Elsevier

Ophthalmology

Volume 115, Issue 9, September 2008, Pages 1494-1500.e2
Ophthalmology

Original article
Morphologic Changes in Acute Central Serous Chorioretinopathy Evaluated by Fourier-Domain Optical Coherence Tomography

https://doi.org/10.1016/j.ophtha.2008.01.021Get rights and content

Objective

To investigate morphologic alterations around fluorescein leakage sites using Fourier-domain optical coherence tomography (FD OCT) in acute central serous chorioretinopathy (CSC).

Design

Observational case series.

Participants

Twenty-one eyes with acute CSC with subjective symptoms for under 3 months.

Methods

Patients underwent measurement of visual acuity, fundus observations, and FD OCT examinations at every visit with the intervals of 2 to 4 weeks until subretinal fluid (SRF) resolved. Fluorescein angiography was performed at baseline to confirm dye leakage sites. Horizontal and vertical OCT scans (B-scans and consecutive raster scans) of the fovea and fluorescein leakage sites were obtained.

Main Outcome Measures

Morphologic changes in the retinal pigment epithelium (RPE), detached retina, and subretinal space around the leakage sites were evaluated repeatedly during follow-up.

Results

The mean period between baseline and the final examination was 108 days (mean no. of examinations, 3.9). Among 23 leakage sites in 21 eyes, FD OCT showed RPE abnormalities in 22 (96%) sites (14 sites [61%] with a pigment epithelial detachment [PED] and 8 [35%] with a protruding or irregular RPE layer). Fibrinous exudates in the subretinal space and sagging/dipping of the posterior layer of the neurosensory retina above the leakage sites were seen at 12 (52%) and 10 (43%) leakage points, respectively. An RPE defect at the edge of or within the PED was observed in 5 leakage sites (22%); in 2 of these, a defect was detectable after the SRF decreased. The posterior surface of the detached retina was smooth in 17 eyes (81%) and granulated in 4 eyes (19%) (mean duration of subjective symptoms, 10 days and 42 days, respectively). The smooth posterior detached retina became granulated in the presence of residual SRF. A PED remained at the 5 leakage sites in 5 eyes (22%) despite SRF resolution.

Conclusions

Fourier-domain OCT examinations showed detailed morphologic changes in eyes with acute CSC including an RPE defect within the PED at a leakage site through which fluid might pass from the sub-RPE to the subretinal area. Fourier-domain OCT findings may offer new information to facilitate understanding of the mechanisms of acute CSC.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Materials and Methods

We prospectively studied 21 eyes of consecutive 20 patients (18 men, 2 women) with acute CSC using the FD OCT system (RTVue-100, Optovue, Fremont, CA) between June 2006 and May 2007 at Osaka University Medical School, Osaka, Japan. This study was approved by the institutional review board, and informed consent was obtained from all patients.

A diagnosis of acute CSC was made based on the presence of a serous detachment of the neurosensory retina, focal dye leakage on FA, and the duration of

Patient Characteristics

The profiles of the patients are shown in Table 1 (available at http://aaojournal.org). The mean age of the 20 patients was 47.4 years (range, 32–65). The duration of symptoms ranged from 1 to 86 days (mean, 16.0). Four eyes had recurrent disease, and the other 2 had CSC history in the fellow eye. The mean BCVA at baseline was 0.84 (range, 0.2–1.5). Nineteen eyes had 1 point of focal leakage and 2 eyes showed 2 points of leakage; 17 leakage points in 16 eyes (74%) had an inkblot pattern, and 6

Discussion

The primary pathology of acute CSC is thought to begin with disruption of the choroidal circulation. The RPE then decompensates and allows exudation from the choroidal vasculature to pass into the subretinal space.1, 2, 3, 4, 5, 6, 7 These hypotheses are based on FA and indocyanine green angiography findings, and precise morphologic correlations have not been observed.

The development of OCT has provided a better understanding of the mechanism in CSC, especially the abnormalities in the RPE

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    Financial Disclosure(s): Dr Tano is a consultant for Optovue, Inc.

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