Current Treatments in Central Serous Chorioretinopathy

Assoc. Prof. Dr. Yelda Yıldız Taşcı

Ankara Yıldırım Beyazıt University, Department of Ophthalmology
Ankara Bilkent City Hospital, Ophthalmology Clinic, Ankara, Türkiye

ABSTRACT

Central serous chorioretinopathy (CSC) is a chorioretinal disease characterized by serous sensory retinal detachment, typically in the macula, accompanied by choroidal thickening, hyperpermeability of the retinal pigment epithelium, increased venous load, and sometimes retinal pigment epithelium detachment (PED). The classification of subretinal fluid (SRF) according to dissolution status is most commonly accepted based as acute, chronic, recurrent, or multifocal. Acute CSC represents cases that last 4-6 months and resolve spon- taneously, while chronic CSC (cCSC) persists beyond 4-6 months and affects 5-15% of patients. Recurrent CSC falls between acute and chronic forms, with most patients eventually developing cCSC, while others maintain an acute clinical presentation. Treatment methods in CSC can be listed as focal laser, photodynamic therapy, subthreshold micropulse laser, mineralocorticoid receptor anthogonists, systemic treatments, and intravitreal anti-vascular endothelial growth factor.

Keywords: Central serous chorioretinopathy; Photochemotherapy; Laser therapy

Referanslar

  1. Von Graefe A (1866) Ueber Centrale Recidiverende ret- initis. Graefes Arch Clin Exp Ophthalmol 12:211-215. [Link]
  2. van Rijssen TJ, van Dijk EHC, Yzer S, Ohno-Matsui K, Keunen JEE, Schlingemann RO, et al. Central serous cho- rioretinopathy: Towards an evidence-based treatment guide- line. Prog Retin Eye Res. 2019 Nov;73:100770. Epub 2019 Jul 15. [Crossref]  [PubMed]
  3. Kitzmann AS, Pulido JS, Diehl NN, Hodge DO, Burke JP. The incidence of central serous chorioretinopathy in Ol- msted County, Minnesota, 1980-2002. Ophthalmology. 2008;115(1): 169-173. [Crossref]  [PubMed]
  4. Pan CK, Vail D, Bhattacharya J, Cao M, Mruthyunjaya P. The Effect of Obstructive Sleep Apnea on Absolute Risk of Central Serous Chorioretinopathy. Am J Ophthalmol. 2020 Oct;218:148-155. [Crossref]  [PubMed]  [PMC]
  5. Tsai DC, Chen SJ, Huang CC, Chou P, Chung CM, Huang PH, et al. Epidemiology of idiopathic central serous chorio- retinopathy in Taiwan, 2001-2006: a population-based study. PLoS One. 2013 Jun 24;8(6):e66858. [Crossref]  [PubMed]  [PMC]
  6. Tsai DC, Chen SJ, Huang CC, Chou P, Chung CM, Chan WL, et al. Risk of central serous chorioretinopathy in adults prescribed oral corticosteroids: a population-based study in Taiwan. Retina. 2014 Sep;34(9):1867-74. [Crossref]  [PubMed]
  7. Nicholson BP, Atchison E, Idris AA, Bakri SJ. Central se- rous chorioretinopathy and glucocorticoids: an update on evidence for association. Surv Ophthalmol. 2018 Jan- Feb;63(1):1-8. Epub 2017 Jun 30. [Crossref]  [PubMed]
  8. Karadimas P, Bouzas EA. Glucocorticoid use represents a risk factor for central serous chorioretinopathy: a prospec- tive, case-control study. Graefes Arch Clin Exp Ophthalmol. 2004 Sep;242(9):800-2. [Crossref]  [PubMed]
  9. Bouzas EA, Karadimas P, Pournaras CJ. Central serous cho- rioretinopathy and glucocorticoids. Surv Ophthalmol. 2002 Sep-Oct;47(5):431-48. [Crossref]  [PubMed]
