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Klin Monbl Augenheilkd 2021; 238(09): 971-979
DOI: 10.1055/a-1531-5605
Übersicht

Chorioretinopathia centralis serosa – ein Überblick

Article in several languages: English | deutsch
Lieselotte Berger
1   Department of Ophthalmology, Inselspital, Bern University Hospital
,
Virginie Bühler
1   Department of Ophthalmology, Inselspital, Bern University Hospital
,
Suzanne Yzer
2   Department of Ophthalmology, Radboud Universiteit, Nijmegen, Niederlande
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Zusammenfassung

Die Chorioretinopathia centralis serosa (CCS) ist durch eine seröse Abhebung der Netzhaut in der Makula charakterisiert. Es sind meist Männer zwischen 30 und 50 Jahren betroffen. Es wird eine akute Form (Krankheitsdauer kürzer als 4 – 6 Monate) von einer chronischen Form (länger als 4 – 6 Monate) unterschieden. Die Pathogenese ist multifaktoriell, es wird aktuell von einer lokalen Hyperpermeabilität der Chorioidea mit sekundären Veränderungen der Photorezeptoren und des retinalen Pigmentepithels (RPE) ausgegangen. Symptome einer akuten CCS sind ein zentrales Verschwommensehen bei häufig geringer Visusverschlechterung. Die optische Kohärenztomografie (OCT) zeigt subretinale Flüssigkeit mit oder ohne einzelne Pigmentepithelabhebungen, in der Fluoresceinangiografie (FAG) findet man meist einen Quellpunkt, die Indocyaningrünangiografie (ICG) zeigt umschriebene Areale verdickter chorioidaler Gefäße. Die akute Form kann spontan abheilen, aber auch rezidivieren und/oder in eine chronische Form übergehen. Nach Erstdiagnose zeigt sich in ca. 70 – 80% der Fälle eine spontane Remission, in ca. 50% kommt es zu einem Rezidiv. Aufgrund des guten Spontanverlaufes sollte bei Erstmanifestation in den ersten 4 – 6 Monaten zugewartet werden. Steroidtherapie gilt als Hauptrisikofaktor. Bei der chronischen Form tritt eine langsame Visusverschlechterung mit vermindertem Kontrastsehen und Farbsehen ein. Es imponieren flächige Veränderungen im RPE mit sekundären degenerativen Veränderungen der Photorezeptoren. Als Komplikation, besonders bei älteren Patienten, kann eine chorioidale Neovaskularisation (CNV) auftreten. Mögliche Therapien sind: Eine fokale Lasertherapie des in der FAG sichtbaren Quellpunktes kann mit Mikropulslaser- oder bei ausreichender Entfernung zur Fovea mit Argonlaserkoagulation behandelt werden. Bei der chronischen CCS belegen Studien, dass die photodynamische Therapie (PDT) gute Resultate zeigt. Für die Therapie mit Mineralkortikoid-Antagonisten gibt es Fallserienberichte mit einer Evidenz der Behandlung für einen Beobachtungszeitraum von 3 – 6 Monaten. Bei Vorliegen einer sekundären CNV sollte eine Anti-VEGF-Therapie erfolgen. Es ist unklar, ob dabei eine Kombinationstherapie mit PDT sinnvoll ist.

Schlüsselwörter

Chorioidea - Chorioretinopathia centralis serosa - Mineralkortikoid-Antagonist - Mikropulslaser - photodynamische Therapie


Publication History

Received: 11 April 2021

Accepted: 15 June 2021

Article published online:
20 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References/Literatur

