Abstract
PurposeTo evaluate morphological characteristics of choroidal neovascularization in chronic central serous chorioretinopathy (CSC) presenting with flat and irregular pigment epithelium detachment (FIPED) by means of innovative multimodal imaging.MethodsIn this observational cross-sectional study, we examined 10 consecutive patients affected by chronic CSC and FIPED using fluorescein angiography (FA), indocyanine-green angiography (ICGA) and optical coherence tomography angiography (OCTA). A qualitative analysis of the nature and characteristics of neovascular membrane was performed, combining available multimodal imaging and literature data.ResultsMultiple areas of retinal pigment epithelium alterations, macular hypo- and hyperpigmentation and atrophic areas were identified. Spectral domain OCT (SD-OCT) showed subretinal fluid in 80% of eyes and the ‘double layer sign’ in all patients. Late FA phases showed staining areas without leakage in all eyes; ICGA showed a hyperfluorescent plaque with surrounding hypofluorescence in 80% of patients. OCTA detected characteristic neovascular networks in the outer retina within the FIPEDs, classified as filamentous vessels with a pruned tree-like pattern in five eyes and a tangled pattern in three eyes. The choriocapillaris network showed dark areas in 80% of eyes and diffuse dark spots in all eyes.ConclusionMultimodal imaging completes clinical characterization of FIPEDs in chronic CSC. This study using OCTA technology describes the phenotype of hidden neovascular lesions in shape and morphology.
Highlights
Central serous chorioretinopathy (CSC) is a posterior segment disease characterized by serous detachments of the neurosensory retina [1, 2]
Ten eyes of 10 patients were diagnosed with chronic CSC presenting with a FIPED
Fundus examination revealed the presence of subretinal fluid involving the macular region in 80% of eyes; all eyes presented multiple zones of retinal pigment epithelium (RPE) alterations, in particular macular hypo- and hyperpigmentation and atrophic areas
Summary
Central serous chorioretinopathy (CSC) is a posterior segment disease characterized by serous detachments of the neurosensory retina [1, 2]. Deep changes in the RPE structure are diagnosed with the presence of areas of atrophy and pigment epithelium detachments (PEDs). A multimodal diagnostic approach represents in these cases an interesting example of clinical evaluation, in particular when chronic CSC is complicated by flat and irregular RPE detachments and neovascularization [6, 7]. Quaranta et al identified CNV applying OCTA in the full sample of seven chronic CSC eyes with ‘slight retinal PED with small undulations’ [11] and Dansingani et al in 95% of 22 eyes with pachychoroid diseases and ‘shallow irregular pigment epithelial detachments’ [12]. CNVs may show different behaviors and clinical morphologies due to chronic subretinal fluid, flat, irregular pigment epithelium detachment (FIPED) and stability during follow-up [13]
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