CSCR Disease (Central Serous Chorioretinopathy)

CSCR disease (central serous chorioretinopathy) develops in the retina’s area of sharp vision and is characterized by the appearance of fluid accumulation between the retinal layers (pigment epithelium and neurosensory layer) with consequent blurred vision. The fluid originates from the choroid, the vascular layer beneath the retina, whose function becomes altered, for example due to stress or following steroid treatments.

CSCR disease belongs to the group of pachychoroidal diseases, which share the common feature of thickening of the choroid beneath the retina. The condition is sometimes incorrectly diagnosed as macular edema or macular degeneration on initial presentation, and the patient only reaches a specialist when treatment proves ineffective.

Symptoms of CSCR Disease

• symptoms are usually unilateral
• central blurred vision and scotoma are characteristic
• the blur in the center of the visual field does not change with eye movement
• objects appear smaller and more distant than when viewed with the other eye
• metamorphopsia, distortion of the visual image, may occur

Causes and Risk Factors of CSCR Disease

The exact cause of central serous chorioretinopathy (CSCR) disease is not fully understood. It is known that severe stress and steroid treatments can trigger the process in some individuals. In addition, certain nasal sprays (for colds, asthma), some bodybuilding substances, or male potency enhancers are also among the triggering factors. The disease most commonly affects working-age men, but women and older age groups are also affected.

Other conditions act as risk factors for the development of CSCR disease, making their management important. In cases of suspicion, we recommend investigation for cardiovascular disease, sleep apnea, Cushing’s disease, or Helicobacter pylori infection.

Course of CSCR Disease

Central serous chorioretinopathy (CSCR) is a condition with a highly variable course. The disease can resolve spontaneously within 2-3 months, especially if the triggering factor can be identified and eliminated. However, even during this short period, cell death occurs, the trace of which remains permanently visible on the fundus in almost every case. It is not uncommon, however, for the disease to persist beyond 4 months, even for years, during which it progressively worsens vision.

The subretinal fluid accumulation that appears beneath the retina separates two layers that can only function properly when closely adhered to each other. The initially reversible blurred vision in the first weeks leads to progressive damage due to persistent cellular dysfunction, resulting in permanent vision loss. The exact timing of this turning point is not known; however, we observe certain cellular damage even with fluid accumulation present for only a few weeks. At the same time, this does not necessarily mean vision loss perceptible in daily life. In cases of spontaneous recovery, the disease may recur months or years later or may appear in the other eye. In rarer cases, the disease may also be complicated by neovascularization.

Treatment of CSCR Disease

In treating central serous chorioretinopathy (CSCR) disease, the most important goal is the earliest possible elimination of subretinal fluid accumulation. In CSCR, fundus micropulse laser treatment as early as possible is primarily recommended, which is a painless, rapid, and side-effect-free intervention.

The goal of treatment is early fluid resorption and thereby achieving minimal cell death. Once the fluid has been reabsorbed and the retinal layers have re-adhered to each other, vision improvement also becomes dramatic, provided there is no severe cellular damage yet. Although anatomical damage becomes visible even within a few weeks, this does not always mean noticeable vision loss; therefore, treatment makes sense even in cases persisting for years.

Earlier treatment methods have been relegated to the background since the availability of micropulse laser treatment, due to unwanted side effects and lower efficacy. Nevertheless, these alternative treatment options remain an important part of the therapeutic arsenal and are occasionally still used today.

Micropulse Laser Treatment of CSCR Disease

Micropulse laser treatment is the most modern treatment method for the disease, during which the lesion is treated with series of short-duration laser pulses.

Its advantages over other devices are indisputable and are reflected in treatment success. Currently, only the Navilas micropulse laser device allows precise treatment planning immediately beforehand, which is a critical function for outcomes.

The treatment is non-contact and painless; the patient perceives only flashing lights and quiet beeping lasting a few minutes. After treatment, expect approximately 10 minutes of very blurred vision temporarily, and the pupil-dilating effect also lasts for several hours. Unlike other devices, thanks to the Navilas micropulse laser’s eye-tracking system, blinking and looking away pose no problem. The treatment will occur at the planned location with documented high precision, regardless of minor movements by the patient or physician.

We then mark on these images the tiny, several hundred densely placed points where the laser will be directed. Next, we test the retina’s individual sensitivity to the laser, then after setting the treatment protocol parameters, we begin the treatment.

With proper settings, micropulse treatment has no known retinal damaging effects. Most often one treatment is sufficient, the effect of which usually appears after a few weeks, but if necessary it can be repeated, typically after 2-4 months.

Vision fluctuation may occur in the first weeks after treatment, and significant reduction of fluid accumulation is expected around 6-8 weeks, which usually brings vision improvement. However, during this transitional period, partial fluid resorption does not always coincide with symptom reduction, but this has no significance for final vision improvement and recovery and should not cause concern.

The observation that even very recent cases recover at a much higher rate during this period than if we simply waited to see if it resolves on its own also supports early micropulse treatment of CSCR disease. If, despite this, we delay treatment by a few months, more significant retinal damage must generally be expected, which fortunately does not necessarily mean permanent vision loss.

There are significant differences among existing micropulse devices, and currently only the Navilas is capable of executing treatment with such high precision. This device was chosen after gaining experience with all micropulse lasers available on the market, and the best, most reliable results were achievable with it.

Dr. Gergely is internationally recognized in this field as well, and based on more than a decade of experience and several thousand treated CSCR patients, he fine-tunes international protocols on an individual basis in order to achieve significantly better results than those published in the literature.

Alternative Treatments for CSCR Disease

Selective aldosterone antagonist tablet treatment previously proved promising; however, we currently rarely use it. International studies have demonstrated the advantages of micropulse laser treatment over this approach. The treatment must be administered as a course for at least 3 months, which can be continued for up to 12 months in cases of weak response. Laboratory and internal medicine examinations are required before and during treatment. In addition, dietary restrictions (potassium-rich foods cannot be consumed) and contraindications for co-administration with other medications exist during treatment. Side effects may occasionally occur during treatment (dizziness, vomiting, diarrhea), but treatment rarely needs to be suspended due to their severity.

Another alternative treatment option is PDT or photodynamic therapy. During this treatment, a medication is administered intravenously into the arm, which is then activated by laser on the diseased part of the fundus. As a side effect of the therapy, retinal atrophy may develop, leading to permanent vision loss; therefore, since the availability of micropulse laser treatment, we use it only as a last resort.

In a subset of pachychoroidal diseases and rarely in CSCR, subretinal neovascularization may develop as a complication of the disease. In such cases, the chosen treatment must be supplemented with intravitreal injection therapy.

The disease and its various treatments are among Dr. Gergely’s main research areas, about which you can read in more detail in the Publications menu.