• General information central serous retinopathy
• case
• details
• PDT laser treatment, Retina 2010
• an update BJO 2010
• laser BJO 2011
• photo/scan
• treatment
• pictures/text

CSR is described here. 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 CSR is not known. In some patients stress seems to play a part. CSR is commoner in males of young adult/middle age, with darker skin.

Sometimes the blister 'CSR' 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.

Technically, such PEDs (pigment epithelial detachments) are likely to be smaller than 1 disc diameter.
Larger PEDs may be CSR. However, especially in older patients, they may be part of ARMD (age-related macular degeneration) with CNV (wet ARMD).

An area of CSR tends to cause dimmer vision. If scarring does follow, then the sight is permanently reduced. Substantial vision problems are uncommon  (5%).

• Generally no treatment is needed, the condition is mild and it gets better itself after about 2 months.

• Avastin or anti-VEGF drugs are not likely to be helpful.

• For more persistent cases, for instance when the fluid and visual disturbance has been present for more than 6 months then treatment may help:

  • PDT laser and here using (low fluence/reduced brightness) may help
  • Retina 2011 Fujita.
  • after PDT Retina 2011
    
    

• anti-steroid drugs such as ketoconazole may also be helpful, but these are very experimental. Ketoconazole has to be given in the anti-steroid dose level, a dose higher than the regular anti-fungal dose. Such a high dose may cause liver problems, increasing liver enzymes, so these have to be monitored. See reports:

  • helpful 600mg
  • not helpful 200 mg od
  • Mifepristone Retina 2011
    
    

• so anti-testosterone drugs may help, no proof yet Finasteride

• treatment of heliobacter may help 2011

• betablockers may help (one case Nottingham 2011)

• Subthreshold fluorescein angiogram targeted laser to the leaky areas helps (although often more than one treatment is needed) Eye 2012

• antivegf  more
• micro-rips close (Gupta 2010)
• subretinal yellow dots Retina 2011 Ichiro
• renal transplant can 'cause' the condtion Retina 2011
• there is a thick choroid in CSR..is this due to vasodilation?