Central serous chorioretinopathy: An evidence-based treatment guideline

TY - JOUR

T1 - Central serous chorioretinopathy: An evidence-based treatment guideline

AU - Feenstra, Helena M A

AU - van Dijk, Elon H C

AU - Cheung, Chui Ming Gemmy

AU - Ohno-Matsui, Kyoko

AU - Lai, Timothy Y Y

AU - Koizumi, Hideki

AU - Larsen, Michael

AU - Querques, Giuseppe

AU - Downes, Susan M

AU - Yzer, Suzanne

AU - Breazzano, Mark P

AU - Subhi, Yousif

AU - Tadayoni, Ramin

AU - Priglinger, Siegfried G

AU - Pauleikhoff, Laurenz J B

AU - Lange, Clemens A K

AU - Loewenstein, Anat

AU - Diederen, Roselie M H

AU - Schlingemann, Reinier O

AU - Hoyng, Carel B

AU - Chhablani, Jay K

AU - Holz, Frank G

AU - Sivaprasad, Sobha

AU - Lotery, Andrew J

AU - Yannuzzi, Lawrence A

AU - Freund, K Bailey

AU - Boon, Camiel J F

N1 - Copyright © 2024. Published by Elsevier Ltd.

PY - 2024/7

Y1 - 2024/7

N2 - Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.

AB - Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.

U2 - 10.1016/j.preteyeres.2024.101236

DO - 10.1016/j.preteyeres.2024.101236

M3 - Guideline, recommendation, statement

C2 - 38301969

VL - 101

SP - 101236

JO - PROG RETIN EYE RES

JF - PROG RETIN EYE RES

SN - 1350-9462

ER -