An intelligent segmentation method for leakage points in central serous chorioretinopathy based on fluorescein angiography images.

Objective To observe the morphologic alterations of retina pigment epithelial around fluorescein leakage site using spectral-domain optical coherence tomography (SD-OCT) in acute central serous chorioretinopathy (CSC) before and after laser coagulation. Methods Twenty-four eyes of 24 consecutive patients with unilateral acute CSC who underwent laser photocoagulation (wave length: 561 nm, energy: 80 - 100 mW, spot diamteter: 100 μm, exposure time: 0.1 s) were enrolled in this retrospective study. The patients included 22 males and 2 females, with an average age of (39.2±7.2) years and an average duration of (1.1±0.6) months. The fluorescein leakage outside the foveal avascular zone and serous retinal detachment were found in all the eyes by fluorescein fundus angiography (FFA) and SD-OCT. Twenty-six leakage sites were observed in 24 eyes on FFA. There were 5 smoky leakage points (19.2%), 21 inky leakage points (80.8%). The retinal pigment epithelial (RPE) layer at leakage points were scanned by SD-OCT before and at 2 weeks, 2 months after treatment. SD-OCT showed that the RPE abnormalities were detected at all of the fluorescein leakage points, including serous pigment epithelial detachment (PED) in 16 leakage points (64.5%), protruding RPE in 5 leakage points (19.5%), and irregular RPE in 5 leakage points (19.2%). The morphologic alterations of RPE around fluorescein leakage point before and after laser coagulation were observed. Results At 2 weeks after laser photocoagulation, PED existed in 7 leakage points (26.9%), protruding RPE in 3 leakage points (11.5%), and irregular RPE in 16 leakage points (61.5%). At 2 months after laser photocoagulation, protruding RPE existed in 3 leakage points (11.5%), and irregular RPE in 5 leakage points (19.2%), including RPE defect in 2 leakage points. And there were undetectable RPE abnormalities in other 16 leakage points (61.5%). Conclusions In acute CSC, SD-OCT shows that morphologic features of the RPE layer are changed, including PED, protruding RPE , irregular RPE around the leakage point. After laser photocoagulation the abnormalities of RPE can also be altered from PED to irregular RPE , and RPE defect is observed in restricted regions. Key words: Central serous chorioretinopathy/therapy; Laser coagulation; Tomography, optical coherence; Diagnostic imaging

Objective To observe the characteristics of blue light(BLAF) versus near infrared wavelength (IRAF) fundus autofluorescence in central serous chorioretinopathy (CSC) patients. Methods Seventy-seven eyes of 81 patients diagnosed with CSC were enrolled in this study. According to the duration of disease, patients were divided into acute CSC group and chronic or recurrent CSC group. All patients were examined with fundus fluorescein angiography, including BLAF and IRAF. There were forty-six patients (47 eyes) with acute, thirty-one patients (34 eyes) with chronic or recurrent CSC. The characteristics of BLAF and IRAF in CSC were compared. Results In acute CSC, there were nineteen eyes (40.4%) showed scattered hyper-fluorescence corresponding to the leaking points, eleven eyes (23.4%) showed mottled hypo-fluorescence in BLAF; while 17 eyes (36.2%) showed normal change corresponding to the leaking points. There were 35 eyes can be observed serous retinal detachments in the BLAF images, 21 eyes (60.0%) showed hypo-fluorescence and 14 eyes (40.0%) showed hyper-fluorescence. In the IRAF images, 25 eyes (53.2%) showed mottled fluorescence corresponding to the leaking points, 11 eyes (23.4%) presented with scattered hyper-fluorescent spots and normal fluorescence. The serous retinal detachments of 26 eyes exhibited hypo-fluorescence in the IRAF images. In chronic or recurrent CSC, 19 eyes (55.9%) showed scattered hyper-fluorescence corresponding to the leakage points; followed by no abnormal change in 10 eyes, accounting for 29.4%; few showed mottled hypo-fluorescence (5 eyes 14.7%). There were 35 eyes (41.2%) can be observed serous retinal detachments in the BLAF images. IRAF mainly displayed mottled hypo-fluorescence (22 eyes, 64.7%), ten eyes (29.4%) presented with scattered hyper-fluorescence and 2 eyes (5.8%) presented without abnormal change. The serous retinal detachments of 3 eyes (8.8%) exhibited hypo-fluorescence in the IRAF images. Conclusions For acute CSC, a variety of fluorescence were showed in BLAF images and the proportion of the various fluorescences was similar; hypo-fluorescence was showed in the IRAF images. For chronic CSC, hyper-fluorescence was showed in BLAF while hypo-fluorescence in the IRAF images. Key words: Central serous chorioretinopathy; Fluorescein angiography; Diagnostic imaging

