Abstract
In this study, using optical coherence tomography angiography (OCTA) we evaluated choriocapillaris perfusion in eyes with central serous chorioretinopathy (CSC) after excluding all possible artifacts caused by alterations of neurosensory retina or retinal pigment epithelium (RPE). We have included 22 unilateral acute CSC patients (18 males and four females, 41.8 ± 5.7 years) and 18 healthy subjects (13 males and five females, 40.9 ± 9.7 years). The number of flow voids per 1 mm2 of scan area and percentage of flow signal area was calculated based on choriocapillaris slab of 3 × 3 mm2 OCTA scans after excluding all possible artifacts caused by alterations of neurosensory retina or RPE. The percentage of flow signal area after the exclusion of neurosensory retina and RPE alterations in the eyes of healthy individuals was higher than in CSC eyes (p = 0.006) and fellow unaffected eyes of CSC patients (p = 0.02). The number of flow voids larger than 25,000 µm2 in eyes of healthy individuals was lower than in the CSC eyes (p = 0.0006). There were no statistically significant differences in study parameters between CSC eyes and fellow eyes of CSC patients (p > 0.05). The general decrease of choriocapillaris perfusion in both eyes of CSC patients exists independently of the presence of acute disease or asymptomatic structural RPE changes.
Highlights
The first mention of choroidal ischemia and related retinal pigment epithelium (RPE) alteration in central serous chorioretinopathy (CSC) was by Hayashi [1] and was based on indocyanine green angiography
Pachychoroidal spectrum is a specific point of interest for the study of changes of the choriocapillaris
There is no clear evidence of the presence/absence of true deterioration of the choriocapillaris flow under RPE alterations and areas of subretinal fluid (SRF) accumulation in eyes with CSC, we suggest that SRF is less likely to be associated with true flow deficit since the distribution of SRF depends on tertiary factors such as the location of the leak, the volume of the SRF, and the action of gravity [12]
Summary
The evaluation of choriocapillaris circulation sheds light on the pathophysiology of central serous chorioretinopathy (CSC). The first mention of choroidal ischemia and related retinal pigment epithelium (RPE) alteration in CSC was by Hayashi [1] and was based on indocyanine green angiography. Optical coherence tomography angiography (OCTA) has allowed higher resolution in the evaluation of choriocapillaris. Using OCTA, many authors have described an increase of the total area of flow signal voids in choriocapillaris in CSC [2,3,4,5] and have shown colocalization of flow signal voids and underlying choroidal pachyvessels [2,4,5]
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