CENTRAL SEROUS

CHORIORETINOPATHY
INTRODUCTION

 Initial description by Von Graefe in 1866 as relapsing central

recurrent retinitis.
 1955 – Bennett – “central serous retinopathy”

 The term “central” refers to the form of the disease causing visual
symptoms due to the presence of serous detachments in the
macular area
INTRODUCTION

 Central serous chorioretinopathy (CSC) causes an idiopathic serous

detachment of the retina related to leakage at the level of the
retinal pigment epithelium (RPE), secondary to hyperpermeability of
the choriocapillaris
 Characterized by blister like serous detachment of neurosensory
retina and retinal pigment epithelium (RPE) in the posterior pole of
the eye.
PATHOPHYSIOLOGY
RPE damaged
via
Strong flow
immunologic
disrupts the
infectious
diffusion barrier
circulatory and
in this area
neuronal
mechanism

RPE secresion in
Choroidal fluid
chorio retinal
gets attracted
direction
into this area
towards retina
PATHOPHYSIOLOGY

 Choroid dysfunction theory

Presentation:
 Unilateral blurred vision with a relative scotoma in the central visual
field
 Unilateral metamorphopsia and/or micropsia
 Patients with extrafoveal involvement may be asymptomatic

 Visual acuity:
 VA ranges from 6/5 to 6/60, usually 6/9 – 6/12
 Acquired hyperopia
Funduscopy

 A round to oval sensory retinal detachment

is present at the posterior pole
 In some small PED within the serous
detachment may be evident
 Absent foveal reflex
 Small dot like deposits in the posterior of
retina which is believed to be the
precipitates of plasma proteins including
fibrin
Funduscopy

Fundus photograph of CSC with fibrin Fundus photograph of CSC with

deposit subretinal precipitates
OCT

 OCT can detect detachments that remained undetected in FA.

 It can also detect subretinal deposits like fibrin and subretinal
precipitates

Fundus picture and OCT image showing subretinal fibrin deposit\

FLUOROSCEIN ANGIOGRAPHY

 Fluoroscein Angiography: Characteristic features:

 Ink-blot appearance:

 Seen in 93% cases

 leakage point/s with uniform dye filling is appreciated.
 Most common location – upper nasal quadrant.
 Least common location – lower temporal quadrant
Smoke-stack appearance:
 Small hyperfluorescent spot in the early phase due to leakage of
dye through the RPE
 Fluorescein passes into the subretinal space and ascends vertically
until the upper border, like a
 smoke-stack, in the late venous phase
 The dye then spreads laterally, taking on a “mushroom” or
“umbrella” configuration until entire area of detachment is filled
 Leakage point/s with uniform dye filling is appreciated
 Most common location – upper nasal quadrant
 Least common location – lower temporal quadrant

In majority of cases (60%), the point leak that appear in the initial
phase of the angiography slowly and symmetrically spread in all sides
to about l/4th DD (inkblot type)
This type of leak probably suggests late phase of the active disease
process and the active stage itself may beof variable duration