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Acta Scientific Ophthalmology (ISSN: 2582-3191)
Volume 5 Issue 8 August 2022
Different Therapeutic Approaches in Central Serous Corioretinopathy: A Case Series
Mary Romano2-3, Vanessa Ferraro1-2*, Jose Luis Vallejo-Garcia1,2,
Alessandro Randazzo1 and Paolo Vinciguerra1,2
1IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
2Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan,
Italy
3Multidisciplinary Department of Medical, Surgical and Dental Sciences, University
of Campania Luigi Vanvitelli, Neaples, Italy
*Corresponding Author: Vanessa Ferraro, Department of Biomedical Sciences,
Humanitas University, Pieve Emanuele, Milan, Italy.
Case Series
Received: July 21, 2022
Published: July 29, 2022
© All rights are reserved by Vanessa
Ferraro., et al.
Abstract
Purpose: To give clinical feedback to what the literature states about the different treatment of Central Serous Corioretinopathy
(CSCR), outlining how, through different treatments customized on different characteristics of the patient it is possible to obtain
excellent results of visual recovery.
Observations: While in acute forms a broad consensus has been reached on whether a wait-and-see attitude can be taken, in chronic
Conclusions: In the acute form (aCSCR), which has a relatively high rate of spontaneous resolution, an effective treatment should
ideally prevent recurrences and subsequent disease progression. In the chronic form (cCSCR), the primary aim of treatment is
Keywords: Subthreshold Micropulse Laser; Argon Laser; Eplerenone; Photodinamyc
Introduction
Central serous chorioretinopathy (CSCR) is the fourth most
common cause of central vision loss, affecting men 20-60 years
of age. To date, no consensus has been reached regarding the
treatment of this disease, in fact there are a variety of different
approaches proposed. According to the literature, many strategies
are available and effective, modulating the choice upon patient’s
characteristics. In the acute form, it is reasonable to wait and observe
could be reabsorbed spontaneously; otherwise, half-dose PDT or
high-density subthreshold micropulse laser could be considered.
In the chronic form, PDT could be performed, adding anti-VEGF
treatment if signs of CNV are present at multimodal imaging.
Another possibility is pharmacological treatment: antagonists of
mineralocorticoid receptors, spironolactone and eplerenone have
prospective randomised controlled trials have been conducted yet.
Findings
Case 1
A 50-year-old woman with a history of CSCR in her right eye
(RE) came to our center in 2019: her BCVA was 20/20 in her RE and
OCT showed parafoveal PED. FA showed a leaking point temporally
to the fovea, with no signs of neovascularization. Therapy with
acetazolamide and curcumin-based integrator was started in
cycles. OCT and BCVA stayed stable until 2021: the patient was
lost for two years at the follow up due to Covid-19 pandemic
DOI:
Citation: Mary Romano., et al. “Different Therapeutic Approaches in Central Serous Corioretinopathy: A Case Series". 5.8
(2022): 101-105.
and neuroepitelium detachment. Pharmacological treatment with
acetazolamide was promptly restarted. Two weeks later BVCA
was 20/25 and OCT showed a reduction in height of PED. After
two weeks she underwent high-density subthreshold micropulse
laser (HSML) and her BVCA was again 20/20. HSML was performed
using these parameters: photonic radiation was delivered to the
retina in pulses lasting 200 msec, the duty cicle was set at 5%, the
Figure 1: OCT in 2019, showing a PED temporally to the fovea
(on the left), FA showing a leaking point in the same area (on
the centre) and ICGA showing iperpermeability in
correspondence (on the right). BCVA was 20/20.
Figure 2: OCT in 2021, showing a PED and a neuroepitelium
Figure 3: After high-density subthreshold micropulse laser
OCT shows the resolution of neuroepitelium detachment and
her BCVA was again 20/20.
Case 2
A 56-year-old man referred to our center in 2015, with a history
was performed: in both eyes there were multiple neuroepitelium
detachments, with focal PED and signs of macular subatrophy.
Indocianine-green angiography showed diffuse leakage of
choriocapillaris. Therapy with eplerenone 50 mg was promptly
started. OCT and BCVA were stable for three years, the patient had
continued his therapy with eplerenone 50 mg, that was reduced in
2018 to 25 mg. By the way, this patient too was lost at the follow
up due to Covid-19 and came back to our clinic in 2021: his BCVA
points and a diffuse neuroepitelium detachment, so PDT was
2)
2) and full treatment
20/200 in his LE.
