Central serous chorioretinopathy: Etiology, diagnosis, and treatment

BACKGROUND: Central serous chorioretinopathy (CSC) is a rare eye disease (estimated prevalence 1.4 per 10 000 people) characterized by a serous fluid collection under the central portion of the retina. Its pathogenesis and optimal treatment remain incompletely understood. METHODS: In this narrative review, we discuss the risk factors, pathophysiology, diagnostic evaluation, and treatment of CSC. RESULTS: Systemic corticosteroids are considered a well-documented precipitating factor for the disease (odds ratio 4.29, 95% confidence interval [2.01; 9.15]). Potential psychosomatic factors have been inadequately studied. The pathophysiology is likewise incompletely understood; choroidal vascular dysregulation and hyperpermeability appear to be key mechanisms. The resulting fluid collection under the retina can markedly impair photoreceptor function and vision. In 80%-90% of acute cases, the fluid is spontaneously resorbed. Various treatments, ranging from laser therapy to medication-based approaches, have been proposed for patients who do not experience spontaneous remission, but non of them has been found to yield superior functional outcomes in network meta-analyses. Morphologically, in two randomized trials, subretinal fluid regressed in 67% and 78%, respectively, of patients treated with photodynamic therapy, compared to 29% and 17% after micropulse laser treatment or oral eplerenone. CONCLUSION: CSC is still incompletely understood, and the treatment options for it are a matter of debate. There is an urgent need for further controlled prospective trials with an adequate period of observation and functional endpoints.