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Background: The choroidal vasculature, including the choriocapillaris and vortex veins, is essential for providing nutrients to the metabolically demanding photoreceptors and retinal pigment epithelium. Choroidal vascular dysfunction leads to vision loss and is associated with age-related macular degeneration and the poorly understood pachychoroid diseases including central serous chorioretinopathy and polypoidal choroidal vasculopathy that are characterized by formation of dilated pachyvessels throughout the choroid. Methods: Using neural crest-specific Angpt1 knockout mice, we show that Angiopoietin 1, a ligand of the endothelial receptor TEK (also known as Tie2) is essential for choriocapillaris development and vortex vein patterning. Results: Lacking choroidal ANGPT1, neural crest-specific Angpt1 knockout eyes exhibited marked choriocapillaris attenuation and 50% reduction in number of vortex veins, with only 2 vortex veins present in the majority of eyes. Shortly after birth, dilated choroidal vessels resembling human pachyvessels were observed extending from the remaining vortex veins and displacing the choriocapillaris, leading to retinal pigment epithelium dysfunction and subretinal neovascularization similar to that seen in pachychoroid disease. Conclusions: Together, these findings identify a new role for ANGPT1 in ocular vascular development and demonstrate a clear link between vortex vein dysfunction, pachyvessel formation, and disease.

To characterize the findings of eyes with choroidal vascular hyperpermeability (CVH), a hallmark of central serous chorioretinopathy, using multimodal imaging and investigate the locational agreement between these findings and CVH.Among patients with central serous chorioretinopathy in either eye, eyes with CVH identified using indocyanine green angiography without exudative changes were included. All eyes were examined using funduscopy, fluorescein angiography, spectral-domain optical coherence tomography, and short-wavelength or near-infrared autofluorescence (SWAF or NIRAF). The locational agreement between CVH and imaging findings was evaluated for each modality. The relative index on how they overlapped was calculated as the overlapping index. Binarized images, particularly for NIRAF, were also evaluated.This study included 69 CVH sites in 33 eyes of 28 patients. Pachydrusen was detected in 36% of CVH sites. Fluorescein angiography revealed hyperfluorescent areas in 39% of CVH sites. Optical coherence tomography findings identified 65% of CVH sites, but the overlapping index was 5%. Short-wavelength or near-infrared autofluorescence imaging identified 89% of CVH sites, but they exhibited variable autofluorescence. NIRAF imaging revealed hypoautofluorescence findings in all CVH sites. When binarized, near-infrared autofluorescent dark dots were observed in all CVH sites. Overlapping indices before and after binarization were 78% and 98%, respectively. The near-infrared autofluorescent dark dots area corresponded well with that of CVH (intraclass correlation coefficient, 0.987 [95% confidence interval, 0.952-0.995]).Hypoautofluorescent findings revealed on NIRAF imaging, especially after binarization processing, corresponded well with CVH sites. These multimodal imaging results may help investigate the anatomical or locational characteristics of CVH in patients with central serous chorioretinopathy.

To evaluate the caliber of the choroidal veins in central serous chorioretinopathy, a disease proposed to be associated with overloading of choroidal venous outflow.Widefield indocyanine green angiograms of eyes with central serous chorioretinopathy were graded for sausaging defined as three or more contiguous fusiform dilations that vary by at least 50% from the narrowest to largest diameters. A bulbosity was defined as a focal 2X dilation of a blood vessel as compared with the diameter of the surrounding host vessel. The data underwent statistical analysis including the use of generalized estimating equations.There were 73 eyes of 41 patients with a mean age of 53.5 years. Sausaging of vessels was seen in a mean and median of three quadrants per eye. Using generalized estimating equations, the only significant risk factor for sausaging was the use of corticosteroids. The two significant predictors of subfoveal choroidal thickness using generalized estimating equations were age ( P = 0.021) and proportion of quadrants involved by sausaging ( P0.001). The decrease in choroidal thickness per year of age was estimated to be 3.7 µ m, while the increase with four quadrant involvement with sausaging was estimated to be 236 µ m. There were a total of 39 bulbosities in 26 eyes (35.6%), preferentially involving intervortex venous anastomoses.Variations in the venous caliber are very common in eyes with central serous chorioretinopathy and seems to be associated with pathophysiologic alterations related to increased pressure within and remodeling of the larger choroidal veins. This may lead to overloading of the choriocapillaris with leakage as one manifestation.

This study aims to investigate retinal and choroidal vascular reactivity to carbogen in central serous chorioretinopathy (CSC) patients.An experimental pilot study including 68 eyes from 20 CSC patients and 14 age and sex-matched controls was performed. The participants inhaled carbogen (5% CONo significant differences were detected in baseline hemodynamic parameters between both groups. A significant positive correlation was found between the participants' age and arterial diameter variation (p 0.001, r = 0.447), meaning that younger participants presented a more vasoconstrictive response (negative variation) than older ones. No significant differences were detected in the vasoreactive response between CSC and controls for both arterial and venous vessels (p = 0.63 and p = 0.85, respectively). Although the vascular reactivity was not related to the activity of CSC, it was related to the time of disease, for both the arterial (p = 0.02, r = 0.381) and venous (p = 0.001, r = 0.530) beds. SFCT and MCCT were highly correlated (r = 0.830, p 0.001). Both SFCT and MCCT significantly increased in CSC patients (p 0.001 and p 0.001) but not in controls (p = 0.059 and 0.247). A significant negative correlation between CSC patients' age and MCCT variation (r = - 0.340, p = 0.049) was detected. In CSC patients, the choroidal thickness variation was not related to the activity state, time of disease, or previous photodynamic treatment.Vasoreactivity to carbogen was similar in the retinal vessels but significantly higher in the choroidal vessels of CSC patients when compared to controls, strengthening the hypothesis of a choroidal regulation dysfunction in this pathology.

Purpose To predict the change of retinal sensitivity using optical coherence tomography (OCT) parameters in eyes with central serous chorioretinopathy (CSC). Methods Twenty-three eyes of 23 patients with CSC were enrolled. Retinal sensitivity was measured twice with a microperimetry in all examined eyes. OCT measurement was simultaneously conducted. The relationship between retinal sensitivities and the thicknesses of i) retinal nerve fiver layer + ganglion cell layer (RNFL+GCL), ii) inner nuclear layer (INL) iii) outer nuclear layer (ONL) and iV) serous retinal detachment height (SRDH) were investigated in a point-wise manner. We also investigated the association between the change of retinal sensitivity and OCT parameters at baseline. Results The mean age of participants was 49.8 ± 10.7 years. The mean SRDH was significantly lower (p

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has accelerated vaccine development. The BNT162b2 messenger RNA (mRNA) vaccine is being administered worldwide. The purpose of this case series is to report a possible association between the BNT162b2 mRNA vaccine and Central serous chorioretinopathy (CSC). Although rare, CSC has been reported following the administration of anthrax, influenza and smallpox vaccines.Four individuals who developed CSC following the BNT162b2 mRNA vaccine were examined in our institution using multimodal imaging of the retina, and their demographic data were analyzed and compared to all the similar cases published to date.Four patients (3 males, 1 female) between the ages of 35 and 65 presented with acute CSC (n=3) and relapsed CSC (n=1) within the first week following the administration of the BNT162b2 mRNA vaccine. Three individuals demonstrated hyper-reflective foci in the outer segments of the retina.The timing of the BNT162b2 mRNA vaccine administration relative to the development of CSC suggests a possible causal relationship. Further research is necessary to explore this possible association.

To evaluate visual function parameters during and after an acute central serous chorioretinopathy (CSC) episode.A prospective study included 19 fovea involving acute CSC patients with episode resolution within 3 months from the episode onset. Optical coherence tomography, best corrected visual acuity (BCVA), contrast sensitivity (CS), microperimetry (MP), and multifocal electroretinography (mfERG) were performed at baseline, 3 and 6 months from the episode onset. In a sub analysis, patients were divided into groups with greater (gMV, N = 9) and lower (lMV, N = 10) macular volume at presentation, and functional outcomes were observed.BCVA (p 0.001), average CS (CS-A) (p 0.001), average retinal sensitivity (MP-A) (p 0.001), mfERG amplitude densities in the first and second ring (mfERG-A1, p 0.001; mfERG-A2, p = 0.017), and implicit times in the first, second, and third ring (mfERG-IT1, p = 0.024; mfERG-IT2, p = 0.002; mfERG-IT3, p = 0.018) improved with episode resolution 3 months after the episode onset. From 3 to 6 months after the episode onset, only CS-A (p = 0.045) continued to improve. Patients in the gMV group had lower mfERG-A1 (p = 0.017) and central retinal sensitivity (MP-C, p = 0.05) 6 months from the episode onset.Although all functional parameters mostly improve with CSC episode resolution, only CS continues to improve thereafter. Patients with greater MV at presentation have worse functional outcomes. Visual function impairment in acute CSC patients is confined to the topographical area of subretinal fluid detachment.

