Dr.Madhuamita Das, Dr.Sumita Mohapatra,Dr.Diptmayee Nayar,Dr.Nibdita Moharana
INTRODUCTION
Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterised by a localized serous detachment of sensory retina at macula secondary to leakage from choriocapillaris through one or more hyper permeable Retinal pigment epithelium sites.
THEORIES OF PATHOGENESIS-
Role of choroid-
Choroid plays an important role in pathogenesis of CSCR. Choroid is thought to be hyper permeable in CSCR, possibly as a result of ischemia, stasis or inflammation. The staining of inner choroid in mid-phase ICG angiography is the primary evidence of choroidal hyper permeablity. The primary role of choroid is further supported by Enhance Depth Imaging Optical Coherence Tomography finding of a thickened choroid in both eyes of patient with CSCR. Hyper permeable choroidal vessels are supposed to produce increased tissue hydrostatic pressure, which promotes the formation of retinal pigment epithelial detachments, overwhelms the barrier function of RPE, leading to accumulation of fluid between retina and RPE.
Role of RPE-
In fluorescein angiography, presence of focal leakage shows RPE detachment. It suggests fluid emanates through choroid and escapes into subretinal space through defect in tight junctions between cells of RPE. Affected RPE cells may lose their normal polarity and pump fluid from choroid towards retina, causing a neurosensory detachment.
Risk factors include –steroid use, smoking, pregnancy, psychological stress, sleep apnoea syndrome, H.pylori infection. CSCR typically affect one eye of a young or middle aged male, female with CSCR tends to be older.
AIM- tostudy the status of the fellow eye in Central serous chorioretinopathy
METHOD-
A prospective study including 40 patients with unilateral CSCR was done who presented to our hospital between October 2017-March 2018. BCVA recorded,fundoscopy done and Subfovealchoroidal thickness of both eyes were measured by Enhance Depth Imaging spectral domain optical coherence tomography(EDI OCT)at presentation.This data is compared with age and sex matched control.
EXCLUSION CRITERIA-
- Patients with bilateral CSCR at presentation
- Patients with previous history of CSCR or other macular diseases
RESULT-
Mean age of presentation is 45±5 year. Male: female is 4:1. BCVA of affected eyes were between 6/12-6/24 and of fellow eye was 6/6. Fundoscopy of fellow eye were normal. Mean Subfovealchoroidal thickness in symptomatic eyes was 422.56±92.22µm,in fellow eye it was 351.92±62.50 µm and in control group 217.80 ±32.42 µm.
ANALYSIS-
Most of the patients are middle agedmales. Mean subfofevalchoroidal thickness in CSCR eyes increased. Also subfovealchoroidal thickness of fellow eye increased in compared to control, which though appeared clinically normal.
CONCLUSION-
Subfovealchoroidal thickness is more in fellow eyes of CSCR patients as compared to normal population, showing that though the disease presents unilaterally, pathology lies in both eyes.So fellow eye of CSCR patients should be evaluated giving equal importance as diseased eye.
References –
- Kanski’s clinical ophthalmology, Eighth edition
- Central serous chorioretinopathy: update on pathophysiology and treatment,BenjaminNicholson,M.D.,Jason Nobel and Catherine Meyerle, Survey of Ophthalmology
- Central serous chorioretinopathy:A Review of the literature,GunjanPrakash,NishaChauhan,Sephali Jain ,Asia Pacific Journal of Ophthamlology
- A deep dive on central serous chorioretinopathy,Jose A.Roca,NataliaAlvarez,RetinaToday,July/August 2018
- PrunteC,FlammerJ,choroidal capillary and venous congestionin central serous chorioretinopathy,Am J Ophthalmology,1996;121:26-34
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