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)

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

doi:10.1016/j.apjo.2025.100252

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)

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. LaiChristopher Seungkyu Lee, Andrew Lotery, Sobha Sivaprasad, Mingwei Zhao, Dennis S. C. Lam^*, Camiel J. F. Boon^*

^*Corresponding author for this work

Macquarie Medical School

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

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Abstract

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.

Original language	English
Article number	100252
Pages (from-to)	1-15
Number of pages	15
Journal	Asia-Pacific Journal of Ophthalmology
Volume	14
Issue number	5
DOIs	https://doi.org/10.1016/j.apjo.2025.100252
Publication status	Published - 25 Oct 2025

Bibliographical note

Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

AAPPO
APVRS
ARI
Central Serous Chorioretinopathy
Consensuses
Controversies
Guidelines

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Radke, N. V., van Dijk, E. H. C., Spaide, R. F., Holz, F. G., Koizumi, H., Freund, K. B., Subhi, Y., Lange, C., Singh, S. R., Chen, H., Chen, L. J., Chen, S.-N., Chhablani, J., Behar-Cohen, F., Das, T., Fung, A. T., Gomi, F., Kim, M., Lai, C.-C., ... Boon, C. J. F. (2025). 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). Asia-Pacific Journal of Ophthalmology, 14(5), 1-15. Article 100252. https://doi.org/10.1016/j.apjo.2025.100252

Radke, Nishant V. ; van Dijk, Elon H. C. ; Spaide, Richard F. et al. / 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). In: Asia-Pacific Journal of Ophthalmology. 2025 ; Vol. 14, No. 5. pp. 1-15.

@article{283c67fd19864712ab69708d707b5ac8,

title = "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)",

abstract = "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 ({\textquoteleft}agree{\textquoteright} \& {\textquoteleft}strongly agree{\textquoteright}) 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.",

keywords = "AAPPO, APVRS, ARI, Central Serous Chorioretinopathy, Consensuses, Controversies, Guidelines",

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

note = "Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2025",

month = oct,

day = "25",

doi = "10.1016/j.apjo.2025.100252",

language = "English",

volume = "14",

pages = "1--15",

journal = "Asia-Pacific Journal of Ophthalmology",

issn = "2162-0989",

publisher = "Lippincott Williams and Wilkins",

number = "5",

}

Radke, NV, van Dijk, EHC, Spaide, RF, Holz, FG, Koizumi, H, Freund, KB, Subhi, Y, Lange, C, Singh, SR, Chen, H, Chen, LJ, Chen, S-N, Chhablani, J, Behar-Cohen, F, Das, T, Fung, AT, Gomi, F, Kim, M, Lai, C-C, Lai, TYY, Lee, CS, Lotery, A, Sivaprasad, S, Zhao, M, Lam, DSC & Boon, CJF 2025, '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)', Asia-Pacific Journal of Ophthalmology, vol. 14, no. 5, 100252, pp. 1-15. https://doi.org/10.1016/j.apjo.2025.100252

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). / Radke, Nishant V.; van Dijk, Elon H. C.; Spaide, Richard F. et al.
In: Asia-Pacific Journal of Ophthalmology, Vol. 14, No. 5, 100252, 25.10.2025, p. 1-15.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - 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)

AU - Radke, Nishant V.

AU - van Dijk, Elon H. C.

AU - Spaide, Richard F.

AU - Holz, Frank G.

AU - Koizumi, Hideki

AU - Freund, K. Bailey

AU - Subhi, Yousif

AU - Lange, Clemens

AU - Singh, Sumit Randhir

AU - Chen, Haoyu

AU - Chen, Li Jia

AU - Chen, San-Ni

AU - Chhablani, Jay

AU - Behar-Cohen, Francine

AU - Das, Taraprasad

AU - Fung, Adrian T.

AU - Gomi, Fumi

AU - Kim, Min

AU - Lai, Chi-Chun

AU - Lai, Timothy Y. Y.

AU - Lee, Christopher Seungkyu

AU - Lotery, Andrew

AU - Sivaprasad, Sobha

AU - Zhao, Mingwei

AU - Lam, Dennis S. C.

AU - Boon, Camiel J. F.

N1 - Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2025/10/25

Y1 - 2025/10/25

N2 - 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.

AB - 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.

KW - AAPPO

KW - APVRS

KW - ARI

KW - Central Serous Chorioretinopathy

KW - Consensuses

KW - Controversies

KW - Guidelines

UR - https://www.scopus.com/pages/publications/105021094421

U2 - 10.1016/j.apjo.2025.100252

DO - 10.1016/j.apjo.2025.100252

M3 - Article

C2 - 41106484

AN - SCOPUS:105021094421

SN - 2162-0989

VL - 14

SP - 1

EP - 15

JO - Asia-Pacific Journal of Ophthalmology

JF - Asia-Pacific Journal of Ophthalmology

IS - 5

M1 - 100252

ER -

Radke NV, van Dijk EHC, Spaide RF, Holz FG, Koizumi H, Freund KB et al. 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). Asia-Pacific Journal of Ophthalmology. 2025 Oct 25;14(5):1-15. 100252. doi: 10.1016/j.apjo.2025.100252

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)

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