  • 1 Gäckle HC, Lang GE, Freissler KA. et al. [Central serous chorioretinopathy. Clinical, fluorescein angiography and demographic aspects]. Ophthalmologe 1998; 95: 529-533
    CrossrefPubMedGoogle Scholar
  • 2 Bujarborua D, Chatterjee S, Choudhury A. et al. Fluorescein angiographic features of asymptomatic eyes in central serous chorioretinopathy. Retina 2005; 25: 422-429
    CrossrefPubMedGoogle Scholar
  • 3 Fine SL, Owens SL. Central serous retinopathy in a 7-year-old girl. Am J Ophthalmol 1980; 90: 871-873
    CrossrefPubMedGoogle Scholar
  • 4 Spaide RF, Campeas L, Haas A. et al. Central serous chorioretinopathy in younger and older adults. Ophthalmology 1996; 103: 2070-2079 discussion 2079–2080
    CrossrefPubMedGoogle Scholar
  • 5 Daruich A, Matet A, Dirani A. et al. Central serous chorioretinopathy: recent findings and new physio-pathology hypothesis. Prog Retin Eye Res 2015; 48: 82-118
    CrossrefPubMedGoogle Scholar
  • 6 Kitzmann AS, Pulido JS, Diehl NN. et al. The incidence of central serous chorioretinopathy in Olmsted County, Minnesota, 1980–2002. Ophthalmology 2008; 115: 169-173
    CrossrefPubMedGoogle Scholar
  • 7 Lange C, Treumer F, Bertram B. et al. Stellungnahme des Berufsverbandes der Augenärzte Deutschlands, der Deutschen Ophthalmologischen Gesellschaft und der Retinologischen Gesellschaft zur Chorioretinopathia centralis serosa (CCS). Ophthalmologe 2019; 116: 10-20
    CrossrefPubMedGoogle Scholar
  • 8 Liu B, Deng T, Zhang J. Risk Factors for Central Serous Chorioretinopathy: A Systematic Review and Meta-Analysis. Retina 2016; 36: 9-19
    CrossrefPubMedGoogle Scholar
  • 9 Gass JD. Pathogenesis of disciform detachment of the neuroepithelium. Am J Ophthalmol 1967; 63: 587/515-615/543
    PubMedGoogle Scholar
  • 10 Hayashi K, Hasegawa Y, Tokoro T. Indocyanine green angiography of central serous chorioretinopathy. Int Ophthalmol 1986; 9: 37-41
    CrossrefPubMedGoogle Scholar
  • 11 Spaide RF, Hall L, Haas A. et al. Indocyanine green videoangiography of older patients with central serous chorioretinopathy. Retina 1996; 16: 203-213
    CrossrefPubMedGoogle Scholar
  • 12 Imamura Y, Fujiwara T, Margolis R. et al. Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy. Retina 2009; 29: 1469-1473
    CrossrefPubMedGoogle Scholar
  • 13 Nicholson B, Noble J, Forooghian F. et al. Central Serous Chorioretinopathy: Update on Pathophysiology and Treatment. Surv Ophthalmol 2013; 58: 103-126
    CrossrefPubMedGoogle Scholar
  • 14 van Rijssen TJ, van Dijk EHC, Yzer S. et al. Central serous chorioretinopathy: Towards an evidence-based treatment guideline. Prog Retin Eye Res 2019; 73: 100770 DOI: 10.1016/j.preteyeres.2019.07.003.
    CrossrefPubMedGoogle Scholar
  • 15 Daruich A, Matet A, Marchionno L. et al. Acute Central Serous Chorioretinopathy: Factors Influencing Episode Duration. Retina 2017; 37: 1905-1915
    CrossrefPubMedGoogle Scholar
  • 16 Wong R, Chopdar A, Brown M. Five to 15 year follow-up of resolved idiopathic central serous chorioretinopathy. Eye (Lond) 2004; 18: 262-268
    CrossrefPubMedGoogle Scholar
  • 17 Matet A, Daruich A, Zola M. et al. Risk factors for recurrences of central serous chorioretinopathy. Retina 2017; 38: 1403-1414
    CrossrefPubMedGoogle Scholar
