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An Optical Coherence Tomography Angiography Study

Matet, Alexandre, MD, PhD*; Daruich, Alejandra, MD*; Hardy, Samuel, MD*; Behar-Cohen, Francine, MD, PhD†,‡

doi: 10.1097/IAE.0000000000002271
Original Study: PDF Only

Purpose: To investigate choriocapillaris flow signal void distribution on optical coherence tomography (OCT) angiography in central serous chorioretinopathy (CSCR) and its correlation to choroidal vessel morphology.

Methods: Fifty-three CSCR eyes (48 patients) and 34 healthy control eyes were included, retrospectively. Exclusion criteria were refractive error >2D, previous laser or photodynamic therapy, low-quality OCT angiography, or excessive shadowing artifacts. Choriocapillaris OCT angiography scans were processed by local-threshold binarization to identify signal voids, and extract their cumulative area. The locations of the two largest voids in each eye were reported on the corresponding enhanced depth imaging OCT raster scan. Choriocapillaris thickness and diameter of underlying outer choroidal vessels were measured at the level of flow voids and of adjacent outer choroidal vessels, not colocalizing with voids.

Results: There were 22 acute, 16 recurrent, and 15 chronic CSCR eyes. Total flow void area was larger in CSCR than control eyes. In univariate analysis, the total flow void area on OCT angiography increased with age (P = 0.0002), duration since CSCR diagnosis (P = 0.004), extension of autofluorescence alterations (P = 0.016), and CSCR severity (P < 0.0001). In multivariate analysis, age (P = 0.014) and CSCR type (P = 0.046) influenced independently the total flow void area. On enhanced depth imaging OCT, outer choroidal vessel diameter was higher (P < 0.0001), and choriocapillaris was thinner (P < 0.0001) at flow voids compared with adjacent sites, independently