A clinical study on central serous chorioretinopathy

INTRODUCTION: Central serous chorioretinopathy is a disease characterized by spontaneous serous macular detachment of unknown etiology, usually self-limiting but often recurs. It was first described by VonGraefe in 1866 and termed it “central recurrent retinitis”, “central angiopathic retinopathy”. Kitahara in 1936 described it as chorioretinitis centralis serosa. Walsh and solan described it as Idiopathic flat detachment of macula. In 1955 Bennet coined the term central serous retinopathy. Klein and Maumenee used fundus fluorescein angiography to observe leaks at the level of retinal pigment epithelium. In 1967 Gass provided the pathogenesis and labelled it as “Idiopathic central serous choroidopathy”. AIM OF THE STUDY: To study the FFA pattern and use of OCT (Optical coherence tomography) in CSCR. Study the effectiveness of early laser photocoagulation in CSCR patients with extrafoveal leakage in terms of visual acuity and central macular thickness and comparing with the control group. To study the epidemiology (incidence, recurrence, persistent cases) of CSCR. To study the association of CSCR with the use of steroids in any form (systemic, inhalers, ointment etc.,) MATERIALS AND METHODS: This study was conducted in Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Egmore, Chennai, from November 2009 to November 2011 for a period of 2 years. This is a single blind randomised prospective and retrospective interventional clinical study. INCLUSION CRITERIA: All new and review cases attending the Ophthal OPD with central serous retinopathy diagnosed clinically. EXCLUSION CRITERIA: 1. Patients with ocular infective and inflammatory condition, 2. Patients with diabetes, 3. Patients with collagen vascular disease METHODOLOGY: History, Visual acuity, Fields, Retinoscopy, Slit lamp examination, Amsler grid, Fundus examination with90D & IDO, FFA, OCT. DISCUSSION AND RESULTS: In our study of 50 patients the age group affected was between 20 and 50 years. Previous studies showed involvement between 20 and 50 years of age (Gass,et.al). CONCLUSION: Central serous chorioretinopathy predominantly affects healthy male (90%). Ink blot pattern is the most common fluorescein pattern found in the study (50%). OCT helps in quantification of macular thickness and look for association of pigment epithelial detachment and choroidal neovascularisation. Early Laser photocoagulation is effective in rapid restoration of vision and reduction in macular thickness within a period of 12 weeks, and there is no complication reported in our study due to laser treatment. Photocoagulation play major role in rapid restoration of vision 6/6-6/9 within period of 12 weeks in about 73.33%, whereas only 13.33% of the patient in placebo group had 6/6-6/9 vision. Early laser photocoagulation results in rapid visual restoration within a period which ranged from 2-12weeks. The recurrence rate of CSCR in our study was 30% and the interval between previous and present episodes ranged from 4 months to 3 years by prospective and retrospective analysis. About 10% of patients had persistent disease of duration more than 4 months. Majority of patients gave history of increased mental stress. History of steroid usage either systemic, topical or inhalers and ointment was noted in minority of patients(10%). LIMITATIONS: Post laser recurrences of CSCR could not be documented with follow up period of 4th weeks and 12th weeks. Furthermore late post laser complications such as CNVM could be identified only by extended follow up