Changes of choroidal biomarkers in patients with central serous chorioretinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Liu Pei ¹ , An Guangqi ¹ , Lu Chenyu ¹ , Li Shu ¹ , Du Liping ^1,2 ,  Jin Xuemin ^1,2

1. The First Affiliated Hospital of Zhengzhou University, Henan Provincial Eye Hospital, Zhengzhou University School of Medical Sciences, Zhengzhou 450003, China;
2. Institute of Fundus Diseases, Zhengzhou University, Zhengzhou 450000, China;

Corresponding?author：

Jin Xuemin, Email: 2740913223@qq.com

Keywords：

Central serous chorioretinopathy; Scanning source light coherence tomography angiography; Choroidal thickness; Choroidal vascular index; Choroidal vascular volume; Choriocapillaris flow area

DOI：

10.3760/cma.j.cn511434-20230103-00004

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Objective To quantitatively evaluate the changes of choroidal biomarkers in patients with central serous chorioretinopathy (CSC) and preliminarily explore its pathogenesis. Methods Clinical cross-sectional study. From July 2021 to December 2022, 74 eyes of 65 patients with CSC (CSC group) confirmed by ophthalmic examination at the First Affiliated Hospital of Zhengzhou University were included in the study. Among them, 46 patients (51 eyes) were male, 19 patients (23 eyes) were female. The duration from the onset of symptoms to the time of treatment was less than or equal to 3 months. A control group consisted of 40 healthy volunteers (74 eyes) matched in age and gender. Among them, 26 patients (50 eyes) were male, and 14 patients (24 eyes) were female. Using VG200D from Microimaging (Henan) Technology Co., Ltd., macular scanning source light coherence tomography angiography was performed, with scanning range 6 mm × 6 mm. According to the division of the diabetes retinopathy treatment research group, the choroid within 6 mm of the macular fovea was divided into three concentric circles centered on the macular fovea, namely, the central area with a diameter of 1 mm, the macular area with a diameter of 1-3 mm, and the surrounding area of the fovea with a diameter of 3-6 mm. The device comes with software to record the three-dimensional choroidal vascular index (CVI), choroidal vascular volume (CVV), perfusion area of the choroidal capillary layer (CFA), choroidal thickness (CT), and three-dimensional CVI, CVV, and CT in the upper, temporal, lower, and subnasal quadrants within 6 mm of the fovea. Quantitative data between the two groups were compared using an independent sample t-test. Qualitative data comparison line χ² inspection. The value of receiver operating curve (ROC) analysis in predicting the occurrence of CSC, including CVI, CVV, CFA, and CT. Results Compared with the control group, the CVI (t=3.133, 4.814), CVV (t=7.504, 9.248), and CT (t=10.557, 10.760) in the central and macular regions of the affected eyes in the CSC group significantly increased, while the CFA (t=－8.206, －5.065) significantly decreased, with statistically significant differences (P＜0.05); CVI (t=7.129), CVV (t=10.020), and CT (t=10.488) significantly increased within 6 mm of the central fovea, while CFA (t=－2.548) significantly decreased, with statistically significant differences (P＜0.05). The CVI (t=4.980, 4.201, 4.716, 8.491), CVV (t=9.014, 7.156, 7.719, 10.730), and CT (t=10.077, 8.700, 8.960, 11.704) in the upper, temporal, lower, and lower nasal quadrants within 6 mm of the central fovea were significantly increased, with statistically significant differences (P＜0.05). In the CSC group, the maximum CVI and CVV were (0.39±0.10)% and (1.09±0.42) mm³, respectively, on the nasal side of the affected eye. Upper CT was (476.02±100.89) μm. The nasal side CVI, CVV, and CT have the largest changes. The ROC curve analysis results showed that the area under the curve of CT, CVV, and CVI within 6 mm of the central region, macular region, and fovea was over than 0.5. Subcentral CT was the most specific for the diagnosis of CSC. Conclusion Choroidal biomarkers CVI, CVV, and CT in CSC patients increase, while CFA decreases. Central CT is the most specific for the diagnosis of CSC.

