Choroidal thickening in retinal vein occlusion patients with serous retinal detachment

Abstract

Purpose To evaluate choroid thickness and macular retinal metrics in treatment naïve retinal vein occlusion (RVO) patients with serous retinal detachment (SRD) before and after intravitreal anti-vascular endothelial cell growth factor (VEGF) injection and to elucidate the possible role of choroid in the development of SRD and the potential role of SRD as a prognostic parameter. Methods This is a retrospective study involving 85 RVO patients, 41 central retinal vein occlusion (CRVO), and 44 branch retinal vein occlusion (BRVO), with macular edema: 21 central retinal vein occlusion and 22 branch retinal vein occlusion with SRD and the rest without SRD. Patients were evaluated with ophthalmic examinations and swept-source optical coherence tomography (SS-OCT) both before and 4-6 weeks after intravitreal anti-VEGF treatment. Choroid thickness and retinal metrics were measured and compared between SRD and non-SRD groups within each RVO subtype. Results In both CRVO and BRVO patients, the mean central subfield foveal thickness (CSFT) and central subfoveal choroid thickness (CSCT) of the SRD groups were thicker than those in the non-SRD groups (p < 0.05) at onset. After one anti-VEGF injection, CSFT and FNRT decreased in all groups (p < 0.05). The CSCTs were thicker in the SRD groups compared with the non-SRD groups (p < 0.05). The mean changes of CSFT were more remarkable in the SRD groups (p < 0.05). Conclusion Thicker choroid was a feature of naïve RVO patients with SRD and SRD may be an indicator of better anatomical recovery of retina in RVO patients after a single dose of anti-VEGF treatment.

Changes in peripapillary and subfoveal choroidal thickness in patients with central retinal vein occlusion

“…One study compared choroidal changes after administration of intravitreal anti-VEGF agents, dexamethasone implants, and triamcinolone acetonide and showed that these agents similarly reduce choroidal thickness in eyes with CRVO [38]. In our study, both mean PCT and SFCT were significantly reduced in patients after their first intravitreal bevacizumab injection, which is consistent with previous reports [17][18][19][20][21][22][23]. In addition, the changed amounts of PCT and SFCT were significantly greater in the CRVO-affected eyes when compared those values in the unaffected contralateral eyes.…”

“…In addition, the changed amounts of PCT and SFCT were significantly greater in the CRVO-affected eyes when compared those values in the unaffected contralateral eyes. These results also support previous studies that anti-VEGF agents can effectively reduce choroidal thickness as well as macular thickness in CRVO patients [17][18][19][20][21][22][23]. In addition, our findings suggest that anti-VEGF agents can affect the peripapillary choroidal area as well as subfoveal area.…”

“…Because the choroid is a major component of the unconventional fluid outflow system, fluid ingress may induce choroidal swelling [36]. Consistent with previous studies [17][18][19][20][21][22][23], we found that both the mean PCT and SFCT were greater in CRVOaffected eyes than in unaffected contralateral eyes, although the difference did not reach statistical significance. Regardless, our findings suggest that choroidal thickening associated with CRVO not only affects the macula but also the peripapillary area.…”

“…Although CRVO mainly affects the inner retina, recent studies have shown that retinal hypoxia due to CRVO further induces choroidal changes [17][18][19][20][21][22][23], as well as hyperpermeability and increased vascular endothelial growth factor (VEGF) expression in the inner retina [28]. VEGF produced in response to retinal ischemia seems to translocate to the choroid, and increased leakage from choroidal blood vessels leads to choroidal thickening, especially in the stromal area [22,[29][30][31].…”

“…Although CRVO primarily affects the inner retina, recent studies have investigated concomitant changes in macular choroidal thickness, suggesting that the macular choroid in CRVO may be altered in association with retinal ischemia [17][18][19][20][21]. Notably, macular choroidal thickness at the time of CRVO diagnosis may be useful for predicting clinical outcomes [22,23]. However, changes in the peripapillary choroid have not been explored in patients with CRVO, although the ONH (including the lamina cribrosa) is the main site of CRVO occurrence.…”