ObjectiveTo observe the change of retinal microstructures and the association between visual outcome with these microstructures in central serous chorioretinopathy (CSC) after laser treatment.MethodsThis is a retrospective study. From April 2016 to February 2017, a total of 52 eyes from 52 patients who underwent conventional laser treatment (27 eyes) or subthreshold laser treatment (25 eyes) for CSC and the sub-retinal fluid (SRF) absorbed completely were included in this study. The were 46 patients (46 eyes) and 6 males (6 eyes), with the mean age of 43.92±8.62 years. The healthy fellow eyes (49 eyes) were selected as control. All patients were underwent BCVA and SD-OCT examination. According to the OCT images for all patients, the thickness of central foveal (CFT), outer nuclear (ONL), inner segment (IS), outer segment (OS) were measured. The status of ellipsoid zone (EZ), interdigitation zone (IZ) and RPE were also evaluated at fovea. Comparing the change of SD-OCT microstructures in two time points, the first visit after SRF absorbed and the last visit respectively. Spearman correlation analysis was used to analyze the relation between BCVA and ONL, IS, OS.ResultsAt the first visit after SRF absorbed, compared with control eyes, the thickness of CFT (182.55±24.14 μm), ONL (72.86±17.39 μm), IS (41.23±5.14 μm), OS (18.52±10.26 μm) in CSC eyes were decreased (P＜0.001). Meanwhile, the mean BCVA of CSC eyes was 81.27±6.39 letters, which was also significantly decreased comparing with control eyes (P＜0.001). At last visit, the thickness of CFT, ONL, IS, OS were 195.19±22.10, 75.44±16.33, 44.56±4.09, 26.60±11.39 μm, and the mean BCVA was 85.50±5.95 letters. All recovered significantly comparing with first visit (P＜0.05). At first visit, the BCVA of patients with integrate EZ (83.38±5.78 letters) was significantly better than the BCVA of patients with unintegrated EZ (77.90±5.97 letters) (P=0.003). And the BCVA of patients with smooth RPE (82.72±5.95 letter) was also significantly better than the BCVA of patients with rough RPE (78.00±6.31 letters) (P=0.020). The result of Spearman correlation analysis showed that the thickness of OS was positively correlated to BCVA at two time points (r=0.423, 0.416; P=0.002, 0.002).ConclusionsIn CSC, the thickness of ONL, IS, OS were decreased, and the integrality of EZ, IZ, the smooth of RPE were disrupted in different extent. After laser treatment, with retinal reattachment, those microstructures including ONL, IS, OS, EZ, IZ recovered slowly. The thickness of OS, the integrality of EZ and the smooth of RPE were associated with visual acuity.
The fundus appearance of polypoidal choroidal vasculopathy (PCV) often demonstrates orange-red nodular lesions. ICGA reveals terminal dilation of the polyps with or without branching vascular networks. Currently, pachychoroid spectrum disease is a series of conditions included choroidal vasodilatation and increased permeability due to choroidal ischemia, choroidal thickening, retinal pigment epitheliopathy, and secondary pigment epithelial detachment, choroidal neovascularization and polyps included uncomplicated pachychoroid, pachychoroid pigment epitheliopathy, pachychoroid neovascularization, central serous chorioretinopathy, and PCV. These entities have the similar characteristics and prognosis, suggesting that they have the similar pathology. The recognition of PCV based on the pachychoroid spectrum disease can provide new ideas for the prevention and intervention of PCV.
Objective To analyze the characteristics of images of fundus fluorescein angiography (FFA) in patients with central serous chorioretinopathy (CSC).Methods We observed the positions of leakage spots of retinal pigment epithelium (RPE) and analyzed their characteristics in 598 CSC patients. The ages, visual acuty, detachment areas of sensory retina, and leakage patterns of RPE were recorded and the correlation of them were analyzed. Results The leakage concentrated in the posterior pole, which occurred more frequently in the superior quadrant, nosal quadrant, and near fovea regions than in the inferior quadrant,temporal quadrant, and far regions from fovea, respectively (chi;2=67.13,20.93, 212.715; Plt;0.01).We found that there were relations between the ages of patients and the patterns of the leakage. A total of 35 patients (54.7% out of 64) at the age of ge;50 had small leakage; 82 patients (53.2% out of 154) at the age of 35-39 had diffusing leakage. Smaller retinal detachment in patients with multiple serous leakage and bigger retinal detachment area in patients with single serous leakage were found; no statistical significance was found (F=1.925,Pgt;0.05). There was negative correlation between the visual acuity and the detachment area in CSC patients (t=-0.335,Plt;0.01), and there was no correlation between the visual acuity and the distances from the leakage spots to the fovea (t=-0.029, -0.145;Pgt;0.05).Conclusion The leakages occurs in various regions whose difference is significant; the patterns of leakage are related to the ages; there is no relation between the serous retinal detachment area and the number of the leakage.
Pachychoroid spectrum diseases includes central serous chorioretinopathy (CSC), pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, and polypoidal choroidal vasculopathy, which share common characteristics, including focal or diffused increased choroidal thickness, choroidal hyper-permeability, and dilated choroidal vessels. These diseases are likely to represent a continuum of the same pathogenic process. Similar features and association among them suggest that they may have similar etiology. It is of great clinical significance to understand the composition and typical morphological changes of pachychoroid-related diseases and to explore its possible pathogenesis.