  10. Zhao M, Célérier I, Bousquet E, Jeanny JC, Jonet L, Savoldelli M, et al. Mineralocorticoid receptor is involved in rat and human ocular chorioretinopathy. J Clin Invest. 2012 Jul;122(7):2672-9. Epub 2012 Jun 11. [Crossref]  [PubMed]  [PMC]
  11. Schubert C, Pryds A, Zeng S, Xie Y, Freund KB, Spaide RF, et al. Cadherin 5 is regulated by corticosteroids and associat- ed with central serous chorioretinopathy. Hum Mutat. 2014 Jul;35(7):859-67. [Crossref]  [PubMed]  [PMC]
  12. Ge G, Zhang Y, Zhang Y, Xu Z, Zhang M. Corticosteroids usage and central serous chorioretinopathy: a meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2020 Jan;258(1):71-77. Epub 2019 Nov 16. [Crossref]  [PubMed]
  13. Khairallah M, Kahloun R, Tugal-Tutkun I. Central serous chorioretinopathy, corticosteroids, and uveitis. Ocul Immu- nol Inflamm. 2012 Apr;20(2):76-85. [Crossref]  [PubMed]
  14. Ho M, Li G, Mak A, Ng D, Iu L, Lai F. Applications of Multimodal Imaging in Central Serous Chorioretinopa- thy Evaluation. J Ophthalmol. 2021 Jul 24;2021:9929864. [Crossref]  [PubMed]  [PMC]
  15. Ng DS, Ho M, Chen LJ, Yip FL, Teh WM, Zhou L, et al. Optical Coherence Tomography Angiography Compared with Multimodal Imaging for Diagnosing Neovascu- lar Central Serous Chorioretinopathy. Am J Ophthalmol. 2021 Dec;232:70-82. Epub 2021 Jun 9. [Crossref]  [PubMed]
  16. Mrejen S, Balaratnasingam C, Kaden TR, Bottini A, Dansin- gani K, Bhavsar KV, et al. Long-term Visual Outcomes and Causes of Vision Loss in Chronic Central Serous Chorioret- inopathy. Ophthalmology. 2019 Apr;126(4):576-588. Epub 2019 Jan 17. [Crossref]  [PubMed]
  17. Breukink MB, Dingemans AJ, den Hollander AI, Keunen JE, MacLaren RE, Fauser S, et al. Chronic central serous chorioretinopathy: long-term follow-up and vision-related quality of life. Clin Ophthalmol. 2016 Dec 20;11:39-46. [Crossref]  [PubMed]  [PMC]
  18. Wang M, Sander B, la Cour M, Larsen M. Clinical charac- teristics of subretinal deposits in central serous chorioreti- nopathy. Acta Ophthalmol Scand. 2005 Dec;83(6):691-6. [Crossref]  [PubMed]
  19. Daruich A, Matet A, Marchionno L, De Azevedo JD, Am- bresin A, Mantel I, et al. Acute Central Serous Chorıoretınop- athy: Factors Influencing Episode Duration. Retina. 2017 Oct;37(10):1905-1915. [Crossref]  [PubMed]  [PMC]
  20. Lai WY, Tseng CL, Wu TT, Lin HS, Sheu SJ. Correlation between baseline retinal microstructures in spectral-domain optic coherence tomography and need for early interven- tion in central serous chorioretinopathy. BMJ Open Oph- thalmol. 2017 Aug 16;2(1):e000054. [Crossref]  [PubMed]  [PMC]
  21. Khatri A, Pradhan E, Singh S, Rijal R, Khatri BK, Lamich- hane G, et al. Going green - treatment outcome and safety profile of chronic central serous chorioretinopathy treated with subthreshold green laser. Clin Ophthalmol. 2018 Oct 5;12:1963-1971. [Crossref]  [PubMed]  [PMC]
  22. Sun Z, Huang Y, Nie C, Wang Z, Pei J, Lin B, et al. Efficacy and safety of subthreshold micropulse laser compared with threshold conventional laser in central serous chorioretinop- athy. Eye (Lond). 2020 Sep;34(9):1592-1599. [Crossref]  [PubMed]  [PMC]
