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      Characteristics of Central Serous Chorioretinopathy without Leakage

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          Abstract

          Purpose:

          To describe optical coherence tomography (OCT) characteristics of central serous chorioretinopathy (CSCR) without any hyperfluorescent leakage on fundus fluorescein angiography (FFA).

          Methods:

          This was a multicentric, retrospective, observational study of ten eyes of ten patients with CSCR without any hyperfluorescence leakage on FFA. Baseline patient characteristics, best corrected visual acuity, and OCT parameters like relative retinal pigment epithelium (RPE) reflectivity at the presumed leak site and control site were measured.

          Results:

          Increased macular thickness, neurosensory detachment, and choroidal thickness were seen at the site of maximum subretinal fluid (SRF). Out of ten eyes, nine had photoreceptor outer segment (PROS) disruption (46% ± 26.33%) at the site of SRF pocket, and five had presumed former leak site characterized by PROS thinning. The presumed leak site demonstrated higher RPE reflectivity compared to the control site (0.92 ± 0.04 vs. 0.87 ± 0.04; P = 0.0058).

          Conclusion:

          CSCR without hyperfluorescent leakage on FFA may have PROS damage and changes in RPE hyperreflectivity.

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          Most cited references7

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          Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis.

          Alejandra Daruich, Alexandre Matet, Ali Dirani … (2015)
          Central serous chorioretinopathy (CSCR) is a major cause of vision threat among middle-aged male individuals. Multimodal imaging led to the description of a wide range of CSCR manifestations, and highlighted the contribution of the choroid and pigment epithelium in CSCR pathogenesis. However, the exact molecular mechanisms of CSCR have remained uncertain. The aim of this review is to recapitulate the clinical understanding of CSCR, with an emphasis on the most recent findings on epidemiology, risk factors, clinical and imaging diagnosis, and treatments options. It also gives an overview of the novel mineralocorticoid pathway hypothesis, from animal data to clinical evidences of the biological efficacy of oral mineralocorticoid antagonists in acute and chronic CSCR patients. In rodents, activation of the mineralocorticoid pathway in ocular cells either by intravitreous injection of its specific ligand, aldosterone, or by over-expression of the receptor specifically in the vascular endothelium, induced ocular phenotypes carrying many features of acute CSCR. Molecular mechanisms include expression of the calcium-dependent potassium channel (KCa2.3) in the endothelium of choroidal vessels, inducing subsequent vasodilation. Inappropriate or over-activation of the mineralocorticoid receptor in ocular cells and other tissues (such as brain, vessels) could link CSCR with the known co-morbidities observed in CSCR patients, including hypertension, coronary disease and psychological stress.
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            Central serous chorioretinopathy: update on pathophysiology and treatment.

            Benjamin Nicholson, Jason Noble, Farzin Forooghian … (2016)
            Recent technological advances--new pathophysiological insights, new imaging techniques for diagnosis and management, and new treatments--have led to an improved understanding of central serous chorioretinopathy (CSC). The primary role of the choroid has become more widely accepted with widespread use of indocyanine green angiography. Optical coherence tomography (OCT), and particularly enhanced depth imaging OCT, demonstrate a thickened and engorged choroid. Adaptive optics, fundus autofluorescence, multifocal electroretinography, microperimetry, and contrast sensitivity testing reveal that patients with even a mild course suffer previously undetected anatomic and functional loss. Although focal laser and photodynamic therapy are the current standard of care for persistent subretinal fluid in CSC, they are not appropriate in all cases, and the optimal timing of intervention remains unclear. Published by Elsevier Inc.
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              Choroidal capillary and venous congestion in central serous chorioretinopathy.

              C Prünte, Andreas J. Flammer (1995)
              Abnormalities in choroidal perfusion have been hypothesized to be causative factors in central serous chorioretinopathy. This prospective study was performed to evaluate changes in the choroidal circulation in cases of central serous chorioretinopathy. In 32 consecutive patients with acute or chronic recurrent central serous chorioretinopathy, complete clinical ophthalmologic examinations, fluorescein angiography, and indocyanine green angiography with a scanning laser ophthalmoscope and a digital imaging system were performed. All patients with acute and chronic recurrent central serous chorioretinopathy demonstrated a localized delay in arterial filling followed by choroidal hyperperfusion in the area of the damaged retinal pigment epithelium, frequently associated with dilated capillaries and dilated draining venules in one or more choroidal lobules. These changes corresponded to areas with pigment epithelial detachment or focal leakage from the retinal pigment epithelium found in fluorescein angiography. Furthermore, in some patients, localized choroidal ischemia could be observed in additional areas throughout the central fundus in both diseased eyes and normal fellow eyes. Delayed arterial filling followed by capillary and venous hyperemia, angiographically appearing as capillary and venous congestion, can be observed frequently in eyes with central serous chorioretinopathy. The results suggested that capillary or venous congestion after ischemia in one or more choroidal lobules might be the reason for the choroidal hyperpermeability associated with central serous chorioretinopathy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Curr Ophthalmol
                Journal ID (iso-abbrev): J Curr Ophthalmol
                Journal ID (publisher-id): JCO
                Title: Journal of Current Ophthalmology
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Electronic): 2452-2325
                Publication date Collection: Apr-Jun 2021
                Publication date (Electronic): 05 July 2021
                Volume: 33
                Issue: 2
                Pages: 152-157
                Affiliations
                [1 ]Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
                [2 ]Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russian Federation, Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, Telangana, India
                [3 ]Department of Ophthalmology, Military Medical Academy, Saint Petersburg, Russia
                [4 ]Department of Retina and Uveitis, L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India
                Author notes
                Address for correspondence: Jay Chhablani, Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Banjara Hills, Hyderabad - 500 034, Telangana, India. E-mail: jay.chhablani@ 123456gmail.com
                Article
                Publisher ID: JCO-33-152
                DOI: 10.4103/joco.joco_35_20
                PMC ID: 8365581
                PubMed ID: 34409225
                SO-VID: 69959e40-0c1c-4532-b884-54e04007fba2
                Copyright © Copyright: © 2021 Journal of Current Ophthalmology
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 18 July 2020
                Date revision received : 20 December 2020
                Date accepted : 25 December 2020
                Categories
                Subject: Original Article

                Keywords: central serous chorioretinopathy,fundus fluorescein angiography,optical coherence tomography,photoreceptor outer segment,retinal pigment epithelium hyperreflectivity
                Data availability:
                Keywords: central serous chorioretinopathy, fundus fluorescein angiography, optical coherence tomography, photoreceptor outer segment, retinal pigment epithelium hyperreflectivity

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