Retinal microvasculature alteration in central serous chorioretinopathy

Abstract

The aim of the present study was to investigate the changes of retinal microvascular network in patients with central serous chorioretinopathy (CSCR). A total of fifteen patients (right eye) with CSCR and 15 normal controls (right eye) were recruited. We used optical coherence tomography angiography to scan 6×6 mm macular retinal blood flow images with the application of a series of customized image segmentation processing program software to obtain microvascular and macrovascular density, and compared the superficial microvascular (SMIR), superficial macrovascular ring (SMAR) and the superficial total microvascular (STMI) density between CSCR patients and control group. Using the annular partition (C1-C6) and quadrant partition methods on the macular, we compared the retinal vessel density changes. We also performed ROC analysis of superficial retinal microvessel density in CSCR retina to investigate the relationship between the microvascular density, the foveal thickness and visual acuity. The density of STMI and SMIR decreased in macular area in the patients with CSCR compared to the normal controls (P<0.05), while the density of SMAR did not change significantly. We found no significant difference in the density of SMIR with the quadrant partition method, whereas the annular partition method showed significantly decreased SMIR density only in the C1 region in patients with CSCR (P<0.05), with no significant difference observed in C2-C6 regions. The density of SMIR had the highest differentiation power in the CSCR group, whereas the density of SC1 ring had the lowest differentiation power by the annular method. The largest area under the ROC curves was 0.77. The correlation index of the SMIR density and visual acuity was −0.544, whereas macular thickness and visual acuity was −0.644 in the CSCR group. The density of STMI and SMIR were decreased in patients with CSCR, which might provide further understanding of the pathogenesis of CSCR.

Quantitative Assessment of Retinal Capillary Vessel Density and Foveal Avascular Zone Area in Central Serous Chorioretinopathy Using OCTA

“…The higher disruption presence of EZ ( p < 0.01) in chronic CSC could also be a piece of evidence to sustain the injury on DCP. Though Yu et al [12] had found a decreased superficial microvascular density and the superficial total microvascular density in acute CSC patients (15 eyes), there was no statistical difference between acute CSC and controls in our study. Depending on the good vision and fine configuration, we propose that the progression of decreasing blood flow is gradual, which may not be presented in an acute course.…”

“…Furthermore, Lee et al [11] described that the FAZ expanded as diabetic retinopathy progresses. Notably and rarely in a CSC study, Yu et al [12] calculated the VD of 15 CSC patients (within 1 month of symptom onset) and 15 controls in 6 × 6 mm OCTA images. The results turned out that VD of a 3-mm macular ring area decreased significantly and had a positive correlation with VA.…”

Optical coherence tomography angiography of central serous chorioretinopathy: quantitative evaluation of the vascular pattern and capillary flow density

“…2). Images showing subretinal hyperreflective material or pigment epithelial detachment (PED) in the macular area were excluded, as these overlying structures can be associated with shadow artefacts at the level of choriocapillaris OCTA [18][19][20][21][22]. Low-quality OCTA images related to improper centring, movement artefacts, or a signal strength less than 6 were excluded from the analysis.…”

“…OCTA imaging of CSC has permitted us to better delineate some aspects of the choroidal circulation, such as abnormal choriocapillaris and choroid flow patterns [17,18], not only in CSC eyes but also in fellow eyes without serous retinal detachment [19], and dark areas and dark spots observed in the choriocapillaris [17,18], which have been interpreted as possible focal flow reductions that should be distinguished from possible imaging artefacts [19,20]. Moreover, inner retinal microvasculature alterations in the macular region have been described [21].…”

Biomarkers for central serous chorioretinopathy

“…A multicenter case-control study of 35 patients with CSCR and 25 age-matched controls showed increased choriocapillaris vascular density during stress in CSCR patients compared to controls, although the former had lower baseline values ( p < 0.05). 81 Yu and colleagues 82 also demonstrated a decrease in superficial total microvasculature in CSCR compared to controls in 15 patients using a customized image segmentation processing program to analyze 6 × 6 mm macular retinal blood flow OCTA images.…”