Pachychoroid pigment epitheliopathy in fellow eyes of patients with unilateral central serous chorioretinopathy

AimsTo investigate the prevalence of pachychoroid pigment epitheliopathy (PPE) in fellow eyes of patients with unilateral central serous chorioretinopathy (CSC) and to determine differences between patients with PPE, uncomplicated pachychoroid (UCP) and normal fellow eyes.MethodsWe retrospectively reviewed 536 patients with CSC. Demographic and medical data, spectral domain optical coherence tomography scans with enhanced depth imaging mode, infrared reflectance images and fundus autofluorescence images were obtained from the patients’ medical records.Results254 (47.4%) of 536 patients had bilateral CSC. The female to male ratio was 1/2.8 in all patients with CSC. In patients with unilateral CSC (282 patients), 61% of fellow eyes had PPE, 30.8% had UCP and 8.2% were normal. There were no significant differences between patients with PPE, UCP and normal eyes in age, duration of disease, sex, presence of systemic hypertension, steroid use, psychopharmacological medication use, refractive error or central foveal thickness. Eyes with PPE and UCP did not differ regarding subfoveal choroidal thickness. In eyes with PPE (172 eyes), 77.3% had retinal pigment epithelium (RPE) bumps and 43% had pigment epithelium detachment.ConclusionPPE is common in fellow eyes of patients with CSC. There is no difference between PPE and UCP regarding demographic characteristics and medical features.

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Central Serous Chorioretinopathy in a Myopic Patient with Pachychoroid

Ophthalmology Point of Care ◽

10.5301/oapoc.0000007 ◽

2017 ◽

Vol 1 (1) ◽

pp. oapoc.0000007

Author(s):

Elon H.C. van Dijk ◽

Kasper L. de Roon Hertoge ◽

Camiel J.F. Boon

Keyword(s):

Central Serous Chorioretinopathy ◽

High Myopia ◽

Retinal Pigment Epithelial ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Fundus Photography ◽

Ophthalmological Examination ◽

Patient Presentation ◽

Pachychoroid Pigment Epitheliopathy

Introduction To report a case of central serous chorioretinopathy (CSC) associated with a retinal pigment epithelium detachment in a myopic patient with marked pachychoroid. Patient presentation Case report of a 37-year-old male patient with relatively high myopia (-5.00D in OD/-5.75D in OS), unilateral CSC, and bilateral retinal pigment epithelial detachments, pachychoroid, and choroidal hyperaemia. Standard ophthalmological examination and multimodal imaging, including fundus photography, fundus autofluorescence, spectral-domain and enhanced depth optical coherence tomography, and indocyanine green angiography were performed. Conclusions Findings characteristic for the spectrum of CSC/pachychoroid pigment epitheliopathy can be observed in patients with relatively high myopia. Based on the outcome of complete ophthalmological examination, this clinical picture can be discerned from other diseases, which is important for the optimal therapeutic approach.

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Mid-Phase Hyperfluorescent Plaques Seen on Indocyanine Green Angiography in Patients with Central Serous Chorioretinopathy

Journal of Clinical Medicine ◽

10.3390/jcm10194525 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4525

Author(s):

Elodie Bousquet ◽

Julien Provost ◽

Marta Zola ◽

Richard F. Spaide ◽

Chadi Mehanna ◽

...

Keyword(s):

Indocyanine Green ◽

Central Serous Chorioretinopathy ◽

Indocyanine Green Angiography ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Multiple Logistic Regression Analysis ◽

Enhanced Depth Imaging ◽

Depth Imaging ◽

Chronic Form

(1) Indocyanine green angiography (ICG-A) shows the presence of mid-phase hyperfluorescent area in central serous chorioretinopathy (CSCR). However, their exact meaning remains uncertain. (2) The clinical and multimodal imaging findings of 100 patients (133 eyes) with CSCR, including the enhanced-depth-imaging OCT (EDI-OCT), blue-light fundus autofluorescence (BAF), fluorescein and indocyanine green angiography (FA and ICG-A) findings were reviewed. Mid-phase hyperfluorescent plaques (MPHP) were defined as fairly well circumscribed hyperfluorescent regions during the midphase of the ICG-A. The association between MPHP and other clinical/imaging parameters was assessed using a multiple logistic regression analysis. (3) MPHP were detected in 59.4% of eyes with CSCR. The chronic form of the disease, the presence of irregular pigment epithelium detachments (PED) and the retinal pigment epithelium (RPE) changes seen on FA were associated with the presence of MPHP in the multivariate analysis (p = 0.015; p = 0.018 and p = 0.002; respectively). OCT showed RPE bulges or PED in 98.7% of areas with MPHP and BAF showed changes in 57.3% of areas with MPHP. (4) MPHP were associated with a chronic form of CSCR and colocated with PED or RPE bulges. MPHP should be recognized as a sign of early RPE dysfunction before it is detected with BAF.