  • 18 Wang M, Sander B, la Cour M. et al. Clinical characteristics of subretinal deposits in central serous chorioretinopathy. Acta Ophthalmol Scand 2005; 83: 691-696
    CrossrefPubMedGoogle Scholar
  • 19 Gerendas BS, Kroisamer JS, Buehl W. et al. Correlation between morphological characteristics in spectral-domain-optical coherence tomography, different functional tests and a patientʼs subjective handicap in acute central serous chorioretinopathy. Acta Ophthalmol 2018; 96: e776-e782
    CrossrefPubMedGoogle Scholar
  • 20 Teke MY, Elgin U, Nalcacioglu-Yuksekkaya P. et al. Comparison of autofluorescence and optical coherence tomography findings in acute and chronic central serous chorioretinopathy. Int J Ophthalmol 2014; 7: 350-354
    PubMedGoogle Scholar
  • 21 Yannuzzi L, Shakin J, Fishe YL. et al. Peripheral retinal detachments and retinal pigment epithelial atrophic tracts secondary to central serous pigment epitheliopathy. Ophthalmology 1984; 91: 1554-1572
    CrossrefPubMedGoogle Scholar
  • 22 Iida T, Yannuzzi LA, Spaide RF. et al. Cystoid macular degeneration in chronic central serous chorioretinopathy. Retina 1984; 23: 1-7 quiz 137–138
    CrossrefPubMedGoogle Scholar
  • 23 Bousquet E, Bonnin S, Mrejen S. et al. Optical Coherence Tomography Angiography of Flat Irregular Pigment Epithelium Detachment in Chronic Central Serous Chorioretinopathy. Retina 2018; 38: 629-638 DOI: 10.1097/IAE.0000000000001580.
    CrossrefPubMedGoogle Scholar
  • 24 Mohabati D, Boon CJF, Yzer S. Risk of Recurrence and Transition to Chronic Disease in Acute Central Serous Chorioretinopathy. Clin Ophthalmol 2020; 14: 1165-1175
    CrossrefPubMedGoogle Scholar
  • 25 Mohabati D, van Dijk EH, van Rijssen EHC. et al. Clinical spectrum of severe chronic central serous chorioretinopathy and outcome of photodynamic therapy. Clin Ophthalmol 2018; 12: 2167-2176
    CrossrefPubMedGoogle Scholar
  • 26 Cheung CMG, Lee WK, Koizumi H. et al. Pachychoroid disease. Eye (Lond) 2019; 33: 14-33 DOI: 10.1038/s41433-018-0158-4.
    CrossrefPubMedGoogle Scholar
  • 27 Spaide RF. The Ambiguity of Pachychoroid. Retina 2021; 41: 231-237 DOI: 10.1097/IAE.0000000000003057.
    CrossrefPubMedGoogle Scholar
  • 28 Matsumoto H, Kishi S, Otani T. et al. Elongation of photoreceptor outer segment in central serous chorioretinopathy. Am J Ophthalmol 2018; 145: 162-168
    CrossrefPubMedGoogle Scholar
  • 29 Yalcinbayir O, Gelisken O, Akova-Budak B. et al. Correlation of spectral domain optical coherence tomography findings and visual acuity in central serous chorioretinopathy. Retina 2014; 34: 705-712
    CrossrefPubMedGoogle Scholar
  • 30 Piccolino FC, De La Longrais RR, Manea M. et al. Posterior cystoid retinal degeneration in central serous chorioretinopathy. Retina 2008; 28: 1008-1012
    CrossrefPubMedGoogle Scholar
  • 31 Cakir B, Reich M, Lang S. et al. OCT Angiography of the Choriocapillaris in Central Serous Chorioretinopathy: A Quantitative Subgroup Analysis. Ophthalmol Ther 2019; 8: 75-86 DOI: 10.1007/s40123-018-0159-1.
    CrossrefPubMedGoogle Scholar
  • 32 Reich M, Boehringer D, Rothaus K. et al. Swept-source optical coherence tomography angiography alleviates shadowing artifacts caused by subretinal fluid. Int Ophthalmol 2020; 40: 2007-2016 DOI: 10.1007/s10792-020-01376-7.
