Central Serous Chorioretinopathy in Myopic Patients

Abstract

Central serous chorioretinopathy (CSC) is typically seen in hyperopic or emmetropic eyes, 1 most of which have a thickened choroid. 2 We describe 6 eyes of 6 patients with CSC and significant myopia (Table and Figure). All eyes had a thickened choroid relative to their refractive error as measured by enhanced-depth imaging spectral-domain optical coherence tomography (Heidelberg Spectralis HRA ϩ OCT; Heidelberg Engineering, Inc). No patients were receiving steroids.Methods. The diagnosis of CSC in 6 patients with moderate to high myopia was confirmed by clinical examination, fluorescein angiography, indocyanine green angiography, fundus autofluorescence imaging, and spectral-domain optical coherence tomography. Choroidal thickness was measured subfoveally using enhanceddepth imaging spectral-domain optical coherence tomography.Results. The clinical information as well as the choroidal thickness measurement and expected choroidal thickness are summarized in the Table. In each of the 3 eyes in which an expected choroidal thickness calculation was appropriate, the expected choroidal thickness was less than the measured thickness.Comment. In a study of 28 eyes with CSC, the mean (SD) subfoveal choroidal thickness was 505 (124) µm.2 This contrasts with a mean (SD) subfoveal choroidal thickness of 287 (76) µm in normal eyes. 4 Although choroidal thickness decreases with age in normal eyes, the same pattern may not hold for patients with CSC. 2,4Our 6 eyes with CSC are unusual in that they were all myopic. With the exception of patient 6, the choroidal thickness of our cases would not normally be considered high for emmetropic eyes. However, it is high for myopic eyes. In a study of 31 patients with high myopia (mean refractive error, −11.9 diopters), the mean subfoveal choroidal thickness was 93.2 µm.3 A regression analysis suggested a decrease in subfoveal choroidal thickness of 7.84 µm per diopter of myopia in eyes with no history of choroidal neovascularization. 3These cases remind us that CSC can occur in myopic eyes. In the absence of a neurosensory detachment, the diagnosis of CSC can be made based on history, fundus appearance, fundus autofluorescence imaging, and measurement of choroidal thickness. In myopic eyes without a neurosensory detachment, CSC may be missed when axial length-related choroidal thickness differences are not considered. Awareness of thin choroids in "normal" myopic patients would allow for the recognition of "thick" choroids relative to refraction in eyes with CSC.

Axial length as a basic anatomical predictor for morphological and clinical characteristics in acute central serous chorioretinopathy

“…Recurrence was also more common among eyes with short AL (77.8%) compared with eyes with long AL (28.6%). All of this supports the suggestion that myopia is a protective factor for CSC [11,12]. Eyes with short and long AL, therefore, may represent the different activity of the disease.…”

Myopic Presentation of Central Serous Chorioretinopathy

“…This is in concordance with an earlier study on myopic CSC and SFCT. 11 It also strengthens the hypothesis that although choroidal thickness in myopic CSC eyes cannot match the choroids of emmetropic CSC eyes, the choroids of these myopic eyes with CSC are unquestionably enlarged. From our findings, we conclude that AL should therefore be taken into consideration when interpreting choroidal thickness in pachychoroid-related diseases.…”

“…10 A diagnosis of CSC indeed seems to be rare in myopic persons, only 10 cases of CSC with myopia could be identified in the literature. 11–13 Subfoveal choroidal thickness in these myopic CSC cases was thicker than expected based on their refractive error and age but within the normal range for emmetropic eyes. 6 This suggests that identification of a pachychoroid disease in a myopic patient can be easily overlooked.…”

Multiple parafoveal retinal detachment in myopic tractional maculopathy

“…[ 22 23 ] However, CSC, one of the diseases in the pachychoroid spectrum, is rarely reported in high myopia. [ 24 ] It is noteworthy that both FA and ICGA in the reported cases of this study showed no signs of hyperpermeability or leakage or pachyvessels. Neither was choroidal thickening found in these two cases.…”