Subretinal hyperreflective material in central serous chorioretinopathy

Multimodal imaging biomarkers of subretinal hyperreflective material accumulation in central serous chorioretinopathy

PURPOSE

To identify multimodal imaging (MMI) biomarkers associated with subretinal hyperreflective material (SHRM) in central serous chorioretinopathy (CSC).

METHODS

This retrospective study enrolled eyes with primary and recurrent CSC with symptoms lasting less than 3 months. Eyes were categorized into two groups based on the presence or absence of SHRM, with SHRM-positive eyes further subdivided into three grades. A comprehensive analysis was performed using optical coherence tomography (OCT), fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), and indocyanine green angiography (ICGA).

RESULTS

259 eyes from 231 patients (216 males) were included. Eyes with SHRM showed higher choroidal vessel index (CVI) at the leakage site compared to those without, with P < 0.05 when leakage was located in the foveal, parafoveal, perifoveal, and peripapillary regions. Differences were also discovered in serous retinal detachment (SRD) dimensions, presence of pigment epithelial detachment (PED) and retinal pigment epithelium (RPE) defects in OCT, gravitational tracks and hyperautofluorescence contours in FAF, leakage patterns and dye pooling area in FFA, and focal choroidal vascular hyperpermeability (CVH) area in ICGA (P < 0.05 for all). Furthermore, CVI at the leakage site, RPE defects presence and dye pooling area were identified as independent factors associated with SHRM presence, with odds ratios (OR) of 1.539 (P < 0.001), 2.766 (P = 0.023), and 1.062 (P = 0.006), respectively.

CONCLUSION

The presence of SHRM was associated with choroidal and RPE alterations, suggesting that changes in hydrostatic pressure and RPE function might be involved in SHRM formation in CSC.

[Morphological and functional changes of secondary macular neovascularization in central serous chorioretinopathy under anti-VEGF treatment]

BACKGROUND

Investigation of the morphological changes by optical coherence tomography angiography (OCT-A) and the development of visual acuity in secondary macular neovascularization (sMNV) in central serous chorioretinopathy (CCS) during anti-vascular endothelial growth factor (VEGF) treatment.

PATIENTS AND METHODS

Retrospective study of all treatment-naïve eyes with respect to anti-VEGF treatment, in which sMNV in CCS was detected by fluorescein angiography (FA) and OCT‑A and which were treated at the University Eye Hospital Würzburg between July 2021 and the end of December 2022. All patients were treated according to a pro re nata injection regimen (PRN regimen) and followed up for 1 year.

RESULTS

In the study 20 eyes from 16 patients with sMNV in CCS were included. Using FA the sMNV could be confirmed in 35% of cases and using OCT‑A in 100% of cases. Morphologically, the sMNV was clearly demarcated by OCT‑A as "sea-fan"-like in 10 eyes and filamentous in 10 eyes. The decrease in area of the sMNV from 0.94 ± 1.2 mm2 at baseline to 0.72 ± 0.82 mm2 at 12 months was not statistically significant (p = 0.12). During the observational period an average of 8.7 ± 1.6 intravitreal injections (IVOM) were administered (5-12 IVOM, median 9 IVOM).

DISCUSSION

Both FA and OCT‑A were used to detect sMNV in CCS, with OCT‑A providing more reliable detection of sMNV than FA. With OCT‑A two different types of sMNV could be detected: 1) the "sea-fan" type and 2) the filamentous MNV type. Within the first year of treatment sMNV in CCS requires a comparable number of IVOMs as the treatment of neovascular age-related macular degeneration.

[Imaging and classification of central serous chorioretinopathy-What do I really need?]

Multimodal imaging plays a key role in the diagnostics and classification of central serous chorioretinopathy (CSC). In this article the most important imaging modalities in CSC, such as optical coherence tomography (OCT), fluorescein angiography, indocyanine green angiography and OCT angiography are presented and their significance explained. Based on these imaging findings, CSC subtypes and possible classification attempts are presented.

Optical Coherence Tomography Features in Fovea-Off Exudative vs Rhegmatogenous Retinal Detachment

PURPOSE

To describe the optical coherence tomography (OCT) features that can differentiate eyes with fovea-off exudative retinal detachment (ERD) vs rhegmatogenous retinal detachment (RRD), with particular attention to outer retinal corrugations (ORCs).

DESIGN

Multicenter, retrospective cross-sectional study.