  23. Ambiya V, Khodani M, Goud A, Narayanan R, Tyagi M, Rani PK, et al. Early Focal Laser Photocoagulation in Acute Central Serous Chorioretinopathy: A Prospective, Random- ized Study. Ophthalmic Surg Lasers Imaging Retina. 2017 Jul 1;48(7):564-571. [Crossref]  [PubMed]
  24. Daruich A, Matet A, Dirani A, Bousquet E, Zhao M, Farman N, et al. Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis. Prog Retin Eye Res. 2015 Sep;48:82-118. [Crossref]  [PubMed]
  25. Yap EY, Robertson DM. The long-term outcome of central serous chorioretinopathy. Arch Oph- thalmol. 1996 Jun;114(6):689-92. [Crossref]  [PubMed]
  26. Robertson DM, Ilstrup D. Direct, indirect, and sham la- ser photocoagulation in the management of central serous chorioretinopathy. Am J Ophthalmol. 1983;95(4):457 466. [Crossref]  [PubMed]
  27. Ficker L, Vafidis G, While A, Leaver P. Long-term follow-up of a prospective trial of argon laser photocoagulation in the treatment of central serous retinopathy. Br J Ophthalmol. 1988 Nov;72(11):829-34. [Crossref]  [PubMed]  [PMC]
  28. Chan WM, Lam DS, Lai TY, Tam BS, Liu DT, Chan CK. Choroidal vascular remodelling in central serous chorio- retinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level. Br J Ophthalmol. 2003 Dec;87(12):1453-8. [Crossref]  [PubMed]  [PMC]
  29. Moreno-Morillo FJ, Fernández-Vigo JI, Güemes-Villahoz N, Burgos-Blasco B, López-Guajardo L, Donate-López J. Update on the management of chronic central serous cho- rioretinopathy. Arch Soc Esp Oftalmol (Engl Ed). 2021 May;96(5):251-264. English, Spanish. [Crossref]
  30. Hu J, Qu J, Li M, Sun G, Piao Z, Liang Z, et al. Optıcal Coherence Tomography Angıography-Guıded Photody- namıc Therapy For Acute Central Serous Chorıoretınop- athy. Retina. 2021 Jan 1;41(1):189-198. [Crossref]  [PubMed]
  31. Reibaldi M, Cardascia N, Longo A, Furino C, Avitabile T, Faro S, et al. Standard-fluence versus low-fluence photody- namic therapy in chronic central serous chorioretinopathy: a nonrandomized clinical trial. Am J Ophthalmol. 2010 Feb;149(2):307-315.e2. Epub 2009 Nov 6. [Crossref]  [PubMed]
  32. Cheng Ck, Chang Ck, Peng Ch. Comparıson Of Photody- namıc Therapy Usıng Half-Dose Of Verteporfın Or Half-Flu- ence Of Laser Lıght For The Treatment Of Chronıc Central Serous Chorıoretınopathy. Retina. 2017 Feb;37(2):325-333. [Crossref]  [PubMed]
  33. Altinel MG, Kanra AY, Totuk OMG, Ardagil A, Kabadayi K. Comparison of half-dose versus half-fluence versus standard photodynamic therapy in chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther. 2021 Mar;33:102081. Epub 2020 Nov 3. [Crossref]  [PubMed]
  34. Chan WM, Lai TY, Lai RY, Liu DT, Lam DS. Half-dose verteporfin photodynamic therapy for acute central se- rous chorioretinopathy: One-year results of a random- ized controlled trial. Ophthalmology 2008;115:1756-65. [Crossref]  [PubMed]
  35. Butler AL, Fung AT, Merkur AB, Albiani DA, Forooghian F. Very minimal fluence photodynamic therapy for chronic central serous chorioretinopathy. Can J Ophthalmol. 2012 Feb;47(1):42-4. [Crossref]  [PubMed]
  36. Hua L, Lin B, Hong J, Min HB, Han WL, Zhou TY, et al. Clinical research on one-third dose verteporfin photody- namic therapy in the treatment of chronic central serous chorioretinopathy. Eur Rev Med Pharmacol Sci. 2018 Jan;22(2):278-284. [Crossref]
