Central Serous Chorioretinopathy Eyes Research Articles

Measurement and analysis of choroidal vascularity index and subfoveal choroidal thickness in central serous chorioretinopathy

Objective To observe the choroidal vascularity index (CVI) and the subfoveal choroidal thickness (SFCT) of central serous chorioretinopathy (CSC), and to compare the stability and consistency of the two methods of measurement. Methods A retrospective study. Thirty-one patients with unilateral acute CSC who visited the Department of Ophthalmology of Beijing Friendship Hospital for the first time during the period from Nov 1st, 2016 to Mar 18th, 2018 were included in the study. Thirty-one healthy age-matched subjects were enrolled as controls. All CSC affected eyes and their fellow eyes and healthy eyes were scanned by single-line enhanced depth imaging of OCT through central fovea of macula to measure their SFCT. The image was binarized and then the CVI of a 1500 μm range below fovea was calculated, i.e. the ratio of vascular (or lumen) area to total choroidal area. CVI and SFCT were compared among CSC eyes, fellow eyes and healthy eyes by variance analysis. Intra-group correlation coefficient (ICC), Bland-Altman curve and coefficient of variation (CV) were used to analyze the repeatability, consistency and stability of CVI and SFCT; and Medcalc18.2.1 software was used to draw the Bland-Altman curve and observe the consistency of the two measurement methods. Results There were statistically significant differences in CVI and SFCT between CSC affected eyes and fellow eyes (t=3.470, 2.844; P=0.001, 0.006), CSC affected eyes and healthy eyes (t=6.977, 6.277; P<0.001,<0.001), fellow eyes and healthy eyes (t=3.508, 3.433; P=0.001, 0.001). Relative consistency analysis of CVI and SFCT showed that the ICC of single measurement and average measurement of CVI were 0.967 and 0.983 respectively, and that of single measurement and average measurement of SFCT were 0.937 and 0.967 respectively. The consistency of CVI and of SFCT was very good. The ICC value of CVI was slightly higher than that of SFCT. The results of repeatability analysis of CVI and SFCT showed that the difference between the two CVI measurements was smaller, and the difference between the two SFCT measurements was larger. And CVI and SFCT stability analysis results showed that the CV of CVI and SFCT were 10.5% and 25.3% respectively. CVI has smaller CV than SFCT. Conclusions Compared with healthy eyes, CVI and SFCT are increased in CSC affected eyes and fellow eyes. And compared with SFCT, CVI has better consistency, repeatability and stability. Key words: Central serous chorioretinopathy; Tomography, optical coherence; Choroidal vascularity index; Subfoveal choroidal thickness

The change of retinal microstructure and the correlation with visual outcome in central serous chorioretinopathy after laser treatment

