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Central Serous Chorioretinopathy

What is Central Serous Chorioretinopathy?

Central serous chorioretinopathy (CSCR) is a condition that causes fluid to build up underneath the center of the retina (macula). Fluid leaks from a layer of blood vessels that run beneath the retina called the choroid. CSCR is more common in men, primarily between the ages of 25 to 50 years.

Most patients notice a central gray or blind spot in their vision. Objects often appear distorted and miniaturized, sometimes appearing farther away in the involved eye. Colors can appear washed out. Rarely is vision severely affected and most cases affect only one eye, but it can involve both eyes.

What causes CSCR?

The exact cause of CSCR remains unknown. However, corticosteroid use in any form (oral, topical, inhaled, or injected) and "Type A" personailty traits have been associated with CSCR. Those with a history of CSCR should avoid steroid medications if possible. Other associations include pregnancy, Cushing syndrome (an endocrine disorder with elevated cortisol levels), high blood pressure, organ transplantation, and lupus.

What is the follow-up and treatment?

In most cases, the fluid under the retina resolves spontaneously over several months and the final visual outcome is usually good, though not always perfect due to damage to the retinal tissue. Given the favorable natural history of this condition, patients are usually followed initially without treatment. However, it is important to realize that CSCR is often a chronic disease. It may recur in 20-30% of patients and some degree of permanent visual loss is more likely in recurrent or prolonged cases.

Treatment may be recommended to promote resolution of the subretinal fluid if it has not reabsorbed after a few months. It may also be advised for recurrence in an eye with visual loss from a previous episode or if there is a need for prompt visual restoration such as for occupational reasons. Treatment options include thermal laser ("hot" laser), photodynamic therapy ("cool" laser), and an intraocular injection of Avastin. If treatment is advised, your retina specialist will review the risks, benefits, and alternatives of the treatment options with you and make tailored recommendations based on the unique findings of your eye.

Finally, we are currently conducting a clinical trial, approved by Wills Eye Hospital, to evaluate the efficacy of an oral medication (eplerenone) for patients who have either acute or chronic CSCR. If interested, please contact our research department for more information.