Wednesday, October 22, 2014

Central Serous Retinopathy

Definition

Retinopathy is a condition in which deterioration of the retina is caused by damage to, or over-production of, the blood vessels in the retina.

Description

Central serous retinopathy is a slight accumulation of fluid in the macular region of the eye thatlies between the retinal pigment epithelium and the outer segments. A relative central scotoma (area of lost or depressed vision within the visual field surrounded by an area of less depressed or normal vision) results, but usually resolves spontaneously within a few months.

Serous means thin and watery-like serum.

Central serous retinopathy is characterized by an accumulation of transparent fluid at the posterior pole of the fundus (base), causing a circumscribed area of retinal detachment at the posterior pole.

When left alone, central serous retinopathy heals spontaneously within 4 to 8 weeks, with full recovery of visual acuity.

However, about one-third to one-half of all patients have recurrences after the first episode of the disease; 10 percent have three or more recurrences.

In almost half of the patients, the recurrence is within one year of the primary episode, but relapses may occur up to ten years later.

Causes

Central serous retinopathy is due to a leakage, of unknown origin, through the pigment epithelium.

Symptoms

Many patients first notice a minor blurring of vision, followed by various degrees of:

  • metamorphopsia (defective, distorted vision)
  • micropsia (distorted visual perception in which objects appear smaller than their actual size)
  • chromatopsia (visual defect in which objects appear unnaturally colored)
  • central scotoma
  • increasing hyperopia (farsightedness)

Visual acuity in the acute stage may range from 20/20 to 20/200 and averages 20/30. In some patients the onset of symptoms is preceded or accompanied by migraine-like headaches.

Diagnosis

The diagnosis is made by an eye examination, sometimes using a fundus contact lens.

The diagnosis is confirmed by fluorescein angiography. Typically the fluorescein enters into the blister and stains its contents, identifying one or more leakage points.

Treatment

Although no medication has thus far proved effective in treating central serous retinopathy, a beneficial effect of laser photocoagulation has been reported in several studies. Findings indicate that direct photocoagulation of the leakage point not only shortens the acute phase of the disease but also lowers the recurrence rate to about one fifth of what would be expected without active treatment.

Questions

What causes central serous retinopathy?

What treatment do you recommend?

What is the prognosis?