Treatment Vs Observation in acute CSCR

Retinal Debate about observation vs treatment for acute CSCR

In this webinar Joslin Dakhil will debate the use of observation for acute CSCR vs Marah Hadid which will debate the treatment for acute CSCR. As Ameen Marashi, MD, SBO will give the final verdict of rational observtion vs treatment for acute CSCR. Dr. Ameen will host Dr Fahd Quhill, who is a Consultant Ophthalmologist specialising in Medical Retina and Ocular inflammatory disease at Moorfields Eye Hospital Dubai in Dubai Healthcare City. As he will share his experience with approaching acute CSCR.

Each talk in this presentation is about five to seven minutes only using the google meet platform Observation VS treatment for Acute CSCR.

Observation for Acute CSCR

Joslin Dakhil ..I have graduated from Faculty of medicine in Al-Baath University I am an ophthalmology resident doctor in Damascus Hospital , 3rd year

Treatment for Acute CSCR 

Dr. Marah Hadid (December 11, 1992).

graduated from damascus university with a doctor of medicine degree in 2017.

started master training program of ophthalmology in al-kalamoon hospital in 2018.

then continued training program in damascus hospital (al-mojtahed) in 2020.

The verdict by Ameen Marashi in the rational of observation VS treatment in cases of Acute CSCR

Dr.Ameen Marashi (born December 9, 1983) is a Syrian ophthalmologist and retina specialist.He has published a number of books and research articles in the field of retina and is the Al-Marashi Clinics Group owner.He graduated with a Diploma degree in Medicine from the Chuvash State University Institute of Medicine in 2008, and a certificate from the International Council of Ophthalmology in 2013, and completed a specialization in ophthalmology in Tartous Hospitals in 2009, and from 2010 until 2013 in Aleppo, and obtained a certificate Syrian Board 2016.

Expert opinion on the observation vs treatment for Acute CSCR

Dr. Fahd Quhill trained in Ophthalmology in the United Kingdom at Oxford, Birmingham and London, completing three Medical Retinal Fellowships in Birmingham, Wolverhampton and Moorfields Eye Hospital, London.He has undertaken research and served as principal investigator in numerous macular degeneration, retinal vein occlusion and diabetic macular oedema trials. He has published 27 research papers on retinal and ocular inflammatory disease in leading journal/s such as Ophthalmology, British Journal of Ophthalmology and Eye, among others.

Meeting Summary 

For Observation round: 

If you have an acute CSCR case ,we need an accurate and precise observation because it is a self-limited disease except some the case that need interventions ..Also ,we should modify the life style of our patients like avoiding stress and limit misusing of steroids.

For Treatment round: 

Although most cases of acute central serous chorioretinopathy can be resolved spontaneously, the choice of treatment should be taken in some special cases. Such as, accurate functions, where the patient needs high visual acuity. and cases in which the other eye is affected with chronic or complicated cscr. Also other cases in which patient can't wait to resolve for any reason. so, every patient with acute cscr is a unique case. and the decision of treatment should not be deferred when it is necessary.

For Expert opinion round: 

Take a good history and careful clinical examination and review of ancillary investigations to correctly diagnose acute CSR and not misdiagnose incorrectly. Identify steroid use or any stressors; and educate the patient that is likely cause for CSR and strategies they can adopt to avoid recurrent CSR. If CSR induced by steroid; caution against its use in the future unless the medical condition is severe enough to warrant oral steroid and risk of recurrent CSR and vision loss can be justified.

Most cases of acute CSR should be observed. But you can treat with focal laser; if the leak is extrafoveal and there are occupational reasons or other reasons where swifter resolution is desired. However, the role of secondary treatments like focal laser or photodynamic therapy should be reserved for persistent cases more than 3 months. Finally consider OCTA to exclude choroidal neovascularization.

For Verdict round:

Acute CSCR is a self limiting disease and usually resolve spontaneously , hence observation is warranted if the there are no high visual demands by the patient after doing a proper counseling and eliminating risk factors like stress and steroid intake. However, it is imperative to rule out other diseases that may mimic CSCR, and we should consider treatment in cases of patients with high visual demands, the other eye suffered from visual loss due to a complication related to CSCR and in cases of recurrent CSCR.