Central Serous Chorioretinopathy Bullous Variant Linked With Pathogenic Risk Factors

Acute central serous chorioretinopathy
Acute central serous chorioretinopathy
Poor initial vision and history of kidney-transplantation is associated with poor visual outcome in patients with bullous variant central serous chorioretinopathy, according to investigators.

The bullous-variant of central serous chorioretinopathy (bvCSC) is linked with systemic corticosteroid use as well as kidney-related and autoimmune/rheumatoid diseases, according to a retrospective case series published in Ophthalmology Retina. Study findings also reveal that patients with better vision at diagnosis who have never had a kidney transplant experience more favorable outcomes. 

Researchers conducted a retrospective, multi-center analysis between September 2020 and March 2021. The study included 62 eyes of 44 patients with bvCSC and 97 eyes of 85 patients with nonbullous CSC. The primary outcome measures were baseline demographics and patient characteristics compared between the 2 groups. Secondary outcomes included factors associated with visual prognosis in the bvCSC group. 

Compared with the nonbullous CSC group, the bvCSC group presented at a younger age (49 vs 52 years; P =.047) and with more bilateral involvement (41% vs 14%; P <.001).

The researchers noted that systemic corticosteroid use was more common in the bvCSC group than in the group with nonbullous CSC, both in terms of any exposure (50% vs 20%; P =.001) and long-term exposure (36% vs 9%; P <.001). The bvCSC group demonstrated higher instances of the following distinct imaging features (all P <.05) compared with control individuals: retinal folding (64% vs 1%), subretinal fibrin (75% vs 13%), multiple retinal pigment epithelium tears (24% vs 2%), and multifocal fluorescein leakages with terminal telangiectasia (36% vs 1%), according to the report.  

At diagnosis, patients with bvCSC experienced poorer vision compared with the control group (20/80 vs 20/44; P =.003). However, treatment response was more robust (fluid resolution by final follow-up, 84% vs 68%; P =.034), resulting in similar final visual outcomes (20/52 vs 20/45; P =.52). 

The team determined that bvCSC was associated with a history of kidney-related (OR: 5.4; 95% CI, 1.3–18.5; P =.045) and autoimmune/rheumatoid diseases (OR: 25.4; 95% CI, 2.8–195.0; P =.004)  They also noted that more favorable outcomes for bvCSC were associated with better initial vision (OR: O.1; 95% CI, 0.05–0.4; P <.001) and not having  kidney-transplantation (OR: 0.2; 95% CI, 0.04–0.75; P =.020).

“The bullous variant of central serous chorioretinopathy is associated with pathogenic risk factors based on underlying medical conditions and systemic corticosteroids exposure,” according to the researchers. “Poor vision at diagnosis and history of renal transplantation were associated with poor visual outcome.”

Limitations of the study include its retrospective design, possible bias due to differences in treatment periods and follow up-durations, and the ethnically homogenous cohort. 


Kang HG, Woo SJ, Lee JY, et al. Pathogenic risk factors and associated outcomes in the bullous variant of central serous chorioretinopathy. Ophthalmol Retina. Published online April 25, 2022. doi:10.1016/j.oret.2022.04.015