    CrossrefPubMedGoogle Scholar
  • 33 Yannuzzi NA, Mrejen S, Capuano V. et al. A central hyporeflective subretinal lucency correlates with a region of focal leakage on fluorescein angiography in eyes with central serous chorioretinopathy. Ophthalmic Surg Lasers Imaging Retina 2015; 46: 832-836
    CrossrefPubMedGoogle Scholar
  • 34 Delori FC, Dorey CK, Staurenghi G. et al. In vivo fluorescence of the ocular fundus exhibits retinal pigment epithelium lipofuscin characteristics. Invest Ophthalmol Vis Sci 1995; 36: 718-729
    Google Scholar
  • 35 Iacono P, Battaglia P, Papayannis A. et al. Acute central serous chorioretinopathy: a correlation study between fundus autofluorescence and spectral-domain OCT. Graefes Arch Clin Exp Ophthalmol 2015; 253: 1889-1897
    CrossrefPubMedGoogle Scholar
  • 36 Spaide RF, Klancnik jr. JM. Fundus autofluorescence and central serous chorioretinopathy. Ophthalmology 2005; 112: 825-833
    CrossrefPubMedGoogle Scholar
  • 37 van Rijssen TJ, Mohabati D, Dijkman G. et al. Correlation between redefined optical coherence tomography parameters and best-corrected visual acuity in non-resolving central serous chorioretinopathy treated with half-dose photodynamic therapy. PLoS One 2018; 13: e0202549
    CrossrefPubMedGoogle Scholar
  • 38 Chuang EL, Sharp DM, Fitzke W. Retinal dysfunction in central serous retinopathy. Eye (Lond) 1987; 1: 120-125
    CrossrefPubMedGoogle Scholar
  • 39 Pichi F, Carrai P, Ciardell A. et al. Comparison of two mineralcorticosteroids receptor antagonists for the treatment of central serous chorioretinopathy. Int Ophthalmol 2016; 37: 1115-1125
    CrossrefPubMedGoogle Scholar
  • 40 Rahimy E, Pitcher JD, Hsu J. et al. A randomized double-blind placebo-control pilot study of eplerenone for the treatment of central serous chorioretinopathy. Retina 2018; 38: 962-969
    CrossrefPubMedGoogle Scholar
  • 41 Schwartz R, Habot-Wilner Z, Martinez MR. et al. Eplerenone for chronic central serous chorioretinopathy-a randomized controlled prospective study. Acta Ophthalmol 2017; 95: e610-e618
    CrossrefPubMedGoogle Scholar
  • 42 Lotery A, Sivaprasad S, OʼConnell A. et al. Eplerenone for chronic central serous chorioretinopathy in patients with active, previously untreated disease for more than 4 months (VICI): a randomised, double-blind, placebo-controlled trial. Lancet 2020; 395: 294-303
    CrossrefPubMedGoogle Scholar
  • 43 Caccavale A, Romanazzi F, Imparato M. et al. Low-dose aspirin as treatment for central serous chorioretinopathy. Clin Ophthalmol 2010; 4: 899-903
    Google Scholar
  • 44 Pikkel J, Beiran I, Ophir A. et al. Acetazolamide for central serous retinopathy. Ophthalmology 2002; 109: 1723-1725
    CrossrefPubMedGoogle Scholar
  • 45 Ficker L, Vafidis G, While A. et al. Long-term follow-up of a prospective trial of argon laser photocoagulation in the treatment of central serous retinopathy. Br J Ophthalmol 1988; 72: 829-834
    CrossrefPubMedGoogle Scholar
  • 46 Maruko I, Iida T, Sugano Y. et al. Subfoveal choroidal thickness after treatment of central serous chorioretinopathy. Ophthalmology 2010; 117: 1792-1799
    CrossrefPubMedGoogle Scholar
  • 47 Gilbert CM, Owens SL, Smith PD. et al. Long-term follow-up of central serous chorioretinopathy. Br J Ophthalmol 1984; 68: 815-820