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Long-Term Effect of Half-Fluence Photodynamic Therapy on Fundus Autofluorescence in Acute Central Serous Chorioretinopathy

Journal of Ophthalmology ◽

10.1155/2020/8491712 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Martin Stattin ◽

Stefan Hagen ◽

Daniel Ahmed ◽

Eva Smretschnig ◽

Florian Frommlet ◽

...

Keyword(s):

Photodynamic Therapy ◽

Central Serous Chorioretinopathy ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Long Term Follow Up ◽

Acute Central Serous Chorioretinopathy ◽

Mean Differences

Purpose. To evaluate normalized short-wavelength fundus autofluorescence (SW-FAF) imaging changes over time as a predictive parameter for the retinal pigment epithelium (RPE) function in eyes compromised by acute central serous chorioretinopathy (CSCR) after indocyanine green angiography-guided verteporfin (Visudyne®, Novartis Pharma, Basel, Switzerland) photodynamic therapy (PDT) with a half-fluence rate (25 J/cm2). Methods. Quantitative data of SW-FAF grey values (SW-FAF GV) from a 350 μm (SW-350) and 1200 μm (SW-1200) diameter circle centered on the fovea and normalized with the level of SW-FAF GV in a 30° image of 20 eyes in 11 patients initially treated for unilateral acute symptomatic CSCR were collected and retrospectively analyzed after 7 years. A 2-sided t-test was calculated to explore the differences of SW-350 and SW-1200 between one month and the long-term follow-up. Results. Mean differences (95% CI) in SW-FAF GV between 1 month and 7 years after half-fluence PDT were 0.07 ± 0.11 for SW-350 ([95% CI: −0.002; 0.14], p=0.06) and 0.11 ± 0.15 for SW-1200 ([95% CI: 0.01; 0.21], p=0.03). Mean differences in SW-FAF GV of the contralateral untreated eye were 0.06 ± 0.14 for SW-350 ([95% CI: −0.04; 0.17], p=0.22) and 0.05 ± 0.13 for SW-1200 ([95% CI: −0.04; 0.15], p=0.22). Conclusion. After 7 years, normalized SW-FAF GV were significantly lower in eyes with resolved acute CSCR treated with reduced-fluence PDT compared to the follow-up after 1 month without correlation to explicit pattern changes or structural damages. Half-fluence PDT remains a safe and considerable treatment option in acute CSCR.

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Multimodal Imaging Evaluations of Focal Choroidal Excavations in Eyes with Central Serous Chorioretinopathy

Journal of Ophthalmology ◽

10.1155/2016/7073083 ◽

2016 ◽

Vol 2016 ◽

pp. 1-12 ◽

Cited By ~ 7

Author(s):

Yao Wang ◽

Zhi-Qing Chen ◽

Wei Wang ◽

Xiao-Yun Fang

Keyword(s):

Central Serous Chorioretinopathy ◽

Multimodal Imaging ◽

Retinal Pigment Epithelial ◽

Multispectral Imaging ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Chinese Patients ◽

Single Institution ◽

Focal Choroidal Excavation

Purpose. To investigate the prevalence and characteristics of focal choroidal excavation (FCE) concurrent with central serous chorioretinopathy (CSC) using multimodal imaging.Methods. This was a retrospective single-institution study. Clinical features and multimodal imaging findings were analyzed in eyes with CSC and FCEs, using imaging methods including optical coherence tomography (OCT), OCT angiography (OCTA), fluorescein angiography (FA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF), and multispectral imaging.Results. Seventeen patients (4.8%) with 21 FCEs (19 eyes) were found among 351 consecutive Chinese patients with CSC. Chronic CSC represented 47.1% of those cases. Window defects in 12 lesions identified through FA and hypoautofluorescence in 13 lesions identified through FAF revealed retinal pigment epithelial attenuation. Choroidal hemodynamic disturbances characterized by localized filling defects at the excavation and circumferential hyperperfusion were validated by both ICGA and OCTA, which were similar to the angiographic features of normal chronic CSC. The hyperreflective tissue beneath FCE, observed on B-scan OCT, presented as intensive choroidal flow signals on OCTA.Conclusions. FCE is not uncommon in patients with CSC. Multimodal imaging suggested that the aberrant choroidal circulation might be a contribution factor for leakage from the dysfunctional retinal pigment epithelium at the area of excavation.

