreitender und irreversibler RPE-Atrophie oder Photorezeptorschädigung führt. Um einen dauerhaften Sehverlust zu verhindern, sollte daher eine individuelle Behandlung in Betracht gezogen werden. Jüngste Entwicklungen im diagnostischen und therapeutischen Ansatz haben zu besseren Ergebnissen bei Patienten mit CCS beigetragen. Weitere Studien sind erforderlich, um unser Verständnis von Epidemiologie, Pathogenese, Diagnose und Behandlung zu verbessern, mit erheblichen Auswirkungen auf das Management dieser herausfordernden klinischen Entität. Ziel dieser Übersichtsarbeit ist es, den aktuellen Wissensstand über klinische Merkmale, diagnostische Abklärung und therapeutisches Vorgehen der CCS zusammenzufassen.

Learning points

• CSCR remains an enigmatic clinical entity, largely due to a natural history of spontaneous resolution in a high proportion of individuals.

• Central serous chorioretinopathy is a pathophysiologic model for related diseases.

• Pachychoroid is probably attributed to vortex vein congestion that leads to remodeling of choroidal drainage routes via intervortex vein anastomosis.

• OCT-A and ICGA can provide pivotal information for the underlying pathogenetic mechanisms in the development of CSCR.

• No single treatment has shown overwhelming evidence of efficacy in the RCTs published to date, but PDT and micropulse laser treatment appear the most promising interventions for evaluation in future trials.

Key words

central serous chorioretinopathy - multimodal imaging - photodynamic therapy - anti-VEGF agents

Schlüsselwörter

Chorioretinopathia centralis serosa - multimodale Bildgebung - photodynamische Therapie - Anti-VEGF

Publication History

Received: 23 January 2023

Accepted: 12 March 2023

Article published online:
19 June 2023

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