Fundus autofluorescence in acute and chronic‐recurrent central serous chorioretinopathy

Abstract

ABSTRACT.Purpose: Central serous chorioretinopathy (CSC) affects mostly young and middle-aged adults. Typically, a serous retinal detachment occurs with a focal leakage point in fluorescein angiography. Fundus autofluorescence (AF) is related to the lipofuscin within the retinal pigment epithelium (RPE). As CSC is thought to be associated with RPE disorders, AF measurements might be able to detect distinct changes within the RPE level. The purpose of this study was to compare AF patterns in acute and chronic-recurrent CSC and to evaluate the potential value of AF as a non-invasive monitoring tool. Methods: From 85 patients diagnosed with CSC (mean age 43 years), AF images were retrospectively evaluated and compared with angiographic and ophthalmoscopic findings. Fluorescein angiography and AF measurements were performed using a Heidelberg retina angiograph. Autofluorescence was excited at a wavelength of 488 nm and detected above 500 nm. Results: Acute CSC as determined by an acute decrease in visual acuity (VA) within the last 6 weeks, focal point leakage and neurosensory retinal detachment was diagnosed in 39 patients. In 36 of those patients (92%), a significantly decreased AF at the leakage point (72%) and/or decreased AF in the area of neurosensory detachment (77%) were observed. Regarding chronic-recurrent CSC as determined by a decrease in VA for longer than 6 weeks and mottled hyperfluorescent appearance in angiography, abnormalities in AF were observed in 44/46 patients (96%). In those patients, decreased or mottled AF was observed at the leakage point itself (76%), whereas significantly increased AF was seen in the area of residual neurosensory retinal detachment (85%). Conclusions: In acute CSC, decreased AF is presumably due to a blockage caused by oedema, whereas in chronic-recurrent forms, irregular and increased AF is observed, possibly reflecting reactive RPE changes secondary to RPE defects and neurosensory detachment. If these findings could be systematically underlined by prospective clinical studies, AF might be an interesting non-invasive tool for monitoring RPE changes in CSC and for performing differential diagnosis.

Foveal Thickness Can Predict Visual Outcome in Patients with Persistent Central Serous Chorioretinopathy

“…This process may cause thinning of foveal thickness after resolution of subretinal fluid. Accumulation of abnormal production of outer segment of the neurosensory retina is related to clinical manifestations in OCT as a granulated profile on the outer surface of detached retina and in fundus camera or scanning laser ophthalmoscope as an autofluorescence in eyes with CSC [14,15,16,17]. We supposed that this abnormal accumulation and/or detached neurosensory retinal swelling [9] may cause foveal thickening before resolution of subretinal fluid in our study.…”

Akut ve Kronik Santral Seröz Koryoretinopatide Fundus Otofloresansı

“…24 Akut SSKR'li hastalarda seröz retina dekolmanı alanının FOF görüntülemede ödemin otofloresansı bloke etmesi nedeniyle hipootofloresans göründüğü bildirilmiştir. [28][29][30] Framme ve ark. 29 çalışmalarında kronik SSKR'li gözlerdeyse nörosensöryel dekolmanın hiperotofloresans görüldüğünün, bu durumada RPE defektleri ve dekolmana ikincil reaktif RPE değişikliklerinin neden olduğunu bildirmişlerdir.…”

“…[28][29][30] Framme ve ark. 29 çalışmalarında kronik SSKR'li gözlerdeyse nörosensöryel dekolmanın hiperotofloresans görüldüğünün, bu durumada RPE defektleri ve dekolmana ikincil reaktif RPE değişikliklerinin neden olduğunu bildirmişlerdir. Bizim çalışmamızda ise seröz retina dekolmanı alanları akut SSKR'li gözlerde çoğunlukla hipootofloresans, kronik SSKR'li gözlerde çoğunlukla hiperotofloresans görülse de elde ettiğimiz sonuçlar istatistiki olarak anlamlı değildi.…”

Review and update for central serous chorioretinopathy

“…Various risk factors mentioned above may induce choroidal vascular dysfunction by ischemia, stasis and inflammation, which lead to abnormal hyperpermeability of the inner choroid and retinal pigment epithelial detachment (RPED). Subsequently, serous fluid accumulates in subretinal space through RPED [21][22][23].…”

“…Subretinal fluid moves downward under the influence of gravity, resulting in various shapes of sensory detachment such as tear, dumbbell, or flask [3,15,19,20]. Atrophic tract connecting posterior pole and inferior sensory detachment can be observed in some chronic cases, which can be more pronounced in FA and fundus autofluorescence (FAF) [21,32,33].…”