METHODS

Multicenter, retrospective cross-sectional study of patients diagnosed with unilateral or bilateral fovea-off ERD or primary, acute, fovea-off RRD between 2016 and 2021. This study was performed with the approval from the Research Ethics Board at the University of Toronto and was conducted in accordance with the Declaration of Helsinki. Patients with any ERD etiology and evidence of extensive, bullous fovea-off detachment and in the RRD group: consecutive patients with acute, primary fovea-off RRD with good quality baseline SD-OCT imaging were included. Patients with exudative choroidal neovascularization from any etiology, optic nerve pit, significant media opacity, or OCT images with poor quality or low signal strength were excluded. Primary outcome was to describe the morphological features of the macula using SD-OCT in patients diagnosed with ERD vs RRD, with specific interest in ORCs.

RESULTS

One hundred sixty-one eyes (51 ERD and 110 RRD) of 154 patients were included. Fifty-one eyes with ERD presented with 1 of 15 etiologies. ERD were associated with a greater risk of having hyperreflective dots in the outer retina (92.2% vs 74.5%, P = .009), hyperreflective material and dots in the subretinal fluid (72.5% vs 34.5%, P < .001), internal limiting membrane and inner retinal undulations (70.6% vs 39.4%, P < .001), and retinal pigment epithelium undulations (44.9% vs 6.4%, P < .001) compared to RRD. RRD was associated with a greater risk of outer retinal corrugations (80% vs 0%, P < .001), intraretinal fluid (90.9% vs 41.2%, P < .001) and ellipsoid zone thickening (90% vs 66.7%, P < .001) compared to ERD.

CONCLUSION

The presence of ORCs are highly specific for RRD and absent in ERD. This is likely related to differences in the pathophysiology of the diseases process, specifically the content of the subretinal fluid. Understanding the differences in OCT morphological features of ERD vs RRD may aid with diagnosis and management.

Fluorescein angiography patterns and subretinal hyperreflective material predict subthreshold micropulse laser response in chronic central serous chorioretinopathy

BACKGROUND

To investigate predictors of navigated subthreshold micropulse laser (SML) treatment in chronic central serous chorioretinopathy (cCSC).

METHODS

In this single-center prospective consecutive case series, patients with cCSC were treated with 577 nm SML and followed up for 12 months. A complete ophthalmological evaluation including spectral optical coherence tomography (SD-OCT), fluorescein angiography (FA) and microperimetry (MP) was performed. FA hyperfluorescence patterns and SD-OCT features were investigated.

RESULTS

Overall, 38 eyes from 38 patients affected by cCSC with a mean age of 48.20 ± 5.95 years were included. Thirty-one eyes (81.6%) demonstrated a significant subretinal fluid (SRF) reduction after treatment at 3 months. Complete SRF resolution was achieved by twenty-three patients (60.5%) at 3 months and attained by an additional patient (24 in total, 63.2%) at 6 months. Twenty-two (57.9%) of such individuals were confirmed with no SRF at the end of the follow-up. Best-corrected visual acuity improved significantly and progressively at all timepoints from baseline, in parallel with macular sensitivity (all p: <0.005). Logistic regression analysis revealed that the presence of subretinal hyperreflective material (SHRM, p: 0.044; OR: -0.225; 95% CI: -0.448 - -0.003) and focal hyperfluorescence pattern on FA (p < 0.001; OR: 0.438; 95% CI: 0.196-0.632) predicted poorer and better treatment response, respectively.

CONCLUSIONS

FA hyperfluorescence pattern and presence of SHRM may predict SML treatment response in cCSC patients.

Subretinal hyperreflective material in retinal and chorioretinal disorders: A comprehensive review

Subretinal hyperreflective material (SHRM) is a common and remarkable optical coherence tomography (OCT) biomarker whose importance is emerging in several retinal and chorioretinal diseases, including age-related macular degeneration, central serous chorioretinopathy, polypoidal choroidal vasculopathy, pathologic myopia, posterior uveitis, vitelliform lesions and macular dystrophies, and rarer disorders. Multimodal imaging, also thanks to the introduction of OCT angiography, allowed a deeper characterisation of SHRM components and its morphological changes after treatment, suggesting its usefulness in clinical practice. We discuss and summarize the nature, multimodal imaging characteristics, and prognostic and predictive significance of SHRM in the different retinal and choroidal disorders in which it has been described.