Citation： Liu Pei, An Guangqi, Lu Chenyu, Li Shu, Du Liping, Jin Xuemin. Changes of choroidal biomarkers in patients with central serous chorioretinopathy. Chinese Journal of Ocular Fundus Diseases, 2023, 39(4): 290-296. doi: 10.3760/cma.j.cn511434-20230103-00004 Copy

1.	Hu J, Qu J, Piao Z, et al. Optical coherence tomography angiography compared with indocyanine green angiography in central serous chorioretinopathy[J]. Sci Rep, 2019, 9(1): 6149. DOI: 10.1038/s41598-019-42623-x.
2.	Ito Y, Ito M, Iwase T, et al. Prevalence of and factors associated with dilated choroidal vessels beneath the retinal pigment epithelium among the Japanese[J]. Sci Rep, 2021, 11(1): 11278. DOI: 10.1038/s41598-021-90493-z.
3.	Prasuhn M, Miura Y, Tura A, et al. Influence of retinal microsecond pulse laser treatment in central serous chorioretinopathy: a short-term optical coherence tomography angiography study[J]. J Clin Med, 2021, 10(11): 2418. DOI: 10.3390/jcm10112418.
4.	van Dijk E, Schellevis RL, van Bergen M, et al. Association of a haplotype in the NR3C2 gene, encoding the mineralocorticoid receptor, with chronic central serous chorioretinopathy[J]. JAMA Ophthalmol, 2017, 135(5): 446-451. DOI: 10.1001/jamaophthalmol.2017.0245.
5.	Shinojima A, Ozawa Y, Uchida A, et al. Assessment of hypofluorescent foci on late-phase indocyanine green angiography in central serous chorioretinopathy[J]. J Clin Med, 2021, 10(10): 2178. DOI: 10.3390/jcm10102178.
6.	Kaye R, Chandra S, Sheth J, et al. Central serous chorioretinopathy: an update on risk factors, pathophysiology and imaging modalities[J/OL]. Prog Retin Eye Res, 2020, 79: 100865[2020-05-11]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(20)30037-9. DOI:10.1016/j.preteyeres.2020.100865.
7.	Lains I, Wang JC, Cui Y, et al. Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA)[J/OL]. Prog Retin Eye Res, 2021, 84: 100951[2021-01-28]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(21)00012-4. DOI:10.1016/j.preteyeres.2021.100951.
8.	Sacks D, Baxter B, Campbell B, et al. Multisociety consensus quality improvement revised consensus statement for endovascular therapy of acute ischemic stroke[J]. Int J Stroke, 2018, 13(6): 612-632. DOI: 10.1177/1747493018778713.
9.	Liu T, Lin W, Shi G, et al. Retinal and choroidal vascular perfusion and thickness measurement in diabetic retinopathy patients by the swept-source optical coherence tomography angiography[J/OL]. Front Med (Lausanne), 2022, 9: 786708[2022-03-18]. https://europepmc.org/article/MED/35372401. DOI:10.3389/fmed.2022.786708.
10.	Cheng D, Ruan K, Wu M, et al. Characteristics of the optic nerve head in myopic eyes using swept-source optical coherence tomography[J]. Invest Ophthalmol Vis Sci, 2022, 63(6): 20. DOI: 10.1167/iovs.63.6.20.
11.	Yang J, Wang E, Yuan M, et al. Three-dimensional choroidal vascularity index in acute central serous chorioretinopathy using swept-source optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(2): 241-247. DOI: 10.1007/s00417-019-04524-7.
