Chronic central serous chorioretinopathy with and without myopia: clinical features and response to half-dose photodynamic therapy

PURPOSE: To compare the clinical characteristics, multimodal imaging features, and treatment response to half-dose photodynamic therapy (PDT) between patients with chronic central serous chorioretinopathy (cCSC) with and without myopia. METHODS: Sixty-six eyes with cCSC received a single session of half-dose PDT and were followed for at least 6 months. Patients were divided into myopic and non-myopic groups based on spherical equivalent less than -0.5 diopters. Multimodal imaging data, including optical coherence tomography (OCT), OCT angiography, fundus autofluorescence (FAF), and indocyanine green angiography (ICGA), were analyzed. RESULTS: The study included 38 eyes in the myopic group and 28 in the non-myopic group. Among myopic eyes, 65.8% had low myopia, 28.9% moderate, and 5.3% high myopia. The myopic group had significantly less subretinal fluid at baseline (145.1 ± 74.4 µm vs. 193.6 ± 113.1 µm, P = 0.039), but more frequent photoreceptor outer segment (OS) elongation (86.8% vs. 64.3%, P = 0.031) and mottled FAF (55.3% vs. 21.4%, P = 0.010). In contrast, the non-myopic group more often showed hyper or hyper/hypo FAF. Slightly greater BCVA improvement was observed in the non-myopic group (-0.14 ± 0.26 vs. -0.03 ± 0.18, P = 0.031). Multivariate analysis identified OS elongation and mottled FAF as independent predictors of both myopic cCSC (P = 0.049 and P = 0.005, respectively) and more myopic refractive status (P < 0.001 and P = 0.005, respectively). CONCLUSIONS: Myopic cCSC is associated with less subretinal fluid, more photoreceptor outer segment elongations and mottled FAF. Post-treatment BCVA improvement was slightly greater in non-myopic eyes.