Central Serous Chorioretinopathy

La Central serous chorioretinopathy causes a serous detachment of the sensorineural retina at the macular level, the most important part of the retina. Very often this pathology undergoes a spontaneous cure, but sometimes it persists over time or is subject to relapses that can cause a reduction in vision.

Central serous chorioretinopathy in multicolor

Fluorangiography of a central serous chorioretinopathy

La Central serous chorioretinopathy (Central Serous Chorioretinopathy, CSCR) is an eye disease directly related to stress. It mainly affects men aged between 20 and 55 years. People who suffer from it often have a hyperactive personality, very competitive or aggressive or exposed to conditions of prolonged stress. Particularly introverted individuals, who have personality alterations and tend to isolate themselves from social relationships, also seem to be more susceptible to CSCR. This disease causes a serous detachment of the sensorineural retina which can persist over time or be reabsorbed spontaneously. Sometimes healing is not definitive and some patients may be subject to recidivism. Permanent macular alterations and damage can occur both in cases of lasting serous detachment and in cases of repeated cycles of remissions and relapses.

Aetiopathogenesis

At the basis of the onset of central serous chorioretinopathy there is an adrenergic hyperactivity. This hyperactivity, associated with prolonged situations of high stress, induces an excessive endogenous production of cortisol e catecholamine.

The high plasma concentration of these substances causes exudation of serum from the blood vessels of the choroid. This causes a thickening of the choroid itself, which in this way exerts a mechanical pressure on theretinal pigment epithelium (EPR), an epithelial and non-sensory type tissue that is functionally separate, but structurally and anatomically associated with the retina, of which it is an integral part.

The pressure exerted on the RPE weakens its intercellular junctions, creating an anatomical discontinuity in this tissue. Under normal physiological conditions, the retinal pigment epithelium is perfectly intact and mediates the transport of oxygen and nutrients from the choroid to the sensorineural retina. The latter is the portion of the retina that includes nerve cells with photoreceptor characteristics responsible for vision (cones and rods).

In pathological conditions, the presence of small "leaks" inside the RPE causes this tissue to lose its anatomical function of separation and this allows the trans-epithelial migration of fluids from the choroid to the subretinal space, causing the serous detachment of the sensorineural retina.

In people particularly sensitive to cortisol, this mechanism can also be induced byintake of cortisone, especially if administered systemically, but also orally (in the form of a spray), topically (for example in cream) or inhaled.

Central serous chorioretinopathy usually begins in one eye only and may be "moderately" asymptomatic in an initial phase. In the most severe clinical pictures, the disease has a rapid course and determines the lifting of the central region of the retina, that is, the area macular, responsible for sharp vision, thus causing significant visual impairment.

Symptoms

The main symptoms are one decreased visual acuity. Una darker view o faded colors. Una distorted or discontinuous perception straight lines (which can be perceived as curved and / or broken). A very small view of the size of objects (micropsy) and the perception of a dark spot (scotoma) at the center of the vision.

Diagnosis

The instrumental tests that the patient, suffering from central serous chorioretinopathy, should perform during an in-depth eye examination to have an accurate monitoring are: Central Computerized Perimetry which measures retinal sensitivity, which is reduced in the presence of this pathology. L'Electroretinogram to evaluate functional damage in signal transmission over time. There Optical Coherence Tomography (OCT) high resolution to analyze each individual retinal layer, particularly useful in identifying and quantifying the serous detachment of the sensorineural retina. L'' Fluorescence Angiography (FAG) and with Indocyanine Green (ICGA), a minimally invasive but very important examination to identify the "vanishing point", that is the point where the blood vessels of the choroid and choriocapillary have an excessive permeability that feeds the detachment of the retinal pigment epithelium.

Instrumental images

Oct and HRA of Central Serous Chorioretinopathy

Fluorangiography and ICGA of a central serous chorioretinopathy

Treatment

Conventional therapy for chorioretinocentral serous pathia and the low fluence photodynamics (PDT), a laser technique refined in the last decade, capable nowadays of obtaining, in suitably selected cases, a very high percentage of success. It is also important to know that this laser treatment can be repeated over time in case of relapses. In addition to the treatment of central serous chorioretinopathy with low fluence PDT, the patient's attention should be focused on theelimination of stressors.

Psychological assistance

In order to facilitate a complete and spontaneous recovery, patients are often advised to change their lifestyle. Where necessary, a course of psychotherapy is recommended to identify and address any relationship problems. Sometimes it even goes so far as to suggest the possibility of changing one's work activity. All this in order to reduce, or completely eliminate, the recurring stress factors that act at a biochemical level and trigger the development of CSCR. To this end, all those activities that can contribute to the reduction of stress are recommended, such as physical exercise, meditation, yoga etc. Patients with CSCR, to promote proper healing, must avoid taking cortisone-based drugs, unless there is a real and urgent need to justify its use with possible risk of relapse.

New therapeutic frontiers

In recent years, a new therapy for central serous chorioretinopathy is being sought through randomized controlled clinical trials. A fermacological therapy very promising, which is getting very good results, consists in using mineralocorticoid antagonists, drugs usually taken by mouth to treat high blood pressure and congestive heart failure. Another therapy that has achieved excellent results in terms of healing in recent years is that which uses “cold lasers"Latest generation through which it is possible to perform sub-threshold laser treatments (subtreshold), such as the 2RT and micropulsed, with no contraindications related to thermal effects. Taking into account the extremely positive clinical trial results, we hope that these next generation therapies will soon be available in common ophthalmological clinical practice.

Pathology and treatment on video

Do you need more information?

Do not hesitate to contact me for any doubt or clarification. I will evaluate your problem and it will be my concern and that of my staff to answer you as quickly as possible.