✍️sporadic disorder of the outer blood retinal barrier
✍️localized detachment of sensory retina at the maculasecondary to focal RPE defect
✍️usually affecting only one eye .
✍️the risk factors of CSCR.
☝️Type A personality.
☝️Untreated or uncontrollable hypertension
✍️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.
• BCVA 6/60 or better.
• Macular detachment greater than 3 DD
• Pin point ink blot, smoke stack leakage in FFA
• Spontaneous resolution.
✍️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
☝️Unilateral blurry vision.
☝️Loss of color saturation.
☝️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.
• 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
☝️high rate of spontaneous remission.
☝️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
☝️uveal effusion syndrome)
☝️autoimmune disease (SLE, PAN)
• malignant hypertension
• toxaemia of pregnancy
• disseminated intravascular coagulation (DIC)
• choroidal tumours (including lymphoma).
✅CENTRAL SEROUS CHORIORETINOPATHY (CSCR)Prognosis
☝️80%, spontaneous recovery to near normal VA (≥6/12) within 1 to 6 months .
☝️Subtle metamorphopsia may persist.
☝️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.