Request. Besides the laser, what medicine or therapy do you recommend for those suffering from central serous retinopathy? The pathology recurs every two or three months with a very annoying and large drop under the left retina and then decreases with the passing of the days. Unfortunately it never disappears completely and in the moments when it is bigger it deforms the sight a lot.
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Reply. Central serous chorioretinopathy (CSC) is a disease that affects the retina and is characterized by the presence of serous fluid between a layer called pigment epithelium and the overlying retinal layers; fluid comes from congested vessels of the underlying choroid and passes over the retina through lesions of the pigment epithelium. CSC is a disease of the retina that is usually not serious but which can be of great concern to those who suffer from it, because it is often anxious and easy to stress people; CSC predominantly affects males between the ages of 30 and 50. Clinically it presents with the appearance of a central dark spot (scotoma), often associated with distorted vision and alterations in color perception. It can resolve spontaneously within 2-4 months with complete visual recovery, but it can relapse and become chronic. In fact, two clinical subtypes have been identified: the acute form, which resolves within 3-4 months, and the chronic form characterized by the presence of a persistent serous detachment for more than 4-6 months. Numerous therapies have been tried over the years for CSC: acetazolamide, beta-blockers, ketokonazole, mifepristone, rifampicin, finasteride, methotrexate, eplerenone, photodynamic therapy (PDT) with verteporfin, anti-VEGF drugs; most of these drugs have been tested for their antysteroid action, given the importance given to hypercortisolism in the pathogenesis of CSC. In recent years, the role of corticosteroids in favoring the onset of CSC episodes has become increasingly evident: high blood levels of cortisol, influencing the production of nitric oxide, prostaglandins and free radicals, indirectly alter the self-regulation processes of blood flow choroidal which in turn cause an increase in capillary blood pressure, hyperpermeability and the formation of liquid. No therapy has so far given a clear demonstration of efficacy, to date the reduced dose photodynamic therapy (PDT) is considered by many ophthalmologists the treatment to be preferred in relapsing forms. Furthermore, the treatment of the anxious state can favor the spontaneous resolution of the pathology in the initial and less serious cases. Finally, remember that most CSCs tend to resolve spontaneously.
* Lia Giustolisi, head of the Diagnosis and Treatment Center of maculopathies at the Policlinico Umberto I in Rome
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