Low incidence of pachydrusen in central serous chorioretinopathy in an Indian cohort

Abstract

Purpose: The aim of this study is to report the prevalence, clinical and swept-source optical coherence tomography (SS-OCT) characteristics of pachydrusen in eyes with central serous chorioretinopathy (CSCR) and their fellow eyes.

Methods: A total of 264 eyes of 132 patients with a diagnosis of CSCR (acute/persistent/recurrent/chronic/inactive) in atleast one eye, were analyzed in this retrospective, cross-sectional study. SS-OCT parameters including choroidal thickness (CT), large choroidal vessel layer thickness (LCVT) at fovea and the site of pachydrusen were recorded. Paired t test and analysis of variance (ANOVA) was used to compare CT in eyes with CSCR (subfoveal and site of pachydrusen) and multiple groups respectively.

Results: The mean age of the study patients was 42.9 ± 9.5 years with 119 males (90.15%). Bilateral CSCR was present in 31 patients. Nine eyes (chronic, 4; persistent, 2; and inactive/resolved CSCR, 3) showed presence of pachydrusen with an overall prevalence of 6.82% (9 eyes of 9 patients out of 132 patients). There was no significant difference of subfoveal CT (SFCT) in eyes with CSCR (422.4 ± 107.8 μ) vs fellow eyes (407.0 ± 96.5 μ) and eyes with CSCR associated with pachydrusen (413.7 ± 101.5 μ) vs fellow eyes of CSCR eyes with pachydrusen (431.6 ± 188.8 μ) (P = 0.71). LCVT as a percentage of CT was higher at the site of pachydrusen compared to SFCT (69.8% vs. 50.8%).

Conclusion: CSCR can be associated with pachydrusen with a lower prevalence rate than previously reported. Whether the thickened large choroidal vessels at site of pachydrusen play any role in formation in pachydrusen needs further evaluation.

Keywords: Central serous chorioretinoapthy; choroidal thickness; large choroidal vessel layer thickness; optical coherence tomography; pachychoroid pigment epitheliopathy; pachydrusen.

Figure 1

Colour fundus, red-free and autofluorescence (AF) images (a-c) of a 56 years old male with resolved central serous chorioretinopathy (CSCR) in left eye, showing presence of pachydrusen temporal to fovea (arrow). AF shows presence of hypoautofluoroscence areas suggestive of previous episodes of CSCR. Horizontal OCT scan of the left eye (d) shows normal foveal contour. SS-OCT line scan through temporal macula (inset) (e) showing presence of homogenous deposits below the RPE suggestive of pachydrusen (arrow)

Figure 2

Colour fundus, red-free and autofluorescence (AF) images (a-c) of a 51 years old male with chronic CSCR and a visual acuity of 20/60 in left eye, showing RPE changes and hypoAF areas suggestive of chronicity along with clustered peripapillary pachydrusen near the vascular arcades. Horizontal SS-OCT scan superior to fovea and vertical scan (vertical line in fig a) through the fovea shows RPE deposits suggestive of pachydrusen (arrow, d and e). Also note the presence of large choroidal vessels, degenerated cystoid spaces, loss of outer retinal layers (e)