CENTRAL SEROUS RETINOPATHY (C.S.R)(C.S.C) DR.ALI SALEHI

C.S.R Idiopathic condition Well-circumscribed serous detachment of sensory retina Resulting from altered barrier and deficient pumping functions at the level of R.P.E

C.S.R CSR is a disease in which a serous detachment of the neurosensory retina occurs over an area of leakage from choriocapillaris through the RPE.

C.S.R Preferentially in healthy men(25-55y) Most patients are asymptomatic unless the central macula is affected. Common in Caucasians, Asians and Hispanics, and rare in Africans Americans

C.S.R CSR 6-10 times more often in men than women Most common in male 20-55y More common in type A personality( competitive drive, easily irritated). More common in stressful persons

Systemic association with CSR Organ transplantation Steroid administration Systemic hypertension S.L.E Pregnancy Gastro –esophageal reflux

SYMPTOMS Sudden onset of blurred and dim vision ,micropsia,metamorphopsia,paracentral scotoma and decreased color vision. V/A from 20/20 to20/200 The decreased vision can often be corrected with hyperopic lens.

RISKS FACTORS Type A personality Hypochondria Hysteria Neurosis Psychiatric medications Elevated steroid level External using or Cushing syn. Stress pregnancy

F.A An expansible dot of hyperflourescence is the most common presentation. Dot is leak from the choroids through the R.P.E and increases in size and intensity. In10-15% of the cases these will appear in a classic smoke stack shape.

O.C.T and C.S.R O.C.T is an excellent noninvasive method to use for diagnosis and following the resolution of the subretinal fluid Subtle fluid accumulation beneath the sensory retina and RPE not evident on F.A and clinical examination can often be picked up by O.C.T

POST-TREATMENT

C.S.R

C.S.R

O.C.T

O.C.T

Differential diagnosis 1)CNV in AMD 2)OPTIC NERVE PITS 3)Idiopathic polypoidal choroidal vasculopathy 4)Idiopathic uveal effusion syn.

Factors associated with reduced V/A during long-term F/A persistent PED persistent subretinal fluid recurrences Sub macular CNV

NATURAL COURSE The visual prognosis is usually good except in chronic, recurrent case. 80-90% undergo spontaneous resorption of subretinal fluid within 3 to 4 months. Recovery of V/A usually follows but can take up to 1 year. 50% of the patients get the severe and extensive form of the disease after 12 years of evolution. Long term complications C.N.V AND PIGMENT EPITHELIOPATHY.

NATURAL COURSE Mild metamorphopsia,faint scotoma, abnormalities in contrast sensitivity and mild color vision deficit frequently persist. Some eyes suffer permanently diminished V/A A small subset of patients has poor visual outcomes.

LASER PHOTOCOAGULATION INDICATIONS The serous detachment persists beyond 3-4 m. The disease recur in eyes with visual deficits from previous episodes. A permanent visual deficit is present from previous episodes in the fellow eye.

LASER CONT. Chronic signs develop such as cystic changes in the neurosensory retina or widespread RPE abnormalities. Occupational or other patient needs require prompt restoration of vision or steropsis.

C.S.R Follow up within 3-4 weeks due to laser may assist in detecting CNV due to CSR that is rare. When the leakage site was too close to the center of fovea for laser P. CSR was resolved by PDT.

Treatment Recently found evidence has also implicated Helicobacter pylori as playing a role. Any ongoing corticosteroid treatment should be stopped. A new anti-microbial treatment will likely be recommended soon in light of recent findings regarding Helicobacter pylori.