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CSCR

Central serous chorioretinopathy (CSCR) is the fourth most common retinopathy. A 46-year-old female presented with floaters, a grey spot in her vision, and distorted vision in her left eye for 5 weeks. Examination found decreased visual acuity in her left eye and optical coherence tomography revealed subretinal fluid in the central macula. She was diagnosed with CSCR based on clinical findings and imaging. She was advised to observe without intervention, refrain from corticosteroids, and reduce stress.

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Анагаахын Орчуулга
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67 views26 pages

CSCR

Central serous chorioretinopathy (CSCR) is the fourth most common retinopathy. A 46-year-old female presented with floaters, a grey spot in her vision, and distorted vision in her left eye for 5 weeks. Examination found decreased visual acuity in her left eye and optical coherence tomography revealed subretinal fluid in the central macula. She was diagnosed with CSCR based on clinical findings and imaging. She was advised to observe without intervention, refrain from corticosteroids, and reduce stress.

Uploaded by

Анагаахын Орчуулга
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Central serous

chorioretinopathy
1st year resident Anudari.B
Central serous chorioretinopathy (CSCR) is the fourth most common
retinopathy after age-related macular degeneration, diabetic retinopathy
and branch retinal vein occlusion.
• Visual acuity ranges from 20/20 to 20/200, but in most
patients, it is better than 20/30. Decreased visual acuity can
often be improved with a small hyperopic correction.
• Patients describe a variety of symptoms, including sudden
onset of blurred or dim vision, micropsia, metamorphopsia,
paracentral scoto­ma, decreased color vision, and prolonged
afterimages.
Choroid dysfunction theory
RPE dysfunction theory
The elevated retina, seen in cross section,
has a thick coat on its inner surface that
has autofluorescent characteristics
consistent with retinal outer segment–
derived fluorophores. These fluorophores
are therefore considered to be derived
from the outer segments that could not be
phagocytized by the retinal pigment
epithelium (RPE) because of the physical
separation, caused by the fluid, between
the retina and RPE. The region of shaggy
photoreceptors contains punctate dots
that are highly reflective; it has been
theorized that these dots are
macrophages.
Brief description
46 y.o/F

Chief complaint: in her LE/ for 5 weeks


• seeing floaters and started noticing
grey area in her visual field
• things look distorted
• Past Ocular History: none
• Past Medical History: Nothing significant
• Allergy: Seasonal allergy
• Medication: Intranasal corticosteroid spray (uses any time of
the day, when symptoms persists)
• Family History: Nothing significant
• Social History: Competitive curler, Works as a barber and
owns her own business
• Review of Systems: Non-contributory, other than noted above
OD OS
VA 20/20 20/60
pH - ni
BCVA - No improvement with
spectacles
IOP 16mmHg 16mmHg
EOM Full duction in all gaze Full duction in all gaze

Confrontation visual field Normal Normal


test

Pupils 5mm in dark, 2mm in 5mm in dark, 2mm in


light light
RAPD - -
OD OS
Lid/lashes Normal anatomical Normal anatomical
structures structures
Conj/sclera No injection, white No injection, white

Cornea Translucent, smooth, Translucent, smooth,


avascular avascular
AC Deep & quiet Deep & quiet

Iris Flat, brown Flat, brown

Lens Clear Clear


LE
OCT-LE
Problem list
From complaint:
1. Floaters
2. Dark, grey spot seen
3. Metamorphosia
From examination:
4. VA: LE-20/60 (not corrected by spectacles)
5. Hypopigmented area near fovea, retina appears
elevated in the central macula
From ancillary tests :
1. Amsler test: central grey area + superior area of distortion.
2. Fundus photo: parafoveal pigmentary changes, area of retinal elevation
3. OCT: subretinal fluid in the central macula
4. Infrared fundus photography: hypo-reflective area in the central macula
5. FFA: ink blot leakage and late phase leakage from a point in the inferior
macula toward the fovea in a smoke stack configuration.
Polypoidal choroidal Wet ARMD
vasculopathy

Choroidal melanoma
Optic nerve pit

VKH
CSCR
Major criteria Minor criteria

(1) presence or evidence of prior (1) mid-phase hyperfluorescent


SRD documented on OCT involving placoid areas on indocyanine
the posterior pole unrelated to angiography;
another disease process (2) 1 or more focal leaks on
(2) at least 1 area of RPE alteration fluorescein angiography; or
on fundus autofluorescence, (3) sub-foveal choroidal thickness
spectral-domain OCT, or infrared (SFCT) of 400 μm or more
imaging. (consider age and axial length).
Management

• Observation & Education


• without intervention + refrain from exogenous
corticosteroid use + stress reduction
• At her 6-week follow up visit, she reported improved vision in
the left eye, with nearly resolved distortion.
Treated patients who received topical CAI had greater reduction in CMT (−145.6 µm, 95% confidence interval [CI]
−170.5 to −120.7) compared to observed controls (−45.1 µm, 95% CI −65.3 to −25.1) at the main study end point of 3
months (P = 0.015). A higher proportion of treated patients achieved complete resolution of SRF compared to
observed controls (77.8% vs. 40.0%, P = 0.04) at 3 months. However, change in BCVA at 3 months was similar in
both groups (P = 0.12).
Thank you for your attention

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