Biomarkers for central serous chorioretinopathy

Abstract

Central serous chorioretinopathy (CSCR) is a common chorioretinal disease characterized by serous retinal detachment that most commonly involves the macular region. Although the natural history of the acute form shows a self-limiting course, a significant number of patients suffer from recurrent episodes leading to chronic disease, often leaving patients with residual visual impairment. Visual morbidity is often worsened by a delay in the diagnosis due to the incorrect understanding of the particular biomarkers of the disease. The aim of this review is to provide clinical understanding of the biomarkers of CSCR with an emphasis on the most recent findings in patient demographics, risk factors, clinical imaging findings, and management options. Patients with these biomarkers, age 30–44 years, male gender, increased stress levels, hypercortisolism (endogenous and exogenous exposures), sleep disturbance, pregnancy, and genetic predisposition have increased susceptibility to CSCR. Also, biomarkers on optical coherence tomography (OCT) such as choroidal thickness (CT) and choroidal vascularity index (CVI) showed good diagnostic and prognostic significance in the management of CSCR. There are nonspecific features of CSCR on OCT and OCT angiography such as choroidal neovascularization, photoreceptor alteration/cone density loss, and flat irregular pigment epithelium detachment. We described rare complications of CSCR such as cystoid macular edema (CME) and cystoid macular degeneration (CMD). Patients with CME recovered some vision when treated with anti-vascular endothelial growth factors (anti-VEGFs). Patients with CMD had irreversible macular damage even after treatment with anti-VEGFs.

Intima-Media Thickness Measurements of the Common Carotid Artery in Patients with Central Serous Chorioretinopathy: A Case-Control Study

“…CSCR is associated with several risk factors and conditions, including systemic glucocorticosteroid use, male sex, high educational attainment, high income, smoking, Helicobacter pylori infection, stress, and hyperopia [7,8]. In addition, a previous study demonstrated that type-A personality, Cushing's syndrome, systemic hypertension, retinal vascular occlusive diseases, and obstructive sleep apnea may be associated with CSCR [1,2,[8][9][10][11]. e possible explanation for these associations is that elevated cortisol and epinephrine levels affect the choroidal circulation's autoregulation [9].…”

Central Serous Chorioretinopathy: A Review of Pathogenesis, Risk Factors, Diagnostic Methods and the Current Treatments

“…Even its etiology and exact pathogenesis are not entirely understood. Choroidal changes play a major role, and CSCR is caused by leakage of fluid from the choroid due to increased choroidal vascular permeability (1)(2)(3)(4).…”

“…Recently advanced Choroidal imaging techniques are essential for both the diagnosing and evaluation of treatment outcomes. Imaging biomarkers such as choroidal thickness, choroidal vascularity index, hyperreflective dots, which are quantifiable parameters, are fundamental for possible prognosis (1)(2)(3)(4)(5). Other several risk factors such as demographic and physiologic factors, lifestyle, and corticosteroid medication are the main predictive factors for the incidence of CSCR.…”

“…Still, photodynamic therapy (PDT), seems to be the most effective method in these patients. (1)(2)(3)(4)(5) Incidence, Age and Gender The incidence of CSCR is higher in men than in women. Its incidence is changing in different populations such as reported that the incidence is 9.9 per 100,000 in men while it is 1.7 per 100,000 in women [5].…”

“…Incidence and was found 9.75:1 in the Egyptian population. On the other hand, an epidemiologic study among the ages between 20 and 60 years in Taiwan demonstrated that CSCR was 1.7 times higher in men than in women [1,2,6,7]. The CSCR is predominantly seen in young and middle-aged individuals within their third to fourth decades with an average age between 39 and 51 years.…”