Scleral thickness as a risk factor for central serous chorioretinopathy and pachychoroid neovasculopathy

Abstract

Background/Objectives. While the exact pathophysiology of pachychoroid disorders remains unclear, scleral changes inducing increased venous outflow resistance are hypothesized to be involved. This work aims to investigate anterior scleral thickness (AST) as a risk factor for central serous chorioretinopathy (CSC) and pachychoroid neovascularization (PNV). Subjects/Methods. Randomized prospective case-control study performed at the Ludwig Maximilians-University, Department of Ophthalmology. 46 eyes of 46 patients were included, with 23 eyes in the CSC/PNV group (9 eyes with PNV) and 23 eyes in the control group. There was no difference in mean age (51.5 ± 8.0 (36 to 65) vs. 47.0 ± 12.9 (30 to 83) years; p = 0.122) or spherical equivalent (0.60 ± 2.23 (-5.5–4.6) vs. -0,93 ± 2.45 (-4.9–5.8); p = 0.441). In all patients, swept source OCT (SS-OCT) with an anterior segment module was used to measure AST. Subfoveal choroidal thickness (SFCT) was assessed using enhanced depth imaging OCT (EDI-OCT). AST and SFCT were then compared to an age and -refraction-matched control group. Results. A significantly higher AST was found in the CSC/PNV as compared to the control group (403.5 ± 68.6 (278 to 619) vs. 362.5 ± 62.6 (218 to 498) µm; p = 0.028). Moreover, the CSC/PNV group showed a higher SFCT (392.8 ± 92.8 (191–523) vs. 330.95 ± 116.5 (167–609) µm, p = 0.004). Conclusions. Compared to age- and refraction-matched controls, patients with CSC and PNV show a significantly thicker anterior sclera. Scleral thickness might contribute to the venous overload hypothesized to induce pachychoroid phenotypes.

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Scleral Thickness as a Risk Factor for Central Serous Chorioretinopathy and Pachychoroid Neovasculopathy

“…Imaging included the acquisition of a standard volume scan centered on the macula consisting of 49 equally spaced B-scans covering 20 × 20 degrees centered on the fovea (on Spectralis HRA + OCT, Heidelberg Engineering, Heidelberg, Germany) [8]. Subfoveal choroidal thickness (SFCT) was assessed by manual measurements of the distance between Bruch's membrane and the transition zone between the choroid and the sclera underneath the foveola.…”

“…Kishi and colleagues recently described a frequent overlap of areas of vortex vein dilatation and areas of reduced perfusion of the choriocapillaris in en-face optical coherence tomography (OCT) imaging in eyes with CSC [4]. They concluded that in CSC, compression of the vortex veins can lead to backflow into the venous system of the choroid and, secondarily, to anterograde filling delay of the choriocapillaris with the formation of ischemic areas [5]. This thesis is supported by the fact that in eyes with CSC, chronic overload of the venous system was observed compared with a control collective.…”