FUNDUS AUTOFLUORESCENCE PATTERNS IN CENTRAL SEROUS CHORIORETINOPATHY

Abstract

Purpose: To investigate the patterns of fundus autofluorescence (FAF) abnormalities in patients with central serous chorioretinopathy (CSC).

Methods: This cross-sectional observational study included 126 eyes of 118 patients who were diagnosed with central serous chorioretinopathy from December 2006 to April 2012 at Kyung Hee University Hospital, Seoul, Korea. Fundus autofluorescence patterns were analyzed with spectral domain optical coherence tomography and visual acuity.

Results: Fundus autofluorescence patterns were grouped as blocked (38.9%), mottled (8.7%), hyper (31.0%), hyper/hypo (13.5%), or descending tract (8.0%). The duration of symptoms was 7.8 (±20.4), 28.3 (±31.8), 42.5 (±69.1), 163.8 (±183.5), and 174.5 (±162.3) days in the blocked, mottled, hyper, descending tract, and hyper/hypo groups, respectively (P < 0.001). The blocked FAF group had the best visual acuity (P = 0.011). The intact ellipsoid zone on the spectral domain optical coherence tomography was mostly found in the blocked FAF group (P < 0.001), and the disrupted ellipsoid zone was commonly exhibited in the hyper/hypo and descending tract groups. Disrupted external limiting membrane line on the spectral domain optical coherence tomography was seen in two patients of the descending tract group only.

Conclusion: The FAF abnormalities in central serous chorioretinopathy show multiple patterns and are related with the chronicity and visual acuity. Fundus autofluorescence patterns in central serous chorioretinopathy are helpful when considering the timing of treatment and predicting the disease status.

Fig. 1.

Fundus autofluorescence image (A) shows a homogeneous background fluorescence and a uniform change from the FAF of the normal background (blocked FAF). There is a decrease in the FAF intensity where the SRF existed and shows uniform changes. Spectral domain optical coherence tomography image (B) shows SRF in the region where the FAF intensity decreased.

Fig. 2.

Fundus autofluorescence image (A) shows a grainy or coarse region (white arrow) of increased FAF compared with the FAF of normal background (mottled FAF). Spectral domain optical coherence tomography image (B) shows SRF. Spectral domain optical coherence tomography image of the foveal and parafoveal regions (C) shows outer segment elongation (dotted double arrow) and subretinal deposits (white arrow).

Fig. 3.

Fundus autofluorescence image (A) shows an increase in FAF intensity around the macula and in the temporal area, compared with the FAF of normal background (hyper FAF). Spectral domain optical coherence tomography image (B) shows an elongation of the photoreceptor's outer segments around the macula and loss of photoreceptor of the temporal area that results in increased transmission of retinal pigment epithelium fluorescence.

Fig. 4.

Fundus autofluorescence image (A) with hyperautofluorescence and hypoautofluorescence (hyper/hypo FAF). Spectral domain optical coherence tomography images (B) and (C) show intact ELM (pointing triangles) and disruption of the EZ (white arrow).

Fig. 5.

Fundus autofluorescence image (A) shows a downward leading swathe of decreased autofluorescence, originating from the posterior pole and extending below the level of the inferior arcade (descending tract). Spectral domain optical coherence tomography images (B) and (C) show the disruption of the ELM and the EZ.

Fig. 6.

Diagram showing the changes of fluorescence and microstructure of the outer retina and the RPE of patients with CSC. ONL, outer nuclear layer; OPL, outer plexiform layer.