Elsevier

Ophthalmology

Volume 107, Issue 4, April 2000, Pages 767-777
Ophthalmology

Original Articles
Polypoidal choroidal vasculopathy masquerading as central serous chorioretinopathy

https://doi.org/10.1016/S0161-6420(99)00173-6Get rights and content

Abstract

Objective

To differentiate polypoidal choroidal vasculopathy (PCV) from central serous chorioretinopathy (CSC).

Design

A retrospective, observational case series.

Participants

Thirteen patients originally diagnosed with CSC proved to have PCV after more extensive evaluation and follow-up.

Methods

A clinical and angiographic review of patients with manifestations of CSC, including macular detachment.

Main outcome measures

Demographic data, funduscopic examination, and fluorescein and indocyanine green (ICG) angiographic findings.

Results

Thirteen patients initially suspected of having CSC were ultimately diagnosed as having PCV. These eyes had exudative macular detachments secondary to a small caliber, polypoidal choroidal vascular abnormality or so-called polypoidal choroidal neovascularization. The clinical manifestations in the fundus varied. They included multiple, variably sized serous pigment epithelial detachments, neurosensory retinal detachment, lipid deposition, patchy atrophy of the pigment epithelium and indistinct staining from decompensation of the posterior blood-retinal barrier on fluorescein angiography. In reality, the suspected PEDs proved to be polypoidal lesions of PCV when imaged with ICG angiography.

Conclusions

The clinical diagnosis of CSC or PCV generally poses little challenge to the experienced retinal specialist. However, in CSC with persistent and/or recurrent exudation, a myriad of retinal pigment epithelial changes may evolve that make it difficult to differentiate these two entities. In such patients, ICG angiography is useful in differentiating CSC from PCV. An accurate clinical diagnosis is important since each of these entities, CSC and PCV, may differ in terms of their risk factors, natural course, and visual prognosis.

Section snippets

Patients and methods

From January to October of 1999, thirteen patients who were originally suspected of having CSC with persistent or recurrent macular detachment were further evaluated and ultimately diagnosed as PCV. A complete ophthalmologic clinical examination, including slit-lamp biomicroscopy with a fundus contact lens and indirect ophthalmoscopy, was performed. Fluorescein angiography with 5 cc of 10% solution and an indocyanine green (ICG) angiogram with a 50 mg dose was obtained for each patient (Topcon

Discussion

For the classic presentation of central serous chorioretinopathy (CSC), there is little difficulty in establishing an accurate diagnosis.1, 2, 3, 4, 5, 6, 7, 8, 9 A young emmetropic or slightly hyperopic male adult with a high-risk behavioral pattern experiences typical central visual disturbances, such as micropsia, scotoma, and metamorphopsia from a neurosensory detachment that usually involves the fovea.2 There is a localized macular detachment and usually one or more small pigment

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    Supported by the LuEsther T. Mertz Retinal Research Laboratory of the Weill Medical College of Cornell University and The Macula Foundation, Inc.

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