Objective To observe the features of frequency domain optical coherence tomography (FD-OCT) in acute central serous chorioretinopathy (CSC).Methods The data of FD-OCT and fundus fluorescein angiography (FFA) of 31 patients with unilateral acute CSC were retrospectively analyzed.The FD-OCT of retinal pigment epithelial (RPE) layer at leakage points, retinal detachment area and RPE layer in the fellow eyes was documented.Results Thirty-four leakage points were detected in 31 eyes on FFA.At the sites of fluorescein leakage, FD-OCT showed that serous pigment epithelial detachment (PED) in 18leakage points (52.9%) and 17 eyes (54.8%), a small RPE protrusion in 8 leakage points (23.5%) and 8eyes (25.8%), RPE irregularity in 6 leakage points (17.6%) and 4 eyes (12.9%) and no detectable RPE abnormality in 2 leakage points (5.9%) and 2 eyes (6.5%).An RPE defect at the edge of or within the fPED was found in 7 leakage points (20.6%) and 7 eyes (22.6%).Serous retinal detachment and interruption or complete disappearance of the hyper-reflective inner/outer segment junction (IS/OS) were detected in all diseased eyes.Uneven thickness of the outer segments (OS) was found in 24 eyes (77.4%),14 of which had sagging sign.Flaking of the OS was found in 10 eyes (32.3%), multiple hyper-reflective dots on the posterior surface of the detached neurosensory retina and on the surface of the RPE were found in 8 eyes (25.8%).Among 31 fellow eyes, FD-OCT also showed RPE abnormalities in 11 eyes (35.5%),in which PED, RPE protrusion and RPE irregularity were detected in 2 (6.5%), 1 (3.2%) and 8 eyes (25.8%), respectively.Conclusions In acute CSC the FD-OCT images at leakage points of are featured by PED, RPE protrusion, RPE irregularity and no detectable RPE abnormality; in retinal detachment area FD-OCT are featured by serous retinal detachment, interruption or disappearance of IS/OS, uneven thickness of OS, flaking of OS and hyper-reflective dots on the posterior surface of the detached neurosensory retina and on the surface of the RPE. Key words: Retinal diseases/ diagnosis; Choroid diseases/ diagnosis; Pigment epithelium of eye; Tomography, optical coherence; Diagnostic imaging

Objective To observe the characteristics of spectral-domain optical coherence tomography (SD-OCT) for leakage point in acute central serous chorioretinopathy (CSC). Methods A total of 21 acute CSC patients (21 eyes) were enrolled in this retrospective study, including 17 men (17 eyes) and 4 women (5 eyes). The mean age was (47.3±8.8) years (range 35 - 66 years). The mean duration was (1.6±0.8) months (range 0.5 - 3.0 months). All patients were underwent mydriatic fundus photography, SD-OCT examination and fluorescein fundus angiography (FFA). SD-OCT and FFA images were carefully compared to observe the SD-OCT examination characteristics of fluorescence leakage point. Results 21/21 eyes had one fluorescein leakage point. In addition to serous retinal detachment, leakage point in the SD-OCT examination showed retinal pigment epithelium (RPE) protrusion in 10 eyes (47.6 %), RPE detachment in 7 eyes (33.3 %), highly reflective areas suggesting fibrinous exudate in the subretinal space in 3 eyes (14.3%), and RPE defect in 1 eye (4.8%). Conclusion The SD-OCT characteristics of acute CSC include RPE protrusion, RPE detachment, highly reflective areas suggesting fibrinous exudate in the subretinal space and RPE defect. Key words: Central serous chorioretinopathy; Tomography, optical coherence; Fluorescein fundus angiography

