Intervortex Venous Anastomosis in the Macula in Central Serous Chorioretinopathy Imaged by En Face Optical Coherence Tomography

Abstract

Purpose: To assess the presence of macular intervortex venous anastomosis in central serous chorioretinopathy (CSCR) patients using en face optical coherence tomography (EF-OCT). Methods: A cross-sectional study where EF-OCT 6 × 6 and 12 × 12 mm macular scans of patients with unilateral chronic CSCR were evaluated for anastomosis between vortex vein systems in the central macula. The presence of prominent anastomoses was defined as a connection with a diameter ≥150 µm between the inferotemporal and superotemporal vortex vein systems which crossed the temporal raphe. Three groups were studied: CSCR eyes (with an active disease with the presence of neurosensorial detachment; n = 135), fellow unaffected eyes (n = 135), and healthy eyes as controls (n = 110). Asymmetries, abrupt termination, sausaging, bulbosities and corkscrew appearance were also assessed. Results: In 79.2% of the CSCR eyes there were prominent anastomoses in the central macula between the inferotemporal and superotemporal vortex vein systems, being more frequent than in fellow eyes and controls (51.8% and 58.2% respectively). The number of anastomotic connections was higher in the affected eye group (2.9 ± 1.8) than in the unaffected fellow eye group (2.1 ± 1.7) and the controls (1.5 ± 1.6) (p < 0.001). Asymmetry, abrupt terminations and the corkscrew appearance of the choroidal vessels were more frequent in the affected eyes, although no differences in sausaging or bulbosities were observed. Conclusions: Intervortex venous anastomoses in the macula were common in CSCR, being more frequently observed in affected eyes than in fellow unaffected eyes and healthy controls. This anatomical variation could have important implications concerning the pathogenesis and classification of the disease.

Effective Focal Laser Photocoagulation for Persistent Central Serous Chorioretinopathy: A Forgotten Technique

“…Additionally, the anatomical location of the PED at the upper margin of the neurosensory detachment suggests that gravitational force contributed to the inferior accumulation of SRF. Furthermore, our patient had a pachyvessel beneath the PED and subretinal hyperreflective material surrounding the PED, both of which are also linked to the area of leakage in CSC [1,22,23]. Therefore, considering all indirect indicators of leakage, some CSC patients may not require angiography before FLP treatment, streamlining the treatment planning process.…”

Choroidal hyperpermeability patterns correlate with disease severity in central serous chorioretinopathy: CERTAIN study report 2

“…Moreover, healthy patients can often show a relatively thick choroid without any pathological changes (Ikuno et al, 2010), while CVH is rarely found in healthy controls, thus making it a more specific sign of the disease (Bacci et al, 2022). The same holds true for other signs of venous overload such as intervortex venous anastomoses, which were observed in between 35% (Bacci et al, 2022) and 58% (Fernández-Vigo et al, 2023) of healthy controls and can thus not be regarded a pathologic sign only observed in diseases that are part of the pachychoroid spectrum (Funatsu et al, 2022;Sonoda et al, 2021). Based on these results, CVH appears to be a more meaningful diagnostic feature of CSC than either a thickened choroid or signs of venous overload.…”

Interocular Symmetry of Choroidal Parameters in Patients with Diabetic Retinopathy with and without Diabetic Macular Edema

“…Although generally symmetrical, various diseases develop unevenly in the eyes of a given patient, e.g., age-related macular degeneration (AMD) [ 8 , 9 ] and glaucoma [ 10 ]. There are also differences between the eyes in the central serous chorioretinopathy (CSCR) [ 11 ] and myopia [ 12 , 13 ].…”