CSR image

Central serous retinopathy (CSR, or more correctly known as Central Serous ChorioRetinopathy (CSCR), is a condition that leads to the accumulation of fluid under the retina, and usually affects the central part of the retina known as the macula. It typically affects males more than females. The usual age of diagnosis is between 20-40 years old. CSR typically presents as blurry central vision, that may be associated with visual distortion. Straight lines may appear kinked, bent or wavy. There may be a grey spot near the centre of your vision, sometimes associated with a bright outline. 

 

While the cause of CSR is not known, a number of factors can exacerbate the condition. Steroid use, in the form of injections, tablets, inhalers or even creams, can make the condition and prolong its duration. Patients with high levels of stress or type A personalities have also been shown to have worse symptoms. Obstructive sleep apnoea may also play a role in this condition.

 

CSR is diagnosed based on the clinical examination as well as characteristic findings on OCT scanning, as shown:

Most cases of CSR resolve spontaneously, usually within 2-3 months. However some patients are prone to recurrent episodes, either in the same eye or both eyes. If a case of CSR does not resolve within 6 months, it is termed “chronic CSR” and requires medical intervention. The appropriate treatment is based on the leakage point, as shown by Fundus Fluorescein Angiography (FFA) and ICG Angiography. Our clinic is equipped with ultra-wide field FFA and ICG imaging using the Optos California, allowing both angiograms to be performed within a short period of time using interweaved technology. ICG imaging allows visualisation of the deeper choroidal circulation, which can more clearly delineate the source of leakage. This specialised test is only available at a limited number of ophthalmology centres.

 

Fundus fluorescein angiography (FFA) demonstrating leakage point in CSR

Fundus fluorescein angiography (FFA) demonstrating leakage point in CSR

Treatment options include micro pulse retinal laser, especially  if the leakage point is away from the central vision. Intravitreal injection of medication may also improve fluid reabsorption. Photodynamic therapy (PDT) has been shown to be an effective treatment for this condition. There is also increasing evidence on the use of oral medication in appropriate situations. Our retinal specialists will discuss the various treatment modalities with you in further detail.