Risks and Side Effects of Central Serous Chorioretinopathy Treatment

✅ Medically reviewed by Dr Sharon Heng

Central serous chorioretinopathy (CSCR) is an eye condition that involves the accumulation of fluid under the retina, typically in the central macular area. This fluid causes a small detachment that can distort vision, leading to blurred or dim vision, a dark spot in the center of the visual field, or straight lines appearing bent. While CSCR often resolves on its own, persistent or severe cases may require intervention. Like any medical approach, central serous chorioretinopathy therapy comes with its own set of risks and side effects.

Common Treatment Approaches

There are various strategies for managing CSCR depending on the severity, duration, and recurrence of the condition. Observation is the first step in many cases since acute CSCR often resolves spontaneously within a few months. However, when intervention is necessary, doctors may consider one or more of the following:

• Photodynamic therapy (PDT) using verteporfin

• Focal or subthreshold laser therapy

• Mineralocorticoid receptor antagonists such as eplerenone or spironolactone
  

Each of these options has its own benefits, but patients must also understand the potential complications that may arise from treatment.

Risks of Photodynamic Therapy (PDT)

Photodynamic therapy is one of the most commonly used treatments for chronic CSCR. It involves injecting a light-sensitive drug (verteporfin) into a vein, which is then activated by a low-energy laser focused on the affected area of the retina.

While PDT can be effective in reducing subretinal fluid and improving vision, it carries some risks. One potential complication is choroidal ischemia, where blood flow to the choroid is reduced, potentially leading to damage of the retinal pigment epithelium (RPE). Over-treatment or incorrect laser targeting can also result in retinal atrophy, which may cause permanent vision changes.

Some patients may also experience temporary visual disturbances or mild pain at the injection site, though these effects tend to be short-lived.

Laser Treatment Risks

Focal laser photocoagulation and subthreshold laser therapy are also used to seal leaking blood vessels or reduce fluid accumulation in select cases. While subthreshold lasers are designed to minimize damage, traditional lasers may sometimes harm surrounding retinal tissue.

A potential side effect of laser therapy is the formation of scotomas, or blind spots in the visual field, especially if the treated area is near the fovea. Additionally, there's a risk that the treatment may not fully resolve the fluid buildup, requiring repeat procedures or alternative therapies.

Medication-Related Side Effects

Another route in the treatment for central serous chorioretinopathy  involves managing systemic factors, particularly in patients whose CSCR may be linked to corticosteroid use. Discontinuing or reducing corticosteroids can help, but this must be done cautiously and under medical supervision, especially if they are needed for other conditions like asthma or autoimmune disease.

For pharmacological options such as eplerenone or spironolactone, which are mineralocorticoid receptor antagonists, side effects may include:

• Electrolyte imbalances (such as increased potassium levels)

• Dizziness or low blood pressure

• Breast tenderness or enlargement (especially in men using spironolactone)

• Gastrointestinal discomfort
  

These medications require regular blood tests to monitor kidney function and electrolytes to avoid serious systemic complications.

Emotional and Psychological Impact

While not a direct side effect of treatment, the emotional toll of CSCR should not be underestimated. Patients often experience anxiety or frustration, especially when vision is significantly affected or when recovery is slow. Some individuals may become overly concerned with their prognosis, particularly if they experience recurrence.

Additionally, the need for repeated treatments or the uncertainty of outcomes can affect mental well-being. It's important for healthcare providers to offer emotional support and clear communication throughout the course of treatment.

Risk of Recurrence

Even with treatment, central serous chorioretinopathy can return. Recurrence rates vary, but some studies suggest that up to 40% of patients experience a relapse. Repeat treatments may be necessary, and each subsequent episode increases the risk of cumulative retinal damage over time.

Because of this, long-term monitoring is often advised. Patients should report any changes in vision promptly and maintain regular checkups with their ophthalmologist, especially if they’ve undergone previous treatments.

Balancing Risks and Benefits

Ultimately, deciding on a central serous chorioretinopathy treatment involves weighing the benefits of restoring or preserving vision against the potential for side effects. Many patients with mild or first-time cases may choose observation, while those with chronic or recurrent CSCR may benefit from more aggressive management.

Patients should be informed of all treatment options, the likelihood of side effects, and what to expect in terms of visual recovery. Personalized care that accounts for individual health history, occupation, and lifestyle factors can help ensure the best outcomes.

Conclusion

Central serous chorioretinopathy treatment has evolved to include a range of therapies tailored to the severity and duration of the condition. While most options are relatively safe and effective, each carries some degree of risk. By understanding these risks and maintaining close communication with an eye care provider, patients can make informed decisions that prioritize both their vision and overall health.