Central Serous Chorioretinopathy Follow-up

  • Author: Kean Theng Oh, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Nov 2, 2011
 

Further Outpatient Care

  • Most patients with central serous chorioretinopathy receive follow-up care for 2 months to determine whether the fluid resolves spontaneously.
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Inpatient & Outpatient Medications

  • Tatham and Macfarlane described a case series of patients who were treated with propranolol for CSCR.[31] They suggested that beta-blockade had a hypothetical mechanism in treating CSCR. Further evidence is needed to substantiate this potential treatment.
  • Nielsen et al proposed the use of mifepristone in the treatment of chronic CSCR in a case report.[32]
  • Intravitreal bevacizumab (Avastin) has been used to successfully treat the rare complication of choroidal neovascularization following CSCR.[33, 34, 35]
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Complications

  • A small minority of patients develops choroidal neovascularization at the site of leakage and laser treatments. A retrospective review of cases shows that one half of these patients may have had signs of occult choroidal neovascularization at the time of treatment. In the other patients, the risk of choroidal neovascularization may have been increased by the laser treatment.[9, 39]
  • Acute bullous retinal detachment may occur in otherwise healthy patients with CSCR. This appearance may mimic Vogt-Koyanagi-Harada disease, rhegmatogenous retinal detachment, or uveal effusion. A case report also has implicated the use of corticosteroids in CSCR as a factor increasing the likelihood of subretinal fibrin formation. Reducing the corticosteroid dose frequently will lead to resolution of the serous retinal detachment.
  • RPE decompensation from recurrent attacks leads to RPE atrophy and subsequent retinal atrophy. RPE decompensation is a manifestation of CSCR but may also be considered as a long-term complication.[49]
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Prognosis

  • Serous retinal detachments typically resolve spontaneously in most patients, with most patients (80-90%) returning to 20/25 or better vision.[50, 49, 51]
  • Patients with classic CSCR (characterized by focal leaks) have a 40-50% risk of recurrence in the same eye.[50, 51, 13]
  • Even with return of good central visual acuity, many of these patients still notice dyschromatopsia, loss of contrast sensitivity, metamorphopsia, or nyctalopia.[50]
  • These patients often have recurrent or chronic serous retinal detachments, resulting in progressive RPE atrophy and permanent visual loss to 20/200 or worse. The final clinical picture represents diffuse retinal pigment epitheliopathy.
  • Risk of choroidal neovascularization from previous CSCR is considered small (< 5%) but has an increasing frequency in older patients diagnosed with CSCR.[8, 13]
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Patient Education

  • If possible, patients should avoid stressful situations. Patient participation in stress-reducing activities (eg, exercise, meditation, yoga) is recommended.
  • Recent evidence associates systemic hypertension with CSCR, but it is unknown as to whether careful control of systemic hypertension will reduce the incidence of CSCR.
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Contributor Information and Disclosures
Author

Kean Theng Oh, MD  Consulting Staff, Associated Retinal Consultants, PC

Kean Theng Oh, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Brian A Phillpotts, MD  Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine

Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, James C Folk, MD, to the development and writing of this article.

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Fluorescein angiography in the early recirculation phase of a patient with a localized neurosensory detachment in the macula from central serous chorioretinopathy. Note the focal hyperfluorescence.
Fluorescein angiography in the late recirculation phase of the same patient as in the image above. Note the distribution of leakage of fluorescein dye within the neurosensory detachment.
 
 
 
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