12.	Ambiya V, Goud A, Rasheed MA, et al. Retinal and choroidal changes in steroid-associated central serous chorioretinopathy[J]. Int J Retina Vitreous, 2018, 4: 11. DOI: 10.1186/s40942-018-0115-1.
13.	Agrawal R, Chhablani J, Tan KA, et al. Choroidal vascularity index in central serous chorioretinopathy[J]. Retina, 2016, 36(9): 1646-1651. DOI: 10.1097/IAE.0000000000001040.
14.	Pang CE, Shah VP, Sarraf D, et al. Ultra-widefield imaging with autofluorescence and indocyanine green angiography in central serous chorioretinopathy[J]. Am J Ophthalmol, 2014, 158(2): 362-371. DOI: 10.1016/j.ajo.2014.04.021.
15.	Prunte C, Flammer J. Choroidal capillary and venous congestion in central serous chorioretinopathy[J]. Am J Ophthalmol, 1996, 121(1): 26-34. DOI: 10.1016/s0002-9394(14)70531-8.
16.	Hiroe T, Kishi S. Dilatation of asymmetric vortex vein in central serous chorioretinopathy[J]. Ophthalmol Retina, 2018, 2(2): 152-161. DOI: 10.1016/j.oret.2017.05.013.
17.	Liu L, Zhu C, Yuan Y, et al. Three-dimensional choroidal vascularity index in high myopia using swept-source optical coherence tomography[J]. Curr Eye Res, 2022, 47(3): 484-492. DOI: 10.1080/02713683.2021.2006236.
18.	Spaide RF, Gemmy CC, Matsumoto H, et al. Venous overload choroidopathy: a hypothetical framework for central serous chorioretinopathy and allied disorders[J/OL]. Prog Retin Eye Res, 2022, 86: 100973[2021-05-21]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(21)00034-3. DOI:10.1016/j.preteyeres.2021.100973.
19.	Imamura Y, Fujiwara T, Spaide RF. Fundus autofluorescence and visual acuity in central serous chorioretinopathy[J]. Ophthalmology, 2011, 118(4): 700-705. DOI: 10.1016/j.ophtha.2010.08.017.
20.	Imamura Y, Fujiwara T, Margolis R, et al. Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy[J]. Retina, 2009, 29(10): 1469-1473. DOI: 10.1097/IAE.0b013e3181be0a83.
21.	Kim S W, Oh J, Kwon SS, et al. Comparison of choroidal thickness among patients with healthy eyes, early age-related maculopathy, neovascular age-related macular degeneration, central serous chorioretinopathy, and polypoidal choroidal vasculopathy[J]. Retina, 2011, 31(9): 1904-1911. DOI: 10.1097/IAE.0b013e31821801c5.
22.	Hosoda Y, Yoshikawa M, Miyake M, et al. CFH and VIPR2 as susceptibility loci in choroidal thickness and pachychoroid disease central serous chorioretinopathy[J]. Proc Natl Acad Sci U S A, 2018, 115(24): 6261-6266. DOI: 10.1073/pnas.1802212115.
23.	Iida T, Kishi S, Hagimura N, et al. Persistent and bilateral choroidal vascular abnormalities in central serous chorioretinopathy[J]. Retina, 1999, 19(6): 508-512. DOI: 10.1097/00006982-199911000-00005.
24.	Agrawal R, Gupta P, Tan KA, et al. Choroidal vascularity index as a measure of vascular status of the choroid: measurements in healthy eyes from a population-based study[J/OL]. Sci Rep, 2016, 6: 21090[2016-02-12]. https://europepmc.org/article/MED/26868048. DOI:10.1038/srep21090.
25.	Zhou H, Dai Y, Shi Y, et al. Age-related changes in choroidal thickness and the volume of vessels and stroma using swept-source OCT and fully automated algorithms[J]. Ophthalmol Retina, 2020, 4(2): 204-215. DOI: 10.1016/j.oret.2019.09.012.