Central serous chorioretinopathy (CSC) is a common macular disease, which can lead to the loss of central vision in young patients. Although the disease is self-limited to some extent, there is no shortage of patients with prolonged course and recurrent attacks, eventually leading to irreversible visual impairment. Therefore, taking reasonable treatment in a certain period is particularly important for the visual prognosis of patients. Although thermal laser photocoagulation of leakage points and photodynamic therapy (PDT) have achieved good effects, there are risks of retinal damage and retinal pigment epithelium atrophy. Subthreshold micropulse laser (SMLP) is a kind of subthreshold short pulse laser, which does not cause visible damage to the retina and is safer. In the era of lack of PDT drugs, SMLP has gradually become an important means of clinical treatment for CSC, especially for patients with no obvious leakage point or subfoveal leakage point. An in-depth understanding of the mechanism of action of SMLP and its efficacy and safety in the treatment of CSC is helpful for the promotion and application of SMLP in the clinical treatment of CSC.
Objective To observe the findings of indocyanine green angiography(ICGA) and fundus fluorescein angiography (FFA) of the patients with multifocal posterior pigment epitheliopathy(MPPE). Methods ICGA and FFA were performed in 6 cases(7 eyes)of MPPE and the findings were analysed and compared between these examinations. Results Five cases(5 eyes)were found to be in the active stage of the disease under FFA,and among them 4 eyes(80%)showed delayed choroidal perfusion at the early stage of ICGA.During the active stage of the disease,ICGA showed leakage relative to FFA leakage,and there were diffuse hyperfluorescence around the points of leakages as well as in the posterior pole of ocular fundus．In convulescence,although FFA revealed no obvious leakage,ICGA still denoted the presence of leakages. Conclusions MPPE was considered to be the more serious type of central serous chorioretinopathy showing the same but more extensive ICGA abnormality. (Chin J Ocul Fundus Dis,2000，16：6-8)
Objective To quantitatively evaluate the changes of choroidal biomarkers in patients with central serous chorioretinopathy (CSC) and preliminarily explore its pathogenesis. MethodsClinical cross-sectional study. From July 2021 to December 2022, 74 eyes of 65 patients with CSC (CSC group) confirmed by ophthalmic examination at the First Affiliated Hospital of Zhengzhou University were included in the study. Among them, 46 patients (51 eyes) were male, 19 patients (23 eyes) were female. The duration from the onset of symptoms to the time of treatment was less than or equal to 3 months. A control group consisted of 40 healthy volunteers (74 eyes) matched in age and gender. Among them, 26 patients (50 eyes) were male, and 14 patients (24 eyes) were female. Using VG200D from Microimaging (Henan) Technology Co., Ltd., macular scanning source light coherence tomography angiography was performed, with scanning range 6 mm × 6 mm. According to the division of the diabetes retinopathy treatment research group, the choroid within 6 mm of the macular fovea was divided into three concentric circles centered on the macular fovea, namely, the central area with a diameter of 1 mm, the macular area with a diameter of 1-3 mm, and the surrounding area of the fovea with a diameter of 3-6 mm. The device comes with software to record the three-dimensional choroidal vascular index (CVI), choroidal vascular volume (CVV), perfusion area of the choroidal capillary layer (CFA), choroidal thickness (CT), and three-dimensional CVI, CVV, and CT in the upper, temporal, lower, and subnasal quadrants within 6 mm of the fovea. Quantitative data between the two groups were compared using an independent sample t-test. Qualitative data comparison line χ2 inspection. The value of receiver operating curve (ROC) analysis in predicting the occurrence of CSC, including CVI, CVV, CFA, and CT. ResultsCompared with the control group, the CVI (t=3.133, 4.814), CVV (t=7.504, 9.248), and CT (t=10.557, 10.760) in the central and macular regions of the affected eyes in the CSC group significantly increased, while the CFA (t=－8.206, －5.065) significantly decreased, with statistically significant differences (P＜0.05); CVI (t=7.129), CVV (t=10.020), and CT (t=10.488) significantly increased within 6 mm of the central fovea, while CFA (t=－2.548) significantly decreased, with statistically significant differences (P＜0.05). The CVI (t=4.980, 4.201, 4.716, 8.491), CVV (t=9.014, 7.156, 7.719, 10.730), and CT (t=10.077, 8.700, 8.960, 11.704) in the upper, temporal, lower, and lower nasal quadrants within 6 mm of the central fovea were significantly increased, with statistically significant differences (P＜0.05). In the CSC group, the maximum CVI and CVV were (0.39±0.10)% and (1.09±0.42) mm3, respectively, on the nasal side of the affected eye. Upper CT was (476.02±100.89) μm. The nasal side CVI, CVV, and CT have the largest changes. The ROC curve analysis results showed that the area under the curve of CT, CVV, and CVI within 6 mm of the central region, macular region, and fovea was over than 0.5. Subcentral CT was the most specific for the diagnosis of CSC. ConclusionChoroidal biomarkers CVI, CVV, and CT in CSC patients increase, while CFA decreases. Central CT is the most specific for the diagnosis of CSC.