{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T18:29:16Z","timestamp":1774895356159,"version":"3.50.1"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Ministry of Trade, Industry & Energy","award":["RS-2024-00507933"],"award-info":[{"award-number":["RS-2024-00507933"]}]},{"name":"the Ministry of Health & Welfare","award":["RS-2025-25454860"],"award-info":[{"award-number":["RS-2025-25454860"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Central serous chorioretinopathy (CSC) is strongly associated with systemic corticosteroid use, but the risk following intravitreal steroid injections remains unclear, with limited evidence from isolated case reports. This study evaluated the association between intravitreal steroid injections and CSC development using a dual-approach design with Clinical Data Warehouse (CDW) analysis and choroidal thickness validation. We performed CDW analysis of 2,336 patients receiving intravitreal triamcinolone acetonide or dexamethasone implant over 21 years (April 2003\u2013October 2024), screening for CSC within 6 months post-injection. Additionally, we conducted detailed subfoveal choroidal thickness analysis in 269 eyes (January 2023\u2013October 2024) at baseline, 1, 3, and 6 months post-injection using optical coherence tomography. No confirmed CSC cases occurred in either cohort (0\/2,336 patients, 95% CI: 0\u20130.13%; 0\/269 eyes). Contrary to the choroidal thickening characteristic of CSC, both steroid formulations produced significant choroidal thinning at 1 month: dexamethasone implant (227.0\u2009\u00b1\u200965.4\u03bcm to 217.9\u2009\u00b1\u200962.0\u03bcm, p\u2009&lt;\u20090.0001) and triamcinolone acetonide (219.8\u2009\u00b1\u200978.7\u03bcm to 218.6\u2009\u00b1\u200977.7\u03bcm, p\u2009&lt;\u20090.0001). Only 4.9% of eyes showed \u226510% choroidal thickening, and none developed CSC features. Both formulations achieved significant macular edema reduction through 6 months. Intravitreal corticosteroids showed no confirmed CSC cases over two decades with choroidal thinning rather than the thickening characteristic of CSC, suggesting distinct pathophysiological mechanisms and a favorable safety profile regarding CSC development.<\/jats:p>","DOI":"10.1371\/journal.pone.0343704","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T17:38:06Z","timestamp":1774892286000},"page":"e0343704","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intravitreal injections of corticosteroid and the risk of central serous chorioretinopathy"],"prefix":"10.1371","volume":"21","author":[{"given":"Jae Ryong","family":"Song","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3692-7169","authenticated-orcid":true,"given":"Se Joon","family":"Woo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"issue":"3","key":"pone.0343704.ref001","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1111\/ceo.14201","article-title":"Central serous chorioretinopathy: a review","volume":"51","author":"AT Fung","year":"2023","journal-title":"Clin Exp Ophthalmol"},{"key":"pone.0343704.ref002","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1167\/tvst.5.2.2","article-title":"Oral mineralocorticoid-receptor antagonists: real-life experience in clinical subtypes of nonresolving central serous chorioretinopathy with chronic epitheliopathy","volume":"5","author":"A Daruich","year":"2016","journal-title":"Transl Vis Sci Technol"},{"key":"pone.0343704.ref003","doi-asserted-by":"crossref","first-page":"100865","DOI":"10.1016\/j.preteyeres.2020.100865","article-title":"Central serous chorioretinopathy: an update on risk factors, pathophysiology and imaging modalities","volume":"79","author":"R Kaye","year":"2020","journal-title":"Prog Retin Eye Res"},{"key":"pone.0343704.ref004","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1016\/S0161-6420(02)01117-X","article-title":"Corticosteroids and central serous chorioretinopathy","volume":"109","author":"CA Carvalho-Recchia","year":"2002","journal-title":"Ophthalmology"},{"issue":"1","key":"pone.0343704.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.survophthal.2017.06.008","article-title":"Central serous chorioretinopathy and glucocorticoids: an update on evidence for association","volume":"63","author":"BP Nicholson","year":"2018","journal-title":"Surv Ophthalmol"},{"issue":"4","key":"pone.0343704.ref006","doi-asserted-by":"crossref","first-page":"281","DOI":"10.3341\/kjo.2017.0144","article-title":"Association of central serous chorioretinopathy with psychosocial factors is dependent on its phase and subtype","volume":"32","author":"YK Kim","year":"2018","journal-title":"Korean J Ophthalmol"},{"issue":"9","key":"pone.0343704.ref007","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1007\/s00417-004-0885-z","article-title":"Glucocorticoid use represents a risk factor for central serous chorioretinopathy: a prospective, case-control study","volume":"242","author":"P Karadimas","year":"2004","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"issue":"5","key":"pone.0343704.ref008","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/archopht.122.5.784","article-title":"Central serous chorioretinopathy after local application of glucocorticoids for skin disorders","volume":"122","author":"P Karadimas","year":"2004","journal-title":"Arch Ophthalmol"},{"issue":"5","key":"pone.0343704.ref009","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/S0039-6257(02)00338-7","article-title":"Central serous chorioretinopathy and glucocorticoids","volume":"47","author":"EA Bouzas","year":"2002","journal-title":"Surv Ophthalmol"},{"issue":"3","key":"pone.0343704.ref010","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1111\/ceo.13702","article-title":"Local delivery of corticosteroids in clinical ophthalmology: a review","volume":"48","author":"AT Fung","year":"2020","journal-title":"Clin Exp Ophthalmol"},{"issue":"1","key":"pone.0343704.ref011","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/j.1600-0420.2005.00379.x","article-title":"Central serous chorioretinopathy following vitrectomy with intravitreal triamcinolone acetonide for diabetic macular oedema","volume":"83","author":"M Imasawa","year":"2005","journal-title":"Acta Ophthalmol Scand"},{"issue":"6","key":"pone.0343704.ref012","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1001\/archopht.122.6.926","article-title":"Central serous chorioretinopathy associated with periocular corticosteroid injection treatment for HLA-B27-associated iritis","volume":"122","author":"CR Baumal","year":"2004","journal-title":"Arch Ophthalmol"},{"issue":"6","key":"pone.0343704.ref013","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1111\/cxo.12420","article-title":"Central serous chorioretinopathy in the fellow eye as a complication of intravitreal dexamethasone implant for the treatment of Irvine-Gass syndrome","volume":"99","author":"I Georgalas","year":"2016","journal-title":"Clin Exp Optom"},{"key":"pone.0343704.ref014","doi-asserted-by":"crossref","first-page":"392","DOI":"10.3341\/kjo.2018.0115","article-title":"Central serous chorioretinopathy following intravitreal dexamethasone implant","volume":"33","author":"GM Noh","year":"2019","journal-title":"Korean J Ophthalmol"},{"key":"pone.0343704.ref015","doi-asserted-by":"crossref","first-page":"145","DOI":"10.4258\/hir.2012.18.2.145","article-title":"Seoul National University Bundang Hospital\u2019s electronic system for total care","volume":"18","author":"S Yoo","year":"2012","journal-title":"Healthc Inform Res"},{"issue":"7","key":"pone.0343704.ref016","doi-asserted-by":"crossref","first-page":"4605","DOI":"10.1167\/iovs.10-6387","article-title":"Pharmacokinetics of a sustained-release dexamethasone intravitreal implant in vitrectomized and nonvitrectomized eyes","volume":"52","author":"J-E Chang-Lin","year":"2011","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"1","key":"pone.0343704.ref017","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1167\/iovs.10-5285","article-title":"Pharmacokinetics and pharmacodynamics of a sustained-release dexamethasone intravitreal implant","volume":"52","author":"J-E Chang-Lin","year":"2011","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"7005","key":"pone.0343704.ref018","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1136\/bmj.311.7005.619","article-title":"Probability of adverse events that have not yet occurred: a statistical reminder","volume":"311","author":"E Eypasch","year":"1995","journal-title":"BMJ"},{"issue":"10","key":"pone.0343704.ref019","doi-asserted-by":"crossref","first-page":"2443","DOI":"10.1007\/s40123-025-01220-0","article-title":"Global incidence of central serous chorioretinopathy: a systematic review, meta-analysis, and forecasting study","volume":"14","author":"IN Frederiksen","year":"2025","journal-title":"Ophthalmol Ther"},{"issue":"8","key":"pone.0343704.ref020","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s003470050310","article-title":"Central serous chorioretinopathy. clinical, fluorescein angiography and demographic aspects","volume":"95","author":"HC G\u00e4ckle","year":"1998","journal-title":"Ophthalmologe"},{"key":"pone.0343704.ref021","article-title":"Epidemiology of idiopathic central serous chorioretinopathy in Taiwan, 2001\u20132006: a population-based study","volume":"8","author":"DC Tsai","year":"2013","journal-title":"PLOS ONE"},{"issue":"1","key":"pone.0343704.ref022","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s00417-019-04486-w","article-title":"Corticosteroids usage and central serous chorioretinopathy: a meta-analysis","volume":"258","author":"G Ge","year":"2020","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"issue":"10","key":"pone.0343704.ref023","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1001\/jamaophthalmol.2018.3293","article-title":"Association of corticosteroid use with incidence of central serous chorioretinopathy in South Korea","volume":"136","author":"TH Rim","year":"2018","journal-title":"JAMA Ophthalmol"},{"issue":"1","key":"pone.0343704.ref024","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1167\/iovs.13-12854","article-title":"Changes in choroidal thickness after systemic administration of high-dose corticosteroids: a pilot study","volume":"55","author":"JM Han","year":"2014","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0343704.ref025","doi-asserted-by":"crossref","first-page":"100973","DOI":"10.1016\/j.preteyeres.2021.100973","article-title":"Venous overload choroidopathy: a hypothetical framework for central serous chorioretinopathy and allied disorders","volume":"86","author":"RF Spaide","year":"2022","journal-title":"Prog Retin Eye Res"},{"issue":"6","key":"pone.0343704.ref026","doi-asserted-by":"crossref","first-page":"3979","DOI":"10.1167\/iovs.14-14188","article-title":"Effect of intravitreal triamcinolone acetonide or bevacizumab on choroidal thickness in eyes with diabetic macular edema","volume":"55","author":"S Sonoda","year":"2014","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"4","key":"pone.0343704.ref027","article-title":"Effect of anti-vascular endothelial growth factor therapy on choroidal thickness in diabetic macular edema","volume":"158","author":"G Yiu","year":"2014","journal-title":"Am J Ophthalmol"},{"issue":"6","key":"pone.0343704.ref028","doi-asserted-by":"crossref","first-page":"627","DOI":"10.5301\/ejo.5000734","article-title":"Comparison of choroidal thickness changes following intravitreal dexamethasone, ranibizumab, and triamcinolone in eyes with retinal vein occlusion","volume":"26","author":"E Yumusak","year":"2016","journal-title":"Eur J Ophthalmol"},{"issue":"8","key":"pone.0343704.ref029","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.3341\/jkos.2016.57.8.1222","article-title":"Changes in choroidal thickness in branch retinal vein occlusion","volume":"57","author":"M Song","year":"2016","journal-title":"J Korean Ophthalmol Soc"},{"issue":"12","key":"pone.0343704.ref030","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1038\/eye.2016.187","article-title":"Subfoveal choroidal thickness in patients with diabetic retinopathy and diabetic macular oedema","volume":"30","author":"R Rewbury","year":"2016","journal-title":"Eye (Lond)"},{"key":"pone.0343704.ref031","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/ICB.0000000000000820","article-title":"Development of pachychoroid pigment epitheliopathy and transformation to central serous chorioretinopathy after intravitreal dexamethasone implantation","volume":"15","author":"MG Ersoz","year":"2021","journal-title":"Retin Cases Brief Rep"},{"issue":"10","key":"pone.0343704.ref032","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1016\/j.ophtha.2012.04.030","article-title":"Sustained delivery fluocinolone acetonide vitreous inserts provide benefit for at least 3 years in patients with diabetic macular edema","volume":"119","author":"PA Campochiaro","year":"2012","journal-title":"Ophthalmology"},{"issue":"4","key":"pone.0343704.ref033","doi-asserted-by":"crossref","DOI":"10.1016\/j.ophtha.2010.12.028","article-title":"Long-term benefit of sustained-delivery fluocinolone acetonide vitreous inserts for diabetic macular edema","volume":"118","author":"PA Campochiaro","year":"2011","journal-title":"Ophthalmology"},{"issue":"6","key":"pone.0343704.ref034","doi-asserted-by":"crossref","DOI":"10.1016\/j.ophtha.2010.03.032","article-title":"Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion","volume":"117","author":"JA Haller","year":"2010","journal-title":"Ophthalmology"},{"issue":"12","key":"pone.0343704.ref035","doi-asserted-by":"crossref","first-page":"2453","DOI":"10.1016\/j.ophtha.2011.05.014","article-title":"Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results","volume":"118","author":"JA Haller","year":"2011","journal-title":"Ophthalmology"},{"issue":"9","key":"pone.0343704.ref036","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1016\/j.ophtha.2008.06.015","article-title":"A randomized trial comparing intravitreal triamcinolone acetonide and focal\/grid photocoagulation for diabetic macular edema","volume":"115","author":"Diabetic Retinopathy Clinical Research Network","year":"2008","journal-title":"Ophthalmology"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0343704","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T17:38:13Z","timestamp":1774892293000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0343704"}},"subtitle":[],"editor":[{"given":"Alon","family":"Harris","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0343704","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,30]]}}}