One year outcome and predictors of treatment outcome in central serous chorioretinopathy: Multimodal imaging based analysis

Abstract

Purpose To evaluate the follow up and treatment outcome of central serous chorioretinopathy (CSCR) based on the new multimodal imaging-based classification and identify the predictors for anatomic and visual outcome. Methods Retrospective, multicentric study on 95 eyes diagnosed with CSCR and a follow up of at least 12 months were included. Eyes with macular neovascularization, atypical CSCR or any other disease were excluded. Results At the baseline, observation was advised to 70% eyes with simple CSCR whereas photodynamic therapy (PDT) was performed in 49% eyes with complex CSCR. Over the follow up, decrease in CMT was significantly higher in simple CSCR as compared to complex CSCR ( P = 0.008) and the recurrences were significantly more in eyes with lower CMT at baseline ( P = 0.0002). Median time of resolution of SRF was 3 months and 6 months in simple and complex CSCR respectively ( P = 0.09). For the 12 months follow up, the median fluid free period was greater ( P = 0.03) while number of interventions performed was lesser in eyes with simple CSCR as compared to complex CSCR ( P = 0.006). Multiple regression analysis showed baseline best corrected visual acuity (BCVA) and baseline persistent SRF to be significantly predictive of BCVA and persistent SRF at 12 months ( P < 0.0001, 0.04) respectively. Conclusions Complex CSCR more often required PDT, was associated with shorter fluid free interval and longer time for SRF resolution. Baseline BCVA and persistent SRF were predictive of final visual and anatomical outcome. The new multimodal imaging based classification is helpful in establishing objective criteria for planning treatment approaches for CSCR.

Prevalence of choroidal nevi in patients with central serous chorioretinopathy

“…Indeed, higher choroidal thickness and lower neurosensory detachment, as well as a trend toward higher frequency of fellow eye involvement and choroidal neovascularization, noted in patients with choroidal nevi are the known biomarkers of chronic CSCR. 27,28 This agrees with the higher prevalence of chronic CSCR among patients with choroidal nevi. These findings also correlate with a growing number of reports on coincidence of choroidal nevi and polypoidal lesions since both CSCR and polypoidal vasculopathy belong to the pachychoroidal spectrum.…”

Predicting persistent central serous chorioretinopathy using multiple optical coherence tomographic images by deep learning

“…It is not clear whether higher CMT or shallow diffuse CMT was prognostic factor for persistent CSC in this study. Arora et al showed that shallow subretinal fluid was associated with recurrent or complicated CSC 22 . This might be the point for predictionin this model, but this interpretation requires caution since the association between CMT and visual outcome depends on types of CSC.…”

Recent Advances in Clinical Applications of Imaging in Retinal Diseases

“…Table 3 outlines the major and minor diagnostic criteria, and Table 4 lists the classification algorithm. The broad range of CSC findings identifiable with novel multimodal imaging tools refined CSC classification with respect to disease severity and duration resulting from enhanced interobserver agreement and validity in several observational studies 57–59…”

“…24 It is important to be aware of the caveats in the interpretation of images, such as signal attenuation by speckle noise, pathologic lesions, eye blinking, undulations of the RPE causing segmentation error, projection artifact, and unreliable thresholding strategy used in flow deficit binarization. 58 There is no standard algorithm for OCTA imaging technique for studying the choriocapillaris. Therefore, assessment of interobserver and intraobserver repeatability, comparison between different scan areas, with different flow segmentation strategies and with control subjects, are important for the validation of quantitative metrics of choriocapillaris flow deficit.…”

“…OCTA detects blood flow as to generate a signal, thus, the dark region represents areas with blood flow below the OCTA device’s decorrelation threshold, which can be caused by true loss of vessels, reduced blood flow or artifact 24. It is important to be aware of the caveats in the interpretation of images, such as signal attenuation by speckle noise, pathologic lesions, eye blinking, undulations of the RPE causing segmentation error, projection artifact, and unreliable thresholding strategy used in flow deficit binarization 58. There is no standard algorithm for OCTA imaging technique for studying the choriocapillaris.…”