Objective To observe the change of retinal microstructures and the association between visual outcome with these microstructures in central serous chorioretinopathy (CSC) after laser treatment. Methods This is a retrospective study. From April 2016 to February 2017, a total of 52 eyes from 52 patients who underwent conventional laser treatment (27 eyes) or subthreshold laser treatment (25 eyes) for CSC and the sub-retinal fluid (SRF) absorbed completely were included in this study. The were 46 patients (46 eyes) and 6 males (6 eyes), with the mean age of 43.92±8.62 years. The healthy fellow eyes (49 eyes) were selected as control. All patients were underwent BCVA and SD-OCT examination. According to the OCT images for all patients, the thickness of central foveal (CFT), outer nuclear (ONL), inner segment (IS), outer segment (OS) were measured. The status of ellipsoid zone (EZ), interdigitation zone (IZ) and RPE were also evaluated at fovea. Comparing the change of SD-OCT microstructures in two time points, the first visit after SRF absorbed and the last visit respectively. Spearman correlation analysis was used to analyze the relation between BCVA and ONL, IS, OS. Results At the first visit after SRF absorbed, compared with control eyes, the thickness of CFT (182.55±24.14 μm), ONL (72.86±17.39 μm), IS (41.23±5.14 μm), OS (18.52±10.26 μm) in CSC eyes were decreased (P<0.001). Meanwhile, the mean BCVA of CSC eyes was 81.27±6.39 letters, which was also significantly decreased comparing with control eyes (P<0.001). At last visit, the thickness of CFT, ONL, IS, OS were 195.19±22.10, 75.44±16.33, 44.56±4.09, 26.60±11.39 μm, and the mean BCVA was 85.50±5.95 letters. All recovered significantly comparing with first visit (P<0.05). At first visit, the BCVA of patients with integrate EZ (83.38±5.78 letters) was significantly better than the BCVA of patients with unintegrated EZ (77.90±5.97 letters) (P=0.003). And the BCVA of patients with smooth RPE (82.72±5.95 letter) was also significantly better than the BCVA of patients with rough RPE (78.00±6.31 letters) (P=0.020). The result of Spearman correlation analysis showed that the thickness of OS was positively correlated to BCVA at two time points (r=0.423, 0.416; P=0.002, 0.002). Conclusions In CSC, the thickness of ONL, IS, OS were decreased, and the integrality of EZ, IZ, the smooth of RPE were disrupted in different extent. After laser treatment, with retinal reattachment, those microstructures including ONL, IS, OS, EZ, IZ recovered slowly. The thickness of OS, the integrality of EZ and the smooth of RPE were associated with visual acuity. Key words: Central serous chorioretinopathy; Laser coagulation; Tomography; optical coherence

The relationship between foveal outer nuclear layer thickness in the active and resolved phases of central serous chorioretinopathy treated with half-dose photodynamic therapy

BackgroundTo investigate the relationship between the foveal outer nuclear layer (ONL) thickness in the active and resolved phases of central serous chorioretinopathy (CSC), and its possible association with optical coherence tomography (OCT) parameters.MethodsThe medical records of CSC patients treated with half-dose photodynamic therapy (PDT) between August 2011 and October 2017 were reviewed. The difference between the foveal ONL thickness at 12 m after half-dose PDT and that before half-dose PDT was analyzed, and its association with OCT parameters was assessed using generalized linear models.ResultsSixty-two patients were included. The mean difference in foveal ONL thickness was 9.15 ± 8.16 μm. The average ratios of the retinal detachment height to the subretinal space width on horizontal and vertical scans were 0.10 ± 0.04 and 0.12 ± 0.04, respectively. The ratio was independently associated with the degree of increase in the foveal ONL thickness difference on both the horizontal scans (β = 103.684, P = .000) and vertical scans (β = 67.569, P = .000), even after adjusting for potential confounders.ConclusionsThe majority of resolved CSC eyes showed some increase in foveal ONL thickness, and the degree of increase was related to the ratio of the retinal detachment height to the subretinal space width in their active phase. It suggested that the retina is stretched when it becomes detached, and recovers with resolution of the subretinal fluid. Therefore, besides photoreceptor cell death, retinal stretch may contribute to the reduction in foveal ONL thickness in eyes with active CSC.

Risk Factors and Outcomes of Choroidal Neovascularization Secondary to Central Serous Chorioretinopathy

We identified clinical characteristics and risk factors of choroidal neovascularization (CNV) in eyes with prior episode of central serous chorioretinopathy (CSC). This retrospective case-control study included those initially diagnosed with CSC and developed CNV secondarily (Group 1, n = 16), those diagnosed with CNV in eyes of previous putative CSC (Group 2, n = 14), and those initially diagnosed with CSC, and did not develop CNV secondarily, as a control group for Group 1 (Group 3, n = 250). Clinical characteristics including treatment outcomes were assessed. Demographics and multimodal imaging at the time of CSC diagnosis of secondary CNV were compared between the groups to identify risk factors. Duration from diagnosis of CSC to development of CNV in Group 1 was 40.2 ± 42.0 months. Classic CNV was noted in 23 (76.7%) eyes. After treatment with intravitreal antiangiogenics with average of 4.9 times, visual acuity improved in Group 1 and Group 2 (p = 0.002). Multivariate analysis revealed that systemic hypertension, pigmentary changes, and double layer sign were associated with development of CNV secondary to CSC (p < 0.05). Hypertension, pigmentary changes, and double layer sign were independent risk factors for CNV secondary to CSC. The CNV’s responded well to treatment, resulting in improved vision.

