Treatment controversy among major challenges for central serous chorioretinopathy
KOLOA, Hawaii — Lack of a consensus classification, overlapping pathophysiologic explanations and controversy over treatment make central serous chorioretinopathy “scream inducing,” according to a speaker.
“These patients often have systemic hypertension and a history of excess cortisol, whether internal from things like Cushing’s syndrome or external from things like exogenous steroid use,” Roger A. Goldberg, MD, MBA, said at Hawaiian Eye 2023. “Interestingly, acute central serous doesn’t really lead to chronic CSC. It’s like two different diseases, and yet they share several genetic risk factors.”
Goldberg said that central serous chorioretinopathy (CSC) is more common in men than women, with 9.9 cases per 100,000 population vs. 1.7 cases per 100,000 population, respectively. The peak age range for the condition is 40s and 50s, and typical patient symptoms include decreased central vision, diplopia, metamorphopsia, altered color vision and central dimness.
Treatment challenges for CSC include a broad range of presentations and clinical courses, Goldberg said, as well as a lack of a classification system. A high likelihood of spontaneous improvement or resolution of subretinal fluid is also a difficulty.
There are several treatment options, including thermal laser, micropulse laser, photodynamic therapy and anti-VEGF agents, among others. However, a shortage of verteporfin for PDT is another problem, Goldberg said, as all verteporfin is made in a single factory.
“It is available, but it is in limited supply for another year,” he said.
Goldberg said that the phrase “ice cream” can be used as a memory device to remember important points regarding CSC: idiopathic, chorioretinopathy, excessive, cortisol, reduced intensity, eplerenone is not helpful, acute CSC can be observed, and maybe treat for a faster resolution.
Collapse
Goldberg RA. Central serous chorioretinopathy: An update lecture. Presented at: Hawaiian Eye 2023; Jan. 14-20, 2023; Koloa, Hawaii.
Read more about