Photoreceptor disruption and vision loss associated with central serous retinopathy

Abstract

PurposeTo present ophthalmic imaging findings in the case of a 40-year-old male with sustained visual loss after a single episode of acute central serous retinopathy (CSR).ObservationsA male subject presented with visual acuity decline to 20/50 OS and was diagnosed with acute CSR. The initial pigment epithelial detachment and subretinal fluid resolved within 6 weeks, but visual acuity remained impaired. Using directional optical coherence tomography (D-OCT) and confocal and split-detector adaptive optics scanning light ophthalmoscopy (AOSLO), we imaged pathologic alterations in the photoreceptor mosaic of the affected eye. A foveal region of intermittent missing cones, a temporal parafoveal region of confluent missing cones, and a nasal parafoveal region of misdirected cones were observed.Conclusions and ImportancePathologic alterations in photoreceptor microanatomy underlie residual visual acuity deficits in this case of acute CSR. Observations of missing cones correlated well across all imaging modalities in the fovea and the temporal parafoveal region of missing cones. However, in the nasal parafovea where cones were present but misdirected, D-OCT and AOSLO may be able to identify and image photoreceptors with greater fidelity as compared to non-directional SDOCT (spectral domain OCT). D-OCT may thus have a clinical role in rapidly assessing photoreceptor mosaic integrity in pathology.

Attenuation Outer Retinal Bands on Optical Coherence Tomography Following Macular Edema

“…Our findings therefore argue for the hypothesis that attenuated areas comprised misaligned outer segments. Our conclusions are similar to those of previous reports supporting the presence of misaligned photoreceptors ouster segments following central serous chorioretinopathy 15 and AMNR 16 .…”

“…These optical properties have been used to explore the orientation of outer segments in retinal diseases. In central serous chorioretinopathy 15 and acute macular neuroretinopathy (AMNR) 16 , directional reflectance of the outer retinal bands suggestive of photoreceptor misalignment have been reported. Finding such feature in two unrelated diseases suggests that photoreceptor misalignement may be rather common.…”

Automated detection of photoreceptor disruption in mild diabetic retinopathy on volumetric optical coherence tomography

“…Moreover, this method is robust to small segmentation inaccuracies. At the same time, en face OCT requires image processing techniques that deal with the numerous confounding shadow artifacts unrelated to the atrophy [21, 22, [43][44][45], such as the large vessel shadow inaccurately segmented in [ Fig. 9 (DR3)].…”

Reflectance adaptive optics findings in a patient with Vogt-Koyanagi-Harada disease

“… 32 Nakamura et al have added to this concept, indicating that end cone densities are often lower than those in normal populations post recovery. 20 Focal disruptions of the photoreceptor mosaic on both cAOSLO and sdAOSLO imaging on the other, have been noted as linked to poor end vision outcomes in a case of central serous retinopathy reported by Sun et al 33 Similar findings have been noted in eyes with poor vision due to various conditions when imaged, showing focal IS/OS losses on OCT and visible photoreceptor mosaic abnormalities on both cAOSLO and sdAOSLO. 34 These studies demonstrate that consistent photoreceptor loss on multimodal imaging correlates with poor vision and that the use of both cAOSLO and sdAOSLO may have some prognostic value in cases wherein photoreceptor loss secondary to eye disease is suspected.…”