Bilateral Central Serous Chorioretinopathy Following High-Dose Systemic Corticosteroid Therapy: A Review of Published Cases
DOI:
https://doi.org/10.5281/zenodo.22206016Keywords:
Central Serous Chorioretinopathy, Corticosteroids, Subretinal Fluid, Photodynamic Therapy, ChoroidAbstract
Central serous chorioretinopathy is usually a unilateral, self-limiting disease of middle-aged men. The corticosteroid-associated form behaves differently: it is more often bilateral, more often severe, and it appears in patients who do not fit the classical demographic. Since the drug is frequently being given for a condition that also requires treatment, the clinical problem is rarely a simple matter of stopping it. Objectives:To review the published evidence linking systemic corticosteroid exposure to central serous chorioretinopathy, the features that t distinguish the corticosteroid-associated form, and the management options where the drug cannot readily be withdrawn. Material and Methods:A narrative review. MEDLINE, Embase and the Cochrane Library were searched from January 1990 to May 2026 for r epidemiological studies, case-control studies, randomised treatment trials, imaging series and reviews addressing central serous chorioretinopathy and corticosteroid exposure. Values were extracted from the primary reports and tabulated without pooling. Results:Population incidence is 9.9 per 100,000 in men and 1.7 per 100,000 in women. Systemic corticosteroid use is the strongest reported d external risk factor, with a multivariate odds ratio of 37.1 in the largest case-control study, and remains significant across independent cohorts. Corticosteroid-associated disease is disproportionately bilateral, multifocal and severe. In the only adequately powered randomised comparison of treatments for chronic disease, half-dose photodynamic therapy resolved subretinal fluid in 67.2% against 28.8% for subthreshold micropulse laser, while a randomised trial of eplerenone found no benefit over placebo.
Conclusion:Recognising the association matters mainly because withdrawal or dose reduction of the corticosteroid is the intervention with the e clearest rationale, and because the diagnosis is easily missed in patients who do not resemble the classical phenotype. Where the drug must continue, half-dose photodynamic therapy has the best randomised evidence.Abbreviations:CSCR – Central Serous Chorioretinopathy, SRF – Subretinal Fluid, RPE – Retinal Pigment Epithelium, OCT – Opticall Coherence Tomography, PDT – Photodynamic Therapy, BCVA – Best-Corrected Visual Acuity, OR – Odds Ratio.
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