As discussed, CSC appears to be caused by hyperpermeability of choroidal vessels. Other entities that may be considered in the differential diagnosis include type 1 CNV and polypoidal choroidal vasculopathy (PCV), which is a variant of type 1 CNV. The fluorescein angiographic findings can overlap significantly; both show leakage of fluorescein and the visualization of the structures underlying the RPE is poor. If CNV is present, OCT demonstrates an irregular wavy, shallow elevation of the RPE by a layer of material with heterogeneous reflectivity. The neovascularization seen in association with CSC are generally easy to detect with OCT angiography. What complicates the issue, particularly regarding treatment, is that type 1 CNV and PCV appear to be associated with CSC; they may be its sequelae.
Figure 9-6 Stages of indocyanine green (ICG) angiography in CSC. A, Early after injection, the dye can be seen within the choroidal vessels. B, During the middle phase of the angiogram, choriocapillaris hyperpermeability results in the appearance of multiple hyperfluorescent clouds. C, Later in the angiogram, the dye has largely been removed from the choroidal vessels. Dye that has leaked into the stroma has diffused posteriorly, silhouetting the larger choroidal vessels.
(Used with permission from Spaide RF, Hall L, Haas A, et al. Indocyanine green videoangiography of older patients with central serous chorioretinopathy. Retina. 1996;16:203–213.)
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.