Central serous chorioretinopathy.
BACKGROUND
Central serous chorioretinopathy is a condition typically affecting young adults between 25 and 50 years of age. It is predominating in type A personality trait men. Central serous chorioretinopathy is defined clinically as a detachment of the sensory retina that is commonly unilateral but can also be bilateral. Laser photocoagulation has been used widely with central serous chorioretinopathy to prevent recurrence and to speed recovery time. Photodynamic therapy is emerging as a potential treatment for chronic central serous chorioretinopathy. The prognosis for resolution and visual recovery for patients with central serous chorioretinopathy is excellent. Approximately 95% of patients with central serous chorioretinopathy will recover to a final visual acuity of 20/30.


METHODS
Patient 1 was a 57-year-old man who reported to the clinic with a complaint of central scotoma involving the left eye. He also had a decrease in best-corrected visual acuity of 20/30 in the left eye. Idiopathic central serous chorioretinopathy was diagnosed, and observation was the management choice. At the 6-month follow-up, the patient's left eye visual acuity had returned to 20/20. Patient 2 was a 63-year-old man who reported to the clinic with decreased central vision of the left eye. His best-corrected visual acuity in that eye was 20/40. This was an unusual case because of the patient's age and the risk of macular degeneration. With fluorescein angiography and optical coherence tomography, the diagnosis of central serous chorioretinopathy was confirmed. At the 10-month follow-up the patient's acuity had returned to 20/20 in the left eye. Patient 3 was a 59-year-old man who reported to the clinic with decreased vision in the left eye. His best-corrected visual acuity was 20/60 in that eye. He is a kidney transplant recipient and was taking 60 mg of prednisone. The patient was found to have steroid-induced central serous chorioretinopathy. Observation was the management of choice for several months without resolution. Focal laser photocoagulation was performed at the 6-month follow-up, which did not help, and his ultimate visual acuity in the left eye was 20/400. He returned to the clinic 3 years later with the same complaint in his right eye. The patient was again found to have steroid-induced central serous chorioretinopathy but in the right eye, with a best-corrected visual acuity of 20/30. Because of the failure of photocoagulation in the left eye, observation was the chosen management option. The central serous chorioretinopathy did not resolve, and because of this it was decided that the patient's nephrologist be contacted to suggest a decrease in the patient's oral prednisone dose. The nephrologist decreased his prednisone from 60 mg daily to 5 mg daily. With this change, the patient's visual acuity stabilized at 20/25. The central serous chorioretinopathy was still present but without subjective visual complaints.


CONCLUSIONS
Central serous chorioretinopathy is a condition that normally affects type A personality trait men. Also, patients taking any type of corticosteroids must be watched closely for the development of central serous chorioretinopathy. There is no good course for treatment, with observation being the best management choice. Photodynamic therapy may become the treatment choice for patients with chronic central serous chorioretinopathy, but more studies on the use of photodynamic therapy need to be completed.
Marcuson
Jeremy
J
Spokane Veterans Affairs Medical Center, Spokane, Washington 99205, USA.
Riley
Thomas
T
D015862:Choroid Diseases / Q000175:diagnosis* / Q000628:therapy; D005451:Fluorescein Angiography; D006801:Humans; D008028:Light Coagulation; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000175:diagnosis* / Q000628:therapy; D041623:Tomography, Optical Coherence