On spectral-domain OCT of the macula in a patient with central serous chorioretinopathy (CSCR), the earliest detectable finding before clinical symptom onset is:

• A Choroidal thickening with dilated outer choroidal vessels (pachychoroid) ✓
• B Subretinal fluid accumulation beneath the neurosensory retina
• C Ellipsoid zone disruption at the fovea
• D Intraretinal cystoid spaces in the outer nuclear layer

Explanation

Pachychoroid — choroidal thickening with dilated outer choroidal (Haller layer) vessels and thinning of the inner choroidal (Sattler and choriocapillaris) layers — is now recognized as the primary structural substrate of CSCR and is detectable on enhanced-depth imaging (EDI) OCT before clinical subretinal fluid appears. Subretinal fluid is a consequence of RPE breakdown driven by pachychoroid. Ellipsoid zone disruption is a late finding. Intraretinal cysts are characteristic of other macular edema aetiologies rather than CSCR.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.