Abnormal choroidal flow on optical coherence tomography angiography in central serous chorioretinopathy.

Analysing choroidal flow in central serous chorioretinopathy (CSC) with novel device. To examine the abnormal morphology of choriocapillary flow with optical coherence tomography angiography (OCTA) according to the presence of subretinal fluid (SRF) in CSC. A hospital-based retrospective study. We analysed OCTA results of 68 eyes (68 patients) diagnosed as CSC with or without SRF (active and resolved CSC, respectively) at the Asan Medical Center. We classified OCTA choriocapillary images into three pattern groups: mixed perfusion, hyper-perfusion and normal perfusion. Data analysis included age, follow-up duration, treatment modalities, number of treatments, subfoveal choroidal thickness and SRF height. The relationship between CSC activity and choriocapillary pattern. Abnormal choroidal flow (mixed and hyper-perfusion) was more frequently found in eyes with active CSC (100%) than resolved CSC (47.5%, P < 0.001). In active CSC eyes, mixed perfusion was predominant (71.4%), while hyper-perfusion was predominant in those with resolved CSC (73.7%). Eyes with recently resolved CSC (SRF absorption present for <2 months) had abnormal choriocapillary flow more often than the remaining eyes with resolved CSC (83.3% vs 32.1%, P = 0.005). Resolved CSC eyes with abnormal choriocapillary flow demonstrated more recurrence than eyes with normal choriocapillary flow (42.1% vs 9.5%, P = 0.017). The pattern of choriocapillary flow abnormalities on OCTA can indicate CSC disease activity. Because eyes with resolved CSC showing abnormal choroidal flow have a high recurrence rate, they should be carefully followed-up.

OCT Angiography of the Choriocapillaris in Central Serous Chorioretinopathy: A Quantitative Subgroup Analysis.

IntroductionTo quantify optical coherence tomography angiography (OCTA) signal changes at the level of the choriocapillaris (CC) in patients with different stages of central serous chorioretinopathy (CSC) and to explore any correlation between subretinal fluid (SRF) and retinal pigment epithelium (RPE) alterations and the OCTA CC signal.MethodsOne hundred one CSC eyes and 42 healthy control eyes were included in this retrospective study. CSC patients were allocated into four groups: acute, non-resolving, chronic atrophic and inactive CSC. CC OCTA images (AngioPlex®, Zeiss) were automatically quantified using an image-processing algorithm. Spatial correlation analysis of OCTA signals was performed by overlapping macular edema heatmaps and fundus autofluorescence images with corresponding OCTA images.ResultsActive CSC subgroups demonstrated significantly more increased and decreased flow pixels in the CC compared with controls (p < 0.0001). No significant OCTA changes were seen within the active CSC groups or between the inactive and healthy subgroup. Spatial correlation analysis revealed a decreased OCTA signal in the SRF area and an increased signal outside the SRF area in acute CSC. Areas of RPE atrophy co-localized with areas of increased choriocapillaris OCTA signal, while areas with RPE alterations exhibited a normal signal compared with unaffected RPE.ConclusionThe decreased OCTA signal in the area of SRF in acute CSC could be evidence of localized CC hypoperfusion or due to shadowing artifacts. The missing CC OCTA changes in altered RPE adjacent to atrophy argues against CC injury. Studies with higher resolution and optimized image acquisition are warranted to further validate our findings.Electronic supplementary materialThe online version of this article (10.1007/s40123-018-0159-1) contains supplementary material, which is available to authorized users.

OCULAR PERFUSION PRESSURE AND CHOROIDAL THICKNESS IN CENTRAL SEROUS CHORIORETINOPATHY AND PIGMENT EPITHELIOPATHY.