    CrossrefPubMedGoogle Scholar
  • 48 Scholz P, Altay L, Fauser S. A review of subthreshold micropulse laser for treatment of macular disorders. Adv Ther 2017; 34: 1528-1555
    CrossrefPubMedGoogle Scholar
  • 49 Chan WM, Lai TYY, Lai RYK. et al. Half-dose verteporfin photodynamic therapy for acute central serous chorioretinopathy: one-year results of a randomized controlled trial. Ophthalmology 2008; 115: 1756-1765
    CrossrefPubMedGoogle Scholar
  • 50 Cheng CK, Chang CK, Peng CH. Comparison of photodynamic therapy using half-dose of verteporfin or half-fluence of laser light for the treatment of chronic central serous chorioretinopathy. Retina 2017; 37: 325-333
    CrossrefPubMedGoogle Scholar
  • 51 Tseng CC, Chen SN. Long-term efficacy of half-dose photodynamic therapy on chronic central serous chorioretinopathy. Br J Ophthalmol 2015; 99: 1070-1077
    CrossrefPubMedGoogle Scholar
  • 52 Nicolò M, Zoli D, Musolino M. et al. Association between the efficacy of half-dose photodynamic therapy with indocyanine green angiography and optical coherence tomography findings in the treatment of central serous chorioretinopathy. Am J Ophthalmol 2012; 153: 474-480.e1
    CrossrefPubMedGoogle Scholar
  • 53 van Dijk EHC, Fauser S, Breukink MB. et al. Half-dose photodynamic therapy versus high-density subthreshold micropulse laser treatment in patients with chronic central serous chorioretinopathy: the place trial. Ophthalmology 2018; 125: 1547-1555
    CrossrefPubMedGoogle Scholar
  • 54 Shin MC, Lim JW. Concentration of cytokines in the aqueous humor of patients with central serous chorioretinopathy. Retina 2011; 31: 1937-1943
    CrossrefPubMedGoogle Scholar
  • 55 Bae SH, Heo JW, Kim C. et al. A randomized pilot study of low-fluence photodynamic therapy versus intravitreal ranibizumab for chronic central serous chorioretinopathy. Am J Ophthalmol 2011; 152: 784-792.e2
    CrossrefPubMedGoogle Scholar
  • 56 Chung YR, Seo EJ, Lew HM. et al. Lack of positive effect of intravitreal bevacizumab in central serous chorioretinopathy: meta-analysis and review. Eye (Lond) 2013; 27: 1339-1346
    CrossrefPubMedGoogle Scholar
  • 57 Lai TYY, Staurenghi G, Lanzetta P. et al. Efficacy and Safety of Ranibizumab for the Treatment of Choroidal Neovascularization due to Uncommon Cause: Twelve-Month Results of the MINERVA Study. Retina 2018; 38: 1464-1477
    CrossrefPubMedGoogle Scholar
  • 58 Hata M, Oishi A, Shimozono M. et al. Early changes in foveal thickness in eyes with central serous chorioretinopathy. Retina 2013; 33: 296-301
    CrossrefPubMedGoogle Scholar
  • 59 Leaver P, Williams C. Argon laser photocoagulation in the treatment of central serous retinopathy. Br J Ophthalmol 1979; 63: 674-677
    CrossrefPubMedGoogle Scholar
  • 60 Mrejen S, Balaratnasingam C, Kaden TR. et al. Long-term visual outcomes and causes of vision loss in chronic central serous chorioretinopathy. Ophthalmology 2019; 126: 576-588
    CrossrefPubMedGoogle Scholar
  • 61 Lai TY, Wong RL, Chan WM. Long-term outcome of half-dose verteporfin photodynamic therapy for the treatment of central serous chorioretinopathy (an american ophthalmological society thesis). Trans Am Ophthalmol Soc 2015; 113: T8
    PubMedGoogle Scholar