Macular ganglion cell complex thickness in acute and chronic central serous chorioretinopathy

Abstract

Central serous chorioretinopathy (CSCR) is characterized by neurosensory retinal detachment. Because the retina pigment epithelium and choroidal pathology is the current mechanism in CSCR, many studies in the literature focused on the outer retinal layers. There is little information about the functional or histological structure of the detached retina. In this study, we assess the ganglion cell complex (GCC) thickness using optical coherence tomography (OCT) in patients with acute and chronic CSCR. The medical records of 16 acute and 19 chronic CSCR patients which have no other disorders that cause a serous macula detachment were analyzed. Chronic cases were also divided into two subgroups: chronic active and chronic nonactive CSCR. The eyes with extramacular involvement or cystoid degeneration and cases which developed choroidal neovascularization were excluded from the study. The mean, minimum, superior-nasal, superior, superior-temporal, inferior-nasal, inferior, and inferior-temporal GCC values obtained using OCT were used for analysis. The duration from the onset was 7.8 ± 4.5 weeks and the mean age was 45.0 ± 10.7 years in acute CSCR, and in chronic cases the values were 36.0 ± 6.2 weeks and 52.9 ± 10.5 years, respectively. There were no significant differences in sex distribution. The chronic cases were statistically significantly older than acute cases (p = 0.02). While there was no difference between the acute and chronic cases, there were statistically significant differences between the chronic CSCR and control group in all values of GCC. Additionally, there were statistically significant differences between the acute CSCR and control group in mean, minimum, and superior-temporal GCC thicknesses. Although choroid and outer retinal layers play an important role in the pathogenesis of CSCR, there is scant information about the functional or histological structure of the detached retina in CSCR. Our results showed that GCC was significantly reduced in both acute and chronic CSCR compared to healthy subjects. Analysis of ganglion cell helps us understand the etiology of the patients which healed anatomically but had limited visual improvement in CSCR.

Pattern electroretinography in patients with unilateral acute central serous chorioretinopathy

“…Given that N95 amplitude is a PERG parameter mostly derived from the retinal ganglion cells, these findings may indicate the likelihood of functional impairment in ganglion cell layers in CSCR patients, besides significant involvement of the photoreceptors. Similar findings related to N95 amplitudes in patients with CSCR were also reported by Goyal et al, 8 while Demirok et al 20 demonstrated thinning of the ganglion cell layer in both the acute and chronic CSCR patients. In addition, in a PERG-based study among CSCR patients by Miyake et al, 21 both b-waves and a-waves along with oscillatory potentials were reported to be impaired in the affected areas, indicating that the functions of the inner retinal layers were also impaired along with the photoreceptors in CSCR.…”

Choroidal thickness, ganglion cell complex, and photoreceptor outer segment length evaluation in patients receiving tamoxifen therapy by spectral domain optical coherence tomography

“…In addition to ganglion cell toxicity, the reduction in GCC thickness in tamoxifen users could be related to vascular changes at the choroidal level. Demirok et al demonstrated that GCC is significantly reduced in both acute and chronic CSCR subjects compared with healthy subjects [31]. Increasing choroidal thickness measurements, development of PPE and CSCR, and reduced GCC thickness measurements in the tamoxifen group support this report.…”

Central Serous Chorioretinopathy Classification

“…The spectrum of pachychoroid disease include CSC, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy (can progress to polypoidal lesion), focal choroidal excavation, and peripapillary pachychoroid syndrome. Detachment of retinal pigment epithelium (PED) higher than 50 micron or associated with the presence of the double sign that indicates irregular and flat vascular PED, a large amount or recurrent subretinal fluid, hyperreflective choroidal vessel walls, intra-and subretinal hyperreflective dots materials, external limiting membrane discontinuation, thinning of the outer nuclear layer, elongation of the photoreceptor outer segments, retinal cystoid degeneration, pigment deposition, fibrinoid reaction, choroidal rifts, and reduction in the ganglion cells complex are all indicative of severe forms with different functional prognosis [9][10][11]14,25,[56][57][58][59][60][61][62][63][64] ( Table 1).…”

“…Multifocal leak zones without correspondence in IVFA [5,6,17,35] OCT CT > 500 micron [25] PED height > 50 micron [59] Large amount or recurrent subretinal fluid [9,14] Choroidal hyperreflective dots [9,10,14] Hyperreflective choroidal vessel walls [9,10,14] Intra-and subretinal hyperreflective dots and material [60] Thinning and atrophy of the outer nuclear layer [61] External limiting membrane discontinuity [62] Cystoid degeneration [11] Elongation of the photoreceptor outer segments [9,10,32] Double sign at external retina (irregular, flat, and dense RPE detachment) [65] Fibrinoid reaction [9,10] Pigment deposition [9,10,32] Choroidal rift [58] Reduced ganglion cell complex thickness [64] OCTA Subretinal neovascularization [65][66][67][68][69][70][71] Flow void zones [72,73]…”