Central Serous Chorioretinopathy Update

Does treatment really even matter?...

Central Serous Chorioretinopathy (CSCR) presents a unique challenge in our practices, characterized by subretinal fluid accumulation beneath the macula. As the fourth most common retinal condition, it requires careful consideration when we approach management. For acute cases, observation is often acceptable, as many resolve spontaneously. However, treatment may be necessary for persistent or chronic cases.

Photodynamic therapy (PDT), particularly half-dose PDT, has re-emerged as a possible option. Level I and II evidence supports its efficacy in achieving anatomic improvement in acute CSCR, though long-term visual acuity benefits remain less definitive. Subthreshold micropulse laser, offers another approach reducing the risk of scotoma created with conventional laser photocoagulation.

Oral medication & injectables are other options, but with mixed results. Intravitreal anti-VEGF therapy has shown inconsistent outcomes for both acute and chronic CSCR. Systemic treatments, such as eplerenone for chronic cases and Helicobacter pylori eradication in positive patients, have demonstrated some promise but require further investigation.

The management of CSCR continues to evolve, with ongoing research exploring novel imaging modalities like OCT angiography to refine treatment strategies. Our approach must be tailored to each patient by considering the duration of symptoms, severity of fluid accumulation, and potential risks of intervention versus pure observation.

-JRM

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