Optical coherence tomography characterisation of idiopathic central serous chorioretinopathy

Abstract

Aim: To describe retinal findings in patients with idiopathic central serous chorioretinopathy (ICSC) as assessed by optical coherence tomography (OCT), and to compare them to fluorescein angiography (FA) findings.

Methods: Case series of 39 eyes from 36 patients with ICSC. Complete ophthalmological examination, last generation OCT (StratusOCT, Software version 3.1) and FA were performed. Six radial scans using OCT were performed and repeated. Singular findings were recorded, OCT images were measured and the results compared with those of FA. The main outcome measures were FA and OCT findings.

Results: Two patterns of distinct OCT findings are described. In the first one, an optically empty vaulted area of different heights was observed under the neurosensory retina in 36 eyes, being related to fluorescein filled areas; in 35 of them, highly characteristic small bulges could be observed protruding from the retinal pigment epithelium (RPE), angiographically related to leaking spots. In the second pattern, three eyes showed an almost semicircular space under the RPE, with thinner overlying retina.

Conclusions: OCT may offer a new approach to the staging and knowledge of ICSC, and may help the understanding of the mechanisms of the disease.

Figure 1

(A-C) Optical coherence tomography (OCT) in acute forms shows bulges protruding from retinal pigment epithelium (RPE) layer under an optically empty space. Integrity of RPE underneath shows absence of RPE detachment. (C) Shows foveal distortion (lack of foveal pit, red arrow) and intraretinal cysts (arrowhead). (D) OCT shows shallow fluid accumulation with hyper-reflective underlying RPE (arrow). (E) and (F) OCT in chronic forms shows vaulted sub-RPE spaces, proving the presence of RPE detachment (arrows). Overlying retina is thinner than normal. Note RPE difference compared to (A)–(C) in which RPE remains in place.

Figure 2

(A–C) Fluorescein angiograms (FA) of eyes shown in figure 1A–C, respectively. Arrows show the direction of OCT scans. Note the correspondence of angiographic leaking spots with OCT bulges previously described. (D) FA of eye in figure 1D. Atrophic and hypertrophic patches in RPE can be seen in the macula. Arrow shows the direction of OCT scan. (E) and (F) Show FA of eyes in figure 1D and E, respectively. Note the accumulation of fluorescein corresponding to RPE detachments in OCT in figure 1. Arrows show the direction of OCT scans.