The purpose of this prospective study was to predict the effectiveness of subthreshold micropulse laser (SML) based on morphological parameters in patients with central serous chorioretinopathy (CSC).Thirty-one patients were examined at presentation, 3 months, and 6 months after the disease onset. In patients with persistent subretinal fluid (SRF) at 3 months, SML was performed. The following morphological parameters were observed just before treatment: central retinal thickness (CRT), maximal SRF, choroidal thickness (CT), pigment epithelial detachment (PED) height and width, number of hyperreflective foci (HF) at fovea and leakage site, secondary choroidal neovascularization (CNV), and severity of retinal pigment epithelium (RPE) alterations using multimodal imaging.Good response was associated with lower SRF (p = 0.038), narrower PED (p = 0.078), and decreasing number of HF at fovea (difHFf) (p = 0 .016) just before the treatment. From a bivariate and multivariate point of view, the two groups differed significantly in the pair (SRF, PED width) (p = 0.048) and in the triple (SRF, PED width, difHFf) (p = 0.026).Lower SRF, narrower PED, and decreasing HF could be associated with good response to SML in CSC patients.

Purpose Pachychoroid spectrum diseases are regarded as being different manifestations of a common pathogenic process. We suggest that pachychoroid diseases are consequences of chronic vortex vein stasis. Methods We describe how we came to this conclusion based on our own recent reports as well as a search of the related literature. Results Central serous chorioretinopathy (CSC) is the first stage of pachychoroid spectrum diseases. CSC is caused by congestion of choroidal veins, which are branches of the vortex veins. The venous outflow tract of the choroid is divided into four quadrants, based on horizontal and vertical watershed zones, with one or two vortex veins in each quadrant being independently responsible for venous outflow. In acute CSC, vortex vein stasis frequently causes asymmetric dilatation of the vortex veins in the horizontal watershed. The area of geographic filling delay in the choriocapillaris coincides with the area of this asymmetrically dilated vortex veins. With chronic stasis of the vortex veins, venous anastomosis occurs in the watershed zone as a means of compensating for the stasis, and the choriocapillaris becomes occluded in the area of filling delay. The anastomotic vessels dilate, becoming often hyperpermeable, and are then recognizable as pachyvessels. With the development of choriocapillaris ischemia, choroidal neovascularization (CNV) occurs at the site of pachyvessels. This is termed pachychoroid neovasculopathy (PNV). Polypoidal choroidal vasculopathy is regarded as a variant of PNV. Conclusions Intervortex venous anastomosis is among the key factors underlying the development of pachychoroid diseases. Remodeling of the venous drainage route though the anastomosis across the watershed zones is apparently a common response to chronic vortex vein stasis.

To estimate the risk of incident age-related macular degeneration (AMD) in patients with central serous chorioretinopathy (CSC).This population-based cohort study was finally conducted from January 2015 to December 2019. All patients with CSC from the entire population aged between 30 and 80 years were included. The incidence of CSC was estimated. Log-rank analysis and Cox proportional hazards regression analysis was used to evaluate the risk of exudative AMD in the CSC group compared with the non-CSC group.During a recent 5-year study period, 36,053 patients were identified as having incident CSC. The annual incidence in the latest year was 19.61 (95% confidence interval, 19.58 to 19.63) per 100,000 people. A total of 11,492 patients were included in the study group and 22,984 in the non-CSC group. The CSC and non-CSC groups included 166 (1.44%) and 73 (0.32%) cases of exudative AMD, respectively. The risk of exudative AMD was significantly higher in the CSC group than in the non-CSC group (adjusted hazard ratio: 4.86; 95% confidence interval: 2.98 to 5.88; P0.001).This study showed that subjects with CSC are at an increased risk of exudative AMD. This evidence supports a possible link between CSC and exudative AMD, particularly in Asian populations.

Purpose: Comparing the effect of half-dose photodynamic therapy and high-density subthreshold micropulse laser treatment on retinal pigment epithelial detachments (PEDs) in chronic central serous chorioretinopathy. Methods: This study included data from the PLACE trial, a prospective randomized controlled trial comparing half-dose photodynamic therapy and high-density subthreshold micropulse laser treatment in chronic central serous chorioretinopathy. Main outcome measurements were changes in both the foveal PED and the highest PED within the macula at baseline compared with first and final evaluation visit. Results: At baseline, a macular PED was detected in 76.9% of patients (123/160), and a PED within 1,500 mu m from the foveal center in 37.5% of patients (60/160). In the half-dose photodynamic therapy arm (61 patients), there was a significantly larger decrease in the highest macular PED compared with the high-density subthreshold micropulse laser treatment arm (62 patients) at both first and final evaluation visits (P < 0.001 and P = 0.012, respectively). The decrease of highest foveal PED was significant at first visit (P = 0.025). Conclusion: Half-dose photodynamic therapy is superior to high-density subthreshold micropulse laser treatment with regard to a statistically significant reduction in the height of macular PEDs in active chronic central serous chorioretinopathy. These findings may also have implications for other diseases within the pachychoroid disease spectrum that can present with PEDs.

To investigate the diagnostic value of elevated retinal pigment epithelium (RPE) and double-layer sign (DLS) in identifying macular neovascularization (MNV) secondary to central serous chorioretinopathy (CSCR).Retrospective, cross-sectional study.Patients with CSCR underwent optical coherence tomography (OCT) and OCT angiography (OCT-A) scanning at Moorfields Eye Hospital. OCT scans were reviewed to identify the presence/absence of an RPE elevation. The maximum length and maximum height of the elevated RPE were measured. A minimum length of 1000 µm and a maximum height of 150 µm were used to define the "double-layer sign." Other qualitative anatomical features were also graded from OCT scans. OCT-A was examined to confirm the presence/absence of MNV. Binary logistic regression analyses were used to assess the association between OCT features and the detection of MNV on OCT-A. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the diagnostic accuracy.One hundred sixty-three eyes from 132 patients were included. Elevated RPE was detected in 148 eyes (91%). OCT-A-confirmed MNV was detected in 54 eyes (33%). The sensitivity and specificity of RPE elevation were 100% and 13.8%, respectively. DLS was identified in 95 eyes (58%). The sensitivity and specificity of DLS for detecting MNV were 87% and 56%, respectively. Hyperreflectivity and nonhomogeneity of the sub-RPE space were independently associated with MNV within the DLS (odds ratio, 17.7 and 14.8, P.001 and P = .02, respectively). None of the other demographic or anatomical features were associated with MNV. The presence of nonhomogeneous hyperreflective RPE elevation had a sensitivity and specificity of 98% and 67%, with PPV and NPV of 60% and 99%, respectively.Nonhomogeneous and hyperreflective space under an elevated RPE of any length or height indicates an eye with higher risk of MNV than DLS. OCT-A should at least be performed for these eyes to confirm the presence of MNV and treat accordingly.

Diagnostic investigation on pachychoroid spectrum disease (PSD) has been growing along with the rapid advancement of imaging technology. In optical coherence tomography (OCT)-based studies, choroidal thickness profile, luminal and stromal choroidal ratio, and abnormalities in the neurosensory retina have demonstrated various patterns in different clinical entities related to PSD. The emerging role of OCT angiography ()CTA) has been expanded to involve the quantitative analysis of the OCTA parameters in different clinical entities of PSD and to evaluate the choriocapillaris signal void and vessel density as indicators of choriocapillaris ischemia. OCTA has broadened our knowledge in characterization and assessment of both active and quiescent choroidal neovascularization and its association with treatment response. Recent studies using indocyanine green angiography have focused on the evaluation of choroidal vascular hyperpermeability and its relationship with other pachychoroid related features. Ultra-widefield indocyanine green angiography enables observation and characterization of peripheral choroidal pathologies and their associations with macular abnormalities. Multicolor imaging is an emerging modality with the capability to demonstrate early abnormalities in PSD. We summarize all investigations reflecting the new insights into the application of multimodal imaging for PSD and focus on novel findings observed in different clinical entities with each imaging modality.

