Association between varicose veins and central serous chorioretinopathy

Aim To investigate the association between varicose veins and central serous chorioretinopathy (CSCR), based on emerging genetic evidence of a shared vascular mechanism. Methods Propensity score-matched retrospective cohort study using the TriNetX Global Collaborative Network. Patients with varicose veins (n=621 513) were matched 1:1 to controls without varicose veins on age, sex, race and ethnicity, with prior CSCR or serous pigment epithelial detachment (PED) excluded. A secondary analysis excluded glucocorticoid users and additionally matched on hypertension, sleep apnoea and healthcare utilisation. A tertiary analysis compared thromboembolic risk (pulmonary embolism (PE) and deep vein thrombosis (DVT)) in varicose vein patients with and without CSCR. Results Varicose veins were significantly associated with CSCR (risk ratio (RR) 2.16; 95% CI 1.86 to 2.52; p<0.0001) and serous PED (RR 1.97; 95% CI 1.69 to 2.93; p<0.0001). Associations persisted after excluding glucocorticoid users and adjusting for comorbidities (CSCR RR 1.83; 95% CI 1.22 to 2.75; p=0.003; PED RR 1.95; 95% CI 1.38 to 3.34; p=0.013). Among varicose vein patients, rates of DVT (RR 1.36; p=0.078) and PE (RR 1.41; p=0.14) did not differ significantly between those with and without CSCR. Conclusions Varicose veins were significantly associated with CSCR and serous PED, independent of glucocorticoid exposure and known comorbidities, supporting a possible systemic vascular mechanism in CSCR pathophysiology.