Central serous retinopathy
The retinitis centralis serosa (RCS ), and central serous chorioretinopathy (from Greek: pathos = suffering, lat serum = the blood fluid ) is a disease of the retina of the eye in which fluid from the choroid through a leak in Bruch's membrane occurs under the retina and thereby locally from the pigment layer lifts ( swelling induced retinal detachment ). In rarer cases, it comes with an intact pigment layer to form a joint withdrawal of the retina and retinal pigment epithelium.
Symptoms
Typical symptoms associated with central serous retinopathy are:
- " Gray area " ( scotoma ) in the visual field
- Image distortion ( metamorphopsia )
- Farsightedness ( hyperopia)
- Color perception disorders.
The symptoms are different depending on the extent and location of the retinal detachment. If a leak occurs in the region of the central retina ( macula) to strong distortions arise. Leaks that occur outside the macula, sometimes only small eccentrically located, iridescent colored spots or rings are perceived. Particularly striking these can be with the blink and the semi-darkness, against tables on the screen and when looking at white space. When working with tables can also be seen easily that the distortion of straight lines to waves and distortions. It has initially mostly just feel a slight glare - but this is only one side shall not pass away within minutes, how is otherwise accustomed.
Diagnostics
When funduscopy the flat, central retinal detachment can be seen. With the vessel performing fluorescein angiography can demonstrate the permeable retinal vessels. Characteristic can be found here at the site of the leak a " point source " of contrast medium, starting fills the location beneath the retina of the bladder. There are also cases with no apparent leak ( Choroideallappenperfusion ). With optical coherence tomography (OCT) can be a cross-sectional image of the retina make on which the withdrawal is directly visible.
Therapy
In any case you should head directly to the eye doctor at one of the above symptoms and the. Without going through the family doctor, who can not know whether immediate treatment is necessary The RCS can also in people under the age of 50 lead to moisture macular degeneration, resulting in total loss of vision without immediate treatment. The therapy then consists of photodynamic therapy on the one hand and on the distance of about 6 weeks followed by two intravitreal injections ( injection into the vitreous of the eye ) with antibodies that bear the common name Avastin or Lucentis. Even a treatment period with micro pulse laser was investigated, and these laser photocoagulation " superior in the treatment of RCS" over drug injection was.
If the swelling far outside the macula in severe and repeated relapses a laser treatment may be considered because otherwise there by the heat development in the rule to the destruction of the irradiated retina. From so-called SRT lasers ( SRT = Selective retina therapy) is hoped that an extension of the application due to these lasers exclusively ( selectively ) destroy the cells of the retinal pigment epithelium, but the adjacent photoreceptors spare. Thus, a failure of the irradiated tissue are avoided. Valid studies on the effectiveness of this new technique in central serous retinopathy, however, are not yet available.
Is the scotoma no leakage by the ophthalmologist seen enough drug treatment with eg diclofenac. Cortisone may no longer be used today and is even discussed as a possible cause for the emergence of a RCS.
Causes
The cause of the failure of the Bruch's membrane is not known. In some cases, cortisone or adrenaline are suspected as a trigger, as well as cortisol. Also increased Diastolic blood pressure is thought to be the cause, in particular when there is no leak in the membrane, but a Choroideallappenperfusion present.
Epidemiology
Particularly common men are affected in young and middle-aged (20-50 ). The occurrence of central serous retinopathy is often associated with intellectual or physical stress.