Inner and Outer Choroidal changes in the Fellow Eye of Patients with Unilateral Central Serous Chorioretinopathy

Association between subretinal fluid duration in central serous chorioretinopathy and chorioretinal structure in unaffected fellow eyes

This study investigated the association between the duration of subretinal fluid (SRF) persistence in affected eyes and baseline chorioretinal structure in unaffected fellow eyes among patients with unilaterally naïve central serous chorioretinopathy (CSC). This retrospective case series comprised 25 healthy control patients and 46 patients with unilaterally naïve CSC, defined as first-episode and untreated within 1 month from symptom onset, who were categorized into prolonged (> 3 months) and nonprolonged (≤ 3 months) groups according to SRF duration in affected eyes from the first visit. Central retinal thickness, outer nuclear layer thickness, central choroidal thickness (CCT), luminal area (LA), stromal area (SA), total choroidal area (TCA), and choroidal vascularity index (CVI) were measured in unaffected fellow eyes at the first visit, and the duration of SRF persistence in affected eyes was recorded. As a result, CCT, SA and TCA were significantly greater, and CVI was significantly lower in the unaffected fellow eyes compared to the healthy control eyes (all p < 0.05). The optimal model for predicting SRF persistence > 3 months in affected eyes involved CVI (p = 0.015) in fellow eyes. Baseline choroidal thickening, mainly in the choroidal stroma of unaffected fellow eyes, was shown to correlate with SRF persistence in the affected eyes in unilateral naïve CSC. This information may be valuable for the identifying cases with a heightened risk of prolonged SRF persistence and for the timely initiation of treatment.

FACTORS PREDICTIVE OF PERSISTENT SUBRETINAL FLUID IN ACUTE CENTRAL SEROUS CHORIORETINOPATHY

PURPOSE

To identify the clinical parameters predictive of persistent subretinal fluid in acute central serous chorioretinopathy (CSC).

METHODS

Clinical data of consecutive eyes diagnosed with first-time, acute, treatment-naïve CSC followed up for at least 6 months from symptom onset were evaluated retrospectively. Acute CSC was defined as CSC in which symptoms were noticed within 3 months of presentation. Subretinal fluid, central retinal thickness, subfoveal choroidal thickness, and fundus autofluorescence were examined.

RESULTS

Of the 48 eyes in 48 patients, 38% exhibited subretinal fluid persisting for at least 6 months after the symptom onset. Fundus autofluorescence alterations at baseline were observed in 52% and 36% of affected and fellow eyes, respectively. Multivariable analysis showed that persistent fluid was significantly associated with the presence of fundus autofluorescence alterations in fellow eyes (odds ratio = 23.5, P = 0.024), in addition to greater age (odds ratio = 1.16, P = 0.015) and thicker central retinal thickness (odds ratio = 1.01, P = 0.022).

CONCLUSION

Fellow eye fundus autofluorescence alterations, in addition to older age and thicker central retinal thickness, were significant predictors of persistent subretinal fluid in patients with acute CSC. These findings underscore CSC's bilateral aspects and noninvasive markers' role in predicting persistent subretinal fluid.

Choroidal and Choriocapillaris Changes after Photodynamic Therapy and Subthreshold Micropulse Laser Treatment for Central Serous Chorioretinopathy

Background and Objectives: The aim of the present study is to analyze choroidal and choriocapillaris structural and functional changes in eyes affected by Central serous chorioretinopathy after Photodynamic Therapy (PDT) and Subthreshold Micropulse laser (SML) treatment. Materials and Methods: Forty-two eyes of forty-two patients were analyzed in this observational study. Twenty-four patients underwent SML treatment, whereas eighteen patients were treated with PDT. Examinations were performed at baseline and after 3 months of treatment. Main outcome measures were: Best corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), pigment epithelial detachment (PED) presence and maximum height (PEDMH), and choroidal vascularity index (CVI) measured by means of Spectralis HRA + OCT (Heidelberg Engineering, Heidelberg, Germany) Optical coherence tomography (OCT) and choriocapillaris flow voids (CCFV) measured on Optical Coherence Tomography Angiography (OCT-A) platform PLEX Elite 9000 device (Carl Zeiss Meditec Inc., Dublin, CA, USA). Results: Changes in BCVA were registered in both groups over time (p < 0.001). Structural changes in terms of reduced CMT and PED presence were noted in the two groups at follow-up (p < 0.001 and p = 0.001, respectively). Structural and functional choroidal changes were found in the two groups with reduced CCT and CVI over time (p = 0.004 and p = 0.007, respectively), with significant differences between the two groups for CVI parameter (p = 0.001). CCFV increased over time in the PDT group and decreased in the SML group. Conclusions: PDT and SML are effective approaches in CSC eyes and are able to improve structural and functional parameters over time. Choroidal and choriocapillaris parameters are promising biomarkers able to monitor disease course, showing greater impact of PDT on choroid-choriocapillaris complex over time.

