- PED = pigment epithelial detachment
- ARMD = age related macular degeneration
- CNV = choroidal new vessels
CSCR is described here. It was previously termed central serous retinopathy (CSR), and a new name in Europe is pachychoroid pigment epitheliopathy and in the USA central serous chorio- retinopathy.
Essentially a little blister of fluid develops under the retina. The fluid develops but then usually disappears itself leaving a tiny scar. Occasionally later more blisters form and the further scars reduce the vision.
The cause of CSCR is not known. In some patients stress seems to play a part. CSCR is commoner in males of young adult/middle age, with darker skin. Sleep apnoea contribues Retina 20
Sometimes the blister 'CSCR' occurs by itself, but sometimes in the middle of the blister there is also a tiny blister of the pigment epithelial layer underneath, causing a pigment epithelial detachment (PED), as in the photo and diagram below. Autofluorescence and OCT are helpful Eye16.
The 'peripapillary pachychoroid syndrome (PPS)' Retina21 may be one type of CSR.
Technically, such PEDs (pigment epithelial detachments) are likely to be smaller than 1 disc diameter. Larger PEDs may be CSCR. However, especially in older patients, they may be part of ARMD (age-related macular degeneration) with CNV (wet ARMD). The condition seems linked to a thicker choroid, the layer under the retina, and is now believed to be one of the 'Pachychoroid Diseases of the Macula' see 2014. Fluid may accumulate in the choroid AJO 15
An area of CSCR tends to cause dimmer vision. If scarring does follow, then the sight is permanently reduced. Substantial vision problems are uncommon (5%).
Risk factors Retina16 "The authors concluded that hypertension, H. pylori infection, steroid usage, sleeping disturbance, autoimmune disease, psychopharmacologic medication use, and Type-A behavior were possible risk factors relating to the occurrence of CSCR".
The duration of the episode Retina 17. An OCTa or autofluorescence will identify atrophic changes and indicate the prognosis. If there are a lot of changes, PDT laser or other treatment will not improve sight. IJO17 2014 . In the family Retina 19
Treatments probably not effective......................
blue circle=atrophic area, long-standing, due to previous chronic CSCR damage
yellow circle=subretinal fluid, which has increased in the last 3 months