Korean J Ophthalmol.  2012 Oct;26(5):347-354. 10.3341/kjo.2012.26.5.347.

Morphologic Changes in Acute Central Serous Chorioretinopathy Using Spectral Domain Optical Coherence Tomography

• Kim HC
• Cho WB
• Chung H

• KMID: 1397485
• DOI: http://doi.org/10.3341/kjo.2012.26.5.347

Abstract

PURPOSE
To investigate morphologic changes of acute central serous chorioretinopathy (CSC) using spectral domain optical coherence tomography (SD-OCT) and confocal scanning laser ophthalmoscopy.
METHODS
This retrospective study included 63 eyes of 63 patients with unilateral acute CSC. All patients underwent simultaneous SD-OCT and fluorescein angiography examination using Spectralis HRA+OCT.
RESULTS
The external limiting membrane could be seen on SD-OCT, although the junction between photoreceptor inner and outer segments (IS/OS) was not detected in all eyes with retinal detachment (RD). However, IS/OS became visible after resolution of serous RD in 51 eyes (81.0%). SD-OCT images at the leakage sites showed a bump of retinal pigment epithelium (RPE) in in 47 cases (68.1%) and pigment epithelial detachment (PED) in 22 of 69 leakage sites (31.9%). In 14 of 69 leakage sites (20.3%), highly reflective areas suggesting fibrinous exudate were observed in the subretinal space. In nine leakage sites (13.0%), sagging or dipping of the posterior retinal layer was seen. Abnormal RPE changes such as RPE bump and PED were observed in 12 of 22 fellow eyes (54.5%).
CONCLUSIONS
A variety of morphologic changes could be identified on SD-OCT, and those findings may contribute more information to our understanding of the pathophysiology of CSC.

Keyword

Central serous chorioretinopathy; Fluorescein angiography; Indocyanine green angiography; Leakage site; Spectral domain optical coherence tomography

MeSH Terms

Acute Disease
Adult
Central Serous Chorioretinopathy/*pathology
Female
Fluorescein Angiography
Humans
Indocyanine Green/diagnostic use
Male
Microscopy, Confocal
Middle Aged
Retrospective Studies
*Tomography, Optical Coherence

Figure

• 

  Fig. 1 Optical coherence tomography image of a 55-year-old woman with central serous chorioretinopathy. External limiting membrane (ELM) is clearly visible; however, the junction between photoreceptor inner and outer segments (IS/OS) is not detected in the detached neurosensory retina. The outer photoreceptor layer of the detached neurosensory retina above the clear subretinal space was irregularly thickened and granulated.

• 

  Fig. 2 Optical coherence tomography images of a 39-year-old man (A) and 46-year-old man (B) after resolution of serous detachment. (A) The junction of photoreceptor inner and outer segments (IS/OS) is intact and clearly visible. (B) IS/OS is disrupted and invisible.

• 

  Fig. 3 (A) Distribution of foveal thickness (FT) of the affected eyes and the fellow eyes after resolution of serous detachment shows that most of the affected eyes have thinner FT than the fellow eyes. (B) FT ratio, the FT of the affected eye divided by that of the fellow eye, shows a significant positive correlation with best-corrected visual acuity (BCVA, logarithm of the minimum angle of resolution [logMAR]).

• 

  Fig. 4 Simultaneous imaging of fluorescein angiography and spectral domain optical coherence tomography (SD-OCT) in a 41-year-old man (A) and a 39-year-old man (B) with acute central serous chorioretinopathy. The horizontal linear scans of the SD-OCT image corresponding to the leakage sites show (A) pigment epithelial detachments (PED) and (B) retinal dipping above the retinal pigment epithelium (RPE) protrusion with fibrinous exudates in the subretinal space.

• 

  Fig. 5 Simultaneous imaging of fluorescein angiography (FA) and spectral domain optical coherence tomography (SD-OCT) in a 59-year-old woman with acute central serous chorioretinopathy. The minute defect in the retinal pigment epithelium (RPE) layer within the pigment epithelial detachment on SD-OCT corresponds exactly to a leakage point on FA.

• 

  Fig. 6 Simultaneous imaging of indocyanine green angiography (ICGA) and spectral domain optical coherence tomography in asymptomatic fellow eyes. An retinal pigment epithelium bump (A) and pigment epithelial detachment (B) are observed at the area of choroidal vascular hyperpermeability on ICGA.

• 

  Fig. 7 The spectral domain optical coherence tomographic findings of all the affected and fellow eyes in our study. RD = retinal detachment; ELM = external limiting membrane; IS/OS = inner and outer segments; RPE = retinal pigment epithelium; PED = pigment epithelial detachment.

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