Choroidal vascularity index in different types of central serous chorioretinopathy: A meta-analysis

PURPOSE

To evaluate the choroidal vascularity index (CVI) in different types of central serous chorioretinopathy (CSC), healthy control eyes, and fellow eyes.

METHODS

Relevant studies published up to January 2023 were identified by searching multiple databases, including PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure (CNKI). Studies investigating the difference in CVI between CSC and control eyes were included. Data from these studies were analyzed using Stata (version 17) software. Weighted mean difference (WMD) and 95% confidence interval (95%CI) were calculated for the CVI in CSC eyes, control eyes, and fellow eyes.

RESULTS

The meta-analysis included 15 studies, with 213 acute CSC eyes, 153 chronic CSC eyes, 92 uncategorized CSC eyes, 40 resolved CSC eyes, 409 eyes of normal healthy controls, and 318 fellow eyes. The result revealed that CVI was higher in acute CSC eyes (WMD = 5.40, 95%CI = 2.36-8.44, P = 0.001) compared to control eyes. Also, CVI in chronic CSC eyes was higher than in control eyes (WMD = 1.26, 95%CI = 0.03-2.49, p = 0.046). The fellow eyes of acute CSC had a higher CVI when compared to control eyes (WMD = 2.53, 95%CI = 0.78-4.28, p = 0.005). There was no significant difference in CVI between acute and chronic CSC eyes (WMD = 0.75, 95%CI = -0.31-1.82, P = 0.167). In the sub-analysis based on the area selected for CVI calculation, the WMDs in the whole image subgroups were lower than the main analysis for the comparisons of fellow eyes of acute CSC and control eyes, acute CSC eyes and control eyes, and acute CSC eyes and fellow eyes. In the macular area subgroups, the WMDs were higher than in the whole image subgroups, suggesting a potential regional variation of CVI in CSC eyes.

CONCLUSIONS

The results demonstrated that CVI is increased in CSC eyes and fellow eyes of acute CSC. There is no significant difference in CVI between acute and chronic CSC eyes. The area selected for CVI calculation can influence the outcome, which requires further clinical research to clarify.

Choroidal morphologic features in central serous chorioretinopathy using ultra-widefield optical coherence tomography

PURPOSE

To analyze the choroidal morphological changes in central serous chorioretinopathy (CSC) using ultra-widefield (UWF)-optical coherence tomography (OCT).

METHODS

This single-center, case-control study included 65 CSC eyes (52 males; age, 55.6 ± 13.0 years) and 65 healthy eyes (50 males; age, 57.1 ± 17.9 years). UWF-OCT (viewing angle, 200°) with real-shape correction was used to create an automated choroidal thickness (CT) map. The CT map had three sub-areas: the central (0-30°), middle (30-60°), and peripheral areas (60-100°), and was divided by vertical and horizontal lines. Differences in the CT and the CT change rate (CTCR) from the central to peripheral areas were examined between the CSC and control groups after adjusting for subjects' demographic and clinical factors. Furthermore, we assessed the vortex veins dilation patterns (VVDP) in the macula and examined the CT and the CTCR differences between CSC patients and controls for each VVDP.

RESULTS

CSC patients had greater CT than those of the controls in all sectors (CSC vs. controls, the peripheral area: supratemporal 284.4 ± 71.2 μm vs. 220.4 ± 71.2 μm, infratemporal 263.3 ± 69.2 μm vs. 195.3 ± 52.3 μm, supranasal 251.9 ± 70.3 μm vs. 189.5 ± 58.1 μm, infranasal 193.6 ± 71.2 μm vs. 146.3 ± 48.9 μm, P < 0.0001 for all sectors). The CTCR was apparently larger in CSC eyes than controls only for the upper-dominant type of VVDP (CSC patients vs. controls, supratemporal 32.1 ± 9.9% vs. 4.6 ± 23.1%, infratemporal 44.0 ± 11.2% vs. 25.6 ± 16.8%, supranasal 42.6 ± 9.8% vs. 22.2 ± 19.4%, infranasal 57.6 ± 41.2% vs. 41.2 ± 13.9%, P < 0.0001 for all sectors).

CONCLUSIONS

CSC has a thicker choroid, even in the peripheral areas, and the macular choroidal thickening was more severe in the upper-dominant type of VVDP. VVDP may affect the location of excessive fluid.