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

To characterize features of central serous chorioretinopathy (CSC) using multicolor (MC) imaging and to compare the efficacy of using MC imaging and traditional color fundus photography (CFP) for detecting features of CSC. A retrospective review of 75 eyes of 69 participants with CSC from the Eye Center of the Renmin Hospital of Wuhan University. The patients underwent same-day CFP, fundus fluorescein angiography (FFA), spectral domain optical coherence tomography (SD-OCT), and MC imaging (including infrared reflectance (IR), green reflectance (GR), blue reflectance (BR), combined standard MC image, and green-blue-enhanced image). Positive CSC lesions were evaluated using FFA and SD-OCT. Features in images of CFP, standard MC, green-blue-enhanced, IR, GR, and BR were analyzed and calculated. Among the 75 eyes of 69 patients, 75 eyes with subretinal fluid (SRF) and retinal pigment epithelial (RPE) leakage point, and 43 eyes with RPE damage were observed by FFA and SD-OCT. The detection rate of SRF was significantly higher with the standard MC image (92.0%), green-blue-enhanced image (92.0%), IR (88.0%), and GR (88.0%) than that with CFP (66.7%) (P < 0.05). Blue reflectance (45.3%) was associated with lower rate of SRF detection compared to CFP (P < 0.05). The standard MC image (84.0%), green-blue-enhanced image (84.0%), IR (78.7%), and GR (80%) delineated the boundaries of SRF more effectively than CFP (44%). The abnormal areas corresponding to RPE leakage points on FFA were observed with the standard MC image, green-blue-enhanced image, and IR at detection rates of 90.7, 82.7, and 90.7%, respectively, which were significantly higher than with CFP (29.3%) (P < 0.05). However, the detection rates of the abnormalities corresponding to leakage on FFA were lower with GR (5.3%) and BR (1.3%) than those with CFP (P < 0.05). Areas of RPE damage on FFA were observed at the same locations with the standard MC image, green-blue-enhanced image, and IR at detection rates of 97.7, 93.0, and 95.3%, respectively, which were significantly higher than with CFP (41.9%) (P < 0.05). Compared with CFP, the detectable rates of RPE damage on GR (14.0%) and BR (9.3%) were lower (P < 0.05). As an adjunct to SD-OCT, the MC image can delineate the extent or boundaries of SRF more effectively than CFP. As an adjunct to FFA, the MC image can identify foci of leakage more effectively than CFP. The MC image, particularly the IR channel, can identify areas of RPE damage more effectively than CFP. Therefore, the MC image may be a useful adjunct to FFA and OCT for detecting or monitoring CSC.

Dilatation of Asymmetric Vortex Vein in Central Serous Chorioretinopathy

Purpose. To study the relationship between axial length (AL) and morphological and clinical characteristics in acute central serous chorioretinopathy Methods. All patients received optical coherence tomography, fluorescein angiography (FA), optical biometry, and retro-mode scanning laser ophthalmoscopy. The distance between the leakage point and the center of the fovea was defined using FA images, and its correlation with AL, subfoveal choroidal thickness (SCT), central retinal thickness (CRT), and neurosensory detachment (NSD) area was calculated. A number of leaks, rate of bilateral involvement, and recurrence rate were evaluated. Results. Forty-seven patients (47 eyes) were included in this study (38 males, 9 females, mean age 43.5 ± 10.8 years). The distance between the leakage point and the center of the fovea had a correlation with AL (r = –0.38, p = 0.008), SCT (r = 0.51, p = 0.0004), and the area of NSD (r = 0.5, p = 0.0006) but not with CRT (r = –0.11, p = 0.45). A statistically significant difference in the distance between the leakage point and the center of the fovea was found between eyes with short (23.0 mm), medium (23.0–24.0 mm), and long (&gt; 24.0 mm) AL (p = 0.014). Number of leaks, rate of bilateral involvement, and recurrence rate had a negative linear association with AL (p &lt; 0.05). Conclusion: Axial length appears to be the basic anatomical predictor, which defines morphological and clinical characteristics in acute central serous chorioretinopathy. Keywords: central serous chorioretinopathy, axial length, leakage point

