Central serous chorioretinopathy (CSCR) is an idiopathic serous detachment of the macula caused by focal leakage of choroidal interstitial fluid through the retinal pigment epithelium. Since von Graefe first described central serous chorioretinopathy in 1866' dozens of papers have reported its demographic characteristics, presenting visual symptoms, and ophthalmological signs. Patients usually report the sudden onset of central blurring, metamorphopsia, and relative scotoma. Serous detachment usually lasts about three months. Focal photocoagulation of the leak site significantly decreases the duration of detachment to about one month, but has no significant effect on visual acuity.2-5 Indirect photocoagulation, which has been employed to avoid direct coagulation ofsubretinal foveal leaks, has no effect on the duration of detachment.56We found in the literature 12 series that included CSCR patients with follow-up of one or more years.2-5 7-13 Seven are retrospective follow-up studies, four are prospective randomised studies, and one is a prospective, nonrandomised study. The studies by Klein et al.'0 Dellaporta," and Nanjiani'2 are most comparable with our study. In our retrospective long-term follow-up study of CSCR patients we studied visual acuity outcome, recurrence tendency, and pigment epithelial leakage pattern and mottling features. We searched for possible prognostic indicators and attempted to determine the long-term effects of focal argon laser photocoagulation. Patients and methodsWe reviewed 157 cases of CSCR with classic focal retinal pigment epithelial dye leakage and macular detachment that were identified from the Wilmer Retinal Vascular Center files. Cases with coexisting ocular disease were not included. Of these 157 cases of active central serous retinopathy 105 (67%) were not treated and 52 (33%) were treated with focal argon laser photocoagulation. We performed a follow-up examination on approximately half of each group: 47 untreated, 26 treated. We obtained followup for an additional 45 patients from their local ophthalmologists or by detailed questionnaire.The initial and interim examinations were performed by the Wilmer Retinal Vascular Center staff. All initial examinations included visual acuity measurement (existing correction plus pinhole) by a technician, direct and indirect ophthalmoscopy, contact lens biomicroscopy, and stereoscopic colour 815 on 12 May 2018 by guest. Protected by copyright.

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A brief survey of the recent ophthalmic literature underscores a resurgence of interest in indocyanine green angiography (ICGA). This cyanine dye (molecular weight 775) which is highly protein bound and does not readily escape from the choriocapillaris. There is a particularly efficient first pass effect in the liver; this limits the recirculation phenomenon which occurs with fluorescein angiography. Indocyanine green absorbs and reflects in the near infrared portion of the spectrum (805 nm and 835 nm, respectively). In this fashion, the retinal pigment epithelium (RPE) is essentially rendered invisible. These characteristics also facilitate visualisation of the choroid through haemorrhage or other pigmentary deposits in the retina or RPE. However, ICG has low fluorescence of only 4% when compared with the total fluorescence of fluorescein.4Early studies Initial interest and investigations with ICG and other vital dyes occurred during the 1970s. A substantial body of initial investigations of ICG was published by Flower and Hochheimer, as well as by others.4-9 Some of their initial work described a camera adapted with appropriate exciter and barrier filters such that simultaneous ICG and fluorescein angiography could be performed after a single injection of a combined mixture of ICG and fluorescein dyes.6 The ICG dosage used in these initial absorption angiography studies tended to be similar to the amount used for cardiac flow studies -that is, 2 mg per kilogram body weight.' The early clinical investigators were uniformly disappointed in the lack of usefulness of ICGA in the confirmation of suspected choroidal neovascularisation.9-11 ICGA was not a useful guide to laser therapy of choroidal neovascularisation, but appeared to show particular promise in evaluation and monitoring growth of choroidal naevi and choroidal melanomas.9-11 In addition, investigators used this new modality to obtain insight into the normal and abnormal appearance of the choroidal circulation.9 11 12 These studies were limited in large part by inadequate photographic quality, the resolution of which did not allow visualisation of the choriocapillaris. Also, the motorised shutter cameras had a maximum frequency of exposure of one per 0-7 seconds (average choroidal transit time about 3 seconds). Attempts were made to adapt a 35 mm film camera to a fundus camera in order to improve the temporal resolution for study of