Differential diagnosis of central serous chorioretinopathy and age-related macular degeneration with OCT angiography

Background: neuroepithelial detachment (NED) is a characteristic feature of a number of macular abnormalities. Since an efficient treatment strategy depends on a correct diagnosis, an urgent issue is to identify a cause of NED. Aim: to demonstrate the authors' own clinical examples of elucidation of macular NED causes. Materials and Methods: two male patients (61 and 54 years old) with local macular NED. An autofluorescence test, optical coherence tomography (OCT), and OCT angiography (OCTA) were performed to identify a cause of NED. Results: in the first example, OCTA revealed NED associated with irregular elevation, fibrovascular pigment epithelium detachment (PED) and active macular neovascularization (MNV). Therefore, this shows exudative age-related macular degeneration (AMD). The patient was referred for anti-VEGF therapy. NED, flat hyporeflective elevation of the pigment epithelium, was identified in the second patient. As no signs of MNV were detected on OCTA image, this was indicatory of central serous chorioretinopathy (CSCR). The patient is recommended to undergo subthreshold micropulse laser treatment. However, subfoveal thickness of the choroid in a patient with AMD was higher than the reference values, and the parameter value did not comply with typical pachychoroid in a patient with CSCR. Conclusions: Local NED is a common clinical symptom for both CSCR and exudative AMD. Differential diagnostic signs of exudative AMD: the patient's age, low best corrected visual acuity, metamorphopsia, irregular elevation and fibrovascular PED. Specific signs of CSCR: young age of the patient, relatively high visual functions, absence of metamorphopsia, hyporeflective elevation of pigment epithelium. Subfoveal choroidal thickness is not a reliable differential diagnostic sign of exudative AMD and CSCR. KEYWORDS: central serous chorioretinopathy, age-related macular degeneration, neuroepithelial detachment, macular neovascular membrane, multimodal diagnosis. FOR CITATION: Kolenko O.V., Pomytkina N.V., Sorokin E.L., Kravchenko I.Z., Kirson A.E. Differential diagnosis of central serous chorioretinopathy and age-related macular degeneration with OCT angiography. Russian Journal of Clinical Ophthalmology. 2025;25(2):152– 158 (in Russ.). DOI: 10.32364/2311-7729-2025-25-2-12