OCT Angiography of the Choriocapillaris in Central Serous Chorioretinopathy: A Quantitative Subgroup Analysis

Cakir, Bertan; Reich, Michael; Lang, Stefan J.; Bühler, Anima; Ehlken, Christoph; Grundel, Bastian; Stech, Milena; Reichl, Sabine; Stahl, Andreas; Böhringer, Daniel; Agostini, Hansjürgen; Lange, Clemens

doi:10.1007/s40123-018-0159-1

Cited by 49 publications

(48 citation statements)

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“…We show that SRF is associated with a disease-independent, reduced SD-OCTA signal from the CC by examining patients with acute CSC and RD. Our results are consistent with previous SD-OCTA studies describing a reduced CC flow signal in patients with CSC and SRF [ 8 , 12 , 13 , 15 – 17 ]. Similarly, numerous investigations have reported dark regions in OCTA CC scans, the so-called flow voids, in association with various chorioretinal diseases such as diabetic retinopathy [ 18 ], age-related macular degeneration [ 19 ] and CSC [ 8 , 17 ] suggesting that they represent potentially disease-relevant hypoperfusion in the CC.…”

Section: Discussionsupporting

confidence: 93%

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Swept-source optical coherence tomography angiography alleviates shadowing artifacts caused by subretinal fluid

et al. 2020

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Purpose To characterize the choriocapillaris (CC) structure in relation to subretinal fluid (SRF) as a possible systematic error source using spectral domain (SD-OCTA) compared to swept-source optical coherence tomography angiography (SS-OCTA). Methods This is a prospective case-control study of 23 eyes. Ten patients with acute central serous chorioretinopathy (CSC), three patients with partial macular-off retinal detachment (RD) and ten healthy, age-matched controls were included. Abnormal CC decorrelation signals were quantitatively compared in CSC and controls by means of custom image processing. To investigate the influence of SRF on CC OCTA signal, the extent of SRF was quantified with a macular heatmap and compared with the corresponding OCTA signal of the CC. Results SS-OCTA yielded a more homogeneous OCTA signal from the CC than SD-OCTA, offering less signal dispersion and variability in healthy and diseased eyes. Both devices demonstrated CC signal voids in CSC and RD, respectively. In CCS, the voids were predominantly located in the area with SRF. Compared to SD-OCTA, SS-OCTA delivered a more homogenous OCTA signal and reduced signal voids in the CC underneath SRF in both RD and CSC (CSC, 7.6% ± 6.3% vs, 19.7% ± 9.6%, p \ 0.01). Despite this significant attenuation of signal voids, SS-OCTA continued to reveal signal voids below SRF and more pixels with reduced OCTA signals in CSC patients compared to controls (7.6% ± 6.3%, 0.1% ± 0.1%, p \ 0.0001). Conclusion Understanding OCTA artifacts is critical to ensure accurate clinical evaluations. In this study, we describe the presence of SRF as an important shadow-causing artifact source for CC OCTA analysis which can be mitigated but not completely eliminated by employing SS-OCTA.

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Section: Discussionsupporting

confidence: 93%

“…Abnormal CC decorrelation signals were quantified using a custom image processing algorithm programmed with “R” ( www.r-project.org ) as described previously [ 8 , 12 – 14 ]. Briefly, images were processed via a Gaussian blur and morphological h -dome-operator, and the image’s average grayscale value was determined.…”

Section: Methodsmentioning

confidence: 99%

Swept-source optical coherence tomography angiography alleviates shadowing artifacts caused by subretinal fluid

et al. 2020

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“…Only patients with classic acute CSC defined by a dome-shaped accumulation of central SRF, no pronounced RPE changes or RPE detachments, and symptoms lasting less than 4 months were included in the study [20]. Data from the baseline examinations of 17 patients were previously published by Cakir et al [12]. Twenty age-matched and healthy participants with best-corrected visual acuity (BCVA) of 20/20 or better and no chorioretinal pathology served as controls.…”

