Optical coherence tomography in diagnostics and treatment of central serous chorioretinopathy

Abstract

Purpose - to identify the signs of leakage points in central serous chorioretinopathy (CSC) patients using optical coherence tomography (OCT) allowing focal laser photocoagulation (FLP) to be performed without the need for fluorescein angiography (FA) in their treatment; to evaluate the effectiveness and safety of the approach. Material and methods. The retrospective part of the study included 54 patients (54 eyes) with distinctive signs of CSC further confirmed by the presence of a leakage point as could be seen with FA. The number of pigment epithelial detachments (PED), the thickness of the photoreceptor outer segments (PROS) layer, maximum horizontal length of the photoreceptor thinning area, and morphological changes in the outer retinal layers were evaluated with OCT. Using FA for each leakage point, its localization and coincidence with PED were evaluated in retro-mode confocal scanning laser ophthalmoscopy and OCT images, respectively. The prospective part of the study included 11 CSC patients (11 eyes) who underwent en face OCT-guided FLP of the leakage point with NAVILAS 532 system. Results. The leakage point s were found to coincide with PED in 50 eyes (92.6%). Mean distance from the superior border of the retinal detachment area to the leakage point was 28.8±14.1% of the retinal detachment height. In 90.3% of cases the PROS layer in the area above the PED was thinner (23.3±7.8 µm) compared to the area outside the leakage point (64.0±9.4 µm) (p<0.001). FA-free OCT-guided FLP required in average 3.3±0.5 laser burns per leakage point. Complete resolution of subretinal fluid occurred in all treated eyes within 7.5±1.0 weeks after the surgery, and no adverse events were observed. Conclusion. Coincidence of PED in the superior half of the area of retinal detachment with thinning of the PROS layer as seen on OCT can be considered a reliable sign of the leakage point. The FA-free FLP based on OCT appears to be an effective and safe procedure for the treatment of CSC.