Multimodal imaging characteristics of fibrinous central serous chorioretinopathy masquerading posterior uveitis

Retrospective study of records of 8 patients (12 eyes) of fibrinous CSCR, misdiagnosed as posterior uveitis elsewhere. Fundus images, fluorescein angiography (FA), autofluorescence and optical coherence tomography (OCT) at baseline and follow up visits were analyzed. Minimum duration of follow up was 3 months. Results – There were 7 men and 1 woman with a mean age of 34.4 years. Six patients were misdiagnosed as active choroiditis and received systemic steroids. One patient was on anti-tubercular therapy and steroids for presumed tubercular choroidal granuloma. One patient was referred as inflammatory choroidal neovascular memebrane. Mean duration of follow up was 10.2 months. Fundoscopy revealed single or multifocal creamy white subretinal fibrinous lesions with a central dark spot in all patients and exudative retinal detachment in 2 patients. FA revealed active leak coinciding with central dark spot. There were no signs of inflammation. OCT revealed subretinal hyperreflective material with or without central cavitation, subretinal hyperreflective dots, pigment epithelial detachment, and subretinal fluid. Systemic treatment was stopped in all patients. Subthreshold laser photocoagulation of active leak points was done in 7 patients. All eyes showed resolution of CSCR on subsequent follow ups.

Conclusions: Atypical variants of CSCR with subretinal fibrin may simulate posterior uveitis. Certain signs on clinical examination and multimodal imaging if identified, help to avoid misdiagnosis, unnecessary investigations and unwarranted treatment.

Clinical Implication: Fibrinous Central serous chorioretinopathy (CSCR) may get misdiagnosed as inflammatory ocular lesion and treatment with steroids may further worsen the disease.