Clinical characteristics of subretinal deposits in central serous chorioretinopathy

PURPOSE: To describe abnormal subretinal material in central serous chorioretinopathy (CSC).

DESIGN: Retrospective observational case series.

PARTICIPANTS: 168 consecutive patients (336 eyes) with a definite diagnosis of serous foveal detachment attributable to CSC in one or both eyes, on one or more occasions.

METHODS: Review of all cases seen during a six-year period. Grading of the amount of subretinal material at presentation as absent, questionable, mild, moderate or severe.

RESULTS: Of 168 patients with CSC, 133 (79%) were men and 35 (21%) women. The median age was 45.2 years (range 22-70 yrs). The median duration of symptoms was 2 months (range 0.1-144 months). Subretinal material was found in the symptomatic eye or, in bilateral cases, in the eye that had most recently become symptomatic in 138 patients and in increasing amounts with increasing duration of symptoms (p < 0.001) but unrelated to age or sex. A substantial fraction of the material was shown by optical coherence tomography to be attached to the photoreceptor outer segments of the detached retina.

CONCLUSIONS: Increasing amounts of subretinal material are found with increasing duration of symptoms in eyes with CSC. This suggests that early granular deposits may be composed of fragments of photoreceptor outer segments that accumulate when the phagocytosis photoreceptor outer segment material is disrupted by the serous detachment of the retina. Other possible origins that cannot be excluded include plasma proteins excluding from the choriocapillaris, inflammatory debris, and lipid exudate originating from occult choroidal neovascularization secondary to CSC.