Choriocapillaris Ischemia at the Leakage Point of Patients With Acute Central Serous Chorioretinopathy.

Zuofen Wang,Zhaoting Xin,Jun Yang,Huawen Lu,Lin Zhu,Haiying Wang

doi:10.3389/fmed.2021.675876

Abstract

Purpose: We aimed to determine ischemia of the choriocapillaris at the leakage point of patients with acute central serous chorioretinopathy (CSC) by optical coherence tomographic angiography (OCTA).Methods: A retrospective study of 38 eyes of 38 acute CSC patients with spontaneous complete resolution of subretinal fluid (SRF) was conducted and patients were followed for 3 months. Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed at baseline. Best corrected visual acuity (BCVA) and OCTA were collected at baseline and at follow-up visits. An age- and refractive error-matched control group consisted of 40 eyes of 40 healthy people.Results: The BCVA of patients significantly improved at 1 and 3 months. At baseline, all eyes showed a decreased choriocapillaris vessel density. The mean vessel density of superficial choroid (VDSC) at the leakage point area was 44.18 ± 9.27, which increased to 54.31 ± 9.70 at 1 month (p < 0.001) and to 55.19 ± 6.46 at 3 months (p < 0.001). The mean vessel density ratio was 0.90 ± 0.16 at baseline, which increased to 0.96 ± 0.15 at 1 month (p = 0.037) and to 0.97 ± 0.08 at 3 months (p = 0.016). The highest VDSC of patients was lower than that of normal control (p < 0.001).Conclusions: The VDSC at the leakage point of acute CSC patients was significantly thinner and regularly increased with the recovery process, which suggested that ischemia might be one of the initiating factors in the pathogenesis of acute CSC.

Highlights

Central serous chorioretinopathy (CSC) is an idiopathic ophthalmopathy in which the neurosensory retina is often detached in the central macular region because of serous leakage from defects of the retinal pigment epithelium (RPE) [1,2,3,4]
The increasing use of fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) in CSC has greatly improved the understanding of the pathogenesis of CSC and demonstrates that choroidal circulation dysfunction primarily leads to CSC
The purpose of our study was to determine the existence of ischemia at the leakage point of acute CSC with optical coherence tomography angiography (OCTA) and investigate whether the ischemia reduced with recovery

Summary

Introduction

Central serous chorioretinopathy (CSC) is an idiopathic ophthalmopathy in which the neurosensory retina is often detached in the central macular region because of serous leakage from defects of the retinal pigment epithelium (RPE) [1,2,3,4]. The pathogenesis of CSC may be related to an alteration of the outer barrier effect and the pumping function of the RPE and an increase in leakage and permeability in the choroidal vasculature [5,6,7]. With the development of examination techniques, optical coherence tomography angiography (OCTA) has been developed to generate a volumetric rendering of blood flow in different layers of the retina and choroid, capable of detecting the vascular morphology and vessel density of the retinochoroid capillaries quantitatively without injecting dye [8,9,10,11,12]. The choroid is primarily a vascular structure consisting mostly of blood vessels, which is the source of oxygen and other nutrition for RPE cells.

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