Treatment of central serous chorioretinopathy: new options for an old disease

Central serous chorioretinopathy (CSC) is a common ocular disease that causes vision loss, particularly in people of working age. Although it was first described over a century ago, research has expanded in recent years, transforming the understanding and management of this complex condition. Here, we propose clinical recommendations for the treatment and management of CSC, based on evidence from the published literature and the consensus of an international group of retinal experts. Recent evidence describing the pathogenesis of and risk factors for CSC focuses on possible dysfunction of the choroid and retinal pigment epithelium, and the role of corticosteroids. It is suggested that CSC lies within the spectrum of pachychoroid disorders that share the characteristic of thickened choroidal tissue. Available evidence supports half-dose (or half-fluence) verteporfin photodynamic therapy as the treatment of choice for CSC to reduce choroidal hyperpermeability. A subset of patients with chronic CSC can develop choroidal neovascularisation, and these patients should be treated with intravitreal anti-vascular endothelial growth factor agents. Finally, posterior multifocal pigment epitheliopathy is a recognised variant of CSC that may progress to large areas of exudative retinal detachment. We propose a step-wise chart for clinical decision-making in the management and treatment of CSC. New data on long-term visual outcomes and the pathogenesis of CSC in relation to the pachychoroid disease spectrum provide a better understanding to inform our management of this disease.