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.