To evaluate the effect of verteporfin photodynamic treatment (PDT) on choroidal thickness in patients with central serous chorioretinopathy (CSC). Choroidal thickness was measured with enhanced depth imaging- optical coherence tomography (EDI-OCT) before and after verteporfin PDT (full-dose verteporfin, half-light dose) in 16 eyes in 16 patients with serous detachment of the fovea secondary to extrafoveal angiographic fluorescein leakage. Treatment was confined to the area of leakage, whereas choroidal thickness before and after treatment was assessed over a larger area of the fundus using OCT. Complete resolution of the serous detachment was seen in all 16 eyes within 1 month of extrafoveal PDT, while choroidal thickness in the area where PDT was applied decreased from 407 μm [mean; 95% confidence interval (CI(95) ) 356-458 μm] to 349 μm (mean; CI(95) 300-399 μm; p < 0.0001), and subfoveal choroidal thickness was reduced from 421 μm (mean; CI(95) 352-489 μm) to 346 μm (mean; CI(95) 278-414 μm; p = 0.0001). Initially, subfoveal choroidal thickness was significantly increased in the treated eye compared with the healthy fellow eye (mean 324 μm; CI(95) 273-376 μm; p = 0.0003), but after treatment, the difference was not significant. Photodynamic therapy of active CSC was followed by choroidal thickness reduction, not only locally but also at considerable distance from the treated area. Thus, the process that causes choroidal thickening in CSC appears to spread laterally within the choroid.

Densitometry of Choroidal Vessels in Eyes With and Without Central Serous Chorioretinopathy by Wide-Field Indocyanine Green Angiography

This study reviewed the concepts and properties of the receiver operating characteristic (ROC) curve and precision recall (PR) curve, and made suggestions on the application of two curves based on the prevalence in combination with the results of simulation data. This study demonstrated that the ROC curve and PR curve had different properties, which could reflect the performance of diagnostic methods from various aspects. These two curves should be selected with a consideration of prevalence and clinical scenarios. When the prevalence was less than 20%, especially less than 5%, the PR curve could be adopted.

Objective To observe the imaging features of short-wave length fundus autofluorescence (SW-AF), near-infrared fundus autofluorescence (NIR-AF)and spectral-domain optical coherence tomograph (SD-OCT) in acute central serous chorioretinopathy (CSC). Methods This is a retrospective observational consecutive case series study. Eighty-two eyes with acute CSC from 76 patients were enrolled in this study.There were 50 males (56 eyes) and 26 females (26 eyes), average age was (41.32±7.37) years old, average course of the disease was (0.47±1.73) months. The routine clinical examinations included best corrected visual acuity, slit lamp microscope, indirect ophthalmoscope, fundus fluorescein angiography (FFA), SW-AF, NIR-AF and SD-OCT. The imaging features of NIR-AF, SW-AF, SD-OCT and FFA in same eye with acute CSC were analyzed comparatively. Results SD-OCT showed retinal pigment epithelium (RPE) detachment corresponding to RPE leakage point on FFA images in all CSC eyes. RPE leakage points in all eyes corresponding to local hypo-NIR-AF, whereas corresponding to normal SW-AF. NIR-AF demonstrated the area of decreased AF corresponding to serous retinal detachment in all eyes, of which, the area of hypo-SW-AF was consistent with that of sensory retinal detachment in 75 eyes. Except for RPE leaking fluorescein in 82 eyes, FFA showed window defects corresponding to clusters of hypo-NIR-AF in 45 eyes, of which, 27 eyes showed hypo-SW-AF appearing concurrently with the locations of window defects of FFA. In 18 eyes, the extent and amount of hypo-SW-AF were less than that of hypo-NIR-AF. Conclusions There was local RPE detachment in all eyes with acute CSC. The locations of sensory retinal detachment, local RPE detachment and RPE depigmentation showed hypo-NIR-AF. The locations of sensory retinal detachment and RPE depigmentation showed hypo-SW-AF in most of acute CSC eyes. Key words: Central serous chorioretinopathy; Tomography, optical coherence; Fluorescein angiography; Diagnostic imaging