Central serous chorioretinopathy (CSCR) is an eye disease of unknown etiology that presents with reduced visual acuity, choroidal thickening (distance between Bruch's membrane and the chorioscleral border), and subretinal fluid leakage. In the present study, the goal was to investigate the role of the interrelated tenascin C, metalloprotein-1, BAX, BCL2, subfatin and asprosin molecules in the pathogenesis of CSCR.Thirty CSCR patients and 30 controls were included. CSCR was diagnosed by optical coherence tomography imaging. A 5mL blood sample was collected from all participants after overnight fasting. Compounds in the blood samples were studied with the Enzyme-Linked Immunosorbent Assay (ELISA) method.Patients with CSCR were found to have macular thickening (P: 0.08) and statistically significantly reduced visual acuity (P: 0.034) compared to controls. With regard to serum parameters, there were statistically significant increases in tenascin C, metalloprotein-1, BAX, BCL2, subfatin and asprosin levels compared to controls. We found a positive correlation between macular thickness and tenascin C (r+0.670, P0.001), metaloprotein-1 (r+0.714, P0.001), BAX, BCL2 (r+0.771, P0.001), subfatin and asprosin levels and a negative correlation between visual acuity and tenascin C (r+0.605 P0.001), metaloprotein-1 (r+0.704, P0.001), BAX, BCL2 (r+0.738, P0.001), subfatin and asprosin levels.The molecules studied herein were negatively correlated with visual acuity and positively correlated with macular thickness, suggesting that these molecules might have a role in the pathogenesis of CSCR. Thus, we predict that these molecules could be new candidates for the diagnosis and follow-up of CSCR in the future.

Purpose: To explore subretinal fluid (SRF) morphology in chronic central serous chorioretinopathy (cCSC) after one session of either high-density subthreshold micropulse laser (HSML) treatment or half-dose photodynamic therapy (PDT). Methods: We retrospectively obtained optical coherence tomography (OCT) scans from a subset of patients from a randomized controlled trial on treatment-naïve eyes with cCSC allocated to either HSML treatment or half-dose PDT. OCT scans were evaluated prior to treatment and 6–8 weeks post-treatment, where we measured maximum SRF height and width, calculated the maximum height-to-maximum width-ratio (maxHWR) and calculated the total SRF volume. Results: Forty-one eyes of 39 cCSC patients were included. SRF morphology ranged from flat to dome-shaped, quantified as maxHWR ranging between 0.02 and 0.12. SRF volume was median 0.373 μl (range: 0.010–4.425 μl) and did not correlate to maxHWR (rho = −0.004, p = 0.982). Half-dose PDT was superior to HSML treatment in complete SRF resolution (RR = 3.28, p = 0.003) and in morphological changes of SRF (Δ maximum height, p = 0.001; Δ maximum width, p

Emerging evidence suggests that choroidal microcirculation and microstructural changes after verteporfin photodynamic therapy (vPDT) for chronic central serous chorioretinopathy (CSC) can be shown in detail using OCT-Angiography (OCT-A). The use of OCT-A for the examination of choriocapillaris (CC) has attracted significant attention as the technique offers potential explanations for the effects of vPDT on choroidal tissue.A meticulous literature search was performed in the PubMed database without restriction on year of publication until June 2021. The reference list of all electronically retrieved articles was carefully reviewed for potentially relevant articles that had not been identified.We identified and reviewed 11 studies reporting a comprehensive update on microvasculature and morphologic changes of the CC layer as seen on OCT-A in chronic CSC. The reviewed articles extensively analyze both the qualitative and quantitative characteristics of the CC flow pattern after applying vPDT safety-enhanced protocols. The changes in the CC plexus indicate the potential of beneficial or deleterious treatment effect on choroidal tissue remodeling. The reviewed series have revealed variability of flow pattern, vessel density, and perfusion of the CC over time.The CC plexus alterations during the post-vPDT period in chronic CSC may imply the treatment effect on choroidal tissue, indicating the potential of anatomical or functional recovery over time. The reviewed literature may confirm the diagnostic value of OCT-A in the assessment of the pathophysiology of eyes with CSC.

To investigate the prognostic factors on spectral domain optical coherence tomography (SD-OCT) associated with incomplete subretinal fluid (SRF) absorption in treated-naïve eyes with central serous chorioretinopathy (CSC) after the half-dose verteporfin photodynamic therapy (vPDT).Patients with CSC who underwent half-dose vPDT with a follow-up period of more than 3 months were included in this retrospective study. Logistic regression was performed to determine the risk factors associated with the SRF persistence at 3 months after the treatment.A total of 143 patients with 150 eyes were enrolled in this study (102 male and 41 female patients). The rate of complete SRF resolution was 82.7% at 3 months for all cases. The duration of symptoms 6 months (odds ratio [OR] = 3.135, 95% confidence interval [95% CI] (1.147-8.573), p = 0.026), larger SRF area with base diameter 3 mm (odds ratio (OR) = 4.051, 95% CI: 1.336-12.284, p = 0.013), and larger flat irregular pigment epithelium detachment (FI-PED) area with base diameter 1 mm (OR = 3.311, 95% CI: 1.249-8.780, p = 0.016) on OCT B-scans were risk factors for incomplete SRF absorption after half-dose vPDT, while outer nuclear layer (ONL) thickness was not significantly associated with the anatomical outcome (OR = 1.015, 95% CI: 0.995-1.036, p = 0.145).The duration of symptoms, baseline SRF, and FI-PED base diameter on SD-OCT were important predictors for the anatomical outcome at 3 months after half-dose vPDT. Further studies are needed to establish a better therapeutic strategy for patients with poor response to half-dose vPDT.

This study aims to evaluate choroidal vascular alterations in patients with central serous chorioretinopathy (CSC) using ultra-widefield (UWF) indocyanine green angiography (ICGA).This was a retrospective case-control study conducted at a single tertiary eye center. In total, 36 eyes in patients with either unilateral (24 patients) or bilateral (six patients) treatment-naïve CSC and 30 eyes in 24 age-matched controls were evaluated. The number of quadrants with vortex vein engorgement on UWF ICGA was evaluated. Dilated choroidal vessels affecting the macula were regarded as extended vortex vein engorgement. Choroidal vascular hyperpermeability (CVH) area on late-phase ICGA was quantified using stereographic projection. The parameters were compared with clinical and optical coherence tomographic findings.Eyes with CSC had larger CVH area, thicker choroid, and more quadrants with vortex vein engorgement and extended vortex vein engorgement compared with control eyes (all P 0.001). In patients with unilateral CSC, affected eyes had larger CVH area, thicker choroid, and more extended vortex vein engorgements compared with unaffected fellow eyes (all P 0.001), but vortex vein engorgement did not significantly differ. CVH was significantly correlated with extended vortex vein engorgement (P 0.001) and subfoveal choroidal thickness (P = 0.007).The increased number and binocular symmetry of engorged vortex veins suggest an anatomical predisposition for CSC. CVH area and extended vortex vein engorgement were indicators of choroidal outflow congestion. These parameters may serve as diagnostic clues or predictors of disease development in eyes with CSC.

To study optical coherence tomography (OCT) en face imaging approach to evaluate retinal pigment epithelium (RPE) alteration in central serous chorioretinopathy (CSC).Forty eyes with CSC were imaged with structural en face OCT, fluorescein angiography (FA), and fundus autofluorescence (FAF). Structural en face OCT projections were generated using a 200-µm slab with the inner limit at the outer choroid to register choroidal hypertransmission signal in transillumination manner. Two masked graders independently defined the area of RPE alteration on resultant images. Agreement between graders and correlation between imaging modalities was assessed by kappa coefficients (k) and intraclass correlation coefficients (ICC), respectively.The measurements derived from three methods were highly correlated with ICC of 0.99 (95% CI 0.99 to 1.0) for OCT and FA, 0.97 (95% CI 0.93 to 0.99) for OCT and FAF, and 0.98 (95% CI 0.95 to 0.99) for FA and FAF. For the measurement of the area of RPE alteration, kappa value for inter-grader agreement was 0.94 for OCT, 0.89 for FA, and 0.92 for FAF.En face OCT proved a reliable tool for the noninvasive evaluation of RPE status in CSC.