To investigate ocular perfusion pressure (OPP) in patients with central serous chorioretinopathy (CSC) and pigment epitheliopathy (PE). In this retrospective study, we included patients with acute idiopathic unilateral CSC and age- and sex-matched normal controls. The patients with CSC were classified into two groups according to the PE presence on their fellow eyes. We compared OPP among CSC patients with or without PE and normal controls. Among a total of 47 patients with CSC, 21 were classified into the PE group and 26 into the non-PE group. The mean OPP (±SD) of CSC and fellow eyes in the PE group (50.02 ± 4.98 and 50.83 ± 4.12 mmHg, respectively) was greater than that in the non-PE group (43.69 ± 6.88 and 44.0 ± 6.57 mmHg, respectively) and normal controls (45.64 ± 8.73 mmHg) (all, P < 0.05). The mean macular choroidal thickness of CSC and fellow eyes in the PE group (344.4 ± 31.8 and 310.1 ± 37.0 μm, respectively) was thicker than that in the non-PE group (318.5 ± 43.8 and 282.8 ± 36.1 μm, respectively) (all, P < 0.05). Greater macular choroidal thickness and higher OPP were associated with PE (P = 0.002 and P = 0.003). Forty-five percent of the patients with acute unilateral CSC had PE in their fellow eyes. Increased OPP may influence the development of bilateral CSC characteristics.

Morphologic features of large choroidal vessel layer: age-related macular degeneration, polypoidal choroidal vasculopathy, and central serous chorioretinopathy.

To compare choroidal vascular characteristics of age-related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV), and central serous chorioretinopathy (CSC) by qualitative and quantitative analyses using swept-source en face optical coherence tomographic (OCT) images. Eyes with non-neovascular AMD (n = 32), neovascular AMD (n = 30), thick and thin choroid PCV (n = 33 and 27), and CSC (n = 34) were enrolled. Subfoveal choroidal thickness (SFCT) and the presence and patterns of pachyvessels were assessed. En face images of the large choroidal vessel layer were converted to binary images for the analysis of vascular density. Pachyvessels were identified in 8 (25%), 14 (46%), 28 (85%), 26 (96%), and 34 (100%) non-neovascular AMD, neovascular AMD, thin choroid PCV, thick choroid PCV, and CSC eyes, respectively (P < 0.001). The pattern of pachyvessels was focal in non-neovascular AMD (100%), neovascular AMD (79%), and thin choroid PCV (89%) while the pattern was mostly diffuse in CSC (88%) and thick choroid PCV (81%). The mean choroidal vascular density in a 6 × 6mm2 macular area of each group was 45.3%, 46.9%, 47.0%, 52.5%, and 54.8%, respectively (P < 0.001). Post hoc analysis revealed significantly higher vascular density in CSC compared with other types (all P < 0.001) except PCV with thick choroid (P = 0.066). Similarities in vascular density of the large choroidal vessel layer and pachyvessel pattern were between CSC and thick choroid PCV and between AMD and thin choroid PCV, suggesting common pathophysiology involving choroidal changes in these eyes.

Choroidal vascularity changes in idiopathic central serous chorioretinopathy after half-fluence photodynamic therapy.

