CENTRAL SEROUS RETINOPATHY (CSR)

Central serous retinopathy (CSR) is characterised by
spontaneous serous detachment of neurosensory
retina in the macular region, with or without retinal
pigment epithelium detachment. Presently it is termed
as idiopathic central serous choroidopathy (ICSC).
Etispathogenesis
It is not known exactly. The condition typically affects
males between 20 and 40 years of age. It is now
believed that an increase in choroidal
hyperpermeability causes a breach in the outer blood
retinal barrier (a small opening or blow out of RPE).
Leakage of fluid across this area results in
development of localized serous detachment of
neurosensory retina. What triggers the choroidal
hyperpermeability is poorly understood. It is being
suggested that an imbalance between the sympathetic
parasympathetic drive that maintains autoregulation
within the choroidal vasculature may be defective in
patients with CSR. Factors reported to induce or
aggravate CSR include: emotional stress,
hypertension, and administration of systemic steroids.
Clinical features
Symptoms. Patient presents with a sudden onset of
painless loss of vision (6/9-6/24) associated with
relative positive scotoma, micropsia and
metamorphopsia.
Ophthalmoscopic examination reveals, mild
elevation of macular area, demarcated by a circular
ring-reflex. Foveal reflex is absent or distorted
(Fig. 11.22).
CSR is usually self-limiting but often recurrent.
Resolution may take three weeks to one year
and often leaves behind small areas of atrophy
and pigmentary disturbances.
Fundus fluorescein angiography helps in confirming
the diagnosis. Two patterns are seen:
Ink-blot pattern. It consists of small hyperfluorescent
spot which gradually increases in size
(Fig. 11.23A).
Smoke-stack pattern. It consists of a small
hyperfluorescent spot which ascends vertically
like a smoke-stack and gradually spreads laterally
to take a mushroom or umbrella configuration
(Fig. 11.23B).
Treatment
1. Reassurance is the only treatment required in
majority of the cases, since CSR undergoes
spontaneous resolution in 80 to 90 percent cases.
Visual acuity returns to normal or near normal
within 4 to 12 weeks.
2. Laser photocoagulation is indicated in following
cases:
Long-standing cases (more than 4 months)
with marked loss of vision.
Patients having recurrent CSR with visual loss.
Patients having permanent loss of vision in
the other eye due to this condition