Central Serous Retinopathy

What is central serous retinopathy (CSR) or central serous chorioretinopathy (CSCR)
Central serous retinopathy (CSR) or central serous chorioretinopathy (CSCR) is a condition where fluid can build up under the retinal layers, most commonly affecting the central retina (macula).

This fluid can resolve by itself or remain causing long term changes to the retina and reduced vision (chronic CSCR).

How does it happen?
The choroid is a layer under the retina. CSCR is the condition when fluid leaks between the retina and choroid. The retinal pigment epithelium (RPE) is the layer of the retina next to the chloroid but it does not function as efficiently in CSCR resulting in fluid build up, causing local retinal detachments (serous retinal detachments).

These detachments can slowly resolve by themselves. However in some people, the serous detachments may remain and require treatment.

What are the symptoms of CSCR?
Blurred central vision.
Distortion
Changes in colours or Objects appearing a different size or different distance away.

Why do I get it?
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CSCR is more common in young men ages 30-50. Some studies show that stress or steroid use are risk factors. Other factors that have been considered to be related are: high blood pressure, type A personality, sleep disorders, Helicobacter pylori infection, primary hyperaldosteronism and autoimmune conditions.

How is the diagnosis made?
Dr Morjaria is a retinal specialist who will examine your eyes to help assess the extent of your condition. Dilating drops will be put in both your eyes to allow assessment of the retina so you will not be able to drive after your appointment.
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Other tests that may be required are:
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Optical coherence tomography (OCT) – This looks for damage to the photoreceptors at the back of the eye
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Fluorescein angiogram
You may need additional tests that involve having a yellow dye injected into your hand to take pictures of the blood circulation in your eye.

This will allow Dr Morjaria to assess for areas of the eye that are not getting enough oxygen or areas that need laser treatment to prevent bleeding in your eye.

Treatments
Ophthalmologists throughout the world have tried many treatments for this condition, varying from non-steroidal eye drops to various tablets including eplerenone. Recent trials have found that these treatments did not show a definitive be VICI trial
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Some people have been shown to benefit from gentle laser to the leaking areas on the retina/choroid or injections to the back of the eye. A treatment called photodynamic therapy (PDT) has also been shown to help trial-link, however not everyone is suitable. Dr Morjaria can discuss your scans with you and advise the most suitable treatments and carry these out.

References

Elon H C van Dijk, Sascha Fauser, Myrte B Breukinket al. Half-Dose Photodynamic Therapy versus High-Density Subthreshold Micropulse Laser Treatment in Patients with Chronic Central Serous Chorioretinopathy: The PLACE Trial. Ophthalmology, 2018 Oct;125(10):1547-1555
Prof Andrew Lotery, Prof Sobha Sivaparasad, Abby O’Connell et al. Eplerenone for chronic serous chorioretinopathy in patients with active, previously untreated disease for more than 4 months (VICI): a randomised, double-blind, placebo-controlled trial. The Lancet. Vol 395, issue 10220 . 294-303

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