Central serous chorioretinopathy in myopic patients.

Abstract

C entral serous chorioretinopathy (CSC) is typically seen in hyperopic or emmetropic eyes, 1 most of which have a thickened choroid. 2 We 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 ϩ OCT; Heidelberg Engineering, Inc). No patients were receiving steroids. Methods. 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. Choroi-dal thickness was measured subfoveally using enhanced-depth imaging spectral-domain optical coherence tomography. Results. The clinical information as well as the choroi-dal 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. Comment. 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 choroi-dal 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 choroi-dal 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 sub-foveal 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. Abbreviations: BCVA, best-corrected visual acuity; D, diopters; NA, not …