Central serous retinopathy

Infobox_Disease
Name = PAGENAME


Caption =
DiseasesDB = 31277
ICD10 = ICD10|H|35|7|h|30
ICD9 = ICD9|362.41
ICDO =
OMIM =
MedlinePlus =
eMedicineSubj = oph
eMedicineTopic = 689
MeshID =

Central serous retinopathy (CSR), also known as central serous chorioretinopathy (CSC), is a visual impairment, often temporary, usually in one eye, mostly affecting males in the age group 20 to 50 but which may also affect women [cite journal |author=QUILLEN D. A., GASS J. D. M., BROD R.D., GARDNER T. W., BLANKENSHIP G. W. and GOTTLIEB J. L. ; |title=Central serous chorioretinopathy in women |journal=Ophthalmology |volume=103 |issue=1 |pages=72–79 |year=1996 |pmid=8628563] . The disorder is characterized by leakage of fluid in the central macula, which results in blurred or distorted vision (metamorphopsia). A blind or gray spot in the central vision is common, along with flashes of light (photopsia).

Diagnosis

The diagnosis usually starts with a dilated examination of the retina, followed with confirmation by fluorescein angiography. The angiography test will usually show one or more fluorescent spots with fluid leakage. In 10%-15% of the cases these will appear in a "classic" smoke stack shape. An Amsler grid could be useful in documenting the precise area of the visual field involved.

Causes

CSR is a fluid detachment of macula layers from their supporting tissue. This allows choroidal fluid to leak into the subretinal space. The buildup of fluid seems to occur because of small breaks in the retinal pigment epithelium.

CSR is sometimes called "idiopathic CSR" which means that its cause is unknown. Nevertheless, stress appears to play an important role. An oft-cited but potentially inaccurate conclusion is that persons in stressful occupations, such as airplane pilots, have a higher incidence of CSR.The "type A personality" has also been linked to this condition. However, the statistics may be skewed by the fact that CSR often goes undiagnosed or misdiagnosed; airline pilots and so-called "type A" people are demonstrably exacting, demanding people with (certainly in the case of pilots) better-than-average vision. They are more likely than the general population to notice the sometimes-subtle degradation of vision caused by CSR and insist on a believable diagnosis of it. People who need glasses may assume that the blurriness caused by CSR is simply a change in their prescription, and fail to have the condition assessed by a retinal specialist. These statistic-skewing factors undermine the conclusion that CSR is a condition specific to "type A" people.

CSR has also been associated with cortisol and corticosteroids, and personswith higher levels of cortisol than normal also have a higherpropensity to suffer from CSR. Cortisol is a hormone secretedby the adrenal cortex which allows the body to deal withstress, which may explain the CSR-stress association. There is extensive evidence to the effect that corticosteroids ("cortisone")--- commonly used to treat inflammations, allergies, skin conditions and even certain eye conditions --- can trigger CSR, aggravate itand cause relapses.cite journal |author=Pizzimenti JJ, Daniel KP |title=Central serous chorioretinopathy after epidural steroid injection |journal=Pharmacotherapy |volume=25 |issue=8 |pages=1141–6 |year=2005 |pmid=16207106 |doi=10.1592/phco.2005.25.8.1141] cite journal |author=Bevis T, Ratnakaram R, Smith MF, Bhatti MT |title=Visual loss due to central serous chorioretinopathy during corticosteroid treatment for giant cell arteritis |journal=Clin. Experiment. Ophthalmol. |volume=33 |issue=4 |pages=437–9 |year=2005 |pmid=16033370 |doi=10.1111/j.1442-9071.2005.01017.x] cite journal |author=Fernández Hortelano A, Sádaba LM, Heras Mulero H, García Layana A |title= [Central serous chorioretinopathy as a complication of epitheliopathy under treatment with glucocorticoids] |language=Spanish; Castilian |journal=Arch Soc Esp Oftalmol |volume=80 |issue=4 |pages=255–8 |year=2005 |pmid=15852168 |doi=]

The incidence of CSR in persons with Cushing's syndromeis 5%. Cushing's syndrome is characterized by very highcortisol levels.