  37. van Rijssen TJ, van Dijk EHC, Scholz P, Breukink MB, Blanco-Garavito R, et al. Focal and Diffuse Chronic Central Serous Chorioretinopathy Treated With Half-Dose Photody- namic Therapy or Subthreshold Micropulse Laser: PLACE Trial Report No. 3. Am J Ophthalmol. 2019 Sep;205:1-10. Epub 2019 Apr 3. [Crossref]  [PubMed]
  38. van Rijssen TJ, van Dijk EHC, Scholz P, Breukink MB, Di- jkman G, Peters PJH, et al. Long-term follow-up of chron- ic central serous chorioretinopathy after successful treat- ment with photodynamic therapy or micropulse laser. Acta Ophthalmol. 2021 Nov;99(7):805-811. Epub 2021 Feb 10. [Crossref]  [PubMed]  [PMC]
  39. van Rijssen TJ, van Dijk EHC, Scholz P, Breukink MB, Dijkman G, Peters PJH, et al. Crossover to Photodynamic Therapy or Micropulse Laser After Failure of Primary Treat- ment of Chronic Central Serous Chorioretinopathy: The RE- PLACE Trial. Am J Ophthalmol. 2020 Aug;216:80-89. Epub 2020 Apr 11. [Crossref]  [PubMed]
  40. van Rijssen TJ, van Dijk EHC, Tsonaka R, Feenstra HMA, Dijkman G, Peters PJH, et al. Half-Dose Photodynamic Therapy Versus Eplerenone in Chronic Central Serous Cho- rioretinopathy (SPECTRA): A Randomized Controlled Tri- al. Am J Ophthalmol. 2022 Jan;233:101-110. Epub 2021 Jun29. [Crossref]  [PubMed]
  41. Iovino C, Iodice CM, Pisani D, Rosolia A, Testa F, Giannac- care G, et al. Yellow Subthreshold Micropulse Laser in Ret- inal Diseases: An In-Depth Analysis and Review of the Lit- erature. Ophthalmol Ther. 2023 Jun;12(3):1479-1500. Epub 2023 Mar 18. [Crossref]  [PubMed]  [PMC]
  42. Enders C, Lang GE, Mayer B, Werner JU. Central Serous Chorioretinopathy: Morphological and Functional Out- come after Subthreshold Thermal Laser Coagulation with a Frequency-Doubled Nd:YAG Continuous-Wave Laser. Ophthalmologica. 2022;245(1):59-68. Epub 2021 Sep 13. [Crossref]  [PubMed]
  43. Altinel MG, Kanra AY, Totuk OMG, Ardagil A, Turkmen OF. Comparison of the efficacy and safety between subthreshold micropulse laser, standard-fluence and low-fluence photody- namic therapy for chronic central serous chorioretinopathy. J Fr Ophtalmol. 2021 Apr;44(4):499-508. Epub 2021 Feb 26. [Crossref]  [PubMed]
  44. Roca JA, Wu L, Fromow-Guerra J, Rodríguez FJ, Berro- cal MH, Rojas S, et al. Yellow (577 nm) micropulse laser versus half-dose verteporfin photodynamic therapy in eyes with chronic central serous chorioretinopathy: results of the Pan-American Collaborative Retina Study (PACORES) Group. Br J Ophthalmol. 2018 Dec;102(12):1696-1700. Epub 2018 Feb 8. [Crossref]  [PubMed]
  45. Zhao M, Célérier I, Bousquet E, Jeanny JC, Jonet L, Savoldelli M, et al. Mineralocorticoid receptor is involved in rat and human ocular chorioretinopathy. J Clin Invest. 2012 Jul;122(7):2672-9. Epub 2012 Jun 11. [Crossref]  [PubMed]  [PMC]
  46. Wang SK, Sun P, Tandias RM, Seto BK, Arroyo JG. Min- eralocorticoid Receptor Antagonists in Central Serous Cho- rioretinopathy: A Meta-Analysis of Randomized Controlled Trials. Ophthalmol Retina. 2019 Feb;3(2):154-160. Epub 2018 Sep 15. [Crossref]  [PubMed]
