✍️ sporadic disorder of the outer blood retinal barrier
✍️ localized detachment of sensory retina at the macula secondary to focal RPE defect
✍️ usually affecting only one eye .
✍️ the risk factors of CSCR.
☝️ Type A personality.
☝️ Emotional stress
☝️ Untreated or uncontrollable hypertension
☝️ Alcohol use
☝️ SLE
☝️ Organ transplantation
☝️ GERD
☝️ Cushing’s disease
☝️ steroid abuse
☝️ Pregnancy
✍️ Common among young or middle aged men
☝️ 30 to 50 years of age.
☝️ Men typically outnumber women with a ratio of at least 6:1
☝️older than 50 years the ratio is changed to 2:1.
✍️ CSCR classification
☝️ Typical CSCR
• BCVA 6/60 or better.
• Macular detachment greater than 3 DD
• Pin point ink blot, smoke stack leakage in FFA
• Spontaneous resolution.
☝️ Atypical CSCR.
✍️ Histologically CSCR (Spitnaz classification) has been classified as
☝️ Type 1 (Detachment of sensory retina)
☝️ Type 2 (RPE detachment)
✍️ Type 3 (intermediate type both sensory retina and RPE are elevated).
✅CENTRAL SEROUS CHORIORETINOPATHY (CSCR) clinical picture
✍️ symptoms
☝️ Unilateral blurry vision.
☝️ Micropsia
☝️ metamorphopsia
☝️ Loss of color saturation.
✍️ Signs
☝️ A round or oval detachment of the sensory retina is present at the macula.
☝️ Yellowish subretinal deposits forming a spot pattern.
✍️ the FFA findings in CSCR
☝️ Smoke stack pattern
• least common 10 %
• Early phase with small hyperfluorescent spot due to leakage of dye through RPE.
• Late phase with fluorescein passes into the subretinal space and ascends vertically to the upper border of detachment, and then spreads laterally until the entire area is filled with dye.
☝️ Ink–blot pattern
• common 80%
• Early phase with hyperfluorescent spot.
• Late phase with spot gradually enlarges centrifugally until the area is filled with dye.
✅CENTRAL SEROUS CHORIORETINOPATHY (CSCR) treatment options
✍️ observation
☝️ high rate of spontaneous remission.
☝️ lifestyle counselling
☝️ the avoidance of steroids medication.
✍️ laser photocoagulation ( for extrafoveal lesion)
✍️ PDT ( foveal lesion )
☝️ half-dose PDT for those with severe disease not amenable to argon laser (subfoveal)
✅CENTRAL SEROUS CHORIORETINOPATHY (CSCR) indications of treatment
☝️ Unresolving CSCR of 4 months or more duration.
☝️ If spontaneous recovery does not occur within a month in a patient with or without a history of recurrent CSCR in the same eye
☝️ if the other eye associated with visual loss due to previous episodes of CSCR.
☝️ For patients with occupational needs for binocular vision (pilot, surgeons).
✅ the settings for laser therapy in CENTRAL SEROUS CHORIORETINOPATHY (CSCR)✍️ Two or three ( usually < 10 burns ) moderate intensity burns are applied to the leakage sites to produce mild greying of the RPE.
✍️ Spot size of 200 μ for 0.2 sec and power of 80 MW titrated until the blanching signs are seen in RPE.
✅ DD of CENTRAL SEROUS CHORIORETINOPATHY (CSCR)
☝️ Optic disk pit
☝️ PCV
☝️ uveal effusion syndrome)
☝️ autoimmune disease (SLE, PAN)
☝️ vascular disease
• malignant hypertension
• toxaemia of pregnancy
• disseminated intravascular coagulation (DIC)
• choroidal tumours (including lymphoma).
☝️ CNV
☝️ VKH
☝️ sympathetic ophthalmia
☝️ Posterior scleritis
☝️ RRD
✅CENTRAL SEROUS CHORIORETINOPATHY (CSCR) Prognosis
☝️ 80%, spontaneous recovery to near normal VA (≥6/12) within 1 to 6 months .
☝️ Subtle metamorphopsia may persist.
☝️ Chronic (5%)
☝️ recurrent episodes (in up to 45%) may be associated with more significant visual loss.
☝️ A small risk (<2 %) of CNV is reported.
☝️ Pregnancy associated CSR usually resolves 1 to 2 months post-delivery.