The suprachoroidal space: from potential space to a space with potential

Abstract

Recent advances have made it possible to image the suprachoroidal space, and the understanding of its clinical applications is currently being greatly expanded. This opinion piece covers the advances in imaging techniques that enable the demonstration of the suprachoroidal space, and its implication in various retinal pathologies. It also reviews its potential uses as a route for drug delivery for the treatment of retinal diseases, and its use in innovative surgical techniques. Current research is leading the way for the suprachoroidal space to be an aspect of retinal disease diagnosis, monitoring, medical treatment, and surgical manipulation.

Choroidal detachments: what do optometrists need to know?

“…Clinically, the suprachoroidal space could only be visualised with ultrasonography during a choroidal detachment. 6 Enhanced depth imaging optical coherence tomography with spectral domain technology provides the capacity to now view the suprachoroidal layer in healthy eyes, and measurements of choroidal thickness are comparable to newer optical coherence tomography technology. 29 However, the resolution of enhanced depth imaging optical coherence tomography is not sufficient to visualise the structures distinctly for accurate measurements of choroidal thickness when pathologies affect this layer due to inadequate penetration into deeper layers, hindering the visibility of the suprachoroidal space.…”

“…32 A hypothesis for the increased visibility of this space in these cases is related to increased permeability of the choroidal vessels with age, which subsequently increases the osmotic pressure in the suprachoroidal space and causes it to be more visible. 6 To date there have not been any studies investigating the usefulness of swept-source optical coherence tomography in the diagnosis and management of clinically significant choroidal detachments.…”

“…5 The suprachoroid is the transitional zone between the choroid and the sclera, consisting of numerous fibrous lamellae of varying thicknesses, melanocytes, and flattened processes of fibroblasts. 6,7 The fibroblasts are responsible for producing extracellular matrix components such as elastin, collagens and proteoglycans. 2 The stroma of the choroid has melanocytes, seen more often in the outer choroidal layers associated with Haller's and Sattler's layers blood vessels, collagen fibrils which are arranged in a circular pattern around the vasculature, 5 elastic fibres and smooth muscle cells.…”

“…Extended depth ocular coherence tomography of a healthy eye in a 67-yearold patient demonstrating the suprachoroidal layer 6. The white arrow indicates the posterior border of the choroid, and the black arrow indicates the anterior border of the sclera, between which the suprachoroidal space lies.…”

Posterior Choroidal Stroma Reduces Accuracy of Automated Segmentation of Outer Choroidal Boundary in Swept Source Optical Coherence Tomography

“…1 Choroidal thickness has been shown to be important in the diagnosis and monitoring of diseases such as central serous chorioretinopathy (CSC), AMD, polypoidal choroidal vasculopathy, vitelliform pattern dystrophy, Vogt-Koyanagi-Harada syndrome, and choroidal tumors. 2,3 Accurate and reproducible measurements of choroidal thickness support the potential use of optical coherence tomography (OCT)-derived parameters for diagnosis, monitoring of disease progression and evaluating treatment response. 3,4 Precise segmentation of the inner (the retina-choroid junction [RCJ]) and outer (choroid-scleral junction [CSJ]) boundaries of the choroid are essential for accurate choroidal thickness measurements.…”