Overview
Acute central serous chorioretinopathy (ACSC) is a condition characterized by serous detachment of the neurosensory retina due to leakage from choroidal capillaries, often affecting the macula and leading to visual disturbances 1.Diagnosis
Key Diagnostic Criteria: Presence of subretinal fluid without retinal pigment epithelial disruption 1.
Recommended Tests:
- Optical coherence tomography (OCT) for detailed imaging of subretinal fluid 2.
- Fluorescein angiography to assess choroidal vascular permeability 1.
Grading: Severity often graded based on extent and duration of subretinal fluid accumulation 1.Management
First-Line Treatments:
- Observation for mild cases, as spontaneous resolution can occur 1.
- Laser photocoagulation for chronic or recurrent cases 1.
Adjunctive Treatments:
- Corticosteroids (topical or systemic) to reduce inflammation 1.
- Tissue plasminogen activator (t-PA) intraoperatively for subretinal hemorrhage management, though not fully effective alone 3.Special Populations
Pediatrics: Subfoveal fluid observed in healthy full-term newborns, though typically transient and asymptomatic 2.
Comorbidities: Older gestational age and maternal diabetes may correlate with presence of subretinal fluid in newborns 2.Key Recommendations
Utilize OCT for monitoring subretinal fluid in ACSC diagnosis and management (Evidence: Moderate 2).
Consider corticosteroid therapy for managing inflammation in ACSC (Evidence: Moderate 1).
In cases requiring surgical intervention for subretinal hemorrhage, consider intraoperative t-PA injection, though anticipate the need for additional surgical maneuvers (Evidence: Weak 3).References
1 Michael CW. Serous fluid cytopathology: Past, present, and future. Diagnostic cytopathology 2021. link
2 Cabrera MT, Maldonado RS, Toth CA, O'Connell RV, Chen BB, Chiu SJ et al.. Subfoveal fluid in healthy full-term newborns observed by handheld spectral-domain optical coherence tomography. American journal of ophthalmology 2012. link
3 Claes C, Zivojnovic R. Efficacy of tissue plasminogen activator (t-PA) in subretinal hemorrhage removal. Bulletin de la Societe belge d'ophtalmologie 1996. link