Artifact-Free Evaluation of Choriocapillaris Perfusion in Central Serous Chorioretinopathy

Abstract

In this study, using optical coherence tomography angiography (OCTA) we evaluated choriocapillaris perfusion in eyes with central serous chorioretinopathy (CSC) after excluding all possible artifacts caused by alterations of neurosensory retina or retinal pigment epithelium (RPE). We have included 22 unilateral acute CSC patients (18 males and four females, 41.8 ± 5.7 years) and 18 healthy subjects (13 males and five females, 40.9 ± 9.7 years). The number of flow voids per 1 mm2 of scan area and percentage of flow signal area was calculated based on choriocapillaris slab of 3 × 3 mm2 OCTA scans after excluding all possible artifacts caused by alterations of neurosensory retina or RPE. The percentage of flow signal area after the exclusion of neurosensory retina and RPE alterations in the eyes of healthy individuals was higher than in CSC eyes (p = 0.006) and fellow unaffected eyes of CSC patients (p = 0.02). The number of flow voids larger than 25,000 µm2 in eyes of healthy individuals was lower than in the CSC eyes (p = 0.0006). There were no statistically significant differences in study parameters between CSC eyes and fellow eyes of CSC patients (p > 0.05). The general decrease of choriocapillaris perfusion in both eyes of CSC patients exists independently of the presence of acute disease or asymptomatic structural RPE changes.

Artifact-Removed Quantitative Analysis of Choriocapillaris Flow Voids

“…Other thresholding methods, such as Phansalkar thresholding, can also be used with our artifact removal process instead of step 3. In a very recent report, Burnasheva et al 28 manually removed hyporeflective and hyporeflective artifacts by using the en-face structural OCT image of the whole retinal slab to evaluate FV in eyes with CSC. However, healthy areas and artifacts are separated more clearly using en-face structural OCT images of the outer retina than of the whole retinal slab.…”

Artifact Removed Quantitative Analysis Of Choriocapillaris Flow Voids

“…Other thresholding methods, such as Phansalkar thresholding, can also be used with our artifact removal process instead of step 3. In a very recent report, Burnasheva et al [27] manually removed hypore ective and hypore ective artifacts using en-face structural OCT image of the whole retinal slab to evaluate FV in eyes with CSC. However, healthy areas and artifacts are separated more clearly using en-face structural OCT image of the outer retina than using en-face structural OCT image of the whole retinal slab.…”

Repeatability of choriocapillaris flow voids by optical coherence tomography angiography in central serous chorioretinopathy

“…We have observed very similar repeatability in eyes with and without SRF, so it seems that the FSV measurement is indeed a reliable parameter. Burnasheva et al described that the presence of the general decrease of CC perfusion in both eyes of CSCR patients was irrespective of the presence of SRF or asymptomatic structural RPE changes [30]. Remarkably, as described by Byon et al in diseased eyes, the RPE fit would generally be preferred for CC assessment, as it would essentially flatten the reference line [16].…”