Objective To observe the of macular serous neuroepithelial detachment and the necessary auxiliary examination methods for the diagnosis.Methods The clinical data of 46 patients (49 eyes) aged above 45 years with macular serous neuroepithelial detachment who have been diagnosed by binocular indirect ophthalmoscope and optical coherence tomography (OCT) were retrospectively analyzed. All the patients had undergone fundus fluorescein angiography (FFA) and indocyanine angiography (ICGA), and the diagnosis was established based on the results of FFA, ICGA and OCT. Results In these 46 patients (49 eyes), central serous chorioretinopathy (CSC) was found in 31 (34 eyes, 69.4%), agerelated macular degeneration (AMD) was found in 12 (12 eyes, 24.5%), and polypoidal choroidal vasculopathy (PCV) was found in 3 (3 eyes, 6.9%). In the 34 eyes with CSC, 12 eyes (35.3%) had typical CSC and 22 eyes (64.7%) had chronic CSC. If the 12 eyes with AMD, 9 eyes (75%) had occult CNV, 2 eyes (16.7%) had minimally classic CNV, and 1 eye had classic CNV. Conclusions The causes of serous macular neuroepithelial detachment in patients aged above 45 years are complex; ICGA may help to establish the definitive diagnosis of chronic CSC, occult CNV,and PCV should be considered.