title: Bullous Variant of Central Serous Chorioretinopathy: Expansion of Phenotypic Features Using Multimethod Imaging.
abstract: To define the phenotypic characteristics of the bullous variant of central serous chorioretinopathy (CSC) using multimethod imaging.
  
  
  
  Retrospective, observational case series.
  
  
  
  Twenty-one eyes of 14 patients with bullous retinal detachment resulting from CSC (bullous CSC group) and 122 eyes of 84 patients with chronic CSC without bullous retinal detachment (nonbullous CSC group).
  
  
  
  We performed a retrospective review of clinical and multimethod imaging data of patients who sought treatment from the authors with bullous retinal detachment resulting from CSC between January 2010 and November 2015. Multimethod imaging comprised color photography, fluorescein angiography, fundus autofluorescence, and high-resolution optical coherence tomography. Consecutive cases of chronic CSC without bullous retinal detachment, seen during the same period, comprised a comparative group.
  
  
  
  Qualitative and quantitative characteristics of the choroid, retinal pigment epithelium, and retina were compared between the 2 groups.
  
  
  
  Mean age of the bullous CSC group was 53.8 years. There was no difference in age, visual acuity, corticosteroid use, or the proportion of white patients and men between the 2 groups (all P > 0.132). Peripheral nonperfusion occurred only in eyes with bullous retinal detachment (38% of cases). Retinal pigment epithelial tears were seen in 95% of eyes in the bullous group and none of the eyes in the nonbullous CSC group. The bullous CSC group demonstrated a greater number of pigment epithelial detachments (PEDs) and more eyes demonstrated PEDs with internal hyperreflectivity (both P < 0.016). Mean subfoveal choroidal thickness in the bullous CSC group (463.1±83.1 μm) was not different compared with that of the nonbullous CSC group (400.6±100.6 μm; P = 0.993). More eyes in the bullous CSC group demonstrated hyperreflectivity around large choroidal vessels and at the level of the choriocapillaris on OCT (P < 0.001). Retinal folds and subretinal fibrin were identified in a greater proportion of eyes in the bullous CSC group (both P < 0.001).
  
  
  
  Bullous retinal detachment is a rare manifestation of chronic CSC and is characterized by a unique constellation of phenotypic and multimethod imaging features.
authors.affiliation: LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Vitreous-Retina-Macula Consultants of New York, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York; Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Australia.
authors.forename: Chandrakumar
authors.initials: C
authors.lastname: Balaratnasingam
authors.affiliation: LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Vitreous-Retina-Macula Consultants of New York, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York.
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
authors.affiliation: LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Vitreous-Retina-Macula Consultants of New York, New York, New York.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Tan
authors.affiliation: LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Vitreous-Retina-Macula Consultants of New York, New York, New York.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mrejen
authors.affiliation: The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Retina Associates, Chatswood, New South Wales, Australia.
authors.forename: Alex P
authors.initials: AP
authors.lastname: Hunyor
authors.affiliation: Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: David J
authors.initials: DJ
authors.lastname: Keegan
authors.affiliation: LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Vitreous-Retina-Macula Consultants of New York, New York, New York.
authors.forename: Kunal K
authors.initials: KK
authors.lastname: Dansingani
authors.affiliation: Retina-Vitreous Associated Medical Group, Los Angeles, California.
authors.forename: Pouya N
authors.initials: PN
authors.lastname: Dayani
authors.affiliation: LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Vitreous-Retina-Macula Consultants of New York, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York.
authors.forename: Irene A
authors.initials: IA
authors.lastname: Barbazetto
authors.affiliation: Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Greater Los Angeles VA Healthcare Center, Los Angeles, California.
authors.forename: David
authors.initials: D
authors.lastname: Sarraf
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Jampol
authors.affiliation: LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Vitreous-Retina-Macula Consultants of New York, New York, New York. Electronic address: layannuzzi@gmail.com.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Yannuzzi
mesh_terms: D000328:Adult; D000368:Aged; D056833:Central Serous Chorioretinopathy / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D061848:Optical Imaging / Q000379:methods; D010781:Photography; D012160:Retina / Q000000981:diagnostic imaging / Q000473:pathology; D012163:Retinal Detachment / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods