Purpose: To investigate the causes of macular serous retinal detachment without hemorrhage at the macula in patients 40 years and older.
Methods: Seventy-one eyes of 71 consecutive Japanese patients 40 years and older with the disease were examined using optical coherence tomography, digital simultaneous fluorescein and indocyanine green angiographies with a confocal laser scanning system.
Results: Of 71 eyes, 17 eyes (24%) had central serous chorioretinopathy, including three eyes with chronic central serous chorioretinopathy, 40 eyes (56%) had polypoidal choroidal vasculopathy (PCV), 10 eyes (14%) had occult choroidal neovascularization secondary to age-related macular degeneration, one had Harada disease, and another had retinal macroaneurysms. In two eyes, the diagnosis could not be established because of difficulty differentiating among chronic central serous chorioretinopathy, PCV, and occult choroidal neovascularization. Thirty-eight of 59 (64%) eyes of patients in the sixth decade of life and older had PCV.
Conclusions: Polypoidal choroidal vasculopathy is a primary cause of macular serous retinal detachment without hemorrhage in Japanese patients over 50 years of age. Since clinical and fluorescein angiographic findings are indistinguishable among central serous chorioretinopathy, PCV, and occult choroidal neovascularization, indocyanine green angiography might help to establish a more definitive diagnosis.