Identification of leakage sites in central serous chorioretinopathy using optical coherence tomography and the assessment of the characteristics of the biomarkers.

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To identify optical coherence tomography (OCT)-based imaging biomarkers that can localize focal leakage points without fluorescein angiography in central serous chorioretinopathy (CSC). This retrospective case-control study analyzed 119 consecutive patients (123 eyes) with CSC between April 2018 and February 2024, comprising 66 eyes with focal-leakage type and 57 eyes with diffuse-leakage type. We assessed leakage sites using OCT, and the proportions of OCT findings were compared between focal- and diffuse-leakage types. Hyporeflective lucency signs were observed in 27 eyes (40.9%) with focal-type CSC, while no such signs were detected in diffuse-type CSC cases (0.0%; P < 0.001). In focal-type CSC, these signs were exclusively localized to leakage points, with no occurrence in other areas within serous retinal detachment. Microrip of retinal pigment epithelium and subretinal hyperreflective material were identified in 23 (34.8%) and 47 (71.2%) eyes with focal-type CSC, respectively, and also in eyes with diffuse-type CSC (5.3% and 19.3%, respectively; P < 0.001 for both comparisons). Only the hyporeflective lucency sign is present exclusively in focal leakage points of fluorescein angiography. Our findings suggested that the hyporeflective lucency sign may serve as a potential therapeutic target in CSC.