Current Choroidal Imaging Findings in Central Serous Chorioretinopathy

Abstract

Background: Central serous chorioretinopathy (CSCR) is a chorioretinal disease affecting mostly middle age males. It is marked by the serous detachment of the neurosensory layer at the macula. This review of the literature provides a framework of the current characteristic/relevant imaging findings of CSCR. Although the pathogenesis of CSCR is unclear, the choroid plays a major role and its changes are fundamental to the diagnosis and treatment of CSCR.

Methods: A systematic literature search focusing on current multimodal imaging for CSCR was performed. Only articles reporting on original clinical data were selected, studies in a language other than English were included only if an English abstract was provided. Additional sources included articles cited in the references list of the first selected articles. We deduced imaging findings based on current and relevant literature on the topic.

Results: We found that sub foveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) were greater in eyes with acute CSCR than in eyes with chronic CSCR or normal eyes. There was increased choroidal thickness (CT) in the macula compared to peripapillary region. In healthy eyes, the highest CVI was found in the nasal region followed by the inferior, temporal, and superior quadrant. The area with the least CVI was the macula. In eyes with CSCR, 100% had asymmetric dominant vortex veins compared to 38% in normal eyes.

Conclusion: Choroidal imaging has advanced the diagnosis of CSCR. This has led to numerous imaging biomarkers like CVI, CT, and hyper-reflective dots for early detection and possible prognostication of CSCR. More techniques like wide field scans and en face imaging are being employed to characterize the choroid in CSCR.

Keywords: CSCR biomarkers; central serous chorioretinopathy (CSCR); choroid; imaging; optical coherence tomography (OCT).

Figure 1

Multimodal imaging in central serous chorioretinopathy (CSCR)—right color fundus photograph (A) showed pocket of subretinal fluid involving fovea. Fluorescein angiography (FA) (B,C) showed ink-blot leakage superior to fovea. Indocyanine green angiography (ICGA) showed increased fluorescence with focal late leakage superior to the fovea (D). Swept source optical coherence tomography showed neurosensory detachment involving fovea with increased subfoveal choroidal thickness.

Figure 2

Choroidal vascularity Index (CVI): montage showing the process of CVI calculation. Top scan shows neurosensory detachment in an eye with CSCR; middle scan shows choroidal boundaries using automated algorithm; and bottom scan shows the binarized image of the choroid with CVI of 0.6491.

Figure 3

Wide-field optical coherence tomography: the infra-red image on the left side showing the horizontal and vertical scans passing through the fovea of an eye with CSCR. Wide-field optical coherence tomography scans on the right side shows presence of neurosensory detachment in horizontal (top) and vertical (bottom) scans.

Figure 4

En face choroidal vascularity: multiple en face scans obtained at 40, 300, 380 µm from the Bruch’s membrane top to bottom respectively (left side). The middle column shows en-face scans following shadow removal. The right column shows corresponding binarized scans. The bottom horizontal B scan shows the neurosensory detachment of the same eye with CSCR.

Figure 5

Optical coherence tomography angiography (OCTA) of an eye with CSCR. Choriocapillaris slab (Above) of OCTA scan above showing choriocapillaris flow void areas (dark areas) and corresponding cross-sectional scan (Below) showing the scan location at the choriocapillaris level.

Figure 6

Choroidal hyperreflective dots: montage showing the process of choroidal hyperreflective dots (HRD) calculation. Top scan shows neurosensory detachment in an eye with CSCR; middle scan shows choroidal boundaries using automated algorithm; and bottom scan shows the yellow hyperreflective dots of the choroid (HRD = 166).

Figure 7

Haller’s layer measurements: scan showing neurosensory detachment with demarcation of various layers of choroid. Large choroidal vessels are marked, and three layers of the choroid are marked.