When you get a well demarcated elevation such as the one here, the angiography is very important. In a typical central serous, you'll have a small area hyperfluoress somewhere within the lesion. This represents the break in the RPE allowing the dye to leak into the separated retina. This case, however, showed the entire area hyperfluoressed, revealing an accompanying retinal pigment epithelial detachment.

These cases are somewhat more difficult to manage than a central serous with no RPE detachment. Laser therapy is controversial, and many patients are simply monitored. Grid photocoagulation, making sure to avoid the macula has been found helpful in some cases.

See you next time...