Table 2 Differential diagnosis of CSC.
From: Treatment of central serous chorioretinopathy: new options for an old disease
Category | Conditions | Key differentiation |
|---|---|---|
Pachychoroid-associated diseases | Pachychoroid pigment epitheliopathy, peripapillary pachychoroid syndrome, PCV, CNV with increased choroidal thickness, focal choroidal excavation [45], peripheral exudative haemorrhagic chorioretinopathy [44] | PCV shows a branching neovascular network on ICGA; CSC exhibits focal leakage without neovascularisation [44] |
Neovascular diseases | AMD with type 1 macular neovascularisation [46] | AMD and PCV show persistent leakage on FA [41] |
Inflammatory diseases | VKH disease is always bilateral, and patients may recall systemic prodromal symptoms. In the acute phase, the choroid is diffusely and massively thickened to an extent not seen with CSC, and anterior chamber inflammatory cells may be observed. VKH disease presenting in the chronic phase may show severe anterior segment inflammation, with posterior iris synechia and vitritis [50] Posterior scleritis can be distinguished by B-mode ultrasonographic findings [51] | |
Choroidal tumours and systemic malignancies | Choroidal melanoma [53], choroidal haemangioma [54], metastases, leukaemia infiltration, Waldenström’s macroglobulinaemia, choroidal lymphoma, bilateral diffuse uveal melanocytic proliferation, paraneoplastic vitelliform maculopathy [46] | Tumours and haematological malignancies can be identified using ultrasound [54], angiography, computed tomography/magnetic resonance imaging and systemic evaluations [46] |
Genetic and developmental disorders | Best vitelliform macular dystrophy, RP1L1-associated occult macular dystrophy, central areolar choroidal dystrophy, optic pit maculopathy, uveal effusion syndrome, tilted disc syndrome, dome-shaped macula [46] | Genetic disorders show family history, absence of leakage on FA, and distinct patterns on OCT; developmental anomalies present with structural variations on OCT and ultrasound [46] |
Drug-induced serous retinopathy | MAPK inhibitor-associated retinopathy [55], FGFR inhibitor-related CSC [56] | History of systemic therapy with MAPK or FGFR inhibitors and the absence of choroidal thickening help differentiate drug-induced cases from CSC [55, 56] |
