Comparative tomography of central serous 2 chorioretinopathy

Purpose: To provide spectral domain optical coherence tomography (SDOCT) of subretinal fibrin leakage and concomitant central serous chorioretinopathy (CSC) morphology in four cases. Likewise, to compare the SDOCT of these cases with others documented. Case reports: Four cases of acute onset CSC exhibiting serous neurosensory and retinal pigment epithelium detachment (PED) associated with a hyper-reflective pattern in the subretinal space that appear to emanate from the PED are described. Initially, all cases showed thickening of the photoreceptor outer segment (POS) as well as zones where the inner segment-outer segment junction line (IS/OS) was not visible. All cases had an outer retinal “dipping” appearance. On follow-up visits all cases showed thinning of the POS with an increase of granular deposits on the posterior surface of the detached retina. As the CSC resolved, the IS/OS junction line became visible and the granular deposits diminished. One case exhibited a relative decrease in foveal thickness compared to the unaffected eye. Conclusion: SDOCT imaging of a hyper-reflective pattern at the subretinal space proximal to a PED in CSD may reflect resonance detection of fluid turbulences and density distribution disparities. This occurs as the serous fluid from the choroidal circulation diffuses into the subretinal space from a focal PED leakage site. A clear hypo-reflective area at the core of the hyper-reflective pattern may result from the distribution of less dense constituents centrally while hyper-reflective denser particles surround and concentrate at the peripheral border. The size of the leakage defect in the PED may determine the outline of the hyper-reflective pattern while the location may influence the spatial orientation. The POS swelling may impart pliability to the outer retina. The hydrostatic and fibrin particle pressure flowing from a PED on this retinal layer may contribute to the apparent outer retinal “dipping” imaged on optical coherence tomography.