PurposeThis study evaluated changes in choroidal vascularity after half-fluence photodynamic therapy (HF-PDT) in patients with central serous chorioretinopathy (CSC) using swept-source optical coherence tomography (SS-OCT) en face imaging.MethodsThis retrospective comparative case series included 50 eyes of 25 patients with unilateral CSC who underwent HF-PDT and 50 age-and sex-matched normal healthy control eyes. En face SS-OCT images of the choriocapillaris, Sattler’s layer, and Haller’s layer were converted into binary images. The vascular proportions were defined as the percentage of the area of vascular lumen against the area of the 3.0-mm-diameter circular area. The main outcome measures were the vascular proportions before HF-PDT and at 6 weeks, 6 months, and 12 months after HF-PDT.ResultsAt baseline, the vascular proportions in the CSC eyes were significantly greater than those in the control eyes in all layers (choriocapillaris: 51.8% ± 15.5% vs. 41.3 ± 18.7%, P = 0.018; Sattler’s: 58.6% ± 13.4% vs. 49.7% ± 15.7%, P = 0.017; Haller’s: 65.3% ± 15.3% vs. 53.0% ± 13.4%, P = 0.001). In the CSC eyes, the vascular proportion in the choriocapillaris significantly decreased at 6 weeks (36.6% ± 16.9%, P < 0.001), 6 months (34.0% ± 12.3%, P < 0.001), and 12 months (34.8% ± 17.6%, P < 0.001) after HF-PDT compared with baseline. The vascular proportions in Sattler’s and Haller’s layers did not show a significant decrease at 6 weeks (Sattler’s: 49.7% ± 17.3%, P = 0.052 and Haller’s: 58.3% ± 12.9%, P = 0.558) but decreased significantly at 6 months (Sattler’s: 48.9% ± 12.4%, P < 0.001 and Haller’s: 57.7% ± 15.7%, P = 0.027) and 12 months after HF-PDT from the baseline values (Sattler’s: 45.8% ± 10.4%, P < 0.001 and Haller’s: 56.8% ± 15.7%, P < 0.001).ConclusionAfter HF-PDT, the choriocapillaris showed the earliest decrease in vascular proportion of en face images, Sattler’s and Haller’s layers showed later decreases. The temporal differences in the response of each layer may reflect the pathophysiology of CSC and the therapeutic mechanism of HF-PDT.

Half-time photodynamic therapy in treatment of chronic central serous chorioretinopathy.

Different modes of photodynamic therapy (PDT) were described for treatment of central serous chorioretinopathy (CSC). The purpose of the current study was to evaluate the outcome of half-time PDT in chronic CSC. A retrospective case series study, including 114 eyes of 103 patients with chronic CSC, treated with reduced-fluence PDT. PDT was applied with full-dose verteporfin (6mg/m2) and half-time fluence (43s). The main outcome measures included timing of complete subretinal fluid (SRF) resolution, recurrences, pre- and post-treatment best-corrected visual acuities (BCVA). Anatomical and functional effects were compared in subgroup analysis on the basis of CSC treatment efficacy. Subsequent analysis was performed to compare eyes with and without recurrences and CSC eyes treated by single and multiple PDT sessions. A total of 114 eyes of 103 patients (81 male; 22 female) were analyzed. The median age was 49 (28-70). The median CSC pretreatment duration was 12months (3-393). The median follow-up period after PDT was 8months (6-111). By the sixth-month period PDT was effective in 80% (91 eyes), with a subsequent enhancement up to 87% (99 eyes) at 12th month and not effective in 13% (15 eyes). SRF resolution was achieved after 8weeks (2-44) with a significant improvement of median LogMAR BCVA from 0.22 (- 0.2-1.3) before PDT to 0.1 (- 0.2-1.0) at last visit after PDT (p < 0.0001). Half-time PDT has proven to be an effective and safe treatment option for patients with chronic CSC with a significant BCVA improvement during the follow-up after the therapy.

The relationship between the central serous chorioretinopathy, choroidal thickness, and serum hormone levels.

The purpose of this study were to compare the levels of serum cortisol, aldosterone, testosterone, dehydroepiandrosterone (DHEA), and renin hormone between patients with central serous chorioretinopathy (CSC) and a control group, and to investigate whether there was a difference regarding serum hormone levels in patients with acute/chronic CSC. This prospective study included 30 CSC eyes, 30 fellow eyes, and 32 normal eyes of 32 healthy volunteers who were age and sex matched. The patients were classified as acute or chronic depending on the clinical, fluorescein angiography (FFA), and optical coherence tomography (OCT) findings. Serum cortisol, aldosterone, renin, total testosterone, and DHEA levels were measured. The levels of hormones were compared with the values of the control group. Choroidal thickness and central macular thickness were measured with spectral domain OCT. Fifteen patients had acute CSC, and 15 patients had chronic CSC. Serum testosterone levels were 357 ± 10.4ng/ml in the CSC group, and 255.94 ± 7.43ng/ml in the control group. The difference between them was statistically significant (p < 0.001). The difference between the levels of cortisol, renin, aldosterone, and DHEA was not statistically significant. Serum hormone levels were within the normal range for all patients and were not statistically different between the acute and chronic CSC groups. According to our results, CSC is related to elevated total testosterone levels. Testosterone may play a role in predisposing males to CSC.

