What exactly is Central Serous Chorioretinopathy (CSC)?
Central serous chorioretinopathy is a condition affecting the macula, the central part of the retina, responsible for sharp, central vision. The onset of the disease is typically sudden, and it occurs more frequently in men than women, especially between the ages of 22 and 50.
The main symptoms include the following:
- Distortion (metamorphopsia) of central vision
- Central scotomas (blind spots in the central visual field)
- Washed-out images or faded color perception
This condition often resolves spontaneously over a period of a few months, but recovery can be accelerated with laser photocoagulation technique.
What are the causes?
The exact cause of CSC is not fully understood. However, high levels of stress are considered one of the primary triggers. The condition is linked to breakdowns in the junctions between cells of the retinal pigment epithelium (RPE).
It often affects individuals with type A personalities, those who are highly active and anxious. The use of corticosteroids can also trigger or worsen the condition, which is why their use should be avoided unless medically necessary. Additionally, CSC may occur during pregnancy, often presenting in a more aggressive form.
How is CSC diagnosed?
A complete ophthalmological examination is essential. This includes:
- Slit-lamp examination
- Dilated fundoscopy to examine the retina and the macula
- Fundus autofluorescence, which highlights chronic changes in the RPE and identifies areas with fluid accumulation
Optical Coherence Tomography (OCT) is critical for identifying and quantifying fluid and macular thickening. A specialized form of OCT, called Enhanced Depth Imaging (EDI-OCT) can visualize the choroidal thickness, which is often increased in CSC patients.
Fluorescein angiography reveals points of leakage, which may be multiple, while Indocyanine Green (ICG) angiography can detect choroidal hyperpermeability and RPE alterations. These findings guide the development of a personalized treatment plan.
Treatment and management
In most cases (approximately 90% of patients), CSC does not require treatment, as it tends to self-resolve within 4-6 months.
Treatment is only considered when the condition:
- Persists beyond a reasonable time frame
- Develops clinical signs that indicate a risk of permanent damage to the macular photoreceptors
The most effective and safe treatment approach is photodynamic therapy (PDT) with cold laser, using the photosensitizing agent Verteporfin (brand name Visudyne). This drug is administered intravenously via an infusion pump, and the laser activates it to target abnormal vessels.
An alternative is low-intensity thermal laser photocoagulation, typically used when leakage points are located away from the central macula. In some cases, acetazolamide may be prescribed to accelerate the absorption of subretinal fluid.
Treatment is always personalized and customized, based on the patient’s specific clinical profile and the stage of the disease.
Thanos Sousouras MD, DO
Ophthalmic Surgeon
Specialized in Retinal Pathology