Clinical and imaging characteristics of central serous chorioretinopathy with subfoveal leak

PurposeTo define the clinical characteristics and to analyse the factors predicting visual acuity in eyes with central serous chorioretinopathy (CSCR) with subfoveal leak.MethodsThis was a multicentric, retrospective, observational comparison of CSCR eyes with subfoveal versus extrafoveal leak, with secondary analysis identifying predictors of 12-month best corrected visual acuity (BCVA) within the subfoveal group.ResultsA total of 134 eyes of 134 patients (113 males and 21 females) with a mean age of 49.6 ± 11.1 years, were included. The median duration of symptoms before presentation was two months. The leak was subfoveal in 50 eyes and extrafoveal in 84 eyes. The duration of symptoms was significantly higher in eyes with extrafoveal leak, than subfoveal leak group (p = 0.01). Eyes with subfoveal leak had higher Haller vessel/choroidal thickness ratio at fovea at baseline. BCVA at one year was similar in both cohorts. On linear regression analysis, factors affecting poor visual acuity at 1 year in eyes with subfoveal leak were greater duration of symptoms, complex CSCR at presentation, history of persistence/recurrences, higher number of leaks, focal retinal pigment epithelium (RPE) atrophy areas, and more months waited before treatment initiation.ConclusionsPatients with CSCR and subfoveal leaks presented earlier and showed a higher baseline Haller to choroidal thickness ratio at the fovea than those without. Although 1-year visual outcomes were similar to extrafoveal leaks, worse BCVA in the subfoveal leak group was associated with complex, persistent or recurrent disease, focal RPE atrophy, longer symptom duration, multiple leaks, and delayed treatment initiation.