Central serous chorioretinopathy (CSC) is the fourth most common retinopathy and can reduce quality of life. CSC is assessed using optical coherence tomography (OCT), but deep learning systems have not been used to classify CSC subtypes. This study aimed to build a deep learning system model to distinguish CSC subtypes using a convolutional neural network (CNN). We enrolled 435 patients with CSC from a single tertiary center between January 2015 and January 2020. Data from spectral domain OCT (SD-OCT) images of the patients were analyzed using a deep CNN. Five-fold cross-validation was employed to evaluate the model’s ability to discriminate acute, non-resolving, inactive, and chronic atrophic CSC. We compared the performances of the proposed model, Resnet-50, Inception-V3, and eight ophthalmologists. Overall, 3209 SD-OCT images were included. The proposed model showed an average cross-validation accuracy of 70.0% (95% confidence interval [CI], 0.676–0.718) and the highest test accuracy was 73.5%. Additional evaluation in an independent set of 104 patients demonstrated the reliable performance of the proposed model (accuracy: 76.8%). Our model could classify CSC subtypes with high accuracy. Thus, automated deep learning systems could be useful in the classification and management of CSC.

Background Corticosteroids are widely used in medicine. Few cases of central serous chorioretinopathy (CSC) have been reported following topical corticosteroid administration. We describe the first case of pediatric CSC related to topical corticosteroid administration. Case presentation A 14-year-old boy presented with decreased vision, pigment epithelial detachments, and serous retinal detachments in the right eye after starting treatment for atopic dermatitis with Betamethasone Valerate 0.1% topical ointment. His condition resolved 2 weeks after discontinuing the steroid and administering Bromfenac 0.9 mg/ml eyedrops. Conclusions Although the pathogenesis of CSC is poorly understood, ophthalmologists should be informed about the potential link between CSC and topical corticosteroid treatment, and they should be aware that CSC might, albeit infrequently, affect children.

Erdafitinib is the first fibroblast growth factor receptor inhibitor approved by the U.S. Food and Drug Administration in April 2019 for the treatment of locally advanced and unresectable or metastatic urothelial carcinoma. Central serous chorioretinopathy is a common ocular adverse effect requiring frequent monitoring with ophthalmic examination.This study aimed to increase awareness of erdafitinib-induced central serous chorioretinopathy, highlight erdafitinib dose management guidelines, and emphasize the importance of collaborating with oncologists to prevent adverse visual consequences.An 80-year-old patient with an advanced urothelial cancer with fibroblast growth factor receptor mutations developed central serous chorioretinopathy when he was treated with daily 8 mg of erdafitinib. The erdafitinib-induced central serous chorioretinopathy resolved completely after the discontinuation of erdafitinib. He was then treated with daily 6 mg of erdafitinib and again developed central serous chorioretinopathy, which resolved completely upon discontinuation of the medication. The patient then decided to stop treatment with erdafitinib.Erdafitinib, a potent tyrosine kinase receptor inhibitor of fibroblast growth factor receptors 1 to 4, demonstrates antitumor activity in advanced urothelial carcinoma with fibroblast growth factor receptor mutations with a response rate of approximately 40%. However, central serous chorioretinopathy develops in 25% of patients treated with a daily 8-mg dose of erdafitinib. Although most mild to moderate erdafitinib-induced central serous chorioretinopathies resolve with dose interruption or reduction, occasionally discontinuation of the medication is necessary. Therefore, careful coordination with oncologists is important to assess the impact of erdafitinib on vision, quality of life, and survival prognosis.

La maladie à virus corona (COVID-19) peut provoquer de nombreuses manifestations oculaires. Nous rapportons un cas rare de choriorétinopathie séreuse centrale bilatérale, post-infection au COVID-19, chez une femme âgée de 38 ans qui s’est présentée pour un flou visuel bilatéral, 1 mois après l’infection au COVID-19. Elle avait de la fièvre, des frissons, une toux et un essoufflement avec fatigue et elle était positive au COVID-PCR. Pendant son séjour de 10 jours à l’hôpital, elle a reçu une oxygénothérapie, des antibiotiques, de l’héparine et des corticoïdes par voie intraveineuse puis relais par voie orale en ambulatoire. Après sa guérison du COVID-19, la patiente a développé une baisse progressive de l’acuité visuelle des 2 yeux : son acuité visuelle de loin corrigée était de 3/10 dans les 2 yeux, le segment antérieur était normal et le vitré était clair. L’examen du fond d’œil, complété par la tomographie en cohérence optique et l’angiographie à la fluorescéine a montré des décollements séreux rétiniens bilatéraux. L’évolution a été marquée par une amélioration de l’acuité visuelle et une régression des décollements séreux rétiniens. La choriorétinopathie séreuse centrale peut survenir après une infection au COVID-19 en raison de l’administration des corticoïdes et un contrôle ophtalmologique précoce est indispensable pour dépister au plus tôt une atteinte oculaire.

Purpose To investigate clinical and morphologic characteristics of serous retinal disturbances in patients taking extracellular signal-regulated kinase (ERK) inhibitors. Design Single-center retrospective study of prospectively collected data. Participants Of 61 patients receiving ERK inhibitors for treatment of metastatic cancer, this study included 40 eyes of 20 patients with evidence of retinopathy confirmed by OCT. Methods Clinical examination, fundus photography, and OCT were used to evaluate ERK inhibitor retinopathy. The morphologic features, distribution, and location of fluid foci were evaluated serially. Visual acuity (VA) and choroidal thickness measurements were compared at baseline, fluid accumulation, and resolution. Main Outcome Measures Characteristics of treatment-emergent choroid and retinal OCT abnormalities as compared with baseline OCT findings and the impact of toxicity on VA. Results Of 20 patients with retinopathy, most showed fluid foci that were bilateral (100%), multifocal in each eye (75%), and with at least 1 focus involving the fovea (95%). All subretinal fluid foci occurred between the interdigitation zone and an intact retinal pigment epithelium. No statistical difference was found in choroidal thickness at fluid accumulation and resolution compared with baseline. Forty-five percent of eyes showed evidence of concomitant intraretinal edema localized to the outer nuclear layer. At the time of fluid accumulation, 57.5% eyes showed a decline in VA (mainly by 1–2 lines from baseline). For all eyes with follow-up, the subretinal fluid and intraretinal edema were reversible and resolved without medical intervention, and best-corrected VA at fluid resolution was not statistically different from baseline. Concomitant intraretinal fluid was not associated with worsening of VA. No patient discontinued or decreased drug dose because of retinopathy. Conclusions This study showed that ERK inhibitors may cause subretinal fluid foci with unique clinical and morphologic characteristics. The observed foci were similar to mitogen-activated protein kinase kinase (MEK) inhibitor–associated retinopathy and distinct from central serous chorioretinopathy. However, unlike with MEK inhibitors, an increased occurrence of concomitant intraretinal fluid without significant additive visual impact seems to occur with ERK inhibitors. In this series, ERK inhibitors did not cause irreversible loss of vision or serious eye damage; retinopathy was self-limited and did not require medical intervention.

