In this interview, Professor Camiel Boon from Amsterdam UMC and Leiden University Medical Center discussed central serous chorioretinopathy (CSC). He explored the disease’s pathophysiology, highlighting choroidal hyperpermeability and thickening as key factors. Boon emphasized the importance of differential diagnosis, presenting research on various disease categories. He also discussed treatment controversies, advocating for photodynamic therapy and stressing the significance of prospective studies, which revealed that up to 30% of chronic cases might show spontaneous improvement.
Note: The following conversation has been lightly edited for clarity.
Ophthalmology Times: You presented on central serous chorioretinopathy at this meeting. Can you share some of the information that you spoke about?
Camiel Boon, MD: I’m a professor of ophthalmology in Amsterdam, UMC and Leiden University Medical Center in the Netherlands. I’d like to tell you something about the courses that we gave on central serous chorioretinopathy. So the first topic of the course we wanted to broadly cover this mysterious disease. Many people are still thinking, “Okay, what is exactly the cause of the disease?” First of all, we wanted to cover the pathophysiology, and quite some interesting new insights have emerged in terms of the pathophysiology. One of the key ones is actually that the choroid and hyper-permeability and thickening of the choroid is a key finding in central serous chorioretinopathy, and probably at the basis of the disease. This is very important because, of course, this might also indicate why certain treatments, such as photomimic therapy, are more successful for this disease. So we presented several imaging finding specific leakage patterns from ICG angiography, which I think is a key imaging modality that you should use, because it can show very typical leakage on ICG-A.
And second of all, I think the differential diagnosis of central serous chorioretinopathy can be very challenging. Previously, Emma van Dyke, colleague of mine, and I, published a paper where we actually describe 12 different disease categories with all types of sub-categories that can have a serous maculopathy-like phenotype, and some of them are very important to distinguish because they can even be life-saving. So you want to know if it’s CSC, but you also want to know if it’s not typical CSC. What’s the other cause, because it can be a tumor, hematological abnormalities like lymphoma. It can be toxic, for instance. But we also described some new phenotypes that haven’t been described before, so it will be very important to distinguish that, because you could also prevent unnecessary treatment for many patients.
OT: Can you share how retinal specialists are treating central serous chorioretinopathy?
Boon: We went to the treatment, because the treatment is also still relatively controversial, despite the fact that several prospective, randomized control trials, some of which we initiated and performed, have come out. We also recently published a an evidence-based guideline paper with an international group of experts on CSC, in which we describe the background of CSC, but also all the treatments that have been described. One thing that is very important for central serous chorioretinopathy, even in chronic cases, is that after a year, up to 30% can show a marked spontaneous improvement or resolution of fluid. That makes it very important that you do prospective studies. Quite a lot of studies have been retrospective, and the prospective evidence that is out there clearly shows that photodynamic therapy or PDT, when it’s available, should be the treatment of choice.