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Discrepancy in current central serous chorioretinopathy classification
  1. Sumit Randhir Singh1,
  2. Alexandre Matet2,3,
  3. Elon H C van Dijk4,
  4. Alejandra Daruich5,6,
  5. Sascha Fauser7,
  6. Suzanne Yzer8,
  7. Enrico Peiretti9,
  8. Sobha Sivaprasad10,
  9. Andrew J Lotery11,
  10. Camiel J F Boon4,
  11. Francine Behar-Cohen5,6,
  12. K Bailey Freund12,13,
  13. Jay Chhablani1
  1. 1 Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
  2. 2 Ophthalmology Department, Institut Curie, PSL Research University, Paris, France
  3. 3 Université Paris Descartes, Paris, France
  4. 4 Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
  5. 5 INSERM, UMRS 872 Team 17, Centre de Recherche des Cordeliers, Paris, France
  6. 6 Ophthalmology Department, Cochin University Hospital, APHP, Paris, France
  7. 7 Laboratory for Experimental Immunology of the Eye, Department of Ophthalmology, University of Cologne, Cologne, Germany
  8. 8 Department of Ophthalmology, Columbia University, New York City, New York, USA
  9. 9 Eye Clinic, University of Cagliari, Cagliari, Italy
  10. 10 National Institute for Health Research Biomedical Research Centre in Ophthalmology, Moorfields Eye Hospital, London, UK
  11. 11 Faculty of Medicine, University of Southampton, Southampton, UK
  12. 12 Vitreous Retina Macula Consultants of New York, New York City, New York, USA
  13. 13 LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA
  1. Correspondence to Dr Jay Chhablani, Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India; jay.chhablani{at}


Aim To report the discordance in central serous chorioretinopathy (CSCR) classification among practising retina specialists.

Methods The study conducted was a multicentre survey. Multimodal retinal images along with relevant clinical details of 100 cases diagnosed as CSCR (from six centres) were circulated among six retina specialists across the globe. The image sets included colour fundus photographs, fundus autofluorescence images, optical coherence tomography b-scans, fluorescein and indocyanine green angiography of the study and fellow eyes. The graders were asked to classify the disease of study eye, according to their own criteria. The graders were masked to the responses of other graders. The final analysis of the pooled response data was done based on the diagnosis of study eye only. The main outcome measure was degree of agreement between six independent observers using Fleiss Kappa statistics.

Results Grading for 100 eyes of 100 patients (men, 93%) was included in the analysis. 20 patients had a history of steroid use. The graders provided 36 different terms to classify the disease, with poor agreement among graders (Fleiss Kappa=0.134). The consistency in diagnosing acute CSCR was statistically higher than for either chronic (p=0.012) or recurrent CSCR (p<0.0001). When collapsing descriptors into six main terms, agreement remained poor (Fleiss Kappa=0.218).

Conclusion The high discordance among experienced retina specialists in describing CSCR clinical subtypes is highlighted. The current work demonstrates the limitations of current empirical CSCR classification methods and the need for a more objective and refined system to bring uniformity in diagnosis and prognostication of the disease.

  • central serous chorioretinopathy
  • fundus autofluorescence
  • optical coherence tomography
  • fluorescein angiography
  • indocyanine green angiography

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  • SRS and AM contributed equally.

  • Contributors SRS, AM and JC were involved in the designing of the study. AM, EHCvD, AD, EP, CJFB and JC were involved in the collection of data. SF, EP, SS, CJFB, FB-C and JC were responsible for interpretation of the data (clinical images). AM, EHCvD and AD did the analysis. SRS, AM, EHCvD and AD were involved in manuscript writing. SF, SY, SS, AJL, CJFB, FB-C, KBF and JC reviewed the article. All the authors conducted the study and equally contributed in the preparation, review and approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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