What Is Central Serous Chorioretinopathy?

Central serous choroidal retinopathy (CSC) is referred to as "medioplasmosis", which refers to neuroepithelial detachment caused by impaired pigment epithelial barrier function in the macula or posterior pole, which can be accompanied by detachment of RPE . Plasma disease has a high incidence in China and is one of the most common fundus diseases. The patients were mostly young males. The age of onset was 20 to 45 years old, and the peak of onset was around 40 years old. The male-to-female ratio is 5: 1 to 10: 1. More than 90% of them suffer from monocular damage, and there is no difference between the left and right eyes. Most of them can recover on their own within 3 to 6 months, which is a self-limiting disease. However, it is also easy to relapse, which can lead to irreversible damage to visual function after repeated iterations.

Basic Information

English name: central serous chorioretinopathy, CSC
Visiting department: Ophthalmology
Multiple groups: 20 to 45 years old male

Common locations: Macula or posterior pole
Common causes: The exact etiology is unknown, stress and fatigue
Common symptoms: Sudden decline in central vision, consciously affected eyes, blurred vision, dim scenery, reduced vision, straight lines become distorted, etc.

Causes of Central Serous Choroid Retinopathy

The exact etiology of the disease is unknown. However, it was agreed that the primary lesions were in the retinal pigment epithelium and choroidal capillaries. RPE dysfunction theory / dispersion theory and choroidal dysfunction / choroidal hyperleakage theory have been successively proposed.

The disease is often induced by stress and fatigue. As for why these inducements can lead to increased choroidal capillary permeability, hemodynamic or vascular regulatory dysfunction? Is choroidal venous blood flow disorder affecting choroidal heat regulation failure? No consensus has yet been reached. In addition, pigmented epithelial cells are tightly bound with closed cells and have a good barrier function between the choroid and the neuroepithelial layer; pigmented epithelial cells and the physiological pump function of the seed plasma fluid toward the choroidal capillaries are only When the barrier effect and the physiological pump function are damaged, serous leakage can stay under the neuroepithelial layer and form plasmosis. Whether the destruction of these physiological mechanisms of pigment epithelium at the onset of plasmosis is caused by choroidal capillaries before or after it is leaked, it is not yet certain.

Clinical manifestations of central serous choroidal retinopathy

Central vision

The visual acuity of the center of the sick eye suddenly drops, the worst is not less than 0.2. Temporary hyperopia often occurs from 0.50D to 2.50D. Early stage of the disease can be corrected with lenses to better vision, or even completely corrected.

2. Central dark spot

The victim consciously suffered from blindness and dark scenery. Some patients also complained of discoid shadows in the center of the field of view. The central field of vision can find the relative dark spots corresponding to the size and formation of the posterior pole lesions. When not found, you can use a small or blue optotype; or reduce the background brightness of the visual field meter; After checking or looking at the white wall for a few minutes, you can check it out.

3. Symptoms and Amblyopia

Compared with healthy eyes, the sighted eyes become smaller and the straight lines become distorted. In this case, the sick person himself feels small, and it is easy to detect with the Amsler grid table.

Central Serous Choroid Retinopathy

Ophthalmoscope inspection

In the early stage of the onset, under the ophthalmoscope, there is a (or occasionally 2 to 3) round or horizontal ellipse with a clear boundary and a shallow detachment zone of 1 to 3 PD neuroepithelium under or near the macula. The color of the detached area is dark, slightly raised, the peripheral reflected light is messy, and the small concave concave reflected light disappears. These changes are even more pronounced with no red light inspection.

2. Slit lamp microscopy

At this time, if a narrow light band examination is performed with a slit lamp microscope plus a front lens or a contact lens, it can be seen that the optical tangent line of the neuroepithelial layer is convex in an arc shape. The pigment epithelium also has a light tangent. Because the liquid is completely transparent between the front and back light tangent lines, it is regarded as an optical space. If the light tangent is moved on the retinal blood vessels that bulge with the neuroepithelial layer, the projection of the blood vessels on the incision surface of the pigment epithelial layer can be seen.

3. Fundus angiography

During fluorescence imaging, the pigment epithelium detachment area has fluorescence leakage in the early stage of arteries, and its brightness gradually increases with the imaging process, and continues to the late stage of imaging. When the normal choroidal fluorescence disappears, it is still clearly visible. This is because fluorescein accumulates under the nerve epithelium with the serum, so the fluorescence lasts a long time. If the separation area is smaller. And the course of the disease is only a few months, when the imaging, the surface is fine particles. If the detached area is large, the fluorescence accumulation is diffusely arranged in spokes.

