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CYSTOID MACULAR DEGENERATION IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY

IIDA, TOMOHIRO MD*; YANNUZZI, LAWRENCE A. MD; SPAIDE, RICHARD F. MD; BORODOKER, NATALIE MD§; CARVALHO, CYNTHIA A. MD; NEGRÃO, SILVANA MD

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Purpose To describe the optical coherence tomography (OCT) and fluorescein angiography findings in the macula of eyes with chronic central serous chorioretinopathy (CSC) and reduced central vision.

Methods Using OCT, clinical examination, and fluorescein and indocyanine green (ICG) angiography, the authors examined eight eyes of seven patients with CSC, an attached macula, and reduced central vision of 20/200 or worse. All had a history of chronic CSC with resolution of the subretinal fluid in the macular area and poor vision.

Results Patient ages ranged from 55 to 82 years (mean, 66 years). All eight eyes had some parafoveal, patchy RPE atrophy with corresponding transmission hyperfluorescence (window defect) on fluorescein angiography. Five eyes also had a window defect in the foveal area. With OCT, the foveal area revealed variable areas of cystoid change and atrophy in seven of the eight eyes. In four of these eyes, the cystoid changes were not seen on clinical examination or fluorescein angiography. The seven eyes with cystoid changes imaged with OCT had no intraretinal leakage of fluorescein in the foveal region. The authors categorized these eyes as having cystoid macular degeneration (CMD). One other eye had foveal thinning or atrophy without cystoid changes.

Conclusions Intraretinal cystoid spaces without intraretinal leakage, or CMD, was a common finding in eyes with chronic CSC and reduced central vision after resolution of subretinal fluid. OCT was useful to establish the presence of CMD and foveal atrophy, even when these changes were not clearly evident on clinical examination or fluorescein angiography. Chronic foveal detachment and antecedent intraretinal leakage were proposed to be the mechanisms for the development of the changes. CMD in conjunction with foveal atrophy was an important clinical finding to account for the poor visual outcome in patients with CSC.

From the LuEsther T. Mertz Retinal Research Center of Manhattan Eye, Ear and Throat Hospital, New York, New York.

*Professor and Chairman, Department of Ophthalmology, Fukushima Medical University School of Medicine, Japan; †Professor, Clinical Ophthalmology, Columbia University School of Medicine and Director of Retinal Research, Manhattan Eye, Ear, Throat Hospital, New York; ‡Clinical Associate Professor of Ophthalmology, New York University; §Resident, Department of Ophthalmology, NYU; ¶Research Fellow, Associated Retinal Consultants, P.C., Division of Vitreoretinal Surgery, William Beaumont Hospital, Royal Oak, Michigan; ∥Retina Specialist, Federal University of Para, Brazil.

Reprint requests: Lawrence A. Yannuzzi, MD, Manhattan Eye, Ear and Throat Hospital, 210 East 64th Street, New York, NY 10021.

Supported by The Macula Foundation, Inc.

The authors have disclosed that they have no significant relationships with or financial interests in any commercial companies that pertain to this educational activity.

© The Ophthalmic Communications Society, Inc.