2020–2021 BCSC Basic and Clinical Science Course™
12 Retina and Vitreous
Part II: Disorders of the Retina and Vitreous
Chapter 09: Choroidal Disease
Central Serous Chorioretinopathy
Imaging
The extent of the detachment can be documented with color fundus photographs. Autofluorescence imaging shows the accumulation of shed outer segments in the subretinal space, as well as distributed defects of the RPE. It has been theorized that the white dots seen under the retina are macrophages with fluorophores from phagocytized outer segments (Fig 9-2). Eyes with chronic CSC can display descending tracts during both fluorescein and autofluorescence imaging (Fig 9-3). Enhanced depth imaging optical coherence tomography (EDI-OCT) shows thickening of the choroid and, in areas where thickening is most prominent, posterior loculation of fluid in the deep choroid. Figure 9-4 shows the internal structure of a healthy choroid, while Figure 9-5 shows the choroid in 1 healthy eye and in 3 eyes with CSC. Although ICG angiography is able to visualize choroidal vascular hyperpermeability (Fig 9-6), it has largely been supplanted by OCT, even for detecting possible coexisting choroidal neovascularization (CNV), which may be present in up to 20% of cases in individuals over the age of 50 years. OCT angiography seems to be adept at detecting type 1 CNV in these patients.
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Imamura Y, Fujiwara T, Margolis R, Spaide RF. Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy. Retina. 2009;29(10):1469–1473.
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Spaide RF, Klancnik JM Jr. Fundus autofluorescence and central serous chorioretinopathy. Ophthalmology. 2005;112(5):825–833.
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.