Central serous chorioretinitis (CSC) is a kind of choroidal retinopathy characterized by choroidal vasodilatation and hyperpermeability, retinal pigment epithelial cell lesions and serous retinal detachment. Various imaging examinations and imaging techniques have been used to describe the characteristics of the retina and choroid. Fundus manifestations of different types of CSC has both generality, and have their respective characteristic. The classification of CSC and its differentiation from other diseases including the choroidal neovascularization and pachychoroidopathy spectrum depending on varieties of fundus imaging techniques. The current study aims to review the various performance characteristics of CSC especially for chronic CSC with multimodal imaging and the current research progress, so as to provide reference for ophthalmologists to more comprehensively and intuitively understand the clinical characteristics and potential pathogenesis of CSC, and also to provide basis for multimodal imaging assisted diagnosis and treatment.
ObjectiveTo compare the differences of optic nerve head (ONH) parameters and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) between acute Vogt-Koyanagi-Harada syndrome (VKH) and acute central serous chorioretinopathy (CSC) patients.MethodsRetrospective clinical case control analysis. This study included 38 eyes of 20 acute VKH patients (VKH group) and 37 eyes of 37 acute CSC patients (CSC group). Seventy five eyes of 57 normal healthy subjects, matching patients with age and gender, were collected as control group. The disc RPE angle, the thickness of average CP-RNFL, the nasal, superior, temporal and inferior quadrant CP-RNFL thickness, and ONH parameters including optic disc area, cup area, rim area, C/D area ratio, linear CD ratio (CDR), vertical CDR were measured by 3D-OCT. Analysis of variance was performed for comparison among three groups. Minimum significant difference t test was performed for comparison between two groups.ResultsThe differences of ONH parameters between VKH group and CSC group: 29 eyes of VKH group appeared retinal detachment next to disc, only 12 eyes appeared in CSC group. Twenty one eyes of VKH group appeared optic disc hyperemia while none in CSC group. The three groups’ disc RPE angles were (138.62±11.96)°, (154.09±5.85)° and (153.41±5.77)°. VKH group were significantly smaller than CSC group (t=－2.05, P=0.00) and control group (t=－1.68, P=0.00), while there was no significant difference between CSC group and control group (t=－1.88, P=0.72). The optic cup area and rim area were significantly bigger in VKH group than in CSC group (t=4.61, 2.71; P=0.00, 0.01), and the thickness of mean CP-RNFL, all quadrants of CP-RNFL were significantly thicker in VKH group than in CSC group (t=6.25, 4.40, 3.53, 5.48, 2.69; P=0.00, 0.00, 0.00, 0.00, 0.01).ConclusionCompared with the acute CSC, VKH patients are likely to appear retinal detachment next to disc, their disc RPE angles are smaller, their optic cup area and rim area are bigger, and their CP-RNFL thickness are thicker.
ObjectiveTo observe the alterations of vascular density of superficial or deep retinal vascular plexus and the area of foveal avascular zone (FAZ) in acute central serous chorioretinopathy (CSC) eyes.MethodsThis is a retrospective study including 22 patients with unilateral CSC in acute stages. The patients were divided into group A (22 affected eyes) and B (22 fellow eyes). Twenty eyes of 20 age and gender-matched healthy volunteers (group C) were enrolled in this study. All subjects underwent optical coherence tomography (OCT) angiography examinations. The observation index included signal intensity of blood flow in choroidal capillary, vessel density and FAZ on the superficial capillary plexus (SCP) and deep capillary plexus (DCP).ResultsThe FAZ on DCP in group A was larger than that in group B and C (t=4.28, 5.57; P=0.00、0.00), but there was no significant difference of FAZ on SCP among 3 groups (t=0.28, 0.80; P=0.78, 0.43). The vessel density of SCP and DCP in group A and B were decreased than those in group C (t=−4.40, −2.91; P=0.00, 0.00). The type of choroidal capillaries dilation had two different manifestations by OCTA, which was circumscribed in 12 eyes and diffuse in 10 eyes. The subretinal fluid in macular area which presented dark chamber with weak reflection was observed by en-face OCT.ConclusionsThe vessel density of SCP and DCP in both eyes of acute CSC are lower than those in normal eyes. The FAZ of DCP in affected eyes of acute CSC is larger than that in fellow eyes and normal eyes. The blood flow of dilated choroidal capillary can be manifested as different morphological enhancements.
