The “SCOLEX” Sign: A Distinct Hyperreflective Foci on the Wall of Serous Pigment Epithelial Detachments in Central Serous Chorioretinopathy – Micron Report Number Seven

Summary

“Scolex Sign” as a novel OCT finding in ICSC: Hyperreflective focus on the PED wall. Present in about 1 of 6 eyes. Benign, no association with worse outcomes or sequelae. Retrospective, 52 eyes.

Abstract

Purpose: To describe a novel optical coherence tomography finding called “scolex sign” in cases of central serous chorioretinopathy.

Methods: This retrospective multicenter study included patients with central serous chorioretinopathy with serous pigment epithelial detachments (PEDs) greater than 100 µ m, with or without subretinal fluid. Eyes showing a distinct hyperreflective focus on the PED wall (scolex sign) were analyzed. An equal number of age-matched controls with PEDs but without the scolex sign were included. Multimodal imaging data were reviewed. A subgroup analysis based on subretinal fluid status was also performed.

Results: Of 291 eyes with large serous PEDs, 52 eyes exhibited the “scolex sign” and were compared with 52 age-matched controls. Baseline characteristics including sex, systemic comorbidities, best-recorded visual acuity and optical coherence tomography parameters were similar in both the groups. However, eyes with the “scolex” sign exhibited a greater number of central PEDs and shorter distance from the foveal center. On follow-up, eyes with the “scolex” sign showed a higher rate of PED flattening and subretinal fluid resolution trended to be higher compared with controls.

Conclusion: The “scolex” sign represents a novel, benign optical coherence tomography feature seen in a subset of central serous chorioretinopathy cases. While not associated with poorer outcomes or adverse sequelae, it may reflect ongoing reparative changes, indicating a resolving stage of the disease.