VA

Conference

Michele Todman

CSC

• 25-55 years old

• M>F

• Common Whites, Hispanics, Asians, and rare in African Americans

• Type A personality and corticosteroids

• Sudden onset of blurred and dim vision, micropsia, metamorphopsia, paracentral scotoma, or decreased color vision.

Natural Course

• 80-90% undergo spontaneous resorption of SRF in 3-4 months and recovery of visual acuity generally follows.

• 40-50% experience one or more recurrences (chronic CSC-detachments ≥6 months)

Pathogenesis

• Unknown

• Theory: Stasis, ischemia, inflammation or combo of inner choroid lead to abnormal permeablility and elevation of RPE. Not associated with proliferation of choroidal vessels. (primary) Disruption in detached RPE causes focal leakage and neurosensory detachment. (secondary)

Laser Photocoagulation

• Laser photocoagulation at site of fluorescein leakage can induce rapid remission and resorption of SRF which can occur within several weeks of photocoagulation.

• If leakage site too close to fovea consider PDT.• Laser photocoagulation can cause

photoreceptor and RPE degeneration, CNV, and the accompanying visual scotoma.

Treatment Guidelines

Laser photocoagulation if:• Serous detachment beyond 3-4 months• Disease recurs in eyes with visual defects from

previous episodes• Permanent visual defect present from prior

episode in fellow eye• Chronic signs develop such as cystic changes in

neurosensory retina or widespread RPE abnormalities

• Occupational or other patient needs require prompt restoration of vision or stereopsis

PDT

• Works for chronic CSC• Hypoperfusion of choriocapillaris in short term

and choroidal vascular remodeling over time which reduces choroidal congestion and vascular permeability

• Desirable for eyes with intense or mod intense hypercyanescence in middle or late phase of ICG

• Good for foveal leaks because unlike photocoagulation won’t cause photoreceptor and RPE degeneration and the accompanying visual scotoma.

TreatmentAssociation Between the Efficacy of Photodynamic Therapy and Indocyanine Green Angiography Findings for CSC. American Journal of Ophthalmology 2010;149:441-446. (32 eyes of 27 patients with chronic CSC—Observational Case Series…Follow-up 1 year…baseline.1.3.6.9.12 months after PDT)

• Inclusion:Visual sympoms such as metamorphopsia; SRF involving fovea on OCT; Active angiographic leakage at level of RPE on FA;abnormal dilation of choroidal vasculature

• Effectiveness of PDT differed depending on variations of hyperpermeability on ICG at baseline. 3 months no SRF in eyes with intense and intermediate hypecyanescence. Persisent SRF in 100% with no hypercyanescence.

• PDT less effective in eyes without hyperpermeability.• High recurrence rate in eyes with intermediate

hypercyanescence.

Intense hypercyanescence—homogenous well defined area brighter than backgroundIntermed hypercyanescense—less defined slight brighter than bkgrndAbsence of hypercyanescence—no distinct hypercyanescence and slightly decreased cyanescence compared with bkgrnd