PURPOSE To assess the diagnostic accuracy of optical coherence tomography angiography (OCTA) compared with multimodal imaging for choroidal neovascularization (CNV) in central serous chorioretinopathy (CSC) eyes and to determine the features that predicted CNV. DESIGN Prospective cross-sectional study. METHODS Consecutive CSC patients were recruited from retina clinic. The reference standard for CNV was determined by interpretation of multimodal imaging with OCTA, structural OCT line scan, fluorescein angiography (FA), indocyanine green angiography (ICGA), ultra-widefield fundus photography and fundus autofluorescence (FAF). Two independent masked graders examined OCTA without FA and ICGA to diagnose CNV. Univariate and multivariate analyses were performed to evaluate factors associated with CNV. RESULTS CNV was detected in 69 eyes in 64 out of 277 CSC patients according to reference standard. The two masked graders who examined OCTA had sensitivity of 81.2% (95% Confidence Interval [CI], 71.9%-90.4%) and 78.3% (95% CI, 68.5%-88.0%), specificity of 97.3% (95% CI, 95.9%-98.8%) and 96.2% (95% CI, 94.5%-98.0%), positive predictive values of 82.4% (95% CI, 73.3%-91.4%) and 76.1% (95% CI, 66.1%-86.0%), and negative predictive values of 97.1% (95% CI, 95.6%-98.7%) and 96.7% (95% CI, 95.0%-98.3%). Their mean area under the receiver operating characteristic curve (AUC) was 0.88 with good agreement (Kappa coefficient 0.80 [95% CI, 0.72-0.89]). Flat irregular pigment epithelial detachment on structural OCT, neovascular network on OCTA and ill-defined late leakage on FA significantly correlated with CNV in CSC from multiple regression (P CONCLUSIONS There is discordance between OCTA and multimodal imaging in diagnosing CNV in CSC. This study demonstrated the caveats in OCTA interpretation, such as small extrafoveal lesions and retinal pigment epithelial alterations. Comprehensive interpretation of OCTA with dye angiography and structural OCT is recommended.

Background and Objective: A previous report demonstrated efficacy of mineralocorticoid antagonist with adjuvant topical dexamethasone (MRA+DEX) in resolving subretinal fluid (SRF) in a chronic central serous chorioretinopathy (CSCR) patient. This pilot study investigates the use of MRA+DEX to treat recalcitrant, chronic CSCR patients. Study Design: Retrospective review of chronic, recalcitrant CSCR patients unresponsive to MRA alone who were treated with MRA+DEX and followed for up to 3 months. Apical SRF thickness and visual acuity were measured. Results: Ten eyes of eight chronic, recalcitrant patients were included with an average follow-up of 109 days. Mean percent reduction in apical fluid thickness at one month and at last follow-up after adding dexamethasone (DEX) was 33% and 52%, respectively. Five eyes (50%) achieved complete resolution of SRF. Three eyes (30%) showed partial response and two (20%) eyes had no response. There was no significant change in visual acuity. Conclusions: MRA+DEX decreased SRF in some recalcitrant, chronic CSCR patients. Large prospective studies are needed to evaluate the utility of MRA+DEX in these chronic CSCR patients. [ Ophthalmic Surg Lasers Imaging Retina 2022;53:659–665.]

The study aims to investigate the morphological integrity of the outer retinal layers (ORLs) (an ellipsoid layer (EL) + external limiting membrane) and visual prognosis in chronic central serous chorioretinopathy (CSCR) with subretinal fluid (SRF) completely resorbed after half-dose photodynamic therapy (HD PDT) using enhanced-depth imaging (EDI) spectral domain optical coherence tomography (SD-OCT). This retrospective study included 40 eyes of 38 chronic CSCR patients treated with HD PDT between December 2012 and June 2016. However, only 34 eyes (85%) with complete SRF resorption 3 months after HD PDT had their 6th and 12th month data analyzed. Morphological integrity of the ORLs was further analyzed in relation to best-corrected visual acuity (BCVA) and disease duration. Thirty-four eyes of 34 patients (male/female: 82.35/17.65%) with mean age of 49.90 ± 7.80 (32–61) years were studied. The mean logMAR BCVA improved significantly from 0.52 ± 0.31 at baseline to 0.34 ± 0.36 and 0.26 ± 0.26 at the 6th and 12th months after HD PDT, respectively (p < 0.001). The proportion of eyes with completely normal morphological ultrastructural integrity of the ORLs was 44.12% at the 6th month, which increased to 64.71% at the 12th month after HD PDT. However, the EL morphological disruption was associated with significantly lower mean logMAR BCVA 12 months after HD PDT (p = 0.029). The disease duration had no effect on mean logMAR BCVA gain. Even after complete resorption of serous neurosensory retinal detachment after HD PDT in chronic CSCR, the ORLs, especially the EL, may not be anatomically restored. The EL morphological ultrastructural integrity seems to be the most important factor influencing visual prognosis. © 2022, The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.

Drusen are precursor lesions to advanced age-related macular degeneration. Although cuticular drusen are located between the retinal pigment epithelium and Bruch's membrane, as are conventional drusen, they possess unique characteristics that are distinct from those of conventional drusen on clinical presentations. Central serous chorioretinopathy (CSC) is a rare complication in eyes with cuticular drusen.A 58-years-old man was referred to our institute for the treatment of persistent subretinal fluid (SRF) in both eyes. Spectral-domain optical coherence tomography revealed focal SRF that did not involve the central macula of the right eye and SRF in the central macula of the left eye. Fluorescein angiography exhibited focal leakage corresponding to SRF and hyperfluorescence resembling a "stars in the sky" appearance in both eyes. On initial presentation, the best-corrected visual acuity values were 1.2 and 0.9 in the right and left eye decimal formats, respectively.Cuticular drusen presenting with CSC in both eyes.No treatment was administered for CSC in the right eye, whereas photodynamic therapy was administered for CSC in the left eye.At the 6-month visit, extrafoveal SRF persisted in the right eye and resolved in the left eye. Best-corrected visual acuity improved from 0.9 to 1.2 in the decimal format in the left eye.Although cuticular drusen presenting with CSC are rare, physicians should be aware of the possibility of CSC development in eyes with cuticular drusen.

The pachychoroid disease spectrum (PDS) includes several chorioretinal diseases that share specific choroidal abnormalities. Although their pathophysiological basis is poorly understood, diseases that are part of the PDS have been hypothesized to be the result of venous congestion. Within the PDS, central serous chorioretinopathy is the most common condition associated with vision loss, due to an accumulation of subretinal fluid in the macula. Central serous chorioretinopathy is characterized by distinct risk factors, most notably a high prevalence in males and exposure to corticosteroids. Interestingly, sex differences and corticosteroids are also strongly associated with specific types of arteriovenous anastomoses in the human body, including dural arteriovenous fistula and surgically created arteriovenous shunts. In this manuscript, we assess the potential of such arteriovenous anastomoses in the choroid as a causal mechanism of the PDS. We propose how this may provide a novel unifying concept on the pathophysiological basis of the PDS, and present cases in which this mechanism may play a role.

Purpose There is no widely accepted treatment for persistent/chronic central serous chorioretinopathy. The present study aimed to evaluate the efficacy, safety, and factors associated to treatment response to navigated micropulse laser in chorioretinopathy. Methods Retrospective observational case series including consecutive patients presenting with symptomatic persistent and chronic chorioretinopathy. All patients were treated with 5% navigated micropulse laser with the Navilas system (Navilas®, OD-OS GmBH, Teltwo, Germany), by overlying fluorescein angiography, indocyanine green angiography and/or spectral domain-optical coherence tomography images of visible leaking points and/or choroidal hyperpermeability/subretinal fluid to plan the laser treatment. Results Thirty-nine eyes of 36 consecutive patients (29 men and 7 women, with a mean age of 51.87 years) were included. Logarithm of the minimum angle of resolution (LogMar) best-corrected visual acuity increased from 0.39 ± 0.24 at baseline to 0.24 ± 0.22 at 3 months ( p Conclusion Navigated micropulse laser laser treatment was found to be effective and safe for the treatment of chorioretinopathy, with significant improvement in visual and anatomical outcomes, unaccompanied by any adverse event at 3 and 6 months follow-up. Factors associated to subretinal fluid resolution may allow a better selection of likely responders to navigated micropulse laser treatment.