During the venous phase, one or more small fluorescent spots appeared at the posterior pole during the angiography. As time goes on, the leakage range can reach its peak after ten minutes, and persist for several hours.

4.OCT inspection

The neuroepithelial bulge can be seen, and the liquid below it is a liquid dark area without a reflection signal or a spot-like patch or a slightly high reflection signal is visible. In some patients, small RPE detachment can be found at the edge of the neuroepithelial detachment, and there are even RPE break points, that is, leakage points.

Diagnosis of Central Serous Choroid Retinopathy

According to the decrease in vision, deformed and discolored vision, typical leakage points of FFA and neuroepithelial detachment seen on OCT examination, the diagnosis of this disease is not difficult.

Differential diagnosis of central serous choroidal retinopathy

Should be distinguished from the following types of lesions.

1. Low retinal detachment in the lower peripheral part

The macula can also be affected and be mistaken for this disease. It is often easy to get a misdiagnosis if you only see it with the ophthalmoscope. Therefore, it is found that there is a shallow detachment of the neuroepithelial layer in the macula, especially if there are radiation wrinkles below it, the pupil must be dilated to check the fundus peripheral area.

2. Uveitis in the middle

Its pathological toxicity products pass from the posterior chamber through the Berger space and invade the Macular area along the Cloquer duct, causing edema and producing symptoms such as small vision, hyperopia, and sclerosis. However, there was dust-like turbidity in the vitreous body of the anterior part of the disease, and sometimes a small amount of posterior corneal deposits appeared; the posterior lens capsule (that is, in the Berger space) had a charcoal yellow crust-like exudate. After full pupil dilation, a trinocular examination was performed, and inflammation exudation, bleeding, and retinal blood vessel white sheaths were found near the serrated margin.

3. Central exudative choroidal lesions (mid-osmosis)

Subosmotic fundus examination showed subretinal hemorrhage and neovascular membrane-like changes. The medium leakage point appears after the venous phase, and the medium leakage point appears early in the arteries for identification.

4. Optic Disc

Congenital optic disc pits with vitreous traction at the edges can cause fluid in the vitreous cavity to enter the retina through the pits, causing retinal detachment in the macular area and cysts. Careful observation of the optic disc will not cause a misdiagnosis. FFA inspection and OCT can be identified.

Central Serous Choroid Retinopathy Treatment

Laser photocoagulation

Laser photocoagulation leak point is the preferred therapy for this disease. About one week after photocoagulation, serous detachment of the neuroepithelial layer began to subside and completely disappeared within 2 to 3 weeks. However, the disease is a self-limiting disease with a tendency to heal itself. If laser photocoagulation is used improperly, it will cause catastrophic results to the patient. The indications are as follows:

(1) There is obvious leakage of fluorescence, the leakage point is located outside the optic disc-macular fiber bundle, and the depression is more than 250 m from the center, and the serous detachment is serious;

(2) Those with a large area of neuroepithelial detachment accompanied by pigment epithelial detachment with a diameter of 1PD or more;

(3) Fluorescence leakage was still seen for more than three months, and there was persistent serous detachment.

2. Photodynamic therapy (PDT)

Pigment epithelium is decompensated for more than 6 months. Generally, chronic CSCs without a clear leak point can be treated with PDT, especially in patients with choroidal neovascularization. Acute CSC has been reported to treat 30% to 60% of the vedel amount of wet age-related macular degeneration. The remaining parameters remain unchanged, which can effectively close the leak point, be safe and effective, and shorten the course of the disease. If the amount is large, new blood vessels may be induced.

3. Drug treatment

Such as vitamin C, E, Luding, Anluoxue and other capillary permeability reducing drugs, you can try. Those with poor sleep can take sedatives orally. Adrenocortical hormone can induce this disease or increase the serous leakage of the neuroepithelial layer, and even form vesicular retinal detachment, which is prohibited.

Prognosis of central serous choroidal retinopathy

This disease is a self-limiting disease, and most cases can be cured on their own. Central vision will be restored within about three months, and it will take about six months for the progressive vision, minor vision, and darkened scenery to gradually disappear. However, in some cases, the delay and recurrence caused irreversible visual function; the macular pigment was disordered and the color was dark.

Prevention of central serous choroidal retinopathy

The true cause of the disease is unknown, and there is a tendency to heal and relapse. It is mostly caused by stress, poor sleep, overwork, etiology and systemic infections, allergic diseases, and external cold effects. Therefore, it should be based on prevention and early treatment. Usually avoid many factors that induce the disease, avoid excessive mental and physical labor, watch less TV and books.