Applications of Multimodal Imaging in Central Serous Chorioretinopathy Evaluation

Abstract

Central serous chorioretinopathy (CSCR) is a macular disease characterized by serous retinal detachment commonly involving the macular region. CSCR has a wide spectrum of clinical presentations. Although a significant proportion of CSCR cases are self-limiting, patients can suffer from persistent or recurrent disease, sometimes complicated with choroidal neovascularization, resulting in permanent visual loss. Multimodal imaging, including fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and optical coherence tomography, has advanced the diagnosis and classification of CSCR cases. Evolution of new imaging techniques including optical coherence tomography angiography, wide-field imaging, and en face reconstruction imaging has also contributed to better understandings of the pathophysiology of CSCR. This review article summarizes the features of multimodal imaging for CSCR and discusses the application of such features in evaluating the disease.

Central serous chorioretinopathy: A review

“…Foveal photoreceptor atrophy can develop as early as 4 months after onset of symptoms 86 . Cystoid macular degeneration is angiographically silent and prognostic of poor vision 87 . Other complications of CSC include CNV, fibrin deposition and development of bullous serous retinal detachment.…”

“…Typically in the early phase of FFA, abnormal hyperfluorescent areas are seen due to increased transmission of normal choroidal fluorescence through areas of RPE defects 1 . Following this, three FFA patterns of leakage have been described including the inkblot, the smokestack, and the minimally enlarging spot 87,107 . The most common of these is the inkblot leakage pattern (53% 104 –80% 105 ), characterised by the progressive and uniform expansion of a circular area of hyperfluorescence arising from a central pinpoint (Figures 6C and 10B).…”

“…However, this is an arbitrary definition and just represents a minimally leaking inkblot. In addition to these leakage patterns, in the mid and late phases of FFA, pooling of dye occurs in areas of serous PED or serous retinal detachment giving diffuse and circular spreading hyperfluorescence 87 …”

“…FFA may show multiple points of indistinct leakage (Figure 6H,M) with inferiorly descending tracts 106 . Patches of granular or mottled hyperfluorescence may be seen in the mid and late phases 87 . In eyes with resolved CSC, areas of early hyperfluorescence may be seen due to increased transmission from window defects due to localised RPE atrophy 87 …”

“…1 Following this, three FFA patterns of leakage have been described including the inkblot, the smokestack, and the minimally enlarging spot. 87,107 The most common of these is the inkblot leakage pattern (53% 104 -80% 105 ), characterised by the progressive and uniform expansion of a circular area of hyperfluorescence arising from a central pinpoint (Figures 6C and 10B). The smokestack pattern seen less commonly (14% 108 -24% 105,107 ) is characterised by ascending hyperfluorescence followed by lateral diffusion at the superior margin of the serous retinal detachment, producing a smokestack like pattern above the leaking point.…”