Contains fulltext : 244034.pdf (Publisher’s version ) (Open Access) PURPOSE: To describe the treatment outcomes and recurrence risk of chronic central serous chorioretinopathy (cCSC) in patients who had complete resolution of subretinal fluid (SRF) after either primary half-dose photodynamic therapy (PDT) or high-density subthreshold micropulse laser (HSML) in the PLACE trial. METHODS: This multicentre prospective follow-up study evaluated cCSC patients at 1 year after completion of the PLACE trial. Outcomes included: complete resolution of SRF on OCT, best-corrected visual acuity (BCVA) in Early Treatment of Diabetic Retinopathy Study (ETDRS) letters, retinal sensitivity on microperimetry and a visual function questionnaire (NEI-VFQ25). RESULTS: Twenty-nine out of 37 patients who received half-dose PDT and 15 out of 17 patients who received HSML could be evaluated at final visit. At final visit, 93% of the patients treated with half-dose PDT had complete resolution of SRF, compared with 53% of HSML-treated patients (p = 0.006). At final visit, the mean estimate increase in the PDT group compared with the HSML group was + 2.1 ETDRS letters, +0.15 dB for the retinal sensitivity and + 5.1 NEI-VFQ25 points (p = 0.103, p = 0.784 and p = 0.071, respectively). The mean estimated central retinal thickness in the half-dose PDT group was -7.0 µm compared with the HSML group (p = 0.566). The mean estimated subfoveal choroidal thickness in the half-dose PDT group was -16.6 µm compared with the HSML group (p = 0.359). CONCLUSION: At 20 months after treatment, cCSC patients successfully treated with half-dose PDT are less likely to have recurrences of SRF compared with those successfully treated with HSML. However, functional outcomes did not differ.

Purpose To describe pulsatile filling of dilated choroidal veins in the watershed zones and propose an alteration in choroidal perfusion pressure. Methods Retrospective review of original and digital subtraction indocyanine green angiography. Results We observed pulsating blood flow within choroidal vein segments in the posterior pole in 14 eyes (diagnosis of polypoidal choroidal vasculopathy, central serous chorioretinopathy, or neovascular age-related macular degeneration). Pulsating dye front was observed in single or multiple large choroidal vein(s) in a location that is ordinarily a watershed zone between the segmental areas of venous drainage, and vessels proximal and distal were often dilated. The pulsatile venous segments filled more slowly than the neighboring veins. In digital subtraction indocyanine green angiography, the dye front advanced in an incremental fashion or oscillated in a back-and-forth manner during several cardiac cycles during the filling of these larger choroidal veins. With indocyanine green angiography, we observed dilated choroidal veins that violated the macula watershed zone, localized bulbous dilations, and arteriole-over-vein crossings with apparent compression. Conclusion These novel observations suggest the pressure gradient for flow in the affected veins varied from low gradients when the filling was slow to high gradients when the filling was faster. The vessels violated the physiological watershed zone and seem to function as anastomoses between the ordinarily segmented venous drainage of the choroid. The dilated segments may result in pooling of venous blood as part of venous outflow abnormalities that may be operative in these diseases.

The pathogenesis of central serous chorioretinopathy (CSCR), a pachychoroid disease, is poorly understood. While choroid hyperpermeability and retinal pigment epithelium dysfunction are cornerstones for developing CSCR, the mechanisms at the retinal, vascular, retinal pigment epithelium, and cellular level continue to be an enigma. A few preclinical studies and the development of small-sized, poorly controlled clinical trials have resulted in limited insight into the disease mechanism. Effective treatments for CSCR are still lacking as current trials have produced inconsistent results for functional and structural gains. Thus, critically evaluating the literature to explore disease mechanisms and provide an up-to-date understanding of pathophysiology can provide valuable information and avenues to new treatments. In this study, a comprehensive summary of the mechanistic insight into CSCR is presented while highlighting the shortcomings of current literature. The mechanism was divided into seven sub-categories including mechanical obstruction, inflammation, oxidative stress, paracrine factors, autonomic dysfunction, mineralocorticoid receptors activation, and medications. We implemented validated tools like the JBI and CAMARADES to objectively analyze the quality of both clinical and preclinical studies, respectively. Overall, our analysis of the literature showed that no single mechanism was populated with a large number of sufficiently sized and good-quality studies. However, compiling these studies gave hints not only to CSCR pathogenesis but also pachychoroid disease in general while providing suggestions for future exploration.摘要: 中心性浆液性脉络膜视网膜病变 (central serous chorioretinopathy, CSCR) 为肥厚性脉络膜疾病, 其发病机制尚不清楚。虽然脉络膜高通透性和视网膜色素上皮功能障碍是CSCR发生的基础, 但其在视网膜、血管、视网膜色素上皮和细胞水平上的机制仍是一个谜。一些临床前研究和小规模、控制不佳的临床试验的进展使我们对疾病机制的了解有限。由于目前的试验对CSCR的功能和结构获得的结果不一致, 因此仍然缺乏有效的治疗方法。因此, 批判性地评估文献以探索疾病机制, 并提供病理生理学方面的最新理解, 可为新的治疗方法提供有价值的信息和途径。在本研究中, 我们全面总结了CSCR的机制, 并强调了当前文献的不足之处。我们将其机制分为机械性阻塞、炎症、氧化应激、旁分泌因子、自主神经功能障碍、盐皮质激素受体激活和药物治疗等7个亚类。我们使用JBI和CAMARADES等验证工具分别客观分析临床和临床前研究的质量。总之, 我们对文献的分析表明, 缺乏大量足够大的、高质量的研究支持某个单一的机制。然而, 这些研究的汇总不仅为CSCR的发病机制提供了线索, 也提示了厚脉络疾病的一般发病机制, 同时为未来的探索提供了建议。.

Purpose: To study interocular asymmetry in distribution of leaks in central serous chorioretinopathy (CSC). Material and methods: Patients with unilateral CSC were included in this retrospective multicenter study. All patients received multimodal imaging. The prevalence of leaks within 1 disk diameter (DD) peripapillary area and the mean shortest distance between a leak and the optic disk edge was analyzed for the right and left eyes separately based on FA images. Clinical and morphological characteristics were collected and compared between eyes with a peripapillary leak and eyes with a leak elsewhere. Results: In total, 152 eyes (77 right eyes and 75 left eyes) of 152 patients (128 males and 24 females) with a mean age of 45.2 ± 9.8years were included. The mean distance from the leak to the edge of the optic disk was statistically significantly lower (p = 0.0003), and the prevalence of the leaks within the 1 DD-peripapillary area was higher in the left eye than in the right eye (32.1% versus 10.7%, respectively, p = 0.0017). The eyes with a peripapillary leak had a longer duration of the disease (p < 0.05), a wider area of retinal pigment epithelium alteration (p < 0.001), and a higher prevalence of outer retinal atrophy (p < 0.001) compared to the eyes with a leak elsewhere. Conclusion: The left eye showed closer location of the leak to the optic disk edge and higher prevalence of leaks within the peripapillary area. The cases with peripapillary leak commonly demonstrated characteristics of chronic CSC despite relative preservation of visual acuity.

Purpose: To study structural and functional outcomes of cystoid macular degeneration (CMD) in chronic central serous chorioretinopathy (CSCR). Methods: This retrospective study included 26 eyes having chronic CSCR with CMD who underwent either observation, photodynamic therapy (PDT), micropulse laser, or eplerenone therapy. Various optical coherence tomography parameters were analyzed at baseline and 1 year. Results: Number of eyes that maintained or gained vision after treatment was 63.1%, compared to a loss of 2.1 ± 1.1 lines in observation group. Sub-foveal large choroidal vessel responded to PDT ( p = 0.03); while CMT ( p = 0.035) and intra-retinal cystoid spaces (0.037) responded to eplerenone. Longer duration of the symptoms and round cystoid spaces were associated with a decrease in CMT ( p = 0.03) and decrease in cystoid spaces size ( p = 0.02) respectively on follow up. Conclusion: Treatment of eyes with CMD prevents further deterioration of vision. Round configuration of intra-retinal cystoid space has a better anatomical outcome.

Patients with unilateral central serous chorioretinopathy showed a decreased density of foveal cones measured by adaptive optics in their asymptomatic fellow eye. These results suggest that photoreceptors could be altered independently of the occurrence of a serous retinal detachment., Purpose: To investigate cone density in the asymptomatic fellow eye of patients with unilateral central serous chorioretinopathy (CSCR). Methods: Seventeen asymptomatic fellow eyes of patients with unilateral CSCR and 17 eyes of aged-matched and gender-matched healthy controls underwent adaptive optics ophthalmoscopy. Cone density and spacing were assessed at the fovea. Clinical and multimodal imaging findings were also recorded. Results: In the CSCR group, the patient mean age was 48.9 ± 9.8 years. The mean (±SD) subfoveal choroidal thickness was 417.8 ± 125.2 µm. The foveal external limiting membrane and ellipsoid zone were intact in all patients. Adaptive optics fundus imaging showed a significant decrease in cone density at 2° of eccentricity nasal and temporal to the fovea in asymptomatic fellow eyes of patients with unilateral CSCR compared with controls (P = 0.001 and P = 0.027, respectively). No statistically significant difference in cone density was found at 4° of eccentricity nasal and temporal to the fovea between both groups. Conclusion: Asymptomatic fellow eyes of patients with unilateral CSCR showed a reduced density of foveal cones in the absence of a decreased visual acuity and photoreceptor line disruption on optical coherence tomography. These results suggest that the photoreceptors could be damaged independently of the occurrence of a serous retinal detachment.

