Choroidal vascular alterations evaluated by ultra-widefield indocyanine green angiography in central serous chorioretinopathy

Wide-field OCT-angiography assessment of choroidal thickness and choriocapillaris in eyes with central serous chorioretinopathy

“…Several studies had demonstrated choroidal outflow congestion in eyes with CSC, so the fellow eyes could also have similar conditions (Jung et al, 2020;Jeong et al, 2022). The choroidal vascular system is similar to an electrical circuit (Spaide 2020): increasing the vascular density increases the cross-sectional area of the resistance, thereby reducing the resistance.…”

Pachychoroid Spectrum Disorders: An Updated Review

“…Separately, increasing evidence has suggested that abnormal venous emptying via vortex vein occlusion may be responsible for choroidal venous congestion and CVH. [ 43 , 92 , 93 , 94 ] Kishi and Matsumoto described ICGA studies in CSCR eyes which revealed a dilation of the vortex vein ampulla, suggesting an obstruction where the vortex vein transverses the sclera; [ 43 ] other authors have hypothesized this site may hold a valve-like function regulating venous outflow. [ 8 , 94 ] Further, eyes with CSCR and PNV have increased scleral thickness, [ 95 ] which may increase outflow resistance [ 94 ] and decrease diffusion permeability, [ 8 ] contributing to venous stasis and congestion.…”

“…[ 43 ] Multiple studies have found an association between inter-vortex venous anastomotic connections and pachychoroid entities. [ 23 , 89 , 93 , 100 ] Spatially, eyes with CSCR and PNV tended to have anastomoses in the central macula, while eyes with PPS had anastomoses near the optic nerve, providing evidence of a common link between these phenotypes. [ 89 ]…”

“…[ 94 ] Similarly, Jeong et al quantitatively evaluated the choroidal vasculature patients with unilateral CSCR, finding no significant difference in vortex vein engorgement in affected and unaffected eyes, providing further evidence that a predisposition may be present in these patients. [ 93 ] Shinojima et al found that 19% of asymptomatic/contralateral eyes of patients with unilateral CSCR ultimately developed a retinal detachment during the follow-up period, further suggesting there may be a predisposing factor. [ 102 ] Gerardy et al found that the asymptomatic eyes of unilateral CSCR cases exhibited significantly reduced foveal cone density, suggesting that photoreceptors may be damaged at baseline in a process independent of retinal detachment; these cones may be particularly sensitive to oxidative stress or abnormal blood flow regulation, which is congruent with findings that CSCR patients exhibit higher levels of oxidative stress biomarkers.…”

“…[ 8 , 20 , 43 ] Chronic CSCR cases have been found to have more hyperpermeable area than acute cases, but without a difference in subfoveal choroidal thickness. [ 93 ] Given that patients with acute CSCR have been found to be about 15 years younger than patients with chronic CSCR, [ 43 ] some have suggested that older eyes with chronic CSCR may no longer be able to compensate for the fluid overload. [ 3 ]…”