Central serous retinopathy (CSR) is a condition of unknown cause in which fluid accumulates underneath the retina in the central macula. This leads to distortion and blurred vision. Most patients with CSR are males in their third and fourth decades. Stress or corticosteroid use may play roles in inciting or aggravation the condition. After the age of 50 or 55, the diagnosis is more difficult to make as there is a certain degree of overlap with age-related macular degeneration. We have seen patients who presented with very typical central serous retinopathy who then later evolved to age-related macular degeneration, so the prognosis in older patients is somewhat different than younger or middle-aged patients.
Fluorescein angiography is a common test that can substantiate the diagnosis of CSR. In this test, an orange dye is injected into the patient’s vein, and this dye is observed as it circulates through the ocular vasculature. Often, areas of previous retinal pigment epithelial disruption can be visualized elsewhere in the same eye or in the macula of the unaffected eye. Ocular coherence tomography (OCT) is another test that is helpful. This imaging modality can accurately detect fluid and swelling in the retina.
The typical patient with central serous retinopathy does not require treatment. Most episodes of this condition are self-limited and resolve within 2 to 3 months. Simple reassurance to the patient that this will occur is beneficial. In some patients, the subretinal fluid persists for longer than this time period, and, in this setting, treatment is recommended. Thermal laser can be applied to the area of the retinal pigment epithelium that is thought to be playing a role in fluid accumulation. Usually, this treatment is quite effective and can be very useful when the area of leakage is well away from the center of vision. Other treatments, including a different laser modality called photodynamic therapy (PDT), can be used in certain situations.
Many patients will recover vision back to the 20/20 level, however, patients will often report that vision in the affected eye is not quite as good as the normal eye even long after the fluid has resolved. Approximately 25% of patients develop a recurrent episode. There is also a subset of patients with significant retinal pigment epithelial abnormalities that are predisposed to attacks in both eyes, often simultaneously, and the prognosis in this group is much less optimistic, though with treatment many can maintain reading and driving vision.