Optical Coherence Tomography Study of Choroidal Response to Exercise-Induced Hypertension in Chronic Central Serous Chorioretinopathy

Background/Objectives: The aim of this study was to evaluate the choroidal vascular response using optical coherence tomography (OCT) in patients with chronic central serous chorioretinopathy (CSCR) during transient increases in blood pressure. Methods: This observational, case–control study enrolled chronic CSCR patients and age-matched healthy controls. OCT scans of the macula were performed at rest and during hand-grip (HG) isometric exercise. Mean ocular perfusion pressure (MOPP) and subfoveal choroidal thickness (SCT) were measured at baseline and during stress. Quantitative OCT assessment included the bright area (BA, stroma), dark area (DA, vascular lumen), and total choroidal area (CA). The choroidal vascularity index (CVI) was calculated as DA/CA to assess vascular response to stress. A comparative analysis between CSCR patients and controls was conducted. Conclusions: MOPP was significantly higher (p = 0.008) at baseline in CSCR patients and further increased under stress compared to controls. SCT and CA were both significantly higher in CSCR patients than in healthy subjects at rest and under stress (p < 0.001), but no change occurred after HG. A significant decrease in CVI (p = 0.005) was noted in controls under stress, but not in CSCR patients. Additionally, a negative correlation between CVI and MOPP was found in healthy subjects (−0.648; p = 0.043). The study demonstrated a choroidal vasoconstrictive response to stress in healthy subjects, as evidenced by a decrease in CVI, but not in CSCR patients. This suggests that CSCR patients may experience impaired choroidal blood flow regulation, resulting in potentially higher perfusion pressures during stress without compensatory vasoconstriction, potentially affecting the choriocapillaris.