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).

PURPOSE: To establish consensus-based guidelines on the diagnosis, classification, and management of central serous chorioretinopathy (CSC) through a structured expert panel initiated by the Asia-Pacific Vitreo-retina Society (APVRS), the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO), and the Academia Retina Internationalis (ARI), 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 all 25 statements, 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.