Correlation of spectral domain optical coherence tomography findings in acute central serous chorioretinopathy with visual acuity

Abstract

PurposeTo evaluate the structural changes in the acute phase of central serous chorioretinopathy and after its resolution, using spectral domain optical coherence tomography, to correlate these tomographic changes with visual acuity (VA).MethodThis was a prospective study of 100 consecutive patients with acute central serous chorioretinopathy. It was based on presenting the best-corrected VA, divided into three groups (Group 1, n = 36, VA 6/6; Group 2, n = 49, VA 6/9–6/18; Group 3, n = 15, VA > 6/18). All patients underwent fundus evaluation followed by fluorescein angiography and spectral domain optical coherence tomography.ResultsThe mean age of the patients was 40 ± 7.17 years. The mean log MAR VA was 0.176 ± 0.0185. Single pigment epithelial detachment (PED), and multiple discrete and multiple confluent PEDs were seen in 21%, 17%, and 32% of the eyes, respectively. The location of the PED was subfoveal in 35% of the eyes. The presence of subretinal fibrin and a rough undersurface of the neurosensory retina were noted in 61% and 64% of the eyes, respectively. On en-face scanning, a break in the walls of the PED and overlying fibrin were seen in 32.8% and 45% of the eyes, respectively. The mean subretinal fluid height at the fovea was 279.11 ± 148.78 μ. The mean outer nuclear layer thickness during the active stage was 95.10 μ and during the resolved stage, it was 77.69 μ (P = 0.012). The average photoreceptor lengths were 73.1 μ, 84.6 μ, and 94.9 μ in groups 1, 2, and 3, respectively, in the acute phase; and 69.5 μ, 70.8 μ, and 61.6 μ, respectively, after resolution (P = 0.013, P = 0.010, and P = 0.011).ConclusionIn the acute phase of the disease, poorer VA showed statistically significant association with greater dimensions of subretinal fluid – particularly, greater subretinal fluid height and thinning of the outer nuclear layer at the fovea. The presence of fibrin, subretinal precipitates, subfoveal location, or type of PED did not have any association with poor VA. In resolved central serous chorioretinopathy, poorer VA was associated with a persistently thinner outer nuclear layer, shorter photoreceptor lengths, and inner and outer segment junction atrophy.

Characteristics of intraretinal deposits in acute central serous chorioretinopathy

“…These changes are most often confined to the macula and associated with leakage of fluid through the RPE into the subretinal space 1. CSC is a common clinical diagnosis, especially in young to middle-aged adults,2 and has been associated with the use of several medications (chronic corticosteroid therapy) and several systemic conditions (hypertensive diseases). Patients usually present with blurred vision, metamorphopsia, micropsia3 or a relative central scotoma 4…”

Factors affecting the visual outcome in acute central serous chorioretinopathy

“…Various other studies from all over the world have reported mean age range from 40-44.7 years, male predominance between 74.60-90% and unilateral involvement in 58-91.63% in patients with CSCR 1,7,12-14. Most common angiographic patterns in our study were ink blot pattern (53.65% eyes) and smoke stack pattern (14.63% eyes).…”

“…Kim et al reported a statistically significant difference between the mean BCVA of eyes with visible IS/OS and that of eyes with invisible IS/OS in patients with acute CSCR 12. Nair et al concluded that in the acute phase of CSCR, poorer VA showed statistically significant association with greater dimensions of SRF and thinning of the ONL at the fovea, whereas, in resolved CSCR, poorer VA was associated with a persistently thinner ONL, shorter photoreceptor lengths, and IS/OS junction atrophy 7. In our study, all patients were managed conservatively with control of modifiable risk factors and topical 0.1% Nepafenac for at least three months.…”

“…Patients with initial VA of less than 6/9 recover two to three Snellen lines during the course of recovery, whereas patients with presenting VA of 6/6 usually maintain that vision 5. Nair et al in their study reported that in acute CSCR, poorer VA showed statistically significant association with greater dimension of SRF and thinning of outer nuclear layer at fovea 7. Aggio et al found that initial VA may be a reliable predictor of the visual outcome in CSCR 8.…”

En face’ optical coherence tomography guided focal navigated laser photocoagulation

“…Другим относительным ограничением являются случаи множественных ОПЭ, фиксируемых на ОКТ, что может сопровождать до 17% случаев ЦСХ [10]. Однако в такой ситуации в связи с безопасностью фокальной навигационной ЛК процедуру можно признать выполнимой, несмотря на то что не все ОПЭ могут являться активными точками просачивания.…”