Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3–4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies—ideally, well-designed randomized controlled trials—are needed in order to evaluate new treatment options for CSC.

中文翻译：

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中心性浆液性脉络膜视网膜病变：循证治疗指南


中心性浆液性脉络膜视网膜病变（CSC）是一种相对常见的疾病，由于黄斑视网膜下液渗漏而导致视力丧失，并且通常与视力相关的生活质量下降有关。在 CSC 中，视网膜下液通过视网膜色素上皮层外血视网膜屏障的缺陷渗漏似乎继发于脉络膜异常和功能障碍。尽管最近从几项大型随机对照试验获得的数据提供了大量可用于建立治疗算法的新信息，但 CSC 的治疗目前仍存在争议。在这里，我们全面概述了我们目前对 CSC 发病机制的理解、当前的治疗策略以及 CSC 的循证治疗指南。对于急性 CSC，诊断后治疗通常可推迟长达 3-4 个月；然而，在某些情况下，使用光敏染料维替泊芬进行半剂量或半通量光动力疗法（PDT）的早期治疗可能是有益的。对于慢性 CSC，针对异常脉络膜的半剂量或半通量 PDT 应被视为首选治疗。如果无法进行 PDT，则可以使用传统激光光凝治疗血管造影显示局灶性、非中心性渗漏的慢性 CSC。伴有黄斑新生血管形成的 CSC 应采用半剂量/半通量 PDT 和/或玻璃体内注射抗血管内皮生长因子化合物进行治疗。鉴于目前维替泊芬的短缺以及缺乏支持其他治疗方案疗效的证据，需要未来的研究（理想情况下是精心设计的随机对照试验）来评估 CSC 的新治疗方案。