International consensuses and guidelines on Central Serous Chorioretinopathy (CSC) by the Asia Pacific Vitreo-retina Society (APVRS), the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and the Academia Retina Internationalis (ARI).

15/10/2025

Asia-Pacific journal of ophthalmology (Philadelphia, Pa.)

Authors: Nishant V Radke, Elon H C van Dijk, Richard F Spaide, Frank G Holz, Hideki Koizumi, K Bailey Freund, Yousif Subhi, Clemens Lange, Sumit Randhir Singh, Haoyu Chen, Li Jia Chen, San-Ni Chen, Jay Chhablani, Francine Behar-Cohen, Taraprasad Das, Adrian T Fung, Fumi Gomi, Min Kim, Chi-Chun Lai, Timothy Y Y Lai, Christopher Seungkyu Lee, Andrew Lotery, Sobha Sivaprasad, Mingwei Zhao, Dennis S C Lam, Camiel J F Boon

PURPOSE: To establish consensus-based guidelines on the diagnosis, classification, and management of central serous chorioretinopathy (CSC) through a structured expert panel initiative by the Asia-Pacific Vitreo-retina Society (APVRS) and the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO), addressing the existing clinical controversies.

METHODS: An international panel of 26 experts from 13 countries collaboratively drafted consensus statements spanning five key areas: disease definition, pathophysiology, investigations, current management, and future developments. Consensus was reached through an iterative Delphi process and anonymous voting using a five-point Likert scale. Statements were accepted when ≥75% agreement ('agree' & 'strongly agree') was achieved.

RESULTS: Consensus was achieved for 28 of 29 statements (96.6%), reflecting strong alignment among experts. Key agreements included defining CSC as a pachychoroid-driven chorioretinal disorder characterized by neurosensory retinal and/or RPE detachment, with multimodal imaging (optical coherence tomography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography) recognized as essential for diagnosis. Half-dose photodynamic therapy (PDT) was unanimously endorsed as the first-line treatment for chronic CSC. Oral mineralocorticoid receptor antagonists (MRAs) lacked consensus for therapeutic benefit, aligning with evidence from the VICI and SPECTRA trials. Anti-vascular endothelial growth factor receptor therapy was recommended solely for CSC complicated by a macular neovascularization. Future priorities highlighted standardizing disease classification and exploring targeted therapies through genetic and nanomedicine research.

CONCLUSION: This consensus initiative provides a robust, evidence-based framework for the diagnosis and management of CSC, promoting standardization across clinical practices and guiding future research directions to address persistent gaps in CSC care.

PMID: 41106484