The Foveal Photoreceptor Layer and Visual Acuity Loss in Central Serous Chorioretinopathy FELICE CARDILLO PICCOLINO, MD, ROBERTA RIGAULT DE LA LONGRAIS, MD, GIAMBATTISTA RAVERA, BSC, CHIARA M. EANDI, MD, LUCA VENTRE, MD, ALI’ ABDOLLAHI, MD, AND MARILISA MANEA, MD ● PURPOSE: To describe changes of the foveal photore- ceptor layer using optical coherence tomography (OCT) in central serous chorioretinopathy (CSC) and evaluate the correlation with visual acuity (VA) loss. ● DESIGN: Observational case series. ● METHODS: We studied 28 eyes with acute or chronic CSC using high-resolution OCT. The tomographic find- ings of the detached foveal photoreceptor layer were compared with VA. Sixteen eyes also were evaluated after foveal reattachment. ● RESULTS: The outer photoreceptor layer (OPL) in the detached fovea was preserved in 14 eyes, of which 13 had symptoms for <1 year and atrophic in 14 eyes with symptoms for >1 year. The preserved OPL had an even profile in 7 eyes and a granulated profile in 7 eyes. Mean VA was 0.19 logMAR with a preserved OPL and 0.72 logMAR with an atrophic OPL (P <.001). Cases seen after the detachment resolved included 6 eyes with preserved even OPL, 5 eyes with preserved granulated OPL, and 5 eyes with atrophic OPL. Mean final VA was 0.06 logMAR in eyes with preserved OPL and 0.90 logMAR in eyes with atrophic OPL (P <.001). The VA improved in 73% of eyes with preserved OPL and no eyes with atrophic OPL (P  .025). The VA recovered completely in 83% of eyes with preserved even OPL and no eyes with preserved granulated OPL (P  .015). ● CONCLUSION: High-resolution OCT demonstrates changes in the foveal photoreceptor layer in CSC that highly correlate with VA loss and may predict visual recovery after macular reattachment. (Am J Ophthal- mol 2005;139:87-99. © 2005 by Elsevier Inc. All rights reserved.) C ENTRAL SEROUS CHORIORETINOPATHY (CSC) IS characterized by idiopathic retinal detachment at the posterior pole caused by passage of fluid from the choroid to the subretinal space through a barrier defect in the retinal pigment epithelium. 1,2 The disease often resolves spontaneously but sometimes recurs or becomes chronic. 1–3 In cases of recent onset, central vision is minimally affected and usually returns to normal after reabsorption of the subretinal fluid. In recurrent and chronic cases, progressive and irreversible visual decline can be associated with the development of central retinal pigment epithelium atrophy, cystoid macular degenera- tion, and foveal atrophy. 3–6 Recently, optical coherence tomography (OCT) has been used to evaluate changes in the retina in cases of acute and chronic CSC. 5–8 Retinal thickening was de- tected in association with serous detachment in acute cases. 8 Foveal attenuation or cystoid degeneration was reported after resolution of the detachment in eyes with persistent visual loss. 5,6 However, the process of visual deterioration due to persistence of the serous macular detachment in CSC is not clear. The photoreceptors might have a critical role in this process because they are separated from their source of nutrients when the retina is detached. The third-generation OCT system has a high- resolution capability and allows for good quality images of the retinal layers in the macula. Using this system, we investigated the pathologic changes in the photoreceptor layer in patients with CSC to determine the mechanism of visual loss in this disease. In this study, we describe the tomographic findings in the photoreceptor layer associated with macular detach- ment in CSC. These findings appear to correlate with visual acuity (VA) during active disease and to predict the visual outcome after macular reattachment. Accepted for publication Aug 17, 2004. From the Institute of Ophthalmology (F.C.P., R.R.L., C.M.E., L.V., A.A., M.M.), Department of Clinical Physiopathology, University of Torino, Torino; and Department of Health Sciences (G.R.), Biostatistics Section, University of Genova, Genova, Italy. Supported in part by Fondazione per la Macula ONLUS, Genoa, Italy. Inquires to: Felice Cardillo Piccolino, MD, Via Cecchi, 21/12, 16129 Genova, Italy; Phone/Fax: +39.010.5707183; e-mail: felice. cardillopiccolino@unito.it © 2005 BY ELSEVIER INC.ALL RIGHTS RESERVED. 0002-9394/05/$30.00 87 doi:10.1016/j.ajo.2004.08.037