Difficulties and possibilities for differential diagnosis of exudative form of age-related macular degeneration and central serous chorioretinopathy

Background. Neuroepithelial detachment (NED) is a pathognomonic symptom of a number of diseases of the macular region of the retina. In this connection, differential diagnosis of the causes of NED is relevant, since the choice of effective treatment tactics and, accordingly, the outcome of the disease depend on a correctly established diagnosis. Aim. To evaluate the possibilities of differential diagnosis of the exudative form of age-related macular degeneration (AMD) and central serous chorioretinopathy (CSCR) using a multimodal approach based on the analysis of a series of clinical cases. Material and methods. Clinical material was presented by 9 patients, there are 6 men and 3 women among them, their average age was 59.4±6.2 years. In all 9 patients, ophthalmoscopy revealed signs of local NED in the macular area. To identify the cause of NED, all 9 patients underwent in-depth methods of studying the macular zone, which included autofluorescence, optical coherence tomography (OCT), OCT angiography (OCTA). Results. According to the results of the studies, active macular neovascularization (MNV) was identified in 7 patients with characteristics of exudative AMD. Anti-VEGF therapy was recommended for them. In two patients, the presence of MNV was not confirmed, so they were diagnosed with «Central serous chorioretinopathy» and subthresholdmicropulse laser treatment was recommended for them. Conclusions. 1. The presence of metamorphopsia in patients of the older age group with local NED in the macular area, accompanied by irregular elevation of the pigment epithelium (PE), with local fibrovascular detachment of the PE, as well as the detection of drusen in fellow eyes in our study were regarded as signs of the exudative form of AMD. 2. The presence of local retinal NED and/or retinal pigment epithelium (RPE) without irregular elevation of the RPE and signs of MNV in patients of a young age group in the absence of complaints of metamorphopsia in our study were regarded as signs of CSC. 3. Multimodal diagnostics, including OCT, OCTA and autofluorescence study is an effective method for the differential diagnosis of CSCR and exudative AMD and the identification of MNV. Key words: central serous chorioretinopathy, age-related macular degeneration, neuroepithelial detachment, macular neovascular membrane, multimodal diagnostics