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TYPE 1 (SUB-RETINAL PIGMENT EPITHELIAL) NEOVASCULARIZATION IN CENTRAL SEROUS CHORIORETINOPATHY MASQUERADING AS NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

Fung, Adrian T. MBBS, MMed*; Yannuzzi, Lawrence A. MD*,†,‡; Freund, KB MD*,†,‡

doi: 10.1097/IAE.0b013e3182680a66
Original Study

Purpose: The purpose of this study was to describe clinical and multimodal imaging features of patients with Type 1 neovascularization who lack findings of age-related macular degeneration but instead have features consistent with long-standing central serous chorioretinopathy (CSC).

Methods: Nonconsecutive, retrospective, observational case series. Two groups of patients were identified and analyzed. Group 1 included patients presenting with Type 1 neovascularization who at the time of diagnosis were found to have findings more consistent with long-standing CSC than age-related macular degeneration. Group 2 included patients with a known history of CSC who developed Type 1 neovascularization over their course of follow-up. Clinical histories and multimodal imaging findings (color and red-free photography, fundus autofluorescence imaging, fluorescein angiography, indocyanine green angiography, spectral domain optical coherence tomography, and enhanced depth imaging optical coherence tomography) were analyzed.

Results: Twenty-seven eyes of 22 patients were identified. Thirteen patients presented with Type 1 neovascularization thought to be secondary to CSC (Group 1), and 9 patients with CSC were observed to develop Type 1 neovascularization over their course of follow-up (Group 2). Eight patients (36%) had polypoidal neovascular structures within their Type 1 neovascular lesions, of which 4 (18% of all patients) had bilateral Type 1 neovascularization. The mean age of patients was 61 years (range, 48–76 years), and the median age was 58.5 years. Thirteen patients (59%) were men. For those patients in Group 2, the mean duration between diagnosis of CSC and detection of Type 1 neovascularization was 139 months (range, 7–365 months). The mean subfoveal choroidal thickness was 354 μm (range, 186–666 μm).

Conclusion: Some patients presenting with Type 1 neovascularization may have clinical and multimodal imaging findings more consistent with long-standing CSC than with age-related macular degeneration. These patients are more likely to be younger, men, have thicker choroids, and have a higher prevalence of polypoidal neovasculopathy than those patients with Type 1 neovascularization secondary to age-related macular degeneration. Proper identification of these patients may have implications for their natural course and management.

We describe clinical and multimodal imaging findings of patients with Type 1 neovascularization believed to be secondary to long-standing central serous chorioretinopathy (CSC). These patients tend to be younger, men, and appear to have a higher prevalence of polypoidal neovasculopathy than those with neovascular age-related macular degeneration. Choroidal hyperpermeability and chronic retinal pigment epithelial disease may predispose to the development of Type 1 neovascular tissue in patients with CSC.

*The LuEsther T. Mertz Retinal Research Center of Manhattan Eye, Ear & Throat Hospital and Vitreous-Retina-Macula Consultants of New York, New York

Department of Ophthalmology, New York University, New York, New York

Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York.

Reprint requests: K. Bailey Freund, MD, Vitreous-Retina-Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022; e-mail: kbfnyf@aol.com

Supported by The Macula Foundation, Inc.

The authors report no conflict of interest.

© The Ophthalmic Communications Society, Inc.