Central Serous Chorioretinopathy Mimics Occult nAMD in Some Patients

Elderly Asian male having eyesight problems and wearing eyeglasses while gazing and reading message on smartphone during breakfast at home. Old man having eye blurred vision indoors.
Patients older than 70 who don’t respond to anti-VEGF therapy, may have been misdiagnosed, a report suggests.

In patients older than 70 years, central serous chorioretinopathy (CSCR) can resemble occult neovascular age-related macular degeneration (nAMD), particularly on fluorescein angiography (FA), according to a study published in Clinical Ophthalmology

Researchers in this retrospective case series looked at 1 year’s worth of records from 522 patients who were initially diagnosed with nAMD to see if they met diagnostic criteria for CSCR at 3 (or more) months follow-up. Clinical examination, FA, and optical coherence tomography (OCT) were used to evaluate cases. Patients were either monitored or treated with anti-vascular endothelial growth factor (anti-VEGF) therapy, or combined anti-VEGF and photodynamic therapy, when they were first evaluated. When they did not respond to anti-VEGF, patients were observed with close follow-up — and a diagnosis of CSCR was “favored,” according to the study.

Researchers found that 11 patients, originally diagnosed with nAMD, met the CSCR diagnostic criteria. On averages, these patients were approximately 75.9 years old. They were seen on follow-up in 16.9 months. Their presenting visual acuity was approximately 20/50+2 (67.9 ± 5.9 ETDRS letters). Their choroidal thicknesses were approximately 232.0 µmand their vision improved to 20/40+ (70.5 ± 7.8 ETDRS letters, P =.289) after observation or treatment. Patients’ neurosensory retinal detachments (NSRD) had no changes with intravitreal bevacizumab treatment, and when changes were observed, they didn’t correlate with when anti-VEGF treatment was administered.

In patients monitored alone, 1 lost 1 line of vision, 1 gained a line, 1 gained 2 lines, and 1 gained 3 lines. A single patient developed a choroidal neovascular membrane (CNVM) in initial follow-up with visual improvement after anti-VEGF treatment; 4 patients developed CNVM.

In patients older than 70 years, CSCR may be considered if those patients “have poor or no response to anti-VEGF agents with resolution of neurosensory retinal detachments at intervals not attributable to anti-VEGF therapy,” the study says. “Historical factors, good initial vision, and exam findings, including the absence of retinal hemorrhage, may help to establish the diagnosis. The disease typically improved with monitoring, however careful follow-up is required due to possible conversion to CNVM.”

The study’s limitations include its retrospective design and small sample size. Researchers point out that “the incidence of CSCR is much less than nAMD” especially for the age group evaluated in this study.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Adrean SD, Chaili S, Pirouz A, Grant S. Central serous chorioretinopathy in elderly patients mimicking occult neovascular age-related macular degeneration. Clin Ophthalmol. 2020;14(11);4073-4078. doi:10.2147/OPTH.S279845.