gms | German Medical Science

Chronic Central Serous Chorioretinopathy (CSCR) is a choroidal disease characterized by central vision loss, typically seen in middle-aged males between 20 and 50 years old.

It has been associated with the use of various drugs, including corticosteroids, stress situations, etc. CSCR encompasses a wide spectrum of manifestations, ranging from acute CSCR, which resolves spontaneously within a few weeks, to chronic CSCR with non-resolving subretinal fluid (SRF) and diffuse retinal pigment epithelium (RPE) changes leading to permanent suboptimal visual acuity. Capillary and venous choroidal congestion associated with delayed arterial perfusion has long been recognized as a cardinal sign of CSCR, leading to pachychoroidal features.

The advent of SD-OCT imaging has allowed for the visualization of findings related to pachychoroid and scleral thickness, opening new avenues for a comprehensive approach to disease onset and prompting the use of regenerative protocols in the management of chronic central serous chorioretinopathy.

Patients and methods: We report on our experiences with two cases of chronic CSCR treated with plasma therapy (activated concentrated platelet-rich plasma). The patients underwent a subtenon injection of 0.7 ml of fresh activated platelet-rich plasma following a pro-nata regimen, with a two-week interval between injections. Two to three injections were necessary to achieve anatomical re-establishment and resolution of the serous detachment.

Case 1: A 47-year-old male who first experienced symptoms 7 years ago and was treated with conventional treatment without results. Chronic evolution followed with a decrease in visual acuity, blurring, and impaired central visual function, with a visual acuity of 0.6 in the Snellen chart.

Case 2: A 52-year-old male treated for bilateral retinitis with vision loss over one year; visual acuity was 0.2/0.3 in the Snellen chart. The initial diagnosis was Harada’s disease, which was treated with corticosteroids. Worsening after steroids intake was observed, and OCT and fluorescein angiography confirmed the diagnosis of bilateral central serous retinochoroiditis, with leakage and pachycoroid features measurements for confirmation.

The preparation of the platelet-rich plasma solution followed the good practice guidelines after obtaining informed consent from the patients.

Results: Case 1: After treatment with two injections of 0.7 ml of concentrated plasma, the first injection at presentation and the second after 10 days, impressive normalization of OCT findings was noted with a gain of two lines on the Snellen chart, and after one month, subcomplete restoration of function was achieved; the best corrected visual acuity (BCVA) reached 0.9 p in the Snellen chart.

Case 2: A bilateral decrease in serous detachment was observed one week after the first injection, reaching complete OCT normalization after three injections, with a gain of two lines on the Snellen chart after one month of treatment. Visual acuity (BCVA) reached 0.4/0.5.

Conclusion: Treatment with platelet-rich plasma in chronic CSCR as a new concept should be discussed after disease progression to prevent visual loss, restore function, and achieve anatomical

OCT normalization. This treatment modality opens a new era of research in the management of chronic CSCR. However, further studies are necessary to prove the treatment’s efficiency.