CENTRAL SEROUS

RETINOPATHY

(C.S.R)(C.S.C)

DR.ALI SALEHI

C.S.R

• Idiopathic condition

• Well-circumscribed serous

detachment of sensory

retina

• Resulting from altered

barrier and deficient

pumping functions at the

level of R.P.E

C.S.R

• CSR is a disease in

which a serous

detachment of the

neurosensory retina

occurs over an area of

leakage from

choriocapillaris through

the RPE.

C.S.R

• Preferentially in healthy

men(25-55y)

• Most patients are

asymptomatic unless

the central macula is

affected.

• Common in

Caucasians, Asians and

Hispanics, and rare in

Africans Americans

C.S.R

• CSR 6-10 times more often in

men than women

• Most common in male 20-55y

• More common in type A

personality( competitive drive,

easily irritated).

• More common in stressful

persons

Systemic association with CSR

1. Organ transplantation

2. Steroid administration

3. Systemic hypertension

4. S.L.E

5. Pregnancy

6. Gastro –esophageal

reflux

SYMPTOMS

• Sudden onset of blurred and

dim

vision ,micropsia,metamorp

hopsia,paracentral scotoma

and decreased color vision.

• V/A from 20/20 to20/200

• The decreased vision can

often be corrected with

hyperopic lens.

RISKS FACTORS

• Type A personality

• Hypochondria

• Hysteria

• Neurosis

• Psychiatric medications

• Elevated steroid level

• External using or Cushing syn.

• Stress

• pregnancy

F.A

• An expansible dot of

hyperflourescence is the most

common presentation.

• Dot is leak from the choroids through

the R.P.E and increases in size and

intensity.

• In10-15% of the cases these will

appear in a classic smoke stack

shape.

O.C.T and C.S.R

• O.C.T is an excellent

noninvasive method to use

for diagnosis and following

the resolution of the

subretinal fluid

• Subtle fluid accumulation

beneath the sensory retina

and RPE not evident on F.A

and clinical examination can

often be picked up by O.C.T

POST-TREATMENT

C.S.R

C.S.R

O.C.T

O.C.T

Differential diagnosis

1)CNV in AMD

2)OPTIC NERVE PITS

3)Idiopathic

polypoidal choroidal

vasculopathy

4)Idiopathic uveal

effusion syn.

Factors associated with reduced V/A during long-term F/A

• persistent PED

• persistent subretinal

fluid

• recurrences

• Sub macular CNV

NATURAL COURSE

• The visual prognosis is usually good

except in chronic, recurrent case.

• 80-90% undergo spontaneous resorption

of subretinal fluid within 3 to 4 months.

• Recovery of V/A usually follows but can

take up to 1 year.

• 50% of the patients get the severe and

extensive form of the disease after 12

years of evolution.

• Long term complications C.N.V AND

PIGMENT EPITHELIOPATHY.

NATURAL COURSE

• Mild metamorphopsia,faint

scotoma, abnormalities in

contrast sensitivity and mild

color vision deficit frequently

persist.

• Some eyes suffer permanently

diminished V/A

• A small subset of patients has

poor visual outcomes.

LASER PHOTOCOAGULATIONINDICATIONS

• The serous detachment

persists beyond 3-4 m.

• The disease recur in eyes

with visual deficits from

previous episodes.

• A permanent visual deficit is

present from previous

episodes in the fellow eye.

LASER CONT.

• Chronic signs develop

such as cystic changes

in the neurosensory

retina or widespread

RPE abnormalities.

• Occupational or other

patient needs require

prompt restoration of

vision or steropsis.

C.S.R

• Follow up within 3-4 weeks

due to laser may assist in

detecting CNV due to CSR

that is rare.

• When the leakage site was

too close to the center of

fovea for laser P.

• CSR was resolved by PDT.

Treatment

• Recently found evidence has

also implicated Helicobacter

pylori as playing a role.

• Any ongoing corticosteroid

treatment should be

stopped.

• A new anti-microbial

treatment will likely be

recommended soon in light

of recent findings regarding

Helicobacter pylori.