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Optical Coherence Tomography Angiography (OCTA) findings in Serpiginous Choroiditis

10.21203/rs.2.23533/v3 ◽

2020 ◽

Author(s):

Sergio Macedo ◽

Dominika Pohlmann ◽

Matthias Lenglinger ◽

Uwe Pleyer ◽

Antonia M. Joussen ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Optical Coherence Tomography Angiography ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Vascular Lesions ◽

Enhanced Depth Imaging ◽

Optical Coherence ◽

Serpiginous Choroiditis ◽

Diagnostic Modalities

Abstract Background. To describe changes in the retina/choroid in patients with Serpiginous Choroiditis (SC) by Optical Coherence Tomography Angiography (OCTA) in a multimodal imaging approach. Methods. Prospective, monocentric study of 24 eyes of 12 consenting patients diagnosed with SC, who underwent OCTA, which was analyzed and compared to other methods such as enhanced depth imaging-OCT, fluorescein angiography, indocyanine green angiography, and fundus autofluorescence. Results. The study group consisted of 9 patients with peripapillary SC, 1 macular SC, and 2 atypical cases. All eyes presented an inactive SC confirmed by standard imaging. OCTA demonstrated the lesions tridimensionally in great detail. There was no difference in the angioarchitecture among the 3 forms of SC. A loss of the choriocapillaris/retinal pigment epithelium left a “window-defect”, where the vessels of larger caliber of the choroid became recognizable and their appearance inverted (“white-on-black”). A relationship between the presence of segmentation errors (SE) in the slabs and low visual acuity was established with a one-way ANOVA. Conclusions. OCTA was able to non-invasively assess vascular lesions of the choroid/retina in patients with SC with a high degree of correlation to other diagnostic modalities. Consequent long-term assessments could lead to a better understanding of disease progression.

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Optical Coherence Tomography Angiography (OCTA) findings in Serpiginous Choroiditis

10.21203/rs.2.23533/v2 ◽

2020 ◽

Author(s):

Sergio Macedo ◽

Dominika Pohlmann ◽

Matthias Lenglinger ◽

Uwe Pleyer ◽

Antonia M. Joussen ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Optical Coherence Tomography Angiography ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Vascular Lesions ◽

Enhanced Depth Imaging ◽

Optical Coherence ◽

Serpiginous Choroiditis ◽

Diagnostic Modalities

Abstract Background. To describe changes in the retina/choroid in patients with Serpiginous Choroiditis (SC) by Optical Coherence Tomography Angiography (OCTA) in a multimodal imaging approach.Methods. Prospective, monocentric study of 24 eyes of 12 consenting patients diagnosed with SC, who underwent OCTA, which was analyzed and compared to other methods such as enhanced depth imaging-OCT, fluorescein angiography, indocyanine green angiography, and fundus autofluorescence. Results. The study group consisted of 9 patients with peripapillary SC, 1 macular SC, and 2 atypical cases. All eyes presented an inactive SC confirmed by standard imaging. OCTA demonstrated the lesions tridimensionally in great detail. There was no difference in the angioarchitecture among the 3 forms of SC. A loss of the choriocapillaris/retinal pigment epithelium left a “window-defect”, where the vessels of larger caliber of the choroid became recognizable and their appearance inverted (“white-on-black”). A relationship between the presence of segmentation errors (SE) in the slabs and low visual acuity was established with a one-way ANOVA.Conclusions. OCTA was able to non-invasively assess vascular lesions of the choroid/retina in patients with SC with a high degree of correlation to other diagnostic modalities. Consequent long-term assessments could lead to a better understanding of disease progression.

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Optical Coherence Tomography Angiography (OCTA) findings in Serpiginous Choroiditis

10.21203/rs.2.23533/v1 ◽

2020 ◽

Author(s):

Sergio Macedo ◽

Dominika Pohlmann ◽

Matthias Lenglinger ◽

Uwe Pleyer ◽

Antonia M. Joussen ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Optical Coherence Tomography Angiography ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Vascular Lesions ◽

Enhanced Depth Imaging ◽

Optical Coherence ◽

Serpiginous Choroiditis ◽

Diagnostic Modalities

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Chronic Central Serous Chorioretinopathy; Signs, Diagnosis and Treatment

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0204 ◽

2020 ◽

pp. 104-111

Keyword(s):

Central Serous Chorioretinopathy ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Fluid Accumulation ◽