OBJECTIVES To investigate the threshold thickness of the foveal outer nuclear layer (ONL) associated with favourable visual outcome after half-dose photodynamic therapy (PDT) in patients with central serous chorioretinopathy (CSC). METHODS The CSC patients were divided into two groups according to whether their best-corrected visual acuity (BCVA) at 1 year after half-dose PDT was 20/20 or worse than 20/20. Three multivariable logistic regression models were respectively created to determine the prognostic value of the pre-PDT foveal ONL thickness, the pre- and the post-PDT foveal ONL thickness ratio, which was defined as the foveal ONL thickness in the CSC eye to that in the normal contralateral eye, for predicting the outcome of half-dose PDT. The areas under the receiver operating characteristic curves (AUCs) were compared and the best cut-off values were determined, respectively. RESULTS Totally, 134 patients were included. The pre-PDT foveal ONL thickness, the pre-PDT and the post-PDT foveal ONL thickness ratios were all independent predictors of the outcome after half-dose PDT in their respective model (all P

The choroid is directly adjacent to the retina and consists of a dense vascular network that supplies the outer retina. Pathologies in the choroid can lead to changes in the retinal pigment epithelium (RPE) and photoreceptors. Thus, the choroid plays a crucial role in the development of retinal diseases such as age-related macular degeneration (AMD), central serous chorioretinopathy (CSCR), pathologic myopia, and inflammatory diseases such as Vogt-Koyanagi-Harada syndrome (VKH). Basic knowledge of the structure and physiology of the choroid, as well as diagnostic options for visualizing choroidal changes, provides a better understanding of the physiology and pathology of choroidal processes. This review provides an overview of the anatomy and function of the choroid, and describes the diagnostic techniques currently available to characterize and visualize the choroid. It also includes an overview of various retinal conditions, which are associated with choroidal changes.Die Aderhaut oder Choroidea liegt direkt außerhalb der Netzhaut an und besteht aus einem dichten Gefäßnetz, das die äußere Netzhaut versorgt. Pathologien im Bereich der Aderhaut können zu Veränderungen des retinalen Pigmentepithels (RPE) und der äußeren Netzhautschichten führen. Die Aderhaut spielt somit eine entscheidende Rolle bei der Entstehung von Netzhauterkrankungen wie der altersabhängigen Makuladegeneration (AMD), der Chorioretinopathia centralis serosa (CRCS, CSCR, RCS), der pathologischen Myopie und bei inflammatorischen Erkrankungen wie dem Vogt-Koyanagi-Harada-Syndrom (VKH). Die grundlegende Kenntnis des Aufbaus und der Physiologie der Aderhaut sowie der diagnostischen Optionen zur Darstellung von choroidalen Veränderungen ermöglicht ein besseres Verständnis der Physiologie und Pathologie choroidaler Prozesse. Diese Arbeit bietet einen Überblick der Anatomie und Funktion der Choroidea und beschreibt die aktuell verfügbaren diagnostischen Verfahren zur Charakterisierung und Darstellung der Aderhaut. Anschließend werden verschiedene Krankheitsbilder, die mit choroidalen Veränderungen assoziiert sind, beleuchtet.

To investigate features of central serous chorioretinopathy with choroidal neovascularization (CNV) on multimodal imaging and analyze their association with treatment response.A total of 37 patients with chronic central serous chorioretinopathy complicated by CNV were divided into bevacizumab and photodynamic therapy groups, and each group was subdivided into responders and nonresponders according to subretinal fluid status at 3 months. We assessed multimodal imaging parameters (subfoveal choroidal thickness; vortex vein engorgement; choroidal vascular hyperpermeability; and CNV morphologic pattern, area, and vessel density) and analyzed their association with treatment responses.Responders in the bevacizumab group showed thinner subfoveal choroidal thickness (384.0 ± 103.2 vs. 398.3 ± 87.1 µm, P = 0.042), smaller CNV area (0.512 ± 0.267 vs. 1.323 ± 0.481 mm2, P = 0.007), open-circuit pattern (84.6% vs. 12.5%, P0.001), and capillary fringe (69.2% vs. 37.5%, P = 0.001) than nonresponders. Responders in the photodynamic therapy group had thicker subfoveal choroidal thickness (420.1 ± 93.5 vs. 395.7 ± 6.5 µm, P = 0.021), more quadrants with engorged vortex veins extending to the macula (P = 0.012), and intense choroidal vascular hyperpermeability (57.1% vs. 50.0%, P = 0.026) than nonresponders. Choroidal neovascularization showing closed-circuit pattern (85.7% vs. 0%, P = 0.001) and peripheral loop (64.3% vs. 0%, P = 0.001) demonstrated a good response to photodynamic therapy.Heterogeneous features of choroidal hyperpermeability, thickness, and CNV morphology in CNV accompanying central serous chorioretinopathy are associated with different therapeutic responses to bevacizumab and photodynamic therapy treatments.

Central serous chorioretinopathy (CSC), characterized by serous detachment of the macular retina, can cause permanent vision loss in the chronic course. Chronic CSC is generally treated with photodynamic therapy (PDT), which is costly and quite invasive, and the results are unpredictable. In a retrospective case–control study design, we developed a two-stage deep learning model to predict 1-year outcome of PDT using initial multimodal clinical data. The training dataset included 166 eyes with chronic CSC and an additional learning dataset containing 745 healthy control eyes. A pre-trained ResNet50-based convolutional neural network was first trained with normal fundus photographs (FPs) to detect CSC and then adapted to predict CSC treatability through transfer learning. The domain-specific ResNet50 successfully predicted treatable and refractory CSC (accuracy, 83.9%). Then other multimodal clinical data were integrated with the FP deep features using XGBoost.The final combined model (DeepPDT-Net) outperformed the domain-specific ResNet50 (accuracy, 88.0%). The FP deep features had the greatest impact on DeepPDT-Net performance, followed by central foveal thickness and age. In conclusion, DeepPDT-Net could solve the PDT outcome prediction task challenging even to retinal specialists. This two-stage strategy, adopting transfer learning and concatenating multimodal data, can overcome the clinical prediction obstacles arising from insufficient datasets.

We aimed to quantitatively compare the choroid blood flow and choroid thickness at the periphery among eyes with central serous chorioretinopathy (CSC), fellow eyes and healthy eyes using ultra-widefield swept-source optical coherence tomography angiography (UWF SS-OCTA). Retrospective analysis of 49 patients with CSC (98 eyes, including unaffected fellow eyes) and 49 age and sex matched controls were included. We obtained 3-dimensional data of vertical 20 mm × horizontal 24 mm × scan depth 6 mm, comprising 9 subfields (superotemporal, upper, superonasal, temporal, central, nasal, inferotemporal, lower, inferonasal regions). CSC eyes presented with greater density of large-vessel choroidal layer in all the 9 subfields compared with controls. Compared with normal eyes, CSC eyes had greater choroidal thickness (superotemporal, upper, superonasal, temporal, central, nasal, inferotemporal, and inferonasal subfields) and choroidal volume (superotemporal, upper, superonasal, temporal, central, and nasal subfields). Compared with control eyes, the choriocapillaris density in the superotemporal, inferotemporal and inferonasal subfields was greater in patients with CSC. Our study may provide further evidence for the congestion of vortex vein in the pathogenesis of CSC. UWF SS-OCTA can be used to evaluate the abnormalities of the choroidal structures even at the periphery in eyes with CSC.

