Fundus image in central serous chorioretinopathy cases

Abstract

Objective To investigate the characteristics of the fundus image in central serous chorioretinopathy (CSC) patients who undergo or not undergo treatment. Methods This was a retrospective case control study. The fundus images of 36 patients who were diagnosed with CSC from Jan. 2009 to Dec. 2010 were analyzed. Eighteen of 36 cases (group A) with less than 3 months since onset were treated with photodynamic therapy (PDT) with a half-dose (3 mg/m2) of verteporfin and 18 of 36 patients (group B) with more than a 3-month period since onset were not treated. All eyes were imaged by spectral domain optical coherence tomography (Spectralis OCT) and fundus autofluorescence (FAF) at each follow-up visit. Eighteen cases in group A were imaged by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) each time and 9 of 18 patients with a severe decrease in visual acuity in group B were imaged by FFA and ICGA. The differences between Group A and B were observed. Results Group A patients presented with an abnormal increase in FAF before treatment and normal FAF after treatment. In the meantime, Spectralis OCT imaging showed serous neuroepithelial detachment with subretinal fluid (SRF), FFA showed ink-dot diffusion or a smokestack phenomenon, and ICGA revealed dilated and tortuous choroidal vessels with diffuse hyperpermeability. After 1 month, Spectralis OCT imaging showed a resolution of SRF in 16 of 18 patients who had undergone PDT treatment (group A). Fundus images of the other 2 patients showed that their conditions did not revert to normal until 3 months after treatment. Three months after treatment, Spectralis OCT clearly showed that there was a resolution of SRF in all patients, and FFA and ICGA showed an absence of fluorescence leakage and a recovery of dilated choroidal vessels. However, 16 of 18 patients in group B showed an abnormal FAF. There were mainly four phenotypic patterns in the FAF shapes such as pachy, variegated, round and short-lagenated. Two of 16 patients showed a descending tract with a downward-leading swathe of decreased autofluorescence originating from the posterior pole and extending below the inferior arcade. We called this the RPE track. There were 9 patients in group B who were imaged with FFA and ICGA due to persistent blurred vision and several recurrences, and the ICGA images showed late-stage obviously damaged areas. The size of the damaged areas in the partial patients was greater than 5 disc diameter. Conclusion Abnormal FAF could be seen in CSC without treatment due to SRF damaging the retinal pigment epithelium (RPE) cells and further leading to permanent RPE cellular dysfunction and poor visual acuity. Therefore, treatment intervention in the early stages is safe and necessary for partial CSC patients to avoid long-term damage and visual function loss. Key words: Chorioretinitis, serous, central; Fluorencein, spontaneous; Fluorescein angiography; Tomography, optical coherence