Polypoidal choroidal vasculopathy masquerading as central serous chorioretinopathy

Objective: To differentiate polypoidal choroidal vasculopathy (PCV) from ce ntral serous chorioretinopathy (CSC). Design: A retrospective, observational case series. Participants: Thirteen patients originally diagnosed with CSC proved to hav e PCV after more extensive evaluation and follow-up. Methods: A clinical and angiographic review of patients with manifestations of CSC, including macular detachment. Main Outcome Measures: Demographic data, funduscopic examination, and fluor escein and indocyanine green (ICG) angiographic findings. Results: Thirteen patients initially suspected of having CSC were ultimatel y diagnosed as having PCV. These eyes had exudative macular detachments sec ondary to a small caliber, polypoidal choroidal vascular abnormality or so- called polypoidal choroidal neovascularization. The clinical manifestations in the fundus varied. They included multiple, variably sized serous pigmen t epithelial detachments, neurosensory retinal detachment, lipid deposition , patchy atrophy of the pigment epithelium and indistinct staining from dec ompensation of the posterior blood-retinal barrier on fluorescein angiograp hy. In reality, the suspected PEDs proved to be polypoidal lesions of PCV w hen imaged with ICG angiography. Conclusions: The clinical diagnosis of CSC or PCV generally poses little ch allenge to the experienced retinal specialist. However, in CSC with persist ent and/or recurrent exudation, a myriad of retinal pigment epithelial chan ges may evolve that make it difficult to differentiate these two entities. In such patients, ICG angiography is useful in differentiating CSC from PCV . An accurate clinical diagnosis is important since each of these entities, CSC and PCV, may differ in terms of their risk factors, natural course, an d visual prognosis. (C) 2000 by the American Academy of Ophthalmology.