Chronic Central Serous Chorioretinopathy (CSCR)

Fundus photograph and red-free image (left eye)

Retinal photos show a pigment mottling at the left macula and areas of hyper-pigmentation superior, temporal and infero-temporal to the macula.

Optomap pseudocolour imaging and fundus autofluorescence (left eye)

FAF shows a gravitational tract in the left eye - an area of hypo-AF with surrounding hyper-AF starting superior to the macula, and extending to inferior midperiphery.

Spectralis OCT volume scan (left eye)

OCT imaging shows shallow, broad retinal detachment, serous PEDs, attenuation of outer retina, and disruptions of ellipsoid zone and interdigitation zones, as well as RPE atrophy. This is consistent with active chronic CSCR.

Spectralis OCT line scan (left eye)

This OCT line scan shows incomplete RPE and outer retina atrophy as well as an area of shallow neurosensory detachment

Fundus photograph and red-free image (right eye)

Colour fundus photograph shows multifocal regions of hypo-pigmentary changes in the posterior pole

Optomap and fundus autofluorescence imaging (right eye)

FAF shows dense hypo-autofluorescence inferior to the fovea signifying RPE atrophy and an oval area of hyper-autofluorescence superotemporal to the macula suggestive of previous subretinal fluid.

Spectralis OCT Volume and line scans (right eye)

OCT imaging shows a juxtafoveal serous pigment epithelial detachment (PED), a small pocket of subretinal fluid, hypo-reflective intraretinal spaces at the central macula. Below the PED, there is a complete loss of the RPE with associated homogenous choroidal hypertransmission, which corresponds to the region of hypo-autofluorescence.

Superotemporal to the right macula, outer retina loss, and RPE disturbance corresponds to the hyper-autofluorescence region. This is a typical sign of chronic CSCR and results from chronic neurosensory detachment.

A thick choroid and dilated large choroid vessels are also evident, particularly in the region of RPE abnormalities.

Cirrus OCT Angiography (right eye)

OCT angiography of the right macula does not show convincing signs of choroidal neovascularisation. This suggests that the hypo-reflective intraretinal spaces are secondary to retinal degeneration rather than exudation from choroidal neovascularisation.

Fundus photograph and red-free image (left eye)

Fundus examination shows an area of hypo-pigmentation with adjacent discrete area of exudative retinal detachment with associated elevation.

Cirrus OCT macular line scan (left eye)

OCT shows a dome shaped serous retinal detachment at the left macula with underlying flat irregular pigment epithelial detachment (FIPED), indicated by the blue arrow. Diffuse choroidal thickening and the presence of pachyvessels can also be appreciated

Cirrus OCT angiography (OCTA) - outer retina

OCT-angiography suggests the presence of a choroidal neovascular network within the FIPED.