An Ayurveda Approach in the Management of Central Serous Chorioretinopathy - A Case Study

Central Serous Chorioretinopathy (CSC) is one among the retinal disorder and a condition having high recurrence rate relatively; etiology and pathogenesis of which remains indeterminate. The effects on the retina are usually self-limited, although some people are left with permanent vision loss due to progressive and irreversible photoreceptor damage or retinal pigment epithelium atrophy. There have been a number of interventions used in CSC, including laser treatment, photodynamic therapy (PDT), intravitreal injection of anti-vascular endothelial growth factor agents, and sub threshold lasers. In Ayurveda the signs and symptoms of this can be considered under 1st and 2nd Patalagata Timira which described under Dristi gata Roga in all classics of Ayurveda. Pathogenesis suggests involvement of Pitta and Kapha dosha mainly. Therefore a treatment attempt was planned in the lines of Pitta Kapha shamana. After the treatment the quality of vision had been showed significant improvement. Foveal thickness and macular volume in OCT findings also showed significant reduction. The present paper discusses a case study of CSC and its Ayurveda Treatment.

Central Serous Chorioretinopathy: A Review of Pathogenesis, Risk Factors, Diagnostic Methods and the Current Treatments

Central serous chorioretinopathy (CSCR) is characterized by serous detachment of the neurosensory layer at the macula. It has a relatively high recurrence rate and mainly affecting middle-aged males. The etiology and pathogenesis of the disease still remain ambiguous. But choroidal changes which increase choroidal vascular permeability are the basic pathology of CSCR. Different diagnostic methods such as FAF, FFA, OCT, OCTA, ICG could be used to detect its biomarkers such as choroidal thickness, choroidal vascularity index, hyperreflective dots for exact diagnosis and treatment response. Acute CSCR generally self-limited, but in recurrent or chronic forms may cause permanent visual loss due to progressive and irreversible damage in the photoreceptor layer of retinal pigment epithelium atrophy. Several treatment alternatives have been reported, such as PDT, intravitreal Anti-VEGF, TTT, Laser, Mineralocorticoid receptor antagonist for chronic and recurrent CSCR.

Unilateral Retinal Pigment Epithelium Dysgenesis: Long-Term Natural Evolution and Multimodal Imaging

Purpose: To present the natural course and describe the characteristic findings of a case of unilateral retinal pigment epithelium dysgenesis (URPED) and highlight the optical coherence tomography angiography characteristics of this rare fundus pattern. Methods: Case report. Results: A 52-year-old male was referred 8 years ago to our clinic due to a distinctive unilateral lesion in his left fundus, of which he was aware from early adulthood. Clinical evaluation revealed an irregularly shaped patch of retinal pigment epithelium atrophy surrounding his left optic nerve, with a characteristic scalloped border and with severe distortion of the overlying retinal and vascular tissue. Retinal pigment epithelial hyperplasia was noted in the margin as well as in distinct lacunae clustered around the periphery of the lesion. Right fundus examination was normal. The patient was diagnosed with URPED and was followed annually with multimodal imaging ever since. No choroidal neovascularization or other complication was noted. However, the lesion appeared to slowly but steadily grow to eventually affect the foveal region causing severe visual loss. Best corrected visual acuity was 20/40 at baseline and 20/200 at last follow-up 8 years after the original diagnosis. Conclusion: URPED is a rare retinal disease with unique clinical characteristics that can progress relentlessly even in the absence of secondary complications.