Management of chronic central serous chorioretinopathy

Abstract

New treatment modalities for the management of central serous chorioretinopathy (CSC) now exist. While acute CSC generally resolves without the requirement for intervention, chronic CSC has been associated with persistent disruption in visual function. Current treatment approaches include photodynamic therapy, oral aldosterone antagonism and subthreshold multifocal laser. There has also been further investigation into a number of new treatments including antivascular endothelial growth factor treatment. Further investigation using developing optical coherence tomography imaging is helping to determine biomarkers of CSC activity, potential indicators of treatment response and indications of chronicity of disease activity. Further comparative study is required to determine the effectiveness of different forms of treatment in a range of patients with varied demographics, aetiology and chronicity of disease.

Pachychoroid Spectrum Disorders: An Updated Review

“…[ 3 ] Chronic cases are more likely to require treatment, given their potential to develop neovascular complications, RPE atrophy, or cystoid macular degeneration. [ 3 , 8 , 9 , 10 ] Patients receiving treatment are more likely to have favorable vision outcomes compared to observation alone. [ 10 , 11 ] Half-dose Verteporfin Photodynamic Therapy (vPDT) has become a popular treatment choice given its efficacy and improved safety compared to full-dose vPDT.…”

“…[ 10 , 11 ] Half-dose Verteporfin Photodynamic Therapy (vPDT) has become a popular treatment choice given its efficacy and improved safety compared to full-dose vPDT. [ 9 , 12 ] The efficacy of spironolactone and eplerenone in CSCR have also been investigated in randomized control trials, finding mixed results in choroidal thickness reduction and significant change in visual acuity. [ 13 , 14 ] Recently, Kumar Sahoo et al found that sub-foveal vessels were significantly more likely to respond to PDT, while eplerenone significantly decreased central macular thickness and intraretinal cysts.…”

Management of Atypical Central Serous Chorioretinopathy Mimicking Vogt-Koyanagi-Harada Disease

“…[9][10][11][12] Focal laser photocoagulation was also found to be effective in managing chronic CSCR; however, because of the potential for CNV development and scotomata, focal laser photocoagulation may be less desirable for chronic CSCR. 8 Mineralocorticoid antagonism has been shown to be an effective treatment for chronic CSCR. Spironolactone, which has a high affinity for the aldosterone receptor, is reported to be effective in managing chronic CSCR, while eplerenone, also a mineralocorticoid antagonist, has shown inconsistent efficacy in treating chronic CSCR.…”

Acute Exudative Maculopathy and Bacillary Layer Detachment in Patients With Central Serous Chorioretinopathy After Photodynamic Therapy

“…6-8 PDT's mechanism of action is postulated to include vascular endothelial damage with short-term CC hypoperfusion and long-term CH vascular remodeling with subsequent reduction of vascular hyperpermeability and leakage. 6,9 However, the efficacy of PDT is highly variable and is not exempt of complications. 10 Among them, PDTinduced acute exudative maculopathy (PAEM) is defined as subretinal serofibrinous exudation within From the…”

“…Currently, one of the preferred treatments for persistent CSCR is photodynamic therapy (PDT). 6–8 PDT's mechanism of action is postulated to include vascular endothelial damage with short-term CC hypoperfusion and long-term CH vascular remodeling with subsequent reduction of vascular hyperpermeability and leakage. 6,9…”