Recently found evidence has also implicated Helicobacter pylori(see gastritis) as playing a role.cite journal |author=Giusti C |title=Association of Helicobacter pylori with central serous chorioretinopathy: hypotheses regarding pathogenesis |journal=Med. Hypotheses |volume=63 |issue=3 |pages=524–7 |year=2004 |pmid=15288381 |doi=10.1016/j.mehy.2004.02.020] cite journal |author=Ahnoux-Zabsonre A, Quaranta M, Mauget-Faÿsse M |title= [Prevalence of Helicobacter pylori in central serous chorioretinopathy and diffuse retinal epitheliopathy: a complementary study] |language=French |journal=J Fr Ophtalmol |volume=27 |issue=10 |pages=1129–33 |year=2004 |pmid=15687922 |doi=] cite journal |author=Cotticelli L, Borrelli M, D'Alessio AC, "et al" |title=Central serous chorioretinopathy and Helicobacter pylori |journal=Eur J Ophthalmol |volume=16 |issue=2 |pages=274–8 |year=2006 |pmid=16703546 |doi=] It would appear that the presence of the bacteria is well correlated with
visual acuity and other retinal findings following an attack.

Recent evidence also shows that sufferers of MPGN Type II kidney disease can develop retinal abnormalities including CSR caused by deposits of the same material that originally damaged the glomerular basement membrane in the kidneys. [citation|author=Colville D, Guymer R, Sinclair RA, Savige J|title=Visual impairment caused by retinal abnormalities in mesangiocapillary (membranoproliferative) glomerulonephritis type II (dense deposit disease)|publisher=American Journal of Kidney Diseases |volume=42|pages=e2-e5|year=2003|url=http://www.ajkd.org/article/S0272-6386(03)00665-6/|id=S0272-6386(03)00665-6]

Prognosis

The prognosis for CSR is generally excellent. Over 90% of patients regain 20/30 vision or better within 6 months. Somevisual abnormalities can remain even if visual acuity is measuredat 20/20. Lasting problems can include decreased night vision,color discrimination problems, and some distortion.cite journal |author=Baran NV, Gürlü VP, Esgin H |title=Long-term macular function in eyes with central serous chorioretinopathy |journal=Clin. Experiment. Ophthalmol. |volume=33 |issue=4 |pages=369–72 |year=2005 |pmid=16033348 |doi=10.1111/j.1442-9071.2005.01027.x |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1442-6404&date=2005&volume=33&issue=4&spage=369] Long term complications can include subretinal neovascularization and
pigment epitheliopathy.cite journal |author=Kanyange ML, De Laey JJ |title=Long-term follow-up of central serous chorioretinopathy (CSCR) |journal=Bull Soc Belge Ophtalmol |volume= |issue=284 |pages=39–44 |year=2002 |pmid=12161989 |doi=]

Treatment

There is no known effective treatment for the disease.
Laser photocoagulation, which effectively burns the leak area shut, is sometimes suggested. In many cases the leak is very near the central macula, where photocoagulation would leave a blind spot.Additionally, a better long term outcome has not beendemonstrated with photocoagulation. So more often than not the condition goes untreated.

Transpupillary thermotherapy has been suggested as a lower-riskalternative to laser photocoagulation in cases where the leakis in the central macula.cite journal |author=Wei SY, Yang CM |title=Transpupillary thermotherapy in the treatment of central serous chorioretinopathy |journal=Ophthalmic Surg Lasers Imaging |volume=36 |issue=5 |pages=412–5 |year=2005 |pmid=16238041 |doi=]

Any ongoing corticosteroid treatment should be stopped. Additionally,a new anti-microbial treatment will likely be recommendedsoon in light of recent findings regarding Helicobacter pylori.

CSR sufferers usually find their own ways to managethe condition, which may include stress reduction andchanges in nutrition.cite web |url=http://www.geocities.com/tim_josling/csrtreat.html |title=CSR - Central Serous Retinopathy- Treatments |accessdate=2008-01-02 |format= |work=]

CSR Support Group http://health.groups.yahoo.com/group/csreye/

References

ee also

* Cortisol
* Cushing's syndrome
* Diabetic retinopathy
* Hypertensive retinopathy
* Macular degeneration
* Posterior vitreous detachment
* Stress