central serous chorioretinopathy

CENTRAL SEROUS CHOROIDOPATHY

Prepared by Saba Kausar

DEFINITION: Localized serous detachment of the

neurosensory retina in the region of the macula without subretinal blood or lipid exudates

Central serous choroidopathy is a disease that causes fluid to build up under the retina, the back part of the inner eye that sends sight information to the brain. The fluid leaks from the blood vessel layer under the retina. This area is called the choroid.

CAUSES, INCIDENCE, AND RISK FACTORS The cause of this condition is unknown. Incidence: 5-6 per 100,000 people. M:F 6:1 Men are affected more often than women, and

the condition is most common at around age 45, but anyone can be affected.

Stress appears to be a risk factor. Early studies found that people with aggressive, "type A" personalities who are under a lot of stress may be more likely to develop central serous retinopathy.

The condition can also occur as a complication of steroid drug use cushing’s sndrome,systemic lupus erythematosus, pregnancy.

SYMPTOMS Sudden onset of unilateral painlesss vision

associated with positive scotoma. Visual acuity is reduced 6/9 – 6/18 ,often correctable

6/6 with weak ‘plus’ lens due to elevation of the sensory retina gives rise to an acquired hypermetropia.

Distortion of straight lines with the affected eye (metamorphopsia)

Objects appearing smaller or farther away with the affected eye(micropsia)

color desaturation (dyschromatopsia),dec. of contrast sensitivity

impaired dark adaptation delayed retinal recovery time to bright light

SIGNS : Retinoscopy show hypermetropia due to

elevation of retina. Fundus examination shows;• Oval or around elevation of sensory

retina of macular area demarcated by circular ring reflex.

• Foveal reflex is absent or distorted.

INVESTIGATIONS TESTS: Amsler grid test: For confirmation of

metamorphopsia. ICG angiography : has demonstrated both

multifocal choroidal hyperpermeability and hyperfluorescent areas suggestive of focal choroidal vascular compromise.

Optical Coherence Tomography (OCT):optically empty neurosensory elevation. A RPE detachment.

OPTICAL COHERENCE TOMOGRAPHY (OCT):

FA: Ink : A small hyperflourescent spot

increases in size gradually is a most common present.

Smoke: stack pattern a small hyperflourescent

spot ascends vertically like a smokstack and gradually spreads laterally to take mashroom or umbrella configuration

Multiple leak pattern : more than one leak may be present

at the posterior pole.

INK SPOT PATTERN:

SMOKE STACK PATTERN:

MULTIPLE LEAKAGE PATTERN:

TREATMENT Most cases clear up without treatment in 1 or

2 months. Patients with more severe leakage and more severe visual loss, or those in whom the disease lasts longer, may be helped by laser treatment or photodynamic therapy to seal the leak and attempt to restore vision.

Intraviteral anti- VEGF used showing good results.

Patients who are using steroid drugs (for example, to treat autoimmune diseases) should stop using them, if possible. Any change in steroid drug use in these conditions must be under the supervision of a physician

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