The morphology of choroidal neovascularization in chronic central serous chorioretinopathy presenting with flat, irregular pigment epithelium detachment

Abstract

Purpose To evaluate morphological characteristics of choroidal neovascularization in chronic central serous chorioretinopathy (CSC) presenting with flat and irregular pigment epithelium detachment (FIPED) by means of innovative multimodal imaging. Methods In this observational cross-sectional study, we examined 10 consecutive patients affected by chronic CSC and FIPED using fluorescein angiography (FA), indocyanine-green angiography (ICGA) and optical coherence tomography angiography (OCTA). A qualitative analysis of the nature and characteristics of neovascular membrane was performed, combining available multimodal imaging and literature data. Results Multiple areas of retinal pigment epithelium alterations, macular hypo- and hyperpigmentation and atrophic areas were identified. Spectral domain OCT (SD-OCT) showed subretinal fluid in 80% of eyes and the ‘double layer sign’ in all patients. Late FA phases showed staining areas without leakage in all eyes; ICGA showed a hyperfluorescent plaque with surrounding hypofluorescence in 80% of patients. OCTA detected characteristic neovascular networks in the outer retina within the FIPEDs, classified as filamentous vessels with a pruned tree-like pattern in five eyes and a tangled pattern in three eyes. The choriocapillaris network showed dark areas in 80% of eyes and diffuse dark spots in all eyes. Conclusion Multimodal imaging completes clinical characterization of FIPEDs in chronic CSC. This study using OCTA technology describes the phenotype of hidden neovascular lesions in shape and morphology.

Effects of Half-Dose Photodynamic Therapy on Chronic Central Serous Chorioretinopathy With or Without Macular Neovascularization Assessed Using Optical Coherence Tomography Angiography

“…It was suggested that the morphology pattern of MNV observed by OCTA may be useful to distinguish the activity grade of type 1 MNV and be responsive to PDT or anti-VEGF agent. 5,6 However, no association between MNV pattern and clinical outcome was unclear in this study; a study with larger cases is needed. In this study, the mean area of MNV increased significantly (3-fold increase) after half-dose PDT in the eyes with definite MNV at baseline.…”

“…Type 1 MNV is considered to be the most common type that occurs in pachychoroid disease, 2,4 and its morphology has been noted to include "pruned tree pattern" and "tangled pattern" defined as follows: pruned tree pattern, filamentous vessels with a main neovascular trunk and a few branches, and tangled pattern, filamentous vessels with a thick net and wool-like appearance. 5 PCV characterized by polypoidal lesion may also be associated with pachychoroid disease. 2,4 In addition, a thicker choroid is a characteristic of CSC, suggesting that cases with MNV have a thinner choroid than those without MNV.…”

Pachychoroid neovasculopathy versus macular neovascularization in age-related macular degeneration with and without shallow irregular pigment epithelial detachment

“…This finding signifies the role of OCTA in detecting the vascular complex under SIPEDs. However, the presence of MNV in SIPED has been reported at rates ranging from 24 to 95% [22][23][24][25][26][27] ; this discrepancy could be related to the absence of well-defined criteria.…”