Central Serous Chorioretinopathy (CSCR) is a chorioretinal disorder characterized by a localized serous detachment of the neural retina in the macular region. Treatment options include observation, laser photocoagulation, systemic beta blockers, photodynamic therapy, and anti-VEGF agents. The Yanuzzi hypothesis suggests that in genetically predisposed individuals, high levels of glucocorticoids caused by stress may cause temporary retinal problems in CSCR. A study examined the effectiveness of oral anxiolytics and antidepressants with lifestyle modifications in resolving CSCR in patients with anxiety disorders. Psychiatric evaluation and treatment led to rapid resolution of CSCR in most acute cases within 2-

1. Central Serous Chorioretinopathy
&
Anxiolytics and Antidepressants
PSYCHIATRIST perspective
Dr. Ajay Dudani
Mumbai Retina Centre
K J Somaiya Hospital
Dr. Vrunda MorePatil
K J Somaiya Hospital

2. INTRODUCTION
• A chorioretinal disorder
characterized by an
idiopathic localized serous
detachment of the neural
retina in the macular
region
– Unilateral
– Pigment epithelial
detachment
– Relative preservation of
visual function despite
prolonged separation of
neural retina from the
RPE

3. TREATMENT
• Observation: 3-4 months in most first episodes of unilateral CSCR
• Laser photocoagulation
• Systemic beta blockers: may have a beneficial role, but not well proven
• PDT: chronic severe, exudative CSCR
• Micro pulse Diode Laser
• Anti-Vascular Endothelial Growth Factor (Anti-VEGF) agents

4. Vortex Vein Congestion
Arterioral pressure from
PCA
Choriocapilaries
(Sinusoidal capillary with
fenestration)
Increased Venous Pressure
Increased Hydrostatic Pressure
• RPE Detachment
• Serous Retinal
Detachment
• PCV??
CSC

5. • YANNUZZI HYPOTHESIS
“Biochemically mediated (adrenergic) alteration in
macula with damage and hyperpermiability of
choriocapillaries leading to degeneration of few RPE
cells and breakdown in posterior blood – retinal
barrier.”
In people genetically prone to retinal disorder ,high
level of glucocorticoids may cause temporary
problems.
If Stress is alleviated hormones normal
reduced glucocorticoids and CSCR RESOLVES
Study done by National Eye Institute,Macular degeneration Support, Inc. May 7,2000

6. CSCR
delays d healing of RPE defect
Suppressing the synthesis of extra cellular matrix components
SLOWS HEALING
Anti-inflammatory property
Increases capillary fragility & permeability
Reduce formation of NO
Corticosteroids
STRESS
SSRIs

7. Anxiety and corticosteroids
Stress
Glucocorticoids
Activation of
catechoalmines
CSCR
Anxiety
Disorder
Science. 2013 Jan 18;339(6117):332-5. doi: 10.1126/science.1226767.
Chronic stress triggers social aversion via glucocorticoids receptor in dopaminoceptive neurons. Baric J, Marti
F, Morel C, Fernandez SP, Lantern C, Godhead G, Dassin JP, Mombereau C, Faure P, Tronche F.

8. AIM
To study the effectiveness of oral anxiolytic and antidepressants
in resolution of central serous chorioretinopathy in type A
personality patients with anxiety disorder.
A double blind case controlled trial was done with a masked
referral to the psychiatrist who assessed the psychological
disease and started the treatment and we saw the rate of
regression of CSCR.

9. MATERIAL AND METHODS
• 50 patients of CSCR were evaluated
• Acute and chronic
• BCVA: Snellens chart(Near and Distance)
Subjective refraction
• SLITLAMP:
• Fundus examination
• DETAILED PSYCHIATRIC WORKUP by PSYCHIATRIC

10. MATERIAL AND METHODS
• OPD papers with psychiatric evaluation.

11. MATERIAL AND METHODS
• Treatment
Monotherapy: Clonazepam(0.5mg) or
Etizolam(0.25 mg - 0.5mg)
Twin therapy: Escitalopram(10mg) added for a
few cases
• Lifestyle modification : Conscious effort to reduce stress
Yog Abhyas
Spa
Exercise
Relaxation therapy
Break from hectic work schedule
Vacations

12. 18.03.2013 (pre treatment) 01.05.2013 (post treatment)
CASE1

13. 19.06.2013 (pre treatment) 30.07.2013 (post treatment)
CASE2

14. 20.11.2012 (pre treatment) 26.03.2013 (post treatment)
CASE3

15. OBSERVATIONS AND RESULTS
• Vision improvement in all acute case 6/6 – 6/9 WITH
PSYCHIATRIC MEDICATIONS
• 3 CASES NEEDED PDT improved to 6/9 – 6/12
• Chronic CSR the vision was ≤ 6/12

16. OBSERVATIONS AND RESULTS
• Acute cases – rapid resolution of fluid
90% -- resolved in 2-3 weeks
Mono/twin
therapy
8% -- resolved in 2-3 months
2% -- exudative CSCR Half
fluence PDT

17. Major Depression
Disorder
05 Twin therapy with
anxiolytic +
antidepressants with
lifestyle modification
Mixed Anxiety Spectrum 17 Monotherapy with
anxiolytics and lifestyle
modification
Adjustment Disorder 20 Monotherapy with
anxiolytics and lifestyle
modification
Anxiety Disorder
Secondary to general
medical condition
05 Monotherapy with
anxiolytics and lifestyle
modification
Nil active psych disorder 03
3 patients required low fluence PDT for chronic CSCR

18. CONCLUSION
The study demostrated the psychiatric evaluation helped
treatment with anxiolytics in CSCR management leading to
rapid resolution and reduction in recurrence, along with life
style modifications.

19. THANK YOU