Multimodal imaging characteristics of central serous chorioretinopathy converted to polypoidal choroidal vasculopathy and pachychoroidal neovascularization

Abstract

Objective To investigate the multimodal imaging characteristics of central serous chorioretinopathy (CSC) converted to polypoidal choroidal vasculopathy (PCV) and pachychoroidal neovascularization(PNV). Methods A retrospective case series study was adopted.The clinical data of 91 eyes from 79 patients with CSC who received treatment from June 2009 to September 2017 in Shenzhen Eye Hospital were analyzed.Color fundus photography, fundus fluorescein angiography (FFA), spectral domain optical coherence tomography (SD-OCT) and indocyanine angiography (ICGA) were performed in the patients.The eyes with recurrence or maintained serous retinal pigment epithelium(RPE) after treatment were examined once more. Results In 91 eyes, 11 eyes of 9 patients converted to PNV.Late stage of FFA showed multifocal hyperfluorecnece in macular area.ICGA showed plaque hyperflurorescence overlying dilated choroidal vessel.OCT revealed irregular flap shallow RPE detachment with retinal neurosensory detachment.OCTA revealed mass-like enlarged choroidal vessel between RPE and Bruch membrane.Nine eyes of 7 patients with CSC converted to PCV, and late stage of FFA showed serous-hemorrhage pigment epithelium detachment(PED) and multifocal enlargement hyperfluorecnece.ICGA showed branch vessels network (BVN) with small polyps.OCT revealed PED like thumb with double-layer sign and retinal neurosensory detachment.OCTA en-face revealed BVN with small polyps at choroidal capillaries layer.The baselines BCVA of PCV and PNV(LogMAR) was 0.282±0.220 and 0.413±0.190, respectively with a significant difference between them (t=0.037, P<0.05). Subfoveal choroidal thickness (SFCT) of CSC, PCV and PNV patients was (373.61±65.11), (296.22±30.24) and (328.63±76.18)μm, with siginificant differences among them (F=3.48, both at P<0.05). SFCT of PNV patients was thicker than that of PCV patients, with a significant difference between the two groups (t=2.91, P<0.05). Conclusions Chronic or recurrence CSC is probably to develop to PNV, and the PNV with serous or hemorrhage PED is probably to switch to PCV.Multimodal imaging examination is helpful to the diagnosis of PNV and PCV. Key words: Central serous chorioretinopathy; Polypoidal choroidal vascularization; Pachychoroidal neovascularization; Fundus multimodal imaging