Figure. Central serous chorioretinopathy in myopic eyes. A, Color photographs of the affected eyes of cases 1, 2, and 3 (from left to right). There are granular retinal pigment epithelial changes in the maculas of all 3 eyes and an absence of funduscopic features of myopic degeneration. B, Fundus autofluorescence imaging of the same eyes. Macular hyperautofluorescence and hypoautofluorescence changes are consistent with central serous chorioretinopathy. C, Enhanced-depth imaging spectral-domain optical coherence tomography of the same eyes demonstrates subretinal fluid. In each case, subfoveal choroidal thickness is high for the degree of myopia.
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Yzer S, Fung AT, Barbazetto I, Yannuzzi LA, Freund KB. Central Serous Chorioretinopathy in Myopic Patients. Arch Ophthalmol. 2012;130(10):1339–1340. doi:10.1001/archophthalmol.2012.850
Central serous chorioretinopathy (CSC) is typically seen in hyperopic or emmetropic eyes,1 most of which have a thickened choroid.2We 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 + OCT; Heidelberg Engineering, Inc). No patients were receiving steroids.
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 enhanced-depth imaging spectral-domain optical coherence tomography.
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.
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.2,4
Our 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.3
These 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.
Correspondence: Dr Freund, Vitreous Retina Macula Consultants of New York, 460 Park Ave, Fifth Floor, New York, NY 10022 (email@example.com).
Financial Disclosure: None reported.
Funding/Support: This work was supported by The Macula Foundation, Inc, and Stichting Wetenschappelijk Onderzoek Oogziekenhuis Rotterdam, Rotterdamse Blindenbelangen, Stichting Blindenhulp, Gelderse Blinden Stichting, Landelijke Stichting voor Blinden (Dr Yzer).
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