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Structural Changes of Inner and Outer Choroid in Central Serous Chorioretinopathy Determined by Optical Coherence Tomography

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      Abstract

      PurposeTo determine the structural changes of the choroid in eyes with central serous chorioretinopathy (CSC) by enhanced depth imaging optical coherence tomography (EDI-OCT).MethodsA retrospective comparative study was performed at two academic institutions. Forty eyes with CSC, their fellow eyes, and 40 eyes of age-matched controls were studied. Subfoveal cross sectional EDI-OCT images were recorded, and the hypo reflective and hyperreflective areas of the inner and outer choroid in the EDI-OCT images were separately measured. The images were analyzed by a binarization method to determine the sizes of the hyporeflective and hyperreflective areas.ResultsIn the inner choroid, the hyperreflective area was significantly larger in the CSC eyes (35,640±10,229 μm2) than the fellow eyes (22,908±8,522 μm2) and the control eyes (20,630±8,128 μm2; P<0.01 vs control for both, Wilcoxon signed-rank test). In the outer choroid, the hyporeflective area was significantly larger in the CSC eyes (446,549±121,214 μm2) than the control eyes (235,680±97,352 μm2, P<0.01). The average ratio of the hyporeflective area to the total choroidal area was smaller in the CSC eyes (67.0%) than the fellow eyes (76.5%) and the control eyes (76.7%) in the inner choroid (P<0.01, both). However, the ratio was larger in the CSC eyes (75.2%) and fellow eyes (71.7%) than in the control eyes (64.7%) in the outer choroid (P<0.01, both).ConclusionsThe larger hyperreflective area in the inner choroid is related to the inflammation and edema of the stroma of the choroid in the acute stage of CSC. The larger hyporeflective areas in the outer choroid is due to a dilatation of the vascular lumens of the larger blood vessels. These are the essential characteristics of eyes with CSC regardless of the onset.

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      Most cited references 24

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      Enhanced depth imaging spectral-domain optical coherence tomography.

      To describe a method to obtain images of the choroid using conventional spectral-domain (SD) optical coherence tomography (OCT) and to evaluate choroidal thickness measurements using these images. Observational case series. The images were obtained by positioning the SD OCT device close enough to the eye to obtain an inverted representation of the fundus in healthy volunteers who did not have pupillary dilation. Seven sections, each comprised of 100 averaged scans, were obtained within a 5- x 15-degree rectangle centered on the fovea. The choroidal thickness under the fovea in each image was measured by independent observers. The choroidal thickness could be evaluated in every subject's choroidal image. The mean choroidal thickness under the fovea was 318 microm in the right eye and 335 microm in the left eye. The choroidal thickness showed a high correlation in both eyes (r = 0.82; P < .001). The correlation between the measurements performed by the independent observers was highly significant (right eye, r = 0.93; left eye, r = 0.97; P < .001 for both). This method provides detailed, measurable images from the choroid, a structure that heretofore has been difficult to image in clinical practice.
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        Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy.

        The purpose of the study was to evaluate the choroidal thickness in patients with central serous chorioretinopathy, a disease attributed to increased choroidal vascular hyperpermeability. Patients with central serous chorioretinopathy underwent enhanced depth imaging spectral-domain optical coherence tomography, which was obtained by positioning a spectral-domain optical coherence tomography device close enough to the eye to acquire an inverted image. Seven sections, each comprising 100 averaged scans, were obtained within a 5 degrees x 30 degrees rectangle to encompass the macula. The subfoveal choroidal thickness was measured from the outer border of the retinal pigment epithelium to the inner scleral border. The mean age of subjects undergoing enhanced depth imaging spectral-domain optical coherence tomography was 59.3 years (standard deviation, 15.8 years). Seventeen of 19 patients (89.5%) were men, and 12 (63.2%) patients had bilateral clinical disease. The choroidal thickness measured in 28 eligible eyes of the 19 patients was 505 microm (standard deviation, 124 microm), which was significantly greater than the choroidal thickness in normal eyes (P < or = 0.001). Enhanced depth imaging spectral-domain optical coherence tomography demonstrated a very thick choroid in patients with central serous chorioretinopathy. This finding provides additional evidence that central serous chorioretinopathy may be caused by increased hydrostatic pressure in the choroid.
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          Central serous chorioretinopathy: update on pathophysiology and treatment.

          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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            Author and article information

            Affiliations
            [1 ]Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
            [2 ]Department of Ophthalmology, Tokushima University Graduate School of Medicine, Tokushima, Japan
            Massachusetts Eye & Ear Infirmary, Harvard Medical School, UNITED STATES
            Author notes

            Competing Interests: The authors have declared that no competing interests exist.

            Conceived and designed the experiments: SS TS. Performed the experiments: NK NA HK NY TY EU TK YM. Analyzed the data: TS EU. Contributed reagents/materials/analysis tools: TS YM. Wrote the paper: SS TS.

            Contributors
            Role: Editor
            Journal
            PLoS One
            PLoS ONE
            plos
            plosone
            PLoS ONE
            Public Library of Science (San Francisco, CA USA )
            1932-6203
            15 June 2016
            2016
            : 11
            : 6
            27305042
            4909210
            10.1371/journal.pone.0157190
            PONE-D-16-13180
            (Editor)
            © 2016 Sonoda et al

            This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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            Figures: 4, Tables: 5, Pages: 16
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            Funding
            The authors received no specific funding for this work.
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