Figure 4: FA showing leaking points (on the left) and OCT in
2021 showing diffuse neuroepitelium detachment in macular
and CF in his LE.
Figure 5:
the detachment and BCVA was 20/50 in his RE and 20/200 in
his LE.
102
Different Therapeutic Approaches in Central Serous Corioretinopathy: A Case Series
Citation: Mary Romano., et al. “Different Therapeutic Approaches in Central Serous Corioretinopathy: A Case Series". 5.8
(2022): 101-105.
Case 3
in 2021 with a subfoveal neuroepitelium detachment in LE and a
leaking point nasal to the fovea in FA. His BCVA was 20/20 in his
RE and 20/25 in his LE. Treatment with curcumin-based integrator
was started and then argon laser was performed on leaking point.
diameter (150 µm), low intensity (70-80 mW), to achieve a slight
whitening of the retina, and short pulse duration (100 mSec). After
totally disappeared. After 6 months, BCVA was still 20/20, but in
OCT a PED reappeared in correspondence of the leaking point.
treatment.
Figure 6: OCT and FA showing a subfoveal neuroepitelium
detachment and a leaking point nasal to the fovea. At this time
BCVA was 20/25.
Figure 7: After argon laser treatment on leaking point OCT
Figure 8: After 6 months OCT showed again a little
neuropitelium detachment nasally to the fovea, but BCVA was
still 20/20.
Figure 9: With only pharmacological treatment after three
Discussion
We report three patients with CSCR that were treated in
different ways.
micropulse laser that consist of repetitive ultrashort laser pulses
targeting the RPE [1]. The pulses are targeted on the points of
released to the choroid and neurosensory retina, and thus avoiding
damaging those structures [2-5]. Micropulse laser treatment may
be more effective in cCSCR eyes with focal leakage compared to
eyes with diffuse leakage [6]. Our case was, indeed, perfect for this
treatment, because of the single points of leakage temporally to the
fovea.
Different Therapeutic Approaches in Central Serous Corioretinopathy: A Case Series
Citation: Mary Romano., et al. “Different Therapeutic Approaches in Central Serous Corioretinopathy: A Case Series". 5.8
(2022): 101-105.
The second patient has a chronic history of CSCR. He was
treated with PDT. It is supposed that PDT acts in CSCR by inducing
choroidal hypoperfusion, vascular narrowing and remodelling in
order to negate choroidal hyperpermeability which is often found
in CSCR [7]. Patients with cCSCR generally respond better to half-
dose PDT compared to HSML treatment [8].
The third patient was treated with argon laser on the point of
leakage. This method of laser treatment targets the focal leakage
points measured on FA and attempts to close the focal defect in
the outer blood-retina barrier by applying photocoagulation to
the affected area of the RPE. Laser photocoagulation should be
limited to extrafoveal leakage sites, as vision loss, scotoma, reduced
contrast sensitivity, and/or CNV can occur at the treated area [9-
11].
Conclusions
to controversy. Regarding aCSCR, treatment can often be deferred,
due to the high rate of spontaneous recovery. When treatment is
indicated in aCSCR, the current evidence suggests that half-dose or
of choice for accelerating SRF resolution, improving vision, and
decreasing the risk of recurrence. Regarding cCSCR half-dose (or
When a good visual result is obtained in these forms, the aim should
be the maintenance of the recovery and this can be reached by using
less invasive approaches such as pharmacological treatment which,
Patient Consent
Patient consent was obtained for this publication.
Acknowledgements and Disclosures
• No funding or grant support.
•
JVG, AR, PV.
• All authors attest that they meet the current ICMJE criteria for
Authorship.
Intellectual Property
protection of intellectual property associated with this work and
that there are no impediments to publication, including the timing
of publication, with respect to intellectual property.
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Different Therapeutic Approaches in Central Serous Corioretinopathy: A Case Series
Citation: Mary Romano., et al. “Different Therapeutic Approaches in Central Serous Corioretinopathy: A Case Series". 5.8
(2022): 101-105.
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Different Therapeutic Approaches in Central Serous Corioretinopathy: A Case Series
Citation: Mary Romano., et al. “Different Therapeutic Approaches in Central Serous Corioretinopathy: A Case Series". 5.8
(2022): 101-105.