A 30-Year-Old Man with a Recent History of COVID-19 Requiring Treatment with Corticosteroids Who Developed Bilateral Central Serous Chorioretinopathy During 7-Month Follow-Up

BACKGROUND Central serous chorioretinopathy (CSCR) involves a localized serous macular detachment, secondary to retinal pigment epithelial and choroidal vascular changes, which can be an adverse effect of corticosteroid use. Most CSCR cases resolve spontaneously, and normal vision returns, while some chronic cases can result in blindness. This report is of a 30-year-old man with a recent history of Corona virus disease (COVID)-19 requiring corticosteroid treatment who developed bilateral CSCR with unilateral fibrin and a 7-month follow-up. CASE REPORT A 30-year-old male patient presented with malaise and high fever. The patient tested positive for COVID-19, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus and was admitted. During hospitalization, he received intravenous (IV) corticosteroids for 1 week (6 mg dexamethasone IV once daily). Following hospitalization, the patient received per os methylprednisolone 16 mg (16 mg once daily for 3 days, 8 mg once daily for 3 days, 4 mg once daily for 3 days, and 2 mg once daily for 3 days). One month later, the patient presented with bilateral visual acuity (VA) deterioration and acute CSCR. The diagnosis and follow-up were performed by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). The patient was followed-up for a period of 7 months, during which, although the VA improved and remained stable, the OCT findings were changing. CONCLUSIONS This report highlights the importance of timely ophthalmological examination in patients with sudden vision loss and identification of the association between corticosteroid use and CSCR, as well as the importance of a longer follow-up period.

Changes of microstructure of central serous chorioretinopathy on OCT and its relationship with prognosis

PURPOSE

To quantitatively evaluate the relationship between retinal microstructure and prognosis in patients with central serous chorioretinopathy(CSC) using optical coherence tomography(OCT).

METHODS

398 affected eyes of patients with central serous chorioretinopathy who visited Zhongshan Ophthalmic Centre(ZOC) from 2015 to 2018 were included in this retrospective study. The optical coherence tomography images of all patients in their first visit were analyzed, and logistic regression analysis were performed with 11 independent variables, and subretinal fluid absorption in 3 months after therapy as well as recur in 6 months after therapy as dependent variable respectively. The correlation between shortage of ellipsoid baseline and height of foveal subretinal fluid, width of foveal subretinal fluid were analyzed respectively. The difference of duration and baseline logMAR visual acuity in eyes with and without double layer sign or subretinal hyper-reflective materials were analyzed respectively. The difference of therapeutic outcome among different therapeutic methods was also analyzed in eyes with double-layer sign and subretinal hyper-reflective materials respectively.

RESULTS

In the regression analysis with subretinal fluid absorption in 3 months after therapy as dependent variable, shortage of ellipsoid zone was statistically significant(P<0.0001,B=1.288).In the regression analysis with recur in 6 months as dependent variable, no independent variable was statisically significant. There is no correlation between shortage of ellipsoid zone and width or height of subretinal fluid. Duration of disease in eyes with double layer sign or subretinal hyper-reflective materials was longer than those without these features. In the eyes with double-layer sign or subretinal hyper-reflective material, the difference of logMAR visual acuity 3 months after treatment between 2 therapeutic methods was not statistically significant.

CONCLUSIONS

When using optical coherence tomography to quantitatively evaluate change microstructure in eyes with central serous chorioretinopathy, we found that subretinal fluid was easier to absorb completely in eyes with less shortage of ellipsoid zone. Double layer sign and subretinal hyper-reflective materials are easier to exist in eyes with longer duration of disease.

Elevated serum fibrinogen/albumin ratios in patients with acute central serous chorioretinopathy

PURPOSE

To evaluate the serum fibrinogen/albumin ratios in patients with acute and chronic central serous chorioretinopathy, and healthy control samples.

METHODS

Serum fibrinogen/albumin ratios were assessed in patients with acute (Group-1, 30 eyes) and chronic (Group-2, 30 eyes) central serous chorioretinopathy, and compared with healthy control (Group-3, 30 eyes) samples.

RESULTS

Fibrinogen/albumin ratios were significantly higher in Group-1 (104.72 ± 12.34) than in Group-2 (75.83 ± 10.06) and in Group-3 (72 ± 9.54) (p = 0.001). No significant correlation was found between age, CMT, and BCVA with fibrinogen/albumin ratios in the Pearson correlation analysis. In the ROC curve analysis, the most appropriate cut-off value of the fibrinogen/albumin ratio for acute CSCR was ≥87.8 and the optimal cut-off value for the fibrinogen/albumin ratio for chronic CSCR was ≥68.6.

CONCLUSION

The fibrinogen/albumin ratio may be useful as an inflammatory biomarker to monitor the systemic inflammatory state during the treatment and follow-up in patients with acute CSCR.

Analysis of Optical Coherence Tomography in Acute versus Chronic Central Serous Chorioretinopathy

SIGNIFICANCE

Central serous chorioretinopathy (CSC) is a common retinal disease that causes vision loss worldwide. Studying the imaging characteristics of CSC is helpful for the differential diagnosis of diseases. This study analyzed the differences between acute and chronic CSC and provide related information.

PURPOSE

The aim of this study was to describe the optical coherence tomography features in patients with acute and chronic CSC.