Fundus Fluorescein Angiography ◽

Blurred Vision ◽

Chronic Central Serous Chorioretinopathy

Central serous chorioretinopathy (CSCR) is a maculopathy characterized by the separation of the neurosensory layer as a result of fluid accumulation between the retinal pigment epithelium (RPE) and the photoreceptor layer. Classically it is classified as acute and chronic forms. When the disease lasts longer than 4-6 months, it is called a chronic form and comprises 15% of all CSCR cases. Although the exact etiology is unknown; studies emphasize changes in choroidal circulation causing choroidal ischemia and vascular hyperpermeability as well as subretinal fluid accumulation due to deterioration pump function of RPEs. Subretinal fluid accumulation can lead to photoreceptor dysfunction and loss of vision. Classical findings in patients are a decrease in visual acuity, blurred vision, metamorphopsia, micropsia, disturbance in color vision and dark adaptation, and scotomas. Diagnosis and follow-up depend on fundoscopy as well as imaging. Optical coherent tomography is the primary method. Fundus autofluorescence (FAF) is useful in defining RPE changes noninvasively. Fundus fluorescein angiography (FFA) shows the source of leakage. In recurrent, unresolved and chronic cases, OCT, FAF, FFA, and indocyanine green angiography can be used all together to manage the disease, to follow-up its extension, and to diagnose possible neovascular as well as polypoidal component. For the treatment of chronic CSCR patients, besides medical treatments such as carbonic anhydrase inhibitors, mineralocorticoid receptor, and glucocorticoid antagonists and intravitreal vascular endothelial growth factor antagonist (Anti-VEGF) injections, half-dose photodynamic therapy and subthreshold micropulse laser treatment are used. Prospective, controlled trials with large series for the treatment of chronic CSCR warranted.

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Assessment of Hypofluorescent Foci on Late-Phase Indocyanine Green Angiography in Central Serous Chorioretinopathy

Journal of Clinical Medicine ◽

10.3390/jcm10102178 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2178

Author(s):

Ari Shinojima ◽

Yoko Ozawa ◽

Atsuro Uchida ◽

Norihiro Nagai ◽

Hajime Shinoda ◽

...

Keyword(s):

Indocyanine Green ◽

Central Serous Chorioretinopathy ◽

Indocyanine Green Angiography ◽

Near Infrared ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Late Phase ◽

Standard Deviation Range ◽

Simple Regression Analysis

To assess the hypofluorescent foci (HFF) on late-phase indocyanine green angiography (ICGA) in central serous chorioretinopathy (CSC) using short-wavelength fundus autofluorescence (SW-FAF), near-infrared autofluorescence (NIR-AF), and fluorescein angiography (FA). The HFF area on late-phase ICGA for at least 20 min was compared with the area of abnormal foci on SW-FAF, NIR-AF, and FA. In 14 consecutive patients (12 men, including 1 with bilateral CSC; and 2 women with unilateral CSC), four kinds of images of 27 eyes were acquired. The mean age ± standard deviation (range) was 46 ± 9.2 years (31–69 years). The HFF on late-phase ICGA were found in 23 eyes (in all 15 CSC eyes and the contralateral 8 eyes). From the results of simple regression analysis, we obtained the following three formulas. The HFF area on ICGA = 1.058 × [abnormal SW-FAF area] + 0.135, the HFF area on ICGA = 1.001 × [abnormal NIR-AF area] + 0.015, and the HFF area on ICGA = 1.089 × [abnormal FA area] + 0.135. Compared to SW-FAF and FA, NIR-AF was found to be the easiest method to detect the HFF on late-phase ICGA, which may indicate melanin abnormalities, especially a decrease, in the retinal pigment epithelium.

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Implementation of the new multimodal imaging-based classification of central serous chorioretinopathy

European Journal of Ophthalmology ◽

10.1177/11206721211013651 ◽

2021 ◽

pp. 112067212110136

Author(s):

Supriya Arora ◽

Alexei N Kulikov ◽

Dmitrii S Maltsev

Keyword(s):

Central Serous Chorioretinopathy ◽

Multimodal Imaging ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Perfect Agreement ◽

Data Set ◽

Kappa Value ◽

Versus Complex

Purpose: To study the implementation of the new multimodal imaging-based classification system of central serous chorioretinopathy (CSCR). Methods: Ninety-three eyes with CSCR with available fundus autofluorescence (FAF), optical coherence tomography (OCT), and OCT angiography at presentation were included in this study. An anonymous data set was classified by two masked graders. Each case was classified as per presence of (i) simple versus complex (< or >2 disc diameters of retinal pigment epithelium abnormality) CSCR; (ii) primary versus recurrent versus resolved CSCR; (iii) persistent (presence of subretinal fluid >6 months) or not; (iv) outer retinal atrophy (ORA); (v) foveal involvement; and (vi) macular neovascularization (MNV). Agreement between the graders was calculated. Results: Kappa value was 0.91 (95% CI 0.8–1.0) for the entire classification; 0.84 (95% CI 0.73–0.95) for simple versus complex; 1.0 (95% CI 1.0–1.0) for primary versus recurrent versus resolved CSCR; 1.0 (95% CI 1.0–1.0) for persistent or not; 0.9 (95% CI 0.81–0.99) for ORA or not; 0.95 (95% CI 0.84–1.0) for presence or absence of MNV; 1.0 (95% CI 1.0–1.0) for presence or absence of foveal involvement. Conclusion: The new multimodal imaging based CSCR classification showed “near perfect” agreement between two retinal experts.

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