Characteristics and Associated Factors of Flat Irregular Pigment Epithelial Detachment With Choroidal Neovascularization in Chronic Central Serous Chorioretinopathy

Abstract

Purpose: Flat irregular pigment epithelial detachment (FIPED) in chronic central serous chorioretinopathy (CSC) is strongly associated with type 1 choroidal neovascularization (CNV). The present study aimed to describe the multimodal imaging characteristics of FIPED in patients with chronic CSC and investigate the factors associated with vascularized FIPED.Methods: We included 55 chronic CSC eyes with vascularized FIPED (47 patients) and 55 chronic CSC eyes with avascular FIPED from age-matched patients (47 patients). None of the included eyes had a history of previous treatment with anti-vascular endothelial growth factor, photodynamic therapy, focal laser, or vitrectomy. The demographic and multimodal imaging data were reviewed. The location, angiography features, height and width, presence of retinal pigment epithelium (RPE) aggregations, RPE thickness, and choroid status of the FIPED area were compared between the groups.Results: The mean age of the included chronic CSC patients was 54.3 ± 7.8 years (range: 33–72 years), and 85.1% were male. Vascularized FIPED eyes had a larger width (1,556.4 ± 731.6 vs. 931.1 ± 486.2 μm, p < 0.001), larger subfoveal RPE thickness (33.4 ± 15.3 vs. 26.3 ± 6.6 μm, p = 0.004), larger maximum RPE thickness of the FIPED area (46.3 ± 20.5 vs. 31.5 ± 8.3 μm, p < 0.001), and more RPE aggregations in the FIPED area (94.5 vs. 54.5%, p < 0.001) than avascular FIPED eyes. RPE aggregations in the FIPED area were an independent factor strongly associated with vascularized FIPED (OR = 7.922, 95% CI = 1.346–46.623, p = 0.022).Conclusion: FIPED with a larger width and RPE thickening may suggest the presence of an underlying type 1 CNV. FIPED with RPE aggregations had an increased occurrence of neovascularization in chronic CSC.

The Temporal Topography of Central Serous Chorioretinopathy in the Chinchilla Rabbits Induced by Intravenous Injection of Adrenaline: An in vivo Study

“…Instead, the original damage of adrenalin on RPE might also play a vital role in development of CSC. 23 , 24 This idea might be of help to further clarify the original pathogenesis of CSC and the following sequence of events.…”

Three-Year Follow-Up Detecting Choroidal Neovascularization with Swept Source Optical Coherence Tomography Angiography (SS-OCTA) after Successful Half-Fluence Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

“…SS-OCT and SS-OCTA have higher wavelengths and scan rates, resulting in a higher definition of images and better contrast of small neovascular structures [11]. Several studies have demonstrated that OCTA increases the detection of CNV in chronic CSC compared to conventional diagnostic modalities [3,5,[12][13][14].…”

En-face optical coherence tomography hyperreflective foci of choriocapillaris in central serous chorioretinopathy

“…Central serous chorioretinopathy (CSC) is a vision-threatening disease characterized by increased choroidal blood flow and hyperpermeability, causing serous neurosensory retinal detachment (SRD), pigment epithelial detachment (PED), or thickened choroid 1 , 2 . In the aggravated case of recurrent episodes, prominent retinal pigment epithelium (RPE) alteration could be observed and lead to choroidal neovascularization (CNV) with persistent SRD 3 . Spaide 4 introduced the starling resistor theory, which can be explained that the structure of noncompliant outershell like brain or eye, that excessively increased blood inflow cannot enlarge vessels anymore, rather constrict the blood flow, leading to maintain suitable volume in the restricted space.…”