Chronic central serous chorioretinopathy imaged by optical coherence tomographic angiography

Abstract PURPOSE: To describe optical coherence tomographic (OCT) angiography findings in chronic central serous chorioretinopathy (CSC), and to characterize their OCT B-scans by means of the split-spectrum amplitude-decorrelation angiography algorithm. DESIGN: Evaluation of an imaging technique in a cohort of patients. METHODS: Fluorescein (FA) and indocyanine green (ICGA) angiography (Heidelberg Spectralis, Heidelberg, Germany), OCT angiography, and OCT angiography with the split-spectrum amplitude-decorrelation angiography algorithm (XR Optovue, Fremont, California, USA) were performed. A qualitative analysis of the entire imaging data was done. RESULTS: Twelve eyes of 10 patients were included. Mean visual acuity was 20/30. All eyes presented findings consistent with chronic CSC (lasting more than 6 months) on biomicroscopic examination, autofluorescence, FA, ICGA, and OCT. ICGA showed the characteristic choroidal hyperpermeability, while there was no evidence of choroidal neovascularization (CNV). OCT B-scans showed 2 distinct profiles of the retinal pigment epithelium (RPE): a slight RPE detachment with small undulations was evident in 7 of 12 eyes, while 5 eyes presented a flat RPE profile. OCT angiography in 7 eyes (58%) revealed the presence of a distinct CNV corresponding to the ICGA hyperpermeability. The qualitative analysis of the OCT B-scans compared to the OCT angiographic images demonstrated that the CNV corresponded to the small undulations within the slight RPE detachment, confirming its vascularized nature. On the contrary, OCT angiography showed a normal choroidal circulation in the remaining 5 eyes (42%) with a flat RPE profile. CONCLUSIONS: OCT angiography allows detection of CNV in chronic CSC not visible with other imaging techniques. CNV corresponds to the small undulating RPE detachment on B-scan. This might allow an appropriate treatment resulting in a better visual outcome.