To detect the leakage points of central serous chorioretinopathy (CSC) automatically from dynamic images of fundus fluorescein angiography (FFA) using a deep learning algorithm (DLA). The study included 2104 FFA images from 291 FFA sequences of 291 eyes (137 right eyes and 154 left eyes) from 262 patients. The leakage points were segmented with an attention gated network (AGN). The optic disk (OD) and macula region were segmented simultaneously using a U-net. To reduce the number of false positives based on time sequence, the leakage points were matched according to their positions in relation to the OD and macula. With the AGN alone, the number of cases whose detection results perfectly matched the ground truth was only 37 out of 61 cases (60.7%) in the test set. The dice on the lesion level were 0.811. Using an elimination procedure to remove false positives, the number of accurate detection cases increased to 57 (93.4%). The dice on the lesion level also improved to 0.949. Using DLA, the CSC leakage points in FFA can be identified reproducibly and accurately with a good match to the ground truth. This novel finding may pave the way for potential application of artificial intelligence to guide laser therapy.

This study aimed to investigate the risk factors associated with central serous chorioretinopathy (CSC) and analyze the relationship between vascular endothelial growth factor (VEGF), high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), and CSC. A total of 109 patients diagnosed with CSC (CSC group) at our ophthalmology clinic from February 2017 to February 2021 were included, with 103 volunteers from our hospital's health examination center serving as the control group. Additionally, the new multimodal imaging classification of 109 CSC patients was further divided into simple CSC (57 cases) and complex CSC (52 cases). Demographic data, underlying diseases, medical history, and medication history were collected. Levels of VEGF, hs-CRP, and ESR were measured, and multifactorial logistic regression analysis was performed to identify factors influencing CSC. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic value of VEGF, hs-CRP, and ESR in CSC. The CSC group showed a higher proportion of males, smoking history, alcohol consumption, comorbid obstructive sleep apnea, hypothyroidism, renal disease, Helicobacter pylori infection, steroid use, and shift work compared to the control group (P < 0.05). VEGF, hs-CRP, and ESR levels were significantly higher in the CSC group than in the control group (P < 0.05). The levels of VEGF, hs-CRP, and ESR in the complex CSC group were higher than those in the simple CSC group (P < 0.05). Male gender, shift work, Helicobacter pylori infection, hypothyroidism, elevated VEGF, hs-CRP, and ESR were identified as risk factors for CSC (P < 0.05). The combined diagnostic value of VEGF, hs-CRP, and ESR (area under the ROC curve: 0.886) was higher than that of individual markers (0.722, 0.728, and 0.703, respectively) (P < 0.05). Male gender, shift work, Helicobacter pylori infection, hypothyroidism, and elevated levels of VEGF, hs-CRP, and ESR are risk factors for CSC. The combined use of VEGF, hs-CRP, and ESR demonstrates higher diagnostic efficiency in identifying CSC.

Purpose Central serous chorioretinopathy (CSC) is a commonly acquired maculopathy characterized by the accumulation of subretinal fluid at the posterior pole. This study aims to analyze optical coherence tomography angiography (OCTA) findings in patients with acute and chronic CSC and to compare them to conventional imaging methods. Methods A series of 43 consecutive eyes of 29 patients diagnosed with CSC and 18 eyes of 9 healthy control subjects were included in this retrospective study. The OCTA images were assessed and compared to conventional fluorescence (FAG) and indocyanine green angiography (ICG). Results All CSC patients demonstrated abnormal areas of focal hypo- and hyperperfusion in the choriocapillaris. These were particularly evident in patients with chronic atrophic CSC. FAG and ICG imaging revealed leakage points in 10 of 43 eyes and choroidal neovascularization (CNV) in 3 of 43eyes. OCTA imaging confirmed leakage points in 4 out of 10 cases and choroidal neovascularization in 2 out of 3 cases. In one case, OCTA demonstrated a CNV which was not detectable by FAG/ICG. Conclusion OCTA reveals areas of focal hypo- and hyperperfusion in the choriocapillaris in patients with CSC. Due to the inability to detect plasma flow, OCTA is not suitable to detect leakage points in CSC with confidence. However, OCTA reliably detects CNV in CSC even in the absence of exudative activity and may, therefore, represent an important supplement in the diagnosis of CSC.