Central serous retinopathy: update on disease understanding and treatment

Purpose of review Investigations over the past 2 years involving novel genomics pathways, imaging techniques, risk factors, and therapeutic interventions have sought to better understand and manage central serous retinopathy (CSR). While most cases of acute CSR are self-resolving, chronic CSR remains a challenging condition to manage given response to therapy may be limited and the risk of permanent, severe vision loss. In this work, we present the latest insights on disease pathophysiology and management for acute and chronic cases of CSR, highlighting data from randomized control trials and meta-analyses to compare efficacy of treatment options. Recent findings There is no difference in best corrected visual acuity (BCVA) or resolution of subretinal fluid (SRF) in cases of chronic CSR that are treated with half-dose/half-fluence photodynamic therapy (PDT) versus full-strength/full-fluence therapy, making half-dose/half-fluence a reasonable option to avoid the atrophic retinal changes that may be more likely with full-strength treatment. Laser therapy could be considered as an alternative to PDT for treating chronic CSR in cases of verteporfin shortage; however, the statistically significant reduction in subretinal fluid seen on optical coherence tomography (OCT) does not translate to a significant improvement in BCVA after intervention. While there may be an early improvement in BCVA and SRF in cases of chronic CSR for which treatment with mineralocorticoid receptor antagonist is initiated, this effect does not appear to persist with extended follow up. Summary With ongoing extensive research on the disease process of CSR and a more nuanced understanding of the factors that increase risk of disease, observation remains the mainstay of management for acute CSR. For chronic CSR, PDT, laser, or anti-VEGF may be considered, with advances in imaging allowing OCTA to be a less invasive alternative method to dye angiography for detecting neovascularization.