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Evaluation of Pre - and Post-Laser Morphologic Changes in Central Serous Chorioretinopathy Using High-Definition Optical Coherence Tomography.

SATHISKUMAR R

Abstract


Objective To evaluate the pre- and post-laser  morphologic changes in central serous chorioretinopathy (CSCR) using High-Definition Optical Coherence Tomography (HD-OCT). Design Observational case series. Methods            Patients attending Retina Clinic with a clinical diagnosis of CSCR between October 2013 and April 2014 were studied. Data collected and analyzed include Best Corrected Visual Acuity, fluorescein angiography at baseline to confirm dye leakage sites, HD-OCT was done at baseline and at every visit with the intervals of 2 to 4 weeks until sub-retinal fluid (SRF) resolved and the treatment methods. Horizontal and vertical OCT scans (B-scans and consecutive raster scans) of the fovea and fluorescein leakage sites were obtained. Main Outcome Measures Morphologic changes in the retinal            pigment epithelium (RPE), detached retina, and sub-retinal space around the leakage sites were evaluated repeatedly during follow-up.Results The mean period between baseline and the time of complete resolution of SRF was 70 days (range30-140days, minimum no. of examinations 3). Among a total of 27 leakage sites in 27 eyes, HD OCT showed RPE abnormalities in 26 (96.3) sites (17 eyes 63 with a pigment epithelial detachment PED and nine eyes 33.3 with a                  protruding or irregular RPE layer). In 17 of 27 (63) leakage sites, hyper-reflective shadow suggesting fibrin in the           sub-retinal space was observed around the leakage points. The posterior surface of the detached retina was smooth in 28 eyes (80) and granulated in seven (20) eyes. The smooth posterior detached retina became granulated in the presence of residual SRF. A PED remained at the 5 leakage sites in five (14) eyes despite SRF resolution. Conclusions HD-OCT provides an easier differential diagnosis of CSCR from other conditions which might be similar by biomicroscopy and FA. HD-OCT helps in monitoring the resolution of SRF  quantitatively during follow-up and it is also safer and less time-consuming than FA, and can be repeated more often. HD-OCT may offer a new approach to the diagnosis and evaluation of retinal damage in CSCR, and help us to              understand its staging and mechanisms.

 

 


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