This retrospective study aimed to evaluate choroidal hemodynamics after half-dose photodynamic therapy (PDT) for central serous chorioretinopathy (CSC) and the effects of smoking using laser speckle flowgraphy. This study included 29 eyes of 29 patients treated with half-dose PDT for CSC, who were followed-up for at least 6 months. The mean blur rate (MBR) in the PDT irradiation area (whole area), the pachyvessel (PV) area, non-PV (NPV) area, and filling delay (FD) area were assessed at baseline and 1, 3, and 6 months post-PDT, respectively. The MBR was also assessed by smoking status. The MBR significantly decreased from baseline in the whole, PV, NPV, and FD areas at all time points (P P = 0.021), PV (P = 0.009), and NPV (P = 0.034) areas, but not in the FD area (P = 0.172). Half-dose PDT for CSC reduced choroidal blood flow in the PDT-irradiated area, which was blunted by current smoking status.

Purpose: To compare the efficacy and safety of crossover treatment to half-dose photodynamic therapy (PDT) and eplerenone treatment after the failure of primary treatment in patients with chronic central serous chorioretinopathy (cCSC). Design: Multicenter crossover clinical trial. Subjects: At 3 months after the baseline visit of the SPECTRA (Half-Dose Photodynamic Therapy Versus Eplerenone: Treatment Trial for Chronic Central Serous Chorioretinopathy) randomized controlled trial, either half-dose PDT or eplerenone treatment was evaluated for each patient, and patients who still demonstrated subretinal fluid (SRF) were included in the current study, the SPECS (Central Serous Chorioretinopathy Treated with Half-Dose PDT or Eplerenone Crossover Study) trial. Methods: At the baseline visits for the current SPECS trial, crossover treatment was performed for patients who still demonstrated SRF. These patients received either half-dose PDT or oral eplerenone for 12 weeks. Both anatomic and functional parameters were evaluated 3 months after crossover treatment. Main Outcome Measures: Complete resolution of SRF on OCT. Results: Forty-nine patients were included in the SPECS trial (38 received primary eplerenone treatment; 11 received half-dose PDT). At 3 months after crossover treatment, 32 of 37 (86.5%) in the crossover to half-dose PDT group and 2 of 9 (22.2%) in the crossover to eplerenone group had complete SRF resolution (P = 0.030). The mean foveal sensitivity increased significantly more in the crossover to half-dose PDT group (mean, +3.08 dB) compared with the crossover to eplerenone group (mean, -0.27 dB; P = 0.009). Conclusions: Patients with cCSC with the persistence of SRF after primary eplerenone treatment can benefit from half-dose PDT, which can induce a relatively fast and complete SRF resolution, along with an improvement in foveal sensitivity. (C) 2022 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology

Weiming Yan1,2 &ast;, Pan Long3 &ast;, Lei Zhang4 &ast;, Meizhu Chen,1 Zuoming Zhang,2 Tao Chen2 1Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hospital Affiliated to Xiamen University), Fuzhou, People’s Republic of China; 2Department of Clinical Aerospace Medicine, The Air Force Medical University, Xi’an, People’s Republic of China; 3Department of Ophthalmology, The General Hospital of Western Theatre Command, PLA, Chengdu, People’s Republic of China; 4Department of Ophthalmology, The Shaanxi Eye Hospital, Xi’an People’s Hospital (Xi’an Fourth Hospital), Affiliated Guangren Hospital, School of Medicine, Xi’an Jiaotong University, Xi’an, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Meizhu Chen, Email jumychen@126.com Tao Chen Email baiidtf0506@126.comPurpose: To explore the temporal topography of the chorioretinopathy in an animal model of central serous chorioretinopathy (CSC) induced by intravenous injection of adrenalin in the Chinchilla rabbits.Methods: Ten Chinchilla rabbits received a daily intravenous injection of adrenaline at 0.04 mg/kg for 8 weeks. Fluorescence fundus angiography (FFA) and electroretinogram (ERG) were performed every week afterwards to see whether there was fluorescence leakage in the fundus and to evaluate the retinal function. Indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were also conducted to detect the change of choroidal vessels. Finally, the eyes of the rabbits were enucleated to make the retinal sections for histological examination with hematoxylin–eosin (HE) staining.Results: Within 8 weeks of the adrenalin administration, 7 out of the 10 rabbits showed different degrees of fluorescence leakage on FFA. The leakage was more obvious during 2– 3 weeks after the adrenalin administration. With the progress of disease, the leakage subsided gradually and a scar-like lesion formed. ICGA revealed the local choroidal ischemia and the dilated choroidal vessels. An obvious detachment of retina and an increased thickness of the choroid were found on OCT, which was most obvious 2 weeks after the adrenalin administration (P< 0.01). ERG revealed no obvious decline of the b-wave amplitude before and after the adrenalin administration (P> 0.05). A circumscribed retinal detachment, the depigmentation of retinal pigment epithelium and enlarged choroidal vessels were shown by the histological examination.Conclusion: The temporal topography of the chorioretinopathy in the Chinchilla rabbits by intravenous injection of adrenaline somewhat mimicked that of the human CSC, which could enhance its application in the exploration for the pathogenesis and the therapeutic measures for human CSC.Keywords: central serous chorioretinopathy, adrenaline, Chinchilla rabbits, choroid

Background To compare swept-source optical coherence tomography angiography (SS-OCTA) and indocyanine green angiography (ICGA) in patients with central serous chorioretinopathy (CSC). Methods SS-OCTA and ICGA images of 39 eyes with symptomatic CSC were collected and aligned. Spatial overlap of the annotations of the coarse granulated high reflective area on choriocapillary OCTA and the hyperfluorescence area on mid-phase ICGA was calculated according to the Jaccard index (JI). SS-OCTA findings of fellow eyes and changes in SS-OCTA abnormalities during the follow-up were also analyzed. Results Three main types of abnormalities in choriocapillaris SS-OCTA images were found: type A, coarse granulated high reflective area (39 eyes [100%]); type B, roundish dark halo around Type A (32 eyes [82.1%]); and type C, coarse granulated low reflective area (39 eyes [100%]). The mean JI of type A on SS-OCTA and the hyperfluorescence area on ICGA were 0.55 ± 0.15 for grader 1 and 0.49 ± 0.15 for grader 2. The mean area of type A abnormalities on SS-OCTA and hyperfluorescence on ICGA was 3.976 (IQR, 2.139–8.168) and 3.043 (IQR, 1.408–4.909) mm2 (P = 0.199). The areas of type A, B and C abnormalities on SS-OCTA after laser treatment or observation were 3.36mm2 (IQR, 2.399–9.312), 2.9mm2 (IQR, 2.15–3.7), and 0.19mm2 (IQR, 0.08–0.23), respectively, which was smaller than those in the baseline (7.311mm2 (IQR 3.788–11.209), P 2 (IQR, 2.8–9.8), P = 0.002;0.33mm2 (IQR, 0.23–0.38), P P = 0.679, 0.732, and 0.892). Conclusion The coarse granulated high reflective area in SS-OCTA corresponded well with the hyperpermeability area in ICGA. SS-OCTA promotes noninvasive visualization and follow-up quantifications of the choroidal vasculature in CSC patients.

Diagnosis retinal abnormalities in Optical Coherence Tomography (OCT) images assist ophthalmologist in the early detection and treatment of patients. To do this, different Computer Aided Diagnosis (CAD) methods based on machine learning and deep learning algorithms have been proposed. In this paper, wavelet scattering network is used to identify normal retina and four pathologies namely, Central Serous Retinopathy (CSR), Macular Hole (MH), Age-related Macular Degeneration (AMD) and Diabetic Retinopathy (DR). Wavelet scattering network is a particular convolutional network which is formed from cascading wavelet transform with nonlinear modulus and averaging operators. This transform generates sparse, translation invariant and deformation stable representations of signals. Filters in the layers of this network are predefined wavelets and not need to be learned which causes decreasing the processing time and complexity. The extracted features are fed to a Principal Component Analysis (PCA) classifier. The results of this research show the accuracy of 97.4% and 100% in diagnosis abnormal retina and DR from normal ones, respectively. We also achieved the accuracy of 84.2% in classifying OCT images to five classes of normal, CSR, MH, AMD and DR which outperforms other state of the art methods with high computational complexity. Clinical Relevance- Clinically, the manually checking of each OCT B-scan by ophthalmologists is tedious and time consuming and may lead to an erroneous decision specially for multiclass problems. In this study, a low complexity CAD system for retinal OCT image classification based on wavelet scattering network is introduced which can be learned by a small number of data.