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Central Serous Chorioretinopathy!




SYMPTOMS:

•Metamorphopsia and micropsia

•Blurred vision

•Impaired dark adaptation

•Colour desaturation


CHRONIC CSCR:

•Diffuse retinal pigment epitheliopathy that progresses in conjunction with persistent or intermittent presence of subretinal fluid.

•The retinal detachments tend to be shallow and more diffuse than in the classic form.

•Cystic intraretinal changes can occur late in the presence of chronic subretinal fluid.


RISK FACTORS:

Systemic:

•Type A personality

•Stress

•Hypertension

•Pregnancy

•SLE

•GERD

•Tobacco/Alcohol use

•Autoimmune disorders


Medications:

•Corticosteroids

•Sympathomimetics

•Sildenafil

•Antihistamines

•Psychopharmacologic medication


MECHANISM OF ACTION:

-Abnormal choroidal circulation

-Localised capillary/venous congestion leads to impairment of circulation causing ischemia.

-This causes increased choroidal exudation, hyperpermeable choroid leading to excess choroidal fluid accumulation causing RPED.

-As detachment increases, target junctions between RPE are broken, focal defect of BRB develops.

-Choroidal fluid passes through causing neural RD.


DIAGNOSIS:

•Fundus Examination: a translucence in the posterior pole between the neural retina and the RPE is seen.

•OCT: hyperreflective dots consistent with punctate precipitates and white material within the serous retinal detachment just under the retina.

•FFA: dye from the choroid leaks through a focal RPE defect and pools in the sub- retinal space.

•Ink blot sign: leaking small PED.

-Smoke stack sign: the PED has a focal defect in the overlying RPE and the dye streams out of this defect into the surrounding subretinal fluid.

•ICG: bilateral multifocal hyperfluorescent areas during the midphase.


Treatment

•Discontinue Corticosteroids

•Mineralocorticoid antagonists and Rifampin

•Laser Photocoagulation

•Photodynamic Therapy


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