Quantitative Changes in Vascular and Neural Fibers Induced by Subretinal Fluid Excluding the Peripapillary Region in Patients with Chronic Central Serous Chorioretinopathy

Abstract

Background: This study aims to evaluate the quantitative changes in retinal nerve fiber layer (RNFL) thickness and radial peripapillary capillary (RPC) vessel density in patients with chronic central serous chorioretinopathy (CSCR), specifically excluding the peripapillary region. Methods: A prospective case-control study was conducted at the Antalya Training and Research Hospital, Health Sciences University, involving 65 patients with chronic CSCR. Participants were categorized into two groups based on the presence or regression of subretinal fluid (SRF). A control group of age- and sex-matched healthy individuals was also included. Optical coherence tomography angiography (OCTA) was used to assess RNFL thickness and RPC vessel density. Statistical analyses were conducted using SPSS, with non-parametric tests employed for between-group comparisons. Results: Patients with persistent SRF exhibited significant increases in RNFL thickness in the inferior and nasal quadrants compared to healthy controls (p = 0.003 and p = 0.014, respectively). Additionally, RPC vessel density in the small vessel disc area (%) was significantly lower in the persistent SRF group compared to controls (p = 0.021). A significant negative correlation was found between nasal quadrant RNFL thickness and small vessel disc area (p = 0.014, r = -0.306). Conclusions: Chronic SRF in CSCR patients, even when not involving the peripapillary region, leads to significant structural changes in both the neural and vascular components of the retina. These findings suggest that SRF contributes to broader retinal alterations and supports the need for early detection and management of CSCR to prevent long-term visual impairment.

Keywords: central serous chorioretinopathy (CSCR); optical coherence tomography angiography (OCTA); radial peripapillary capillary (RPC) vessel density; retinal nerve fiber layer (RNFL) thickness; subretinal fluid (SRF).

Figure 1

Three-dimensional visualization of optical coherence tomography (OCT) imaging illustrating significant subretinal fluid accumulation in the peripapillary region of a patient with central serous chorioretinopathy (CSCR).

Figure 2

Small vessel inside disc area (%) for persistent SRF, regressed SRF, and control groups. Boxplot shows the median, interquartile range, and minimum/maximum values for each group. A statistically significant difference (* p < 0.05) was observed between the persistent SRF and regressed SRF groups.

Figure 3

OCTA imaging of a 48-year-old male patient with peripapillary involvement due to central serous chorioretinopathy (CSCR).

Figure 4

Optical Coherence Tomography Angiography (OCTA) images and corresponding optical coherence tomography (OCT) scans of two male patients with central serous chorioretinopathy (CSCR). The first and third columns (c,g,k,o) represent images from a 48-year-old male patient with peripapillary involvement, while the second and fourth columns (d,h,l,p) represent a 46-year-old male patient without peripapillary involvement. (a,b) Enface OCTA images highlighting the vascular structures of the macular region in both patients. (e,f) OCTA images showing the vascular density distribution in the central macular region, emphasizing differences between patients with and without peripapillary involvement. (i,j) Vascular perfusion maps focusing on the central macular area, showing localized reductions in vascular density in the patient with peripapillary involvement. (m,n) Color-coded maps of radial peripapillary capillary (RPC) vessel density, illustrating microvascular differences between the two cases. (r,s) Cross-sectional OCTA scans showing structural and vascular characteristics near the optic nerve head. (t,u) OCT cross-sectional scans displaying the retinal layer thickness and subretinal fluid accumulation in the two patients, highlighting the structural differences in the presence and absence of peripapillary involvement.