Ring-shaped subretinal fibrinous exudate in central serous chorioretinopathy

Purpose: To clarify the pathologic changes of the ring-shaped, grayish white subretinal fibrinous exudate in central serous chorioretinopathy (CSC), we examined patients with fluorescein angiography (FA) and optical coherence tomography (OCT). Methods: Using OCT, we prospectively examined 13 consecutive patients (12 men, one woman) (13 eyes) with acute CSC. The fundi were scanned by OCT through the ring-shaped, grayish white lesion. Results: FA showed focal dye leakage at the center of the ring-shaped, grayish white subretinal exudates. In the area of the exudates, OCT showed moderately or highly reflective masses bridging the neurosensory retina and the retinal pigment epithelium in all eyes. Because the area of the pellucid core of the ring-shaped exudate showed an optically clear space beneath the neurosensory retina, the subretinal reflective masses were separated on cross-sectional images in all 13 eyes. Pigment epithelium detachment was observed in the area of the grayish white lesion by OCT and FA in 7 of the 13 eyes. Conclusions: In eyes with a ring-shaped, grayish white exudate in CSC, OCT and FA findings indicate that the pellucid core of the exudate is the route of the exudative fluid from the choroid into the subretinal space. A surrounding grayish white lesion seems to be fibrinous exudate that has accumulated in the subretinal space.