Punctate Hyperfluorescence Spot as a Common Choroidopathy of Central Serous Chorioretinopathy and Polypoidal Choroidal Vasculopathy

Purpose To characterize punctate hyperfluorescence spot as common choroidopathy in central serous chorioretinopathy (CSC) and polypoidal choroidal vasculopathy (PCV). Design Cross-sectional retrospective study. Methods A total of 150 patients with 50 each allocated to CSC, PCV, and typical neovascular age-related macular degeneration (AMD) groups were included. Punctate hyperfluorescence spot was determined using mid-to late-phase indocyanine green angiography and subfoveal choroidal thickness by enhanced depth imaging optical coherence tomography. Each group was subcategorized based on concurrent punctate hyperfluorescence spot. Results The punctate hyperfluorescence spot incidence was higher in CSC (80.0%) and PCV (86.0%) than in AMD (40.0%, P < .001), with similar contralateral findings (86.1%, 86.7%, and 60%, respectively, P = .014). Punctate hyperfluorescence spot lesions comprised clustered polyps connected to vascular networks mimicking PCV. Choroidal thickness was 370.7 ± 81.9 μm, 332.6 ± 101.6 μm, and 172.5 ± 80.1 μm in affected eyes ( P < .001) and 323.0 ± 70.5 μm, 306.4 ± 94.4 μm, and 180.2 ± 83.6 μm in contralateral eyes ( P < .001) in CSC, PCV, and AMD groups, respectively. In the AMD group, choroidal thickness was greater in eyes with punctate hyperfluorescence spot (204.8 ± 92.3 μm) than in those without punctate hyperfluorescence spot (150.2 ± 62.9 μm, P = .028) in affected eyes; however, the difference was not observed in contralateral eyes in the AMD group and in both eyes in the CSC and PCV groups. Conclusions Based on angiography and OCT, punctate hyperfluorescence spot may be a form of PCV, and CSC and PCV may share common choroidopathy distinct from typical neovascular AMD. However, infrequent PHS lesions along with thickened choroids in AMD eyes suggest that AMD may encompass a wide choroidal pathologic spectrum shared in part with PCV.