Multifocal and recurrent (serous) choroidopathy (MARC) syndrome: a new variety of idiopathic central serous choroidopathy.

Presented is a group of 110 patients with patches of granular atrophy of the retinal pigment epithelium which I believe represents a new subtype of idiopathic central serous choroidopathy (ICSC). It is designated as multifocal and recurrent (serous) choroidopathy (MARC) syndrome. Such patients are the 'older' ICSC patients and they usually have bilateral involvement which may show marked asymmetry. The history is seldom helpful in defining previous episodes of leaking. The fundus changes are thought to represent the sequelae of multiple, recurrent, or chronic choroidopathy in the form of serous detachments of the retinal pigment epithelium and/or neurosensory retina. Such detachments may not be present at the time of a single examination, and thus the fundus picture may be puzzling without an awareness of this syndrome which exhibits a wide spectrum of severity. Difficulties in detecting the low detachments and fluorescein leaking are emphasized. There is often a marked disparity between the ophthalmoscopic and the fluorescein angiographic pictures, and examination by the latter technique is urged. I do not believe this entity progresses to senile disciform disease, but can result in marked visual loss. If extrafoveal leaking is found in the presence of decreased acuity and a macular detachment, and if there is evidence of previous attacks, photocoagulation can effectively flatten the retina. I believe photocoagulation therapy under these conditions is justifiable.