Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy

Abstract

Purpose Central serous chorioretinopathy (CSCR) is a complex ocular entity that, in its chronic form, can lead to serious visual impairment and morphological damage to the retina. The aim of the current retrospective study was to evaluate the damage present after long-standing but resolved central serous chorioretinopathy and refer it to healthy individuals. Correlations between measurable factors—for example, duration of the disease, baseline retinal morphological parameters, or patient age and/or their degree of impairment—were also assessed. Materials and methods The study group consisted of thirty-two eyes (13 female and 19 male, mean age 49.6 years SD +/− 10.5) with chronic central serous chorioretinopathy (mean duration 18.9 months SD +/− 15.4) in which complete resolution of subretinal fluid was achieved after subthreshold micropulse laser treatment. Inclusion criterion was a lack of subretinal fluid within the whole area of the central retina scanned by the spectral domain optical coherence tomography. The group was extracted out of 51 cases of chronic CSCR that were treated with that method. They were analyzed according to final best-corrected visual acuity and retinal morphological parameters as measured by spectral optical coherence tomography with angiography option (OCTA). Results were compared with the outcomes of a control group, which consisted of 40 eyes of healthy individuals with full distance visual acuity (0.0 logMAR, 1.0 Snellen) never treated with subthreshold micropulse laser. Statistical analysis included regarding correlation between final visual acuity and final central retinal thickness and retinal and functional parameters prior to treatment. Results Final best-corrected visual acuity after chronic central serous chorioretinopathy was 0.23 logMAR (0.6 Snellen) and central retinal thickness was 39.32 μm smaller than in controls. No correlation was found between final visual acuity and retinal thickness and duration of the disease, patient age, and baseline morphological retinal parameters. OCTA scans revealed impaired choriocapillaries flow signal even following resolution of the disease. Conclusion Chronic central serous chorioretinopathy is a potentially damaging clinical entity that results in serious visual impairment, retinal thinning, and choroidal flow defects. Further research is needed to determine precisely the timepoint of this damage.

Imbalance in the Levels of Angiogenic Factors in Patients with Acute and Chronic Central Serous Chorioretinopathy

“…As the pathogenesis and pathophysiology of CSC have not been fully explained, the available treatment modalities are suboptimal, especially in long-standing cases [ 2 , 6 ]. Growing evidence indicates that the pathomechanism of CSC is associated with dysfunction of the thickened choroid (an important risk factor), with subsequent impairment of the RPE [ 1 , 7 ].…”

Choriocapillaris Ischemia at the Leakage Point of Patients With Acute Central Serous Chorioretinopathy

“…To the best of our knowledge, this is the first retrospective study to quantitatively investigate the vessel density ratio of the superficial choroidal layer at the leakage point of patients with acute CSC using OCTA. A previous study by Chan et al (14,28) has shown that the high signal intensity of the choriocapillaris on OCTA is more common in chronic CSC. However, according to our data, a reduced blood signal intensity in the superficial choriocapillaris layer of OCTA occurs more frequently in acute CSC eyes, which corresponds to the location of the leakage point on FFA, and most of them are not surrounded by high signals, as described in chronic CSC eyes.…”

Central Serous Chorioretinopathy Classification

“…We can aggregate the nature of the episode as an alternative and complementary way to classify the CSC spectrum. With effect from first recognition and during long-term follow-up, controlling biomarkers could help to define the case management recommendation [42][43][44][45][46][47][48].…”

“…Autofluorescence and infrared autofluorescence evidence, such as persistence of hyperautofluorescence of the serous detachment zone, a granular pattern sometimes associated with the appearance of descending tracks, could be associated with long evolution or a recurrent situation [42][43][44][45][46][47][48][49][50][51][52][53]. IVFA in acute CSC typically shows two patterns: inkblot or smoke stack.…”

“…Descending or gravitational tracks progression [49][50][51][52] Persistent hyperautofluorescence in the zone of serous detachment [41][42][43][44] Increase granularity after resolution [42][43][44][45]…”