eMedicine Specialties > Ophthalmology > Retina

Chorioretinopathy, Central Serous: Differential Diagnoses & Workup

Author: Kean Theng Oh, MD, Consulting Staff, Associated Retinal Consultants, PC
Coauthor(s): James Folk, MD, Professor, Department of Ophthalmology and Visual Science, University of Iowa College of Medicine
Contributor Information and Disclosures

Updated: Jul 16, 2007

Differential Diagnoses

ARMD, Exudative
Neovascularization, Choroidal
ARMD, Nonexudative
Retinal Detachment, Exudative
Macular Edema, Irvine-Gass
Retinal Detachment, Rhegmatogenous
Macular Hole
Vogt-Koyanagi-Harada Disease
Neovascular Membranes, Subretinal

Other Problems to Be Considered

Idiopathic polypoidal choroidal vasculopathy
Pattern dystrophy (adult foveomacular dystrophy)
Retinal angiomatous proliferation

Workup

Laboratory Studies

  • Laboratory tests, in general, are not helpful in the diagnosis, although a recent case report identified an elevated level of plasminogen activator inhibitor 1 in the serum of patients with CSCR.

Imaging Studies

  • Optical coherence tomography (OCT) reveals many aspects of the pathophysiology of CSCR, ranging from subretinal fluid, pigment epithelial detachments, and retinal atrophy following chronic disease. OCT is especially helpful in identifying subtle, even subclinical, neurosensory macular detachments. Spaide correlated lipofuscinoid deposition of material in CSCR that might mimic vitelliform lesions in pattern dystrophies.7 OCT showed accumulation of this material on the outer surface of the retina in neurosensory detachments.
  • FA of classic CSCR shows one or more focal leaks at the level of the RPE. The classic "smokestack" appearance of the fluorescein leak is seen only in 10-15% of cases. FA of diffuse retinal pigment epitheliopathy demonstrates focal granular hyperfluorescence corresponding to window defects and blockage caused by RPE atrophy and clumping with one or more areas of subtle continued leakage.
  • ICG angiography has shown hypofluorescent areas early in the angiogram followed by late hyperfluorescence and leakage in choroidal vasculature. Often, multiple areas of leakage are seen on ICG angiography that are not evident clinically or on FA. According to some researchers, characteristic mid phase findings on ICG angiography allow differentiation from occult choroidal neovascularization in older individuals. Multiple patches of hyperfluorescence presumably are due to choroidal hyperpermeability, which, in later phases, results in silhouetting or negative staining of larger choroidal vessels.

Other Tests

  • Multifocal electroretinography has been used to identify focal regions of decreased retinal function, even in asymptomatic or clinically inactive eyes. Furthermore, investigators, including Lai et al, are using multifocal electroretinography as a means of assessing the efficacy and safety of new treatment modalities for CSCR.8  
  • Microperimetry (using the Nidek MP-1 microperimeter) has also shown that, despite clinical resolution of CSCR, there is lower retinal sensitivity in the macula even once visual acuity returned to 20/20. Fixation studies showed stability of central fixation.

More on Chorioretinopathy, Central Serous

Overview: Chorioretinopathy, Central Serous
Differential Diagnoses & Workup: Chorioretinopathy, Central Serous
Treatment & Medication: Chorioretinopathy, Central Serous
Follow-up: Chorioretinopathy, Central Serous
Multimedia: Chorioretinopathy, Central Serous
References
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References

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Further Reading

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Keywords

idiopathic central serous chorioretinopathy, central serous retinopathy, central serous chorioretinopathy, CSCR, choriocapillaris, retinal pigment epithelium, RPE, retinal pigment epithelium leaks, RPE leaks, RPE leakage, choroidal neovascularization, retinal pigment epithelial dysfunction, neurosensory retina

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Contributor Information and Disclosures

Author

Kean Theng Oh, MD, Consulting Staff, Associated Retinal Consultants, PC
Kean Theng Oh, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Society of Retina Specialists, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

James Folk, MD, Professor, Department of Ophthalmology and Visual Science, University of Iowa College of Medicine
James Folk, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Brian A Phillpotts, MD, Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine
Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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