Central Serous Chorioretinopathy: Etiology, Diagnosis, and Treatment.

Abstract

Central serous chorioretinopathy (CSC) is a rare eye disease (estimated prevalence 1.4 per 10 000 people) characterized by a serous fluid collection under the central portion of the retina. Its pathogenesis and optimal treatment remain incompletely understood. In this narrative review, we discuss the risk factors, pathophysiology, diagnostic evaluation, and treatment of CSC. Systemic corticosteroids are considered a well-documented precipitating factor for the disease (odds ratio 4.29, 95% confidence interval [2.01; 9.15]). Potential psychosomatic factors have been inadequately studied. The pathophysiology is likewise incompletely understood; choroidal vascular dysregulation and hyperpermeability appear to be key mechanisms. The resulting fluid collection under the retina can markedly impair photoreceptor function and vision. In 80%-90% of acute cases, the fluid is spontaneously resorbed. Various treatments, ranging from laser therapy to medication-based approaches, have been proposed for patients who do not experience spontaneous remission, but non of them has been found to yield superior functional outcomes in network meta-analyses. Morphologically, in two randomized trials, subretinal fluid regressed in 67% and 78%, respectively, of patients treated with photodynamic therapy, compared to 29% and 17% after micropulse laser treatment or oral eplerenone. CSC is still incompletely understood, and the treatment options for it are a matter of debate. There is an urgent need for further controlled prospective trials with an adequate period of observation and functional endpoints.