• Retina/Vitreous

    This article reviews the epidemiology, risk factors, clinical presentation, natural history and pathophysiology of central serous chorioretinopathy (CSCR).

    The authors conducted a literature search for CSCR, as well as other names that have been used to describe the condition, including idiopathic central serous choroidopathy, central serous retinopathy and diffuse retinal pigment epitheliopathy.

    CSCR is a common retinal cause of vision loss. It is predominantly a disease of middle-aged men but can occur in older individuals and women. The best estimate of mean age-adjusted incidence is 9.9 per 100,000 in men, with the disease occurring six times more commonly in men than women.

    Clinically, CSCR can present acutely as serous neurosensory detachment that often resolves spontaneously within six months, as recurrent episodes often occurring within the first year, or chronically with distinctive retinal pigment epithelium changes and persistent shallow retinal detachments.

    Most acute CSCR cases resolve spontaneously within two to three months. Prognosis is highly dependent on presenting visual acuity. Patients with initial visual acuities of 6/6 remain at that level, while patients with initial visual acuities of less than 6/9 recover on average two to three Snellen lines over the next few years. Up to half of patients may have a recurrence, often within the first year of the primary episode.

    The main risk factors for CSCR are systemic corticosteroid use, type A personality, pregnancy and endogenous Cushing syndrome. Other risk factors that have been described include obstructive sleep apnea, collagen vascular diseases, hypertension, elevated plasma testosterone and H. pylori infection.

    The pathophysiology of CSCR remains obscure, although disorders in both choroidal circulation and retinal pigment epithelium are implicated.