Short-Term Choriocapillaris Changes in Patients with Central Serous Chorioretinopathy after Half-Dose Photodynamic Therapy.

Background: Although photodynamic therapy (PDT) has become the standard treatment for central serous chorioretinopathy (CSC), its mechanism of action remains unclear. It is assumed that PDT induces short-term choriocapillaris (CC) occlusion and long-term choroidal vascular remodeling. In this paper, we describe the short-term CC changes induced by Half-Dose PDT (HD-PDT) in chronic CSC using optical coherence tomography-angiography (OCTA). Methods: This is a prospective interventional case series. Chronic CSC eyes underwent Spectral-Domain OCT, Fundus Autofluorescence, FA, ICGA (Heidelberg Spectralis, Heidelberg, Germany) and OCTA (RTVue XR Avanti with AngioVue; Optovue Inc., Fremont, CA, USA) before HD-PDT, with follow-up after one hour, one week, and one month. Vascular changes after PDT were analyzed within the CC layer. The CC vessel density was defined as the percentage of an area occupied by flow pixels, using Image J software to obtain measurements by applying a grey level threshold. All pixels with a grey level above the threshold were considered as indicators of blood flow. Results: 20 eyes of 19 patients were included. At baseline the mean CC vessel density was 94.87 ± 2.32%. It significantly differed from the density at 1 week and 1 month (92.79 ± 3.16% and 95.55 ± 2.05%, p < 0.001, respectively), but not with values at 1 h (94.8 ± 2.28%, p = 0.516). Conclusions: CC vessel density was significantly reduced at 1 week as compared with baseline, suggesting a possible short-term effect of PDT on CC perfusion. After 1 month however, the CC vessel density was even higher than the baseline, probably due to a CC recovery. OCTA seems to be useful in the visualization of CC vessels and in confirming the mechanism of action of PDT treatment in eyes with chronic CSC.

Retinal vessels functionality in eyes with central serous chorioretinopathy

PurposeTo analyse static characteristics and dynamic functionality of retinal vessels in eyes with central serous chorioretinopathy (CSCR) by means of Dynamic Vessel Analyzer (DVA).MethodsPatients presenting with treatment-naïve CSCR and normal...

Choroidal Vascular Flow Area in Central Serous Chorioretinopathy Using Swept-Source Optical Coherence Tomography Angiography.

To report the choroidal vascular flow area in eyes with central serous chorioretinopathy (CSC) compared with healthy subjects and unaffected fellow eyes using swept-source (SS) optical coherence tomography (OCT) angiography. Prospective case series of 19 eyes of 19 consecutive patients affected by CSC, compared with 15 unaffected fellow eyes and 20 eyes of 10 healthy subjects. Patients underwent SS-OCT angiography in order to evaluate the choroidal vascular flow area of choriocapillaris (CC) and deeper choroidal layers. The choroidal vascular flow area was higher in eyes with CSC than in control eyes (53.4 ± 5.8% vs. 49.45 ± 8.16%; P = 0.0001). Within the choroid of CSC patients choroidal vascular flow area of the CC was significantly lower than the deeper level (50.97 ± 2.8% vs. 54.22 ± 6.3%; P = 0.025). There were no differences within the choroid of control eyes. The choroidal vascular flow area at the level of the CC was higher in the unaffected fellow eye (50.74 ± 0.9%; P = 0.019) than in control eyes. Choroidal vascular flow area of unaffected fellow eyes did not differ from CSC eyes (P = 0.17). The choroidal vascular flow area at the level of the CC was higher in the CSC eyes (P = 0.0009) compared with unaffected fellow eyes. Choroidal vascular flow area is larger in CSC eyes compared with control eyes. However, within the choroid of eyes with CSC, there might be some differences in flow area between CC and deeper choroidal levels. This difference might be secondary to a compensatory mechanism of the choroid.

Subfoveal Choroidal Thickness in Central Serous Chorioretinopathy: A Meta-Analysis.

