Elsevier

Ophthalmology

Volume 121, Issue 3, March 2014, Pages 719-726
Ophthalmology

Original article
En Face Enhanced-Depth Swept-Source Optical Coherence Tomography Features of Chronic Central Serous Chorioretinopathy

https://doi.org/10.1016/j.ophtha.2013.10.014Get rights and content

Objective

To characterize en face features of the retinal pigment epithelium (RPE) and choroid in eyes with chronic central serous chorioretinopathy (CSCR) using a high-speed, enhanced-depth swept-source optical coherence tomography (SS-OCT) prototype.

Design

Consecutive patients with chronic CSCR were prospectively examined with SS-OCT.

Participants

Fifteen eyes of 13 patients.

Methods

Three-dimensional 6×6 mm macular cube raster scans were obtained with SS-OCT operating at 1050 nm wavelength and 100 000 A-lines/sec with 6 μm axial resolution. Segmentation of the RPE generated a reference surface; en face SS-OCT images of the RPE and choroid were extracted at varying depths every 3.5 μm (1 pixel). Abnormal features were characterized by systematic analysis of multimodal fundus imaging, including color photographs, fundus autofluorescence, fluorescein angiography, and indocyanine-green angiography (ICGA).

Main Outcome Measures

En face SS-OCT morphology of the RPE and individual choroidal layers.

Results

En face SS-OCT imaging at the RPE level revealed absence of signal corresponding to RPE detachment or RPE loss in 15 of 15 (100%) eyes. En face SS-OCT imaging at the choriocapillaris level showed focally enlarged vessels in 8 of 15 eyes (53%). At the level of Sattler's layer, en face SS-OCT documented focal choroidal dilation in 8 of 15 eyes (53%) and diffuse choroidal dilation in 7 of 15 eyes (47%). At the level of Haller's layer, these same features were observed in 3 of 15 eyes (20%) and 12 of 15 eyes (80%), respectively. In all affected eyes, these choroidal vascular abnormalities were seen just below areas of RPE abnormalities. In 2 eyes with secondary choroidal neovascularization (CNV), distinct en face SS-OCT features corresponded to the neovascular lesions.

Conclusions

High-speed, enhanced-depth SS-OCT at 1050 nm wavelength enables the visualization of pathologic features of the RPE and choroid in eyes with chronic CSCR not usually appreciated with standard spectral domain (SD) OCT. En face SS-OCT imaging seems to be a useful tool in the identification of CNV without the use of angiography. This in vivo documentation of the RPE and choroidal vasculature at variable depths may help elucidate the pathophysiology of disease and can contribute to the diagnosis and management of chronic CSCR.

Section snippets

Methods

This study was performed under approved institutional review board protocols from the New England Eye Center and Massachusetts Institute of Technology. The research adhered to the tenets of the Declaration of Helsinki and complied with the Health Insurance Portability and Accountability Act of 1996. Signed informed consent was obtained before SS-OCT examination. Consecutive patients examined at the New England Eye Center between October 2012 and April 2013 with the clinical diagnosis of chronic

Results

Fifteen eyes of 13 patients seen consecutively and diagnosed with chronic CSCR were enrolled in the study. Their baseline characteristics were as follows: 11 male patients, 10 Caucasian and 3 Asian patients, mean age 50.7 years (standard deviation ± 9.5 years), and mean best-corrected visual acuity 20/50 (range, 20/20–20/800). All enrolled patients had a history of at least 6 months of visual symptoms in the affected eye(s). The mean period of time since initial presentation was 13.6 months

Discussion

Serous detachment of the neurosensory retina is characteristic of the typical presentation of CSCR, but the source of the subretinal fluid is still not completely agreed upon.1, 9 Retinal PEDs have been identified in up to 63% of affected eyes when studied with angiography and cross-sectional OCT imaging and may or may not be associated with neurosensory retinal detachments or clinical symptoms.9 Because FA shows focal, single, or multiple leaks from the RPE that are characteristic of the

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    Supplemental material is available at www.aaojournal.org.

    Financial Disclosure(s): The author(s) have made the following disclosure(s): M.F.K. has a patent owned by MIT and licensed to Optovue, Inc. J.G.F. has personal financial interest in Optovue, Inc, and patents owned by MIT and licensed to Carl Zeiss Meditech, Inc, and Optovue, Inc. J.S.D. receives research support from Carl Zeiss Meditech, Inc, and Optovue, Inc.

    Support was provided by the National Institutes of Health (R01-EY011289-27, R01-EY013178-12, R01-EY018184-05, R44EY022864-01, R01-CA075289-16, R01-NS057476-05, and R44-EY022864-01); The Air Force Office of Scientific Research (AFOSR) (FA9550-10-1-0551 and FA9550-10-1-0063); Research to Prevent Blindness; Massachusetts Lions Club; and German Science Foundation DFG (DFG-GSC80-SAOT). The funding organizations had no role in the design or conduct of this research.

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