Section: Methodsmentioning

confidence: 99%

“…Since its introduction, several groups have used OCTA to investigate the CC in patients with CSC [12–19]. However, none of these studies provides follow-up data in acute CSC assessing the OCTA signal at the level of the CC when SRF is absorbed.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Analysis of the Choriocapillaris Using Optical Coherence Tomography Angiography Reveals Subretinal Fluid as a Substantial Confounder in Patients with Acute Central Serous Chorioretinopathy

et al. 2019

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IntroductionTo describe the influence of subretinal fluid (SRF) in analysis of the flow signal from the choriocapillaris (CC) via optical coherence tomography angiography (OCTA) in patients with acute central serous chorioretinopathy (CSC).MethodsObservational, longitudinal, cross-sectional case–control study. Twenty-three eyes of 22 patients with acute CSC were compared with 20 eyes of 20 healthy controls. OCTA images (AngioPlex®, Zeiss) were recorded at baseline and follow-up examination and automatically quantified using an image-processing algorithm. Abnormal CC decorrelation signals (increased and decreased flow, IF and DF) were quantified using a custom image-processing algorithm. To analyze the spatial correlation between SRF and OCTA, CC signal heat-map images containing macular thickness information were used.ResultsChoriocapillaris flow alterations were significantly more pronounced at baseline than at follow-up examination in patients with acute CSC and resolving SRF (IF: p < 0.002; DF: p < 0.003). The extent of SRF correlated significantly with the abnormal CC decorrelation signals when comparing baseline with follow-up examinations (IF: rho = 0.56, p < 0.005; DF: rho = 0.64, p < 0.001). In particular, the reduced OCTA flow signal in the area occupied by SRF at baseline disappeared at follow-up examination (p < 0.02). In comparison with controls, CSC patients with complete resorption of SRF continued to show a reduced OCTA flow signal in the CC (p < 0.008).ConclusionsThe temporospatial association between SRF and reduced OCTA signal from the CC demonstrates that fluid might be a significant confounder for OCTA analysis in patients with CSC. CSC patients with complete absorption of the SRF at follow-up, however, show persistently reduced CC flow signals.

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“…The study was able to demonstrate that eyes with CSCR show increased and decreased OCTA signals at the level of the choriocapillaris compared to normal eyes with consistent choriocapillaris vascular network. 80 …”

Section: Fafmentioning

confidence: 99%

Biomarkers for central serous chorioretinopathy

et al. 2020

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Central serous chorioretinopathy (CSCR) is a common chorioretinal disease characterized by serous retinal detachment that most commonly involves the macular region. Although the natural history of the acute form shows a self-limiting course, a significant number of patients suffer from recurrent episodes leading to chronic disease, often leaving patients with residual visual impairment. Visual morbidity is often worsened by a delay in the diagnosis due to the incorrect understanding of the particular biomarkers of the disease. The aim of this review is to provide clinical understanding of the biomarkers of CSCR with an emphasis on the most recent findings in patient demographics, risk factors, clinical imaging findings, and management options. Patients with these biomarkers, age 30–44 years, male gender, increased stress levels, hypercortisolism (endogenous and exogenous exposures), sleep disturbance, pregnancy, and genetic predisposition have increased susceptibility to CSCR. Also, biomarkers on optical coherence tomography (OCT) such as choroidal thickness (CT) and choroidal vascularity index (CVI) showed good diagnostic and prognostic significance in the management of CSCR. There are nonspecific features of CSCR on OCT and OCT angiography such as choroidal neovascularization, photoreceptor alteration/cone density loss, and flat irregular pigment epithelium detachment. We described rare complications of CSCR such as cystoid macular edema (CME) and cystoid macular degeneration (CMD). Patients with CME recovered some vision when treated with anti-vascular endothelial growth factors (anti-VEGFs). Patients with CMD had irreversible macular damage even after treatment with anti-VEGFs.

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OCT Angiography of the Choriocapillaris in Central Serous Chorioretinopathy: A Quantitative Subgroup Analysis

Cited by 49 publications

References 30 publications

Swept-source optical coherence tomography angiography alleviates shadowing artifacts caused by subretinal fluid

Swept-source optical coherence tomography angiography alleviates shadowing artifacts caused by subretinal fluid

Longitudinal Analysis of the Choriocapillaris Using Optical Coherence Tomography Angiography Reveals Subretinal Fluid as a Substantial Confounder in Patients with Acute Central Serous Chorioretinopathy

Biomarkers for central serous chorioretinopathy

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