From the Guidelines
The treatment for Central Serous Chorioretinopathy (CSC) is half-dose Photodynamic Therapy (PDT).
Treatment Options
- Half-dose PDT is currently the treatment of choice for achieving rapid subretinal fluid (SRF) resolution, a faster improvement in best-corrected visual acuity (BCVA), and a decreased risk of recurrence compared to other available treatments 1.
- Argon laser photocoagulation can be considered in specific cases, particularly if the focal leak on fluorescein angiography (FA) is located at a relatively safe distance from the central macula, but it carries risks such as causing a symptomatic paracentral scotoma, myopic neovascularization (MNV), and/or chorioretinal adhesions with secondary intraretinal cystoid fluid 1.
- Intravitreal injections of anti-VEGF medication can be used in combination with half-dose PDT for CSC with MNV 1.
Treatment Approach
- Observation is the most commonly used and recommended strategy during the first 4 months for acute CSC (aCSC), given the high rate of spontaneous SRF resolution during this time frame 1.
- Treatment can be performed soon after presentation for patients who require rapid SRF resolution and restoring of visual function, such as for professional reasons 1.
- ICGA-guided half-dose PDT may be the method of choice in aCSC, as this method can optimally treat the underlying choroidal abnormalities 1.
From the Research
Treatment Options for Central Serous Chorioretinopathy (CSC)
The treatment for Central Serous Chorioretinopathy (CSC) varies depending on the severity and duration of the condition. Some of the treatment options include:
- Observation: As most cases of CSC resolve spontaneously within 3 months, observation is often the initial treatment approach 2, 3.
- Photodynamic Therapy (PDT): PDT with verteporfin has been shown to be effective in improving visual acuity, reducing subretinal fluid, and maintaining long-term effectiveness 2, 4, 5.
- Subthreshold Laser Treatment (SLT): SLT has been found to be valuable in improving visual acuity and reducing subretinal fluid 2.
- Mineralocorticoid Receptor (MR) Antagonists: MR antagonists may be a viable choice for the treatment of chronic CSC 2.
- Anti-vascular Endothelial Growth Factor (anti-VEGF) Drugs: The efficacy of anti-VEGF drugs in treating CSC is still unclear, with no clear evidence of efficacy achieved 2.
- Modified Photodynamic Therapy: Modified PDT with ICG-guided laser photocoagulation has been shown to be effective in treating recurrent CSC 4.
- Reduced-dose or Reduced-fluence PDT Regimens: These regimens have been found to be effective in treating chronic CSC, with comparable efficacy and safety to standard PDT 5.
Factors Influencing Treatment Choice
The choice of treatment for CSC depends on various factors, including:
- Duration and severity of the condition
- Presence of chronic or recurrent disease
- Patient demographics and underlying health conditions
- Response to initial treatment approaches
Ongoing Research and Development
Further research is needed to determine the effectiveness of different treatment approaches for CSC, including the use of new technologies such as optical coherence tomography imaging 6. Additionally, comparative studies are required to determine the best treatment options for patients with varied demographics, aetiology, and chronicity of disease 6.