ObjectiveTo investigate the value of pattern reversal visual evoked potential (PRVEP) and sweep pattern visual evoked potential (SPVEP) in evaluating the visual function of patients with central serous chorioretinopathy (CSC).MethodsA retrospective clinical trial. A total of 38 monocular CSC patients were enrolled from March 2016 to December2018 in Heping Hospital Affiliated Changzhi Medical College. There were 34 males and 4 females with the mean age of 40.0±5.2 years. All patients undergo PRVEP detection in both the acute phase (disease course ≤ 3 months) and the clinical cure phase (disease course ≤ 6 months) using the German Roland electrophysiological RETIport system.The stimulation pattern adopted a checkerboard with 1.00° and 0.25° stimulation angles. The P100 peak amplitude and peak time were observed. SPVEP inspection equipment and methods were the same as PRVEP, and the spatial frequency was 1, 2, 4, 6, 8, 12, 16, 22 cpd. The difference between SPVEP vision and subjective vision were compared. The PRVEP peak amplitude, peak time and SPVEP amplitude and phase of the affected eye and the contralateral eye were compared by paired t test; the subjective vision and SPVEP visual acuity of the affected eye and the contralateral eye were compared by Wilcoxon paired rank test; Pearson product-moment correlation analysis was performed on SPVEP vision.ResultsIn the acute phase, the peak amplitude of P100 in the affected eye was lower than that in the contralateral eye (t=30.26, 13.59), and the peak time was prolonged (t=－19.89, －29.41). The difference was statistically significant (P＜0.01); in clinically cured period, the P100 peak amplitude (t=1.49, －0.57) and peak time (t=－1.22, －1.84) of the affected eye and the contralateral eye showed no significant difference (P＞0.05). In the acute phase, the difference in SPVEP amplitude between the affected eye and the contralateral eye with different spatial frequencies was statistically significant (P＜0.01); the phase of the affected eye and the contralateral eye were compared about the spatial frequency 1, 2, 4, 6, 8, 12 cpd, the difference was statistically significant (P＜0.01). During the clinical cure period, the spatial frequency of 6, 8, 12, 16 cpd, the SPVEP amplitude of the affected eye and the contralateral eye, the difference was statistically significant (P＜0.01); on the spatial frequency of 6, 8, 12 cpd, the phase of SPVEP was compared between the affected eye and the contralateral eye, the difference was statistically significant (P＜0.01). During the acute phase and the clinical cure phase, the SPVEP visual acuity of the affected eye was lower than that of the contralateral eye, and the difference was statistically significant (P＜0.01); during the acute phase and clinical cure phase, the SPVEP visual acuity of the affected eye and the contralateral eye were lower than the subjective vision. The difference was statistically significant (acute phase: Z =－5.38, －3.00; P＜0.001, 0.003; clinical cure phase: Z=－5.36, －5.38; P＜0.001,＜0.001). In the acute phase, the subjective visual acuity of the affected eye was positively correlated with SPVEP visual acuity (r=0.847, P＜0.001).ConclusionsPRVEP and SPVEP are useful for objectively assessing the visual function of the patients with CSC. Especially, the slight and potential visual impairment in CSC can been detected by SPVEP.
ObjectiveTo observe the imaging features of short-wave length fundus autofluorescence (SW-AF), near-infrared fundus autofluorescence (NIR-AF)and spectral-domain optical coherence tomograph (SD-OCT) in acute central serous chorioretinopathy (CSC). MethodsThis is a retrospective observational consecutive case series study. Eighty-two eyes with acute CSC from 76 patients were enrolled in this study.There were 50 males (56 eyes) and 26 females (26 eyes), average age was (41.32±7.37) years old, average course of the disease was (0.47±1.73) months. The routine clinical examinations included best corrected visual acuity, slit lamp microscope, indirect ophthalmoscope, fundus fluorescein angiography (FFA), SW-AF, NIR-AF and SD-OCT. The imaging features of NIR-AF, SW-AF, SD-OCT and FFA in same eye with acute CSC were analyzed comparatively. ResultsSD-OCT showed retinal pigment epithelium (RPE) detachment corresponding to RPE leakage point on FFA images in all CSC eyes. RPE leakage points in all eyes corresponding to local hypo-NIR-AF, whereas corresponding to normal SW-AF. NIR-AF demonstrated the area of decreased AF corresponding to serous retinal detachment in all eyes, of which, the area of hypo-SW-AF was consistent with that of sensory retinal detachment in 75 eyes. Except for RPE leaking fluorescein in 82 eyes, FFA showed window defects corresponding to clusters of hypo-NIR-AF in 45 eyes, of which, 27 eyes showed hypo-SW-AF appearing concurrently with the locations of window defects of FFA. In 18 eyes, the extent and amount of hypo-SW-AF were less than that of hypo-NIR-AF. ConclusionsThere was local RPE detachment in all eyes with acute CSC. The locations of sensory retinal detachment, local RPE detachment and RPE depigmentation showed hypo-NIR-AF. The locations of sensory retinal detachment and RPE depigmentation showed hypo-SW-AF in most of acute CSC eyes.
