Central Serous Chorioretinopathy - Histology

Central Serous Chorioretinopathy (CSC) is a retinal disorder characterized by the accumulation of fluid under the retina. This leads to a localized detachment of the neurosensory retina from the underlying retinal pigment epithelium (RPE). The condition primarily affects the macula, the central part of the retina responsible for detailed vision.

Histologically, CSC involves changes in the choroid, the layer of blood vessels between the retina and the sclera. The choroid often shows increased thickness due to congestion and dilation of the choroidal blood vessels. The RPE may exhibit focal detachments and disruptions, which are indicative of leakage and fluid accumulation.

The choroid plays a crucial role in CSC. In normal conditions, the choroid supplies oxygen and nutrients to the outer retina, including the RPE and the photoreceptors. In CSC, the choroid becomes hyperpermeable, leading to increased fluid leakage. This fluid accumulates between the RPE and the neurosensory retina, causing the characteristic retinal detachment.

The exact mechanism of CSC is not fully understood, but it is believed to involve a combination of factors such as choroidal vascular hyperpermeability, RPE dysfunction, and physiological stress. Histologically, the hyperpermeability of choroidal vessels is a key feature, which leads to fluid accumulation under the retina.

Several risk factors and triggers are associated with CSC, including psychological stress, corticosteroid use, and systemic hypertension. These factors can influence the permeability of the choroidal vessels and the functionality of the RPE, exacerbating the histological changes seen in CSC.

Histological examination of eyes affected by CSC reveals several key features. The choroid shows significant vascular congestion and increased thickness. The RPE may exhibit focal detachments and areas of degeneration. The neurosensory retina overlying the RPE detachment often appears edematous and elevated.

Clinically, CSC presents with symptoms such as blurred vision, metamorphopsia (distorted vision), and a central scotoma (a blind spot in the central vision). These symptoms correlate with the histological findings of fluid accumulation and retinal detachment. Imaging techniques like optical coherence tomography (OCT) and fluorescein angiography are used to confirm the diagnosis and visualize the extent of fluid accumulation.

The treatment of CSC aims to reduce the fluid accumulation and restore normal retinal anatomy. This can include lifestyle modifications to reduce stress, discontinuation of corticosteroids, and medical treatments such as oral mineralocorticoid receptor antagonists. In chronic or severe cases, laser photocoagulation or photodynamic therapy may be used to target the leaking choroidal vessels. The prognosis is generally good, with many patients experiencing spontaneous resolution of symptoms.

Understanding the histological features of CSC is crucial for accurate diagnosis and effective treatment. The condition involves changes in the choroid, RPE, and neurosensory retina, leading to fluid accumulation and retinal detachment. Recognizing the histopathological patterns helps in correlating clinical symptoms and guiding appropriate therapeutic interventions.