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Central Serious Retinopathy CSRS

What is Central Serious Retinopathy (CSR) ??
Central serous chorioretinopathy is a retinal disorder which affects the macula. It was first described in ophthalmology more than one hundred years ago. Essentially, it is an “idiopathic disorder” which means that the precise cause is unknown. Central serous is associated with an elevation (detachment) of the macula due to leakage of fluid from the circulation behind it (choroidal circulation). The leakage occurs through a defect in the tissue layer known as the retinal pigment epithelium. The retinal pigment epithelium is a single–celled layer that lies between the retina and the choroid This tissue layer normally serves to prevent fluid from the choroidal circulation from leaking under the retina. In central serous, fluid equilibrium is disturbed leading to leakage beneath the retina which elevates it to produce a macular detachment which distorts vision.

Although the precise pathophysiologic events leading to macular detachment are still poorly understood, the clinical manifestations begin with a disturbance in the retinal pigment epithelium which alters its normally impermeable state so that fluid leakage occurs, producing detachment of the retina itself. In this regard, the retina appears to be affected only secondarily.

Who gets CSR?
The syndrome is much more common in men who represent 85–90% of the cases. The onset is usually between the ages of 25 and 45. Central serous patients in general tend to be slightly hyperopic (far–sighted) but not to have other eye disease.
There has always been an impression that patients with central serous exhibit a characteristic personality. Patients have been observed to be energetic, dynamic, harried, pressured, and emotionally stressed. One of our earlier reports has identified the Type A Behavioral Pattern as a risk factor for the disease.

What are the symptoms and signs of CSR?
Patients usually present with a disturbance in central vision, either a gray zone or a blind spot in the central field or metamorphopsia which is waviness or undulation in the central portion of the vision. On clinical examination, the ophthalmologist may find one or more small blister–like elevations to the retinal pigment epithelium. In the acute stages, there is an overlying elevation of the neurosensory retina. Occasionally, patients who have detachments of the retina are asymptomatic, simply because the fluid does not involve the center of the macula or the foveal region. Signs of previous detachments of the retina can often be detected by the clinician. These are atrophic and pigmentary degenerative zones in the retina. When the neurosensory retina is elevated, it is displaced from its normal source of nutrition, the choroidal circulation. In time, the outer retina may become degenerated. Even when the macula resolves and is no longer detached, it does not function because of the degenerative change.

 

Clinical photo of a patient with central serous retinopathy (CSR) demonstrating a serous neurosensory detachment

OCT showing serous detachment of the fovea with and underlying pigment epithelial detachment.

What is the treatment for CSR?

Indications for treatment are;

One known method to reduce the duration of the detachment in an attempt to preserve the detached retina is laser photocoagulation. The site of leakage can be identified by flourescein angiography and laser treatment can be done to seal the leak.