1. Hu J, Qu J, Piao Z, et al. Optical coherence tomography angiography compared with indocyanine green angiography in central serous chorioretinopathy[J]. Sci Rep, 2019, 9(1): 6149. DOI: 10.1038/s41598-019-42623-x.
2. Ito Y, Ito M, Iwase T, et al. Prevalence of and factors associated with dilated choroidal vessels beneath the retinal pigment epithelium among the Japanese[J]. Sci Rep, 2021, 11(1): 11278. DOI: 10.1038/s41598-021-90493-z.
3. Prasuhn M, Miura Y, Tura A, et al. Influence of retinal microsecond pulse laser treatment in central serous chorioretinopathy: a short-term optical coherence tomography angiography study[J]. J Clin Med, 2021, 10(11): 2418. DOI: 10.3390/jcm10112418.
4. van Dijk E, Schellevis RL, van Bergen M, et al. Association of a haplotype in the NR3C2 gene, encoding the mineralocorticoid receptor, with chronic central serous chorioretinopathy[J]. JAMA Ophthalmol, 2017, 135(5): 446-451. DOI: 10.1001/jamaophthalmol.2017.0245.
5. Shinojima A, Ozawa Y, Uchida A, et al. Assessment of hypofluorescent foci on late-phase indocyanine green angiography in central serous chorioretinopathy[J]. J Clin Med, 2021, 10(10): 2178. DOI: 10.3390/jcm10102178.
6. Kaye R, Chandra S, Sheth J, et al. Central serous chorioretinopathy: an update on risk factors, pathophysiology and imaging modalities[J/OL]. Prog Retin Eye Res, 2020, 79: 100865[2020-05-11]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(20)30037-9. DOI:10.1016/j.preteyeres.2020.100865.
7. Lains I, Wang JC, Cui Y, et al. Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA)[J/OL]. Prog Retin Eye Res, 2021, 84: 100951[2021-01-28]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(21)00012-4. DOI:10.1016/j.preteyeres.2021.100951.
8. Sacks D, Baxter B, Campbell B, et al. Multisociety consensus quality improvement revised consensus statement for endovascular therapy of acute ischemic stroke[J]. Int J Stroke, 2018, 13(6): 612-632. DOI: 10.1177/1747493018778713.
9. Liu T, Lin W, Shi G, et al. Retinal and choroidal vascular perfusion and thickness measurement in diabetic retinopathy patients by the swept-source optical coherence tomography angiography[J/OL]. Front Med (Lausanne), 2022, 9: 786708[2022-03-18]. https://europepmc.org/article/MED/35372401. DOI:10.3389/fmed.2022.786708.
10. Cheng D, Ruan K, Wu M, et al. Characteristics of the optic nerve head in myopic eyes using swept-source optical coherence tomography[J]. Invest Ophthalmol Vis Sci, 2022, 63(6): 20. DOI: 10.1167/iovs.63.6.20.
11. Yang J, Wang E, Yuan M, et al. Three-dimensional choroidal vascularity index in acute central serous chorioretinopathy using swept-source optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(2): 241-247. DOI: 10.1007/s00417-019-04524-7.
12. Ambiya V, Goud A, Rasheed MA, et al. Retinal and choroidal changes in steroid-associated central serous chorioretinopathy[J]. Int J Retina Vitreous, 2018, 4: 11. DOI: 10.1186/s40942-018-0115-1.
13. Agrawal R, Chhablani J, Tan KA, et al. Choroidal vascularity index in central serous chorioretinopathy[J]. Retina, 2016, 36(9): 1646-1651. DOI: 10.1097/IAE.0000000000001040.
14. Pang CE, Shah VP, Sarraf D, et al. Ultra-widefield imaging with autofluorescence and indocyanine green angiography in central serous chorioretinopathy[J]. Am J Ophthalmol, 2014, 158(2): 362-371. DOI: 10.1016/j.ajo.2014.04.021.
15. Prunte C, Flammer J. Choroidal capillary and venous congestion in central serous chorioretinopathy[J]. Am J Ophthalmol, 1996, 121(1): 26-34. DOI: 10.1016/s0002-9394(14)70531-8.
16. Hiroe T, Kishi S. Dilatation of asymmetric vortex vein in central serous chorioretinopathy[J]. Ophthalmol Retina, 2018, 2(2): 152-161. DOI: 10.1016/j.oret.2017.05.013.
17. Liu L, Zhu C, Yuan Y, et al. Three-dimensional choroidal vascularity index in high myopia using swept-source optical coherence tomography[J]. Curr Eye Res, 2022, 47(3): 484-492. DOI: 10.1080/02713683.2021.2006236.
18. Spaide RF, Gemmy CC, Matsumoto H, et al. Venous overload choroidopathy: a hypothetical framework for central serous chorioretinopathy and allied disorders[J/OL]. Prog Retin Eye Res, 2022, 86: 100973[2021-05-21]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(21)00034-3. DOI:10.1016/j.preteyeres.2021.100973.
19. Imamura Y, Fujiwara T, Spaide RF. Fundus autofluorescence and visual acuity in central serous chorioretinopathy[J]. Ophthalmology, 2011, 118(4): 700-705. DOI: 10.1016/j.ophtha.2010.08.017.
20. Imamura Y, Fujiwara T, Margolis R, et al. Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy[J]. Retina, 2009, 29(10): 1469-1473. DOI: 10.1097/IAE.0b013e3181be0a83.
21. Kim S W, Oh J, Kwon SS, et al. Comparison of choroidal thickness among patients with healthy eyes, early age-related maculopathy, neovascular age-related macular degeneration, central serous chorioretinopathy, and polypoidal choroidal vasculopathy[J]. Retina, 2011, 31(9): 1904-1911. DOI: 10.1097/IAE.0b013e31821801c5.
22. Hosoda Y, Yoshikawa M, Miyake M, et al. CFH and VIPR2 as susceptibility loci in choroidal thickness and pachychoroid disease central serous chorioretinopathy[J]. Proc Natl Acad Sci U S A, 2018, 115(24): 6261-6266. DOI: 10.1073/pnas.1802212115.
23. Iida T, Kishi S, Hagimura N, et al. Persistent and bilateral choroidal vascular abnormalities in central serous chorioretinopathy[J]. Retina, 1999, 19(6): 508-512. DOI: 10.1097/00006982-199911000-00005.
24. Agrawal R, Gupta P, Tan KA, et al. Choroidal vascularity index as a measure of vascular status of the choroid: measurements in healthy eyes from a population-based study[J/OL]. Sci Rep, 2016, 6: 21090[2016-02-12]. https://europepmc.org/article/MED/26868048. DOI:10.1038/srep21090.
25. Zhou H, Dai Y, Shi Y, et al. Age-related changes in choroidal thickness and the volume of vessels and stroma using swept-source OCT and fully automated algorithms[J]. Ophthalmol Retina, 2020, 4(2): 204-215. DOI: 10.1016/j.oret.2019.09.012.

Chinese Journal of Ocular Fundus Diseases

Changes of choroidal biomarkers in patients with central serous chorioretinopathy

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