METHODS

Sixty-two eyes of 56 patients with CSC were included in the study. Optical coherence tomography was performed to observe the image features. The photoreceptor outer-segment (PROS) thickness above the pigment epithelium detachment (PED) coinciding with the leakage point in fundus fluorescein angiography was measured and compared with the mean PROS thickness outside the PED in acute cases. The SPSS 23.0 software (IBM Co., Chicago, IL) was used for statistical analysis.

RESULTS

Of our 56 patients (62 eyes), 41 (73.21%) were male and 15 (26.79%) were female. There were 53 eyes (85.48%) with acute CSC and 9 eyes (14.52%) with chronic CSC. Besides other common features, the new feature of a high-reflection band in the outer nuclear layer was found to be limited to the macular detachment area. In acute cases, the mean PROS thickness above the retinal pigment epithelium layer protuberance coinciding with the leakage point was 22.7 ± 8.8 μm, which was less than the mean PROS thickness outside the PED at 64.3 ± 21.3 μm (P ≤ .001).

CONCLUSIONS

The high-reflection band in the outer nuclear layer within the serous neurosensory detachment limited to the macular area was a new finding in CSC patients. This finding can be used as an imaging feature to aid in the diagnosis of CSC.

Dynamic changes and correlation analysis of outer retinal microstructure in macular area of central serous chorioretinopathy patients during restoration period

PURPOSE

To investigate the dynamic changes and possible affecting variables of outer retinal microstructure in macular area of central serous chorioretinopathy (CSC) patients.

METHODS

This was a retrospective study. The data of optical coherence tomography (OCT) and autofluoroscopy (AF) of 36 CSC patients admitted to our hospital from February 2012 to February 2013 were included. Dynamic variations and possible correlated variables of central retinal thickness (CRT), subretinal fluid diameter (SRFD), ellipsoid zone (EZ), interdigitation zone (IZ) and/or hyperautofluorescent spot (HAS) were analyzed.

RESULTS

The outer retinal microstructure was gradually restored along with the subretinal fluid absorption during the follow-up. EZ in 94.4% (34/36) and the IZ in 100% (36/36) eyes were completely disappeared at baseline and restored (completed or incomplete) in 88.9% (8/9) and 44.4% (4/9) eyes, respectively, after 6-month follow-up. HAS was evident in 25% eyes (8/32 eyes) at baseline, and the density was initially increased and then declined during follow-up. Correlation analysis demonstrated that the restoration of EZ and IZ was correlated with the restoration period and subretinal fluid absorption.

CONCLUSION

The outer retinal microstructure was restored during the subretinal fluid absorption in CSC patients, with EZ restored earlier than IZ. The restoration period and the absorption of subretinal fluid were two closely correlated variables of macular microstructure restoration.

Multimodal Imaging in the Management of Choroidal Neovascularization Secondary to Central Serous Chorioretinopathy

The diagnosis and treatment of choroidal neovascularization (CNV) in eyes with chronic central serous chorioretinopathy (CSCR) can be challenging. The purpose of this study was to classify eyes with suspected CNV using multimodal imaging. The effect of intravitreal anti-vascular endothelial growth factor (VEGF) was assessed and compared to controls. This retrospective study included chronic CSCR patients with suspected secondary CNV who received intravitreal bevacizumab. Eyes were divided into "definite CNV" and "no CNV" based on optical coherence tomography angiography (OCTA). Eyes that did not undergo OCTA imaging were considered as "presumed CNV". One-year outcome in visual acuity (VA) and central foveal thickness (CFT) were investigated and compared to non-treated control patients to assess the response to anti-VEGF. Logistic regression analysis was used to explore predictive biomarkers of CNV detection and improvement after anti-VEGF. Ninety-two eyes with chronic CSCR from 88 participants were included in this study. Sixty-one eyes received bevacizumab and 31 eyes were non-treated control subjects. The presence of subretinal hyperreflective material (SHRM) and shallow irregular retinal pigment epithelium (RPE) elevation (SIRE) with sub-RPE hyperreflectivity on OCT was associated with a significantly increased risk of detecting CNV on OCTA. Intravitreal anti-VEGF caused significant functional and anatomical improvement in patients with neovascular CSCR as compared to non-treated eyes. In contrast, VA and CFT changes were not significantly different between treated and non-treated CSCR with no evidence of CNV on OCTA. No clinical or anatomical biomarkers were found to be associated with response to treatment. In conclusion, OCTA should be used to confirm the presence CNV in suspected chronic CSCR patients. Intravitreal anti-VEGF treatment resulted in a significantly better one-year outcome in patients with definitive OCTA evidence of CNV.