  47. Lotery A, Sivaprasad S, O'Connell A, Harris RA, Culli- ford L, Ellis L, et al. VICI trial investigators. Eplerenone for chronic central serous chorioretinopathy in patients with active, previously untreated disease for more than 4 months (VICI): a randomised, double-blind, placebo-controlled tri- al. Lancet. 2020 Jan 25;395(10220):294-303. [Crossref]
  48. Venkatesh R, Pereira A, Jayadev C, Prabhu V, Aseem A, Jain K, et al. Oral Eplerenone Versus Observation in the Man- agement of Acute Central Serous Chorioretinopathy: A Pro- spective, Randomized Comparative Study. Pharmaceuticals (Basel). 2020 Jul 29;13(8):170. [Crossref]  [PubMed]  [PMC]
  49. Duan J, Zhang Y, Zhang M. Efficacy and safety of the miner- alocorticoid receptor antagonist treatment for central serous chorioretinopathy: a systematic review and meta-analysis. Eye (Lond). 2021 Apr;35(4):1102-1110. Epub 2021 Jan 7. [Crossref]  [PubMed]  [PMC]
  50. Moisseiev E, Holmes AJ, Moshiri A, Morse LS. Finasteride is effective for the treatment of central serous chorioretinop- athy. Eye (Lond). 2016 Jun;30(6):850-6. Epub 2016 Apr 8. [Crossref]  [PubMed]  [PMC]
  51. Pikkel J, Beiran I, Ophir A, Miller B. Acetazolamide for central serous retinopathy. Ophthalmology. 2002 Sep;109(9):1723-5. [Crossref]  [PubMed]
  52. Chung YR, Kim JW, Song JH, Park A, Kim MH. Twelve- Month Effıcacy Of Intravıtreal Bevacızumab Injectıon For Chronıc, Atypıcal, Or Recurrent Central Serous Chorıoretınopathy. Retina. 2019 Jan;39(1):134-142. [Crossref]  [PubMed]
  53. Lu HQ, Wang EQ, Zhang T, Chen YX. Photodynamic thera- py and anti-vascular endothelial growth factor for acute cen- tral serous chorioretinopathy: a systematic review and me- ta-analysis. Eye (Lond). 2016 Jan;30(1):15-22. Epub 2015 Oct 30. [Crossref]  [PubMed]  [PMC]
  54. Bae SH, Heo J, Kim C, Kim TW, Shin JY, Lee JY, et al. Low-fluence photodynamic therapy versus ranibizumab for chronic central serous chorioretinopathy: one-year results of a randomized trial. Ophthalmology. 2014 Feb;121(2):558-65. Epub 2013 Nov 20. [Crossref]  [PubMed]
  55. Zhao T, Li J, Wang Y, Guo X, Sun Y. Intravitreal injections with anti-VEGF agent aflibercept versus subthreshold mi- cropulse laser for chronic central serous chorioretinopathy: the alternative treatment regimens for verteporfin-shortage in China. Ann Med. 2023 Dec;55(1):2227424. [Crossref]  [PubMed]  [PMC]
  56. Pitcher JD 3rd, Witkin AJ, DeCroos FC, Ho AC. A prospec- tive pilot study of intravitreal aflibercept for the treatment of chronic central serous chorioretinopathy: the CONTAIN study. Br J Ophthalmol. 2015 Jun;99(6):848-52. Epub 2015 Jan 16. [Crossref]  [PubMed]
  57. Lee JY, Kim MH, Jeon SH, Lee SH, Roh YJ. The Effect of Selective Retina Therapy with Automatic Real-Time Feedback-Controlled Dosimetry for Chronic Central Se- rous Chorioretinopathy: A Randomized, Open-Label, Con- trolled Clinical Trial. J Clin Med. 2021 Sep 22;10(19):4295. [Crossref]  [PubMed]  [PMC]
  58. Venkatesh P, Chawla R, Tripathy K, Singh HI, Bypareddy R. Scleral resection in chronic central serous chorioretinop- athy complicated by exudative retinal detachment. Eye Vis (Lond). 2016 Sep 9;3(1):23. [Crossref]  [PubMed]  [PMC]