ObjectiveTo compare the choriocapillaris flow density and choroidal vessel volume (CVV) of acute and chronic central serous chorioretinopathy (CSC).MethodsA cross-sectional observational clinical study. A total of 64 eyes of 64 patients (CSC group) diagnosed with CSC at Department of Ophthalmology of West China Hospital of Sichuan University from May 2019 to October 2020, and a total of 64 eyes of 64 age and gender matched healthy volunteers (control group) during the same period were included in this study. In the CSC group, there were 34 patients with acute CSC (acute CSC group) and 30 patients with chronic CSC (chronic CSC group). There was no significant difference in age (t=－0.041) and sex composition ratio (χ2=0.191) between CSC group and control group (P＞0.05). There were statistically significant differences in age (t=－1.872) and sex composition ratio (χ2=8.778) between acute CSC group and chronic CSC group (P＜0.05). Swept source optical coherence tomography angiography (SS-OCTA) was performed using VG200D. The scanning mode was 512×512 and scannig range was 12 mm × 12 mm. The choriocapillaris flow density of the 3 mm, 6 mm, 12 mm circular area and 1-3 mm ring, 3-6 mm ring, and 6-12 mm ring, and the CVV of the of the 3 mm, 6 mm, 12 mm circular area was automatically generated by the built-in software (v1.28.6). The age, choriocapillaris flow density and CVV were compared between two groups using independent sample t test.ResultsCompared with the control group, the choriocapillaris flow density decreased in the CSC group, and there were statistically significant differences in the 3 mm, 6 mm circular area (t=－7.210, －4.040; P＜0.001). There were statistically significant differences between CSC group and control group in the 3 mm, 6 mm, 12 mm circular area (t=1.460, 12.270, 11.250; P＜0.05). Compared with the acute CSC group, the choriocapillaris flow density decreased in the chronic CSC group, and there were statistically significant differences (P＜0.05) in the 3 mm, 6 mm circular area (t=3.230, 2.330), the total and four quadrants of 1-3 mm ring (t=2.780, 2.060, 2.140, 2.620, 3.770), the superior quadrants of the 3-6 mm ring (t=2.550), and the superior and temporal of 6-12 mm ring (t=3.070, 2.610). There was no significant difference of CVV in the 3 mm, 6 mm and 12 mm circular area between the acute CSC group and the chronic CSC group (t=0.250, 0.070, －0.110; P＞0.05).ConclusionCompared with acute CSC, chronic CSC exhibits significant decreased choriocapillaris flow density and no change in CVV.
ObjectiveTo quantitatively analyze the changes of choroidal capillaries in chronic central serous chorioretinopathy (CCSC) before and after half-dose photodynamic therapy (PDT).MethodsA retrospective cohort study. Nineteen patients (21 eyes) with CCSC were enrolled in this study from November 2017 to September 2018 in People’s Hospital of Wuhan University. Among them, there were 14 males (15 eyes) and 5 females (6 eyes), with diseases course over than 6 months. All patients underwent half-dose PDT. Twenty normal subjects (40 eyes) matched with age and sex in CCSC group were taken as controls. The subfoveal choroidal thickness (SFCT) was measured by Heidelberg depth enhanced imaging-OCT before and after PDT treatment in CCSC patients and in normal subjects. Spectral-domain OCT (Retina map) and Angio-OCT angiography (3 mm×3 mm) were arranged for all subjects at the same time. Macular fovea retinal thickness (CMT) was recorded under OCT-Retina map mode, and Angio-OCT 3 mm×3 mm choroidal capillary images were binarized using Image J software, and calculating the area ratio of low pixel area as flow signal void (FSV). BCVA, spectral-domain OCT and Angio-OCT were performed 1 week and 1, 3 months after PDT with the same equipment and methods before PDT. The changes of CMT, SFCT, FSV and BCVA in CCSC patients before and after PDT treatment were compared. Pearson correlation analysis was used to analyze the correlation between FSV and SFCT, age.ResultsThe average CMT, SFCT and FSV in CCSC patients increased significantly compared with the controls (P＜0.05). The average SFCT and FSV in CCSC patients 3 months after treatment were higher and the average CMT decreased compared with the controls (P=0.000, 0.000, 0.000). Comparison before and after PDT in CCSC patients: there were significant differences in average CMT, SFCT and FSV before and after PDT (P=0.000, 0.000, 0.000). Post Hoc multiple comparisons showed that the average CMT (P=0.000, 0.000, 0.000, 0.000, 0.000) and FSV (P=0.010, 0.000, 0.000, 0.001, 0.000) decreased significantly in all time points except for 1 month and 3 months after treatment, so as the average FSV (P=0.788, 0.702). The average SFCT decreased 1 month and 3 months after treatment compared with the baseline (P=0.024, 0.008), and there was no significant difference between before treatment and 1 week after treatment (P=0.162), and between 1 month and 3 months after treatment (P=0.687). The correlation analysis showed that there was no correlation between FSV and age in CCSC patients (r=0.052, P=0.822), but there was a correlation between FSV and age in controls (r=0.716, P=0.000).ConclusionQuantitative analysis of OCTA showes the degree of choriocapillary ischemia in the form of FSV in CCSC patients decreased after PDT treatment, however, which is still higher than normal controls.