PurposeTo evaluate the relationship between subfoveal choroidal thickness (SFCT) and eyes with central serous chorioretinopathy (CSC) versus fellow or control eyes.MethodsWe performed a meta-analysis using databases including PubMed, Embase and ISI Web of Science to find relevant studies. Weighted mean difference (WMD) was calculated for the SFCT in CSC eyes, the unaffected fellow eyes and normal controls.ResultsTwelve studies were selected for this meta-analysis, including 1108 eyes (397 CSC eyes, 228 unaffected fellow eyes and 483 eyes of normal controls). The meta-analysis clearly demonstrated that the subfoveal choiroid of eyes with a clinical presentation of CSC was thickened compared to unaffected fellow eyes (WMD = 52.81, 95% confidence interval (CI), 39.13–66.49, P<0.00001) and was thickened compared to control eyes (WMD = 145.03, 95%CI, 121.33–168.73, P<0.00001). The mean SFCT measurement of the unaffected fellow eyes showed also significantly increased choroidal thickness compared to that of normal control eyes (WMD = 77.20, 95% CI, 44.98–109.42, P<0.00001). Similar results were obtained in a sub-analysis based on the same instrument.ConclusionIt is demonstrated that SFCT is significantly increased in eyes with clinical manifestation of CSC, and in the clinically non-manifested fellow eyes. These results support the hypothesis that CSC is a bilateral disorder with an initial unilateral clinical presentation.

Effect of Intravitreal Injection of Bevacizumab on Acute Central Serous Chorioretinopathy Patients Who Visited Feiz Hospital during 2014-2015 Period.

Background:Aim of this clinical trial is the evaluation of the effect of intravitreal injection of bevacizumab on acute central serous chorioretinopathy (CSC).Materials and Methods:In a nonrandomized clinical trial, 36 CSC eyes (with <1-month disease history) were examined. Initially, all the patients underwent posterior and anterior segment examinations as well as complete eye examination to evaluate the best spectacle-corrected visual acuity (BSCVA). Then, optical coherence tomography was performed to confirm the diagnosis. The patients were divided to the two groups each of 18 subjects, which 18 patients received intravitreal injection of bevacizumab (1.25 mg) and the rest of them did not receive any treatment (control group). The patients were health checked by the end of the 1st and 3rd months. Significance level was considered as P < 0.05.Results:In the BSCVA, no significant difference in visual improvement was observed in baseline vision compared to each other (P = 0.481). There was also no significant difference in the vision of intervention and control groups 1 and 3 months after injection (P = 0.379 and P = 0.557). A significant decrement existed in the intervention group compared with the control group in the maximum central macular thickness at 1 month after injection (P = 0.001); however, the difference was not significant when comparing the two groups at baseline and 3 months after injection (P = 0.925 and P = 0.338).Conclusion:In general, according to the results of this study, intravitreal injection of bevacizumab was not effective in improvement of patients with acute CSC, although it had no side effects.

The analysis of macular perimetry with octopus 900 in acute central serous chorioretinopathy

Background: To find the changes of macular perimetry (MP) and the correlations between MP and best correct visual acuity (BCVA) in different phases of the acute central serous chorioretinopathy (CSC). Methods: Twenty-one eyes with acute CSC and their fellow eyes were analysed retrospectively. MP at 2°, 4° and BCVA in the active and resolved phase were collected and analyzed. The differences of these parameters in CSC eyes and fellow eyes were analyzed. Spearman correlation was used for analysis of correlation between MP and BCVA. Results: From 29 eyes with CSC analysed 27 eyes (93.10%) recovered to the previous VA. Compared with the active phase, MP at 2°, 4° and BCVA were significantly improved in the resolved phase (P=0.000, 0.000, 0.000, respectively). MP at 2°, 4° and BCVA of CSC eyes were significantly poor compared with the fellow eyes in the active phase (P=0.000, 0.000, 0.000, respectively). In the resolved phase there was no significant difference between the CSC eyes and fellow eyes (P=0.339, 0.141, 0.161, respectively). BCVA was shown to significantly correlate with MP at 2° in the active phase (ρ=–0.630, P Conclusions: The acute CSC often had a good prognosis both in BCVA and MP. MP can provide an additional objective parameter to evaluate the retinal function changes at macula of acute CSC.

Findings of Optical Coherence Tomographic Angiography at the Choriocapillaris Level in Central Serous Chorioretinopathy

Purpose: To reveal vascular signals at the choriocapillaris level in central serous chorioretinopathy (CSC) using optical coherence tomographic angiography (OCTA). Procedures: We analyzed vascular signals at the choriocapillaris level in 58 CSC and 51 contralateral eyes by OCTA (RTVue XR Avanti with AngioVue; Optovue Inc., Fremont, Calif., USA). Data analysis included age, best corrected visual acuity (BCVA), disease duration and serous retinal detachment (SRD) height. Results: Morphologically, abnormal signals at the choriocapillaris level were detected in all CSC eyes (100%), and then classified into three patterns. Age, BCVA, disease duration and SRD height showed no significant correlation with signal patterns. Thirty-one contralateral eyes (61%) showed abnormal signals at the choriocapillaris level on OCTA, while 20 (39%) had a normal pattern. Conclusions: OCTA revealed three types of abnormal signals not only in CSC eyes but also in fellow eyes without SRD. OCTA may provide information for elucidating the underlying pathogenesis of CSC.

CHOROIDAL VASCULARITY INDEX IN CENTRAL SEROUS CHORIORETINOPATHY.

To evaluate choroidal vascularity index (CVI) in eyes with central serous chorioretinopathy (CSC) using an image binarization tool on enhanced depth imaging using spectral domain optical coherence tomography scans. In this retrospective cohort study, enhanced depth imaging optical coherence tomography scans of both eyes of patients with CSC were taken at baseline; they were segmented and compared with enhanced depth imaging optical coherence tomography scans of fellow eyes without CSC as well as age-matched healthy subjects. Subfoveal choroidal area (1,500 μm) was segmented into luminal area and stromal area using image binarization. Choroidal vascularity index was defined as the proportion of luminal area to the total circumscribed subfoveal choroidal area. Eyes with acute CSC (32 eyes) had significantly higher CVI compared with their fellow eyes (27 eyes) (P < 0.0001), 19 eyes with resolved CSC (P < 0.0001) and with 30 eyes of age-matched healthy eyes (P < 0.0001). Fellow eyes of subjects with acute CSC also had significantly higher CVI compared with eyes with resolved CSC (P < 0.0001) and age-matched healthy eyes (P < 0.0001). Increased CVI suggests increased vascular component compared with the stromal component in acute CSC. Increased CVI was noted in fellow eye of the subjects with acute CSC in comparison with age-matched healthy subjects. The CVI could be a useful index for early diagnosis of CSC and to assess the treatment response after laser photocoagulation or photodynamic therapy.

Investigation of the Etiology of Central Serous Chorioretinopathy Using En-Face Optical Coherence Tomography and Indocyanine Green Angiography

Purpose: To identify locations of hypofluorescent lesions on late-phase indocyanine green angiography (ICGA) in patients with central serous chorioretinopathy (CSC) using en-face optical coherence tomography (OCT). Procedures: We retrospectively studied 25 consecutive untreated CSC patients, using swept-source OCT and ICGA. En-face swept-source OCT images were automatically segmented and flattened with Bruch's membrane (BrM). We compared the sizes of hyperreflective areas in the 25 CSC and 25 contralateral eyes on en-face images and hypofluorescent areas on ICGA after 30 min. Results: All 25 CSC eyes and 13 contralateral eyes showed abnormal hypofluorescent areas on late-phase ICGA and hyperreflective areas on en-face OCT from BrM to the choriocapillaris, and these findings correlated with the abnormal areas (r = 0.9988; p < 0.001). Conclusions: In CSC patients, we detected abnormal hypofluorescence on ICGA in the late phase, which corresponded to abnormal hyperreflective areas from BrM to the choriocapillaris level in en-face images.