Clinical characteristics and outcomes in central serous chorioretinopathy with subretinal hyper-reflective material: MICRoN report 6

Purpose: To evaluate the clinical features and longitudinal outcomes of chronic central serous chorioretinopathy (CSCR) presenting with subretinal hyperreflective material (SHRM). Design: Retrospective, multicentre clinical cohort study from the Macula Society CSCR Study Group. Participants: This study included consecutive patients with a diagnosis of CSCR, with and without SHRM. Methods: Baseline and final best-recorded visual acuity (BRVA) and multimodal imaging parameters were compared between SHRM and non-SHRM groups. Main outcome measures: Longitudinal changes in BRVA and imaging parameters in both groups; factors affecting subretinal fluid (SRF) persistence, and change in BRVA. Results: A total of 503 eyes (103 with SHRM and 400 eyes without SHRM) were analysed. The SHRM group showed poorer baseline BRVA (0.4 ± 0.3 logMAR; 20/50) compared to the non-SHRM group (0.2 ± 0.3 logMAR; 20/30) (p = 0.006). SHRM eyes demonstrated greater RPE alteration (p = 0.04), higher neurosensory retinal detachment (p <0.001), more photoreceptor irregularities (p = 0.004), hyperreflective foci (p < 0.001),and double-layer sign (p < 0.001). The incidence of concurrent macular neovascularization (p = 0.01) and persistent subretinal fluid (p < 0.001) was higher in the SHRM group. Despite visual improvement in both groups, final height of neuro-sensory detachment (p < 0.001) remained higher in SHRM eyes. Eyes with a history of steroid exposure and ellipsoid zone (EZ) loss (post-resolution) were greater in higher SHRM grades. Logistic regression revealed non-SHRM status, and combination therapy had lower odds of SRF persistence. Conclusion: CSCR with SHRM presented with worse initial vision. Although vision improved after treatment, persistent SRF and EZ loss (in resolved cases) remain more frequent in SHRM eyes.