Occult Central Serous Chorioretinopathy

Abstract

 

Purpose

 

To describe the clinical and multi-modal imaging findings of a new variant of central serous chorioretinopathy: occult central serous chorioretinopathy (OCSC).

 

Methods

 

Retrospective review of the clinical histories and multi-modal imaging findings of patients with the diagnosis of OCSC based on a characteristic funduscopic appearance, fundus autofluorescence (FAF) imaging abnormalities, and increased subfoveal choroidal thickness as measured with enhanced depth imaging optical coherence tomography (EDI-OCT).

 

Results

 

Fourteen eyes of 7 patients (5 females and 2 males; age: 27-89 years) were diagnosed with OCSC. Each patient had mild or no visual symptoms. The funduscopic appearance was characteristic in all cases with either diffuse or focal areas of decreased choroidal vascular markings suggestive of increased choroidal thickness, that was confirmed with EDI-OCT (mean subfoveal choroidal thickness = 462.6 microns). Each patient demonstrated a variety of drusenoid and pigmentary changes in the macula of one or both eyes with occasional small serous retinal pigment epithelial detachments (PED) detectable only on OCT. No subjects had a history of, or subsequently developed, macular edema or subretinal fluid over the course of follow-up, and patients showed mean vision improvement over the follow-up period (16-192 months).

 

Conclusions

 

OCSC should be suspected in patients with a characteristic funduscopic appearance of a thick choroid and nonspecific RPE abnormalities. Imaging with EDI-OCT to confirm a choroidal thickening and FAF to show RPE alterations consistent with central serous chorioretinopathy support the diagnosis of OCSC. As these patients are frequently misdiagnosed as having early AMD, macular dystrophies, or inflammatory chorioretinopathies such as punctate inner choroidopathy, the recognition of OCSC may avoid unnecessary diagnostic testing and interventions.

 

 

Color (A), FAF (B), OCT (C), and EDI-OCT (D) images of the right eye (OD, right column) and left eye (OS, left column) of a healthy 28-year-old woman with slight metamorphosia OU. There are minimal choroidal markings, and multiple discrete drusenoid and pigmentary lesions (arrows, A) that are hypoautofluorescent (B). OCT scans (C) through the lesions indicated by arrows show a PED inferonasal to the fovea OD and RPE elevation superotemporally OS. EDI-OCT (D) shows a thickened subfoveal choroid of 609 microns OD and 573 microns OS.

 

Keywords: 585 macula/fovea • 452 choroid • 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)