Polypoidal choroidal vasculopathy masquerading as central serous chorioretinopathy

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Objective To differentiate polypoidal choroidal vasculopathy (PCV) from central serous chorioretinopathy (CSC). Design A retrospective, observational case series. Participants Thirteen patients originally diagnosed with CSC proved to have 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 fluorescein and indocyanine green (ICG) angiographic findings. Results Thirteen patients initially suspected of having CSC were ultimately diagnosed as having PCV. These eyes had exudative macular detachments secondary 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 pigment epithelial detachments, neurosensory retinal detachment, lipid deposition, patchy atrophy of the pigment epithelium and indistinct staining from decompensation of the posterior blood-retinal barrier on fluorescein angiography. In reality, the suspected PEDs proved to be polypoidal lesions of PCV when imaged with ICG angiography. Conclusions The clinical diagnosis of CSC or PCV generally poses little challenge to the experienced retinal specialist. However, in CSC with persistent and/or recurrent exudation, a myriad of retinal pigment epithelial changes 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, and visual prognosis.