Central Serous Chorioretinopathy Definition

Serous detachment of the retina and/or retinal pigment epithelium.

Etiology: Serous detachment occurs through a defect in the outer blood - retina barrier ("tight junctions" in the retinal pigment epithelium). Local factors that may be related to physical or psychological stress are presumably involved.

Epidemiology: The disorder primarily affects men in the third and fourth decade of life.

Symptoms: Patients present with a loss of visual acuity, a relative central scotoma (dark spot), image distortion (metamorphopsia), or perception of objects as larger or smaller than they are (macropsia or micropsia).

Diagnostic considerations: Ophthalmoscopy will reveal a serous retinal detachment, usually at the macula. In chronic cases, a fine brown and white pigment epithelial scar will develop at the site of the fluid effusion. Swelling in the central retina shortens the visual axis and produces hyperopia. The site of fluid effusion can be identified during the active phase with the aid of fluorescein angiography (Fig. 12.26a and b).

Treatment: Usually no treatment is required for the first occurrence of the disorder. Retinal swelling resolves spontaneously within a few weeks. Recurrences may be treated with laser therapy provided the site of fluid effusion lies outside the fovea centralis. Corticosteroid therapy is contraindicated as the therapy itself can lead to development of central serous chorioreti-nopathy in rare cases.

336 12 Retina Central serous chorioretinopathy.

Fig. 12.26 a Bullous fluid accumulation beneath the retina (arrows).

b Angiogram of the same patient. The site of fluid effusion appears as a hy-perfluorescent spot (arrow).

Clinical course and prognosis: The prognosis is usually good. However, recurrences or chronic forms can lead to a permanent loss of visual acuity.

H Local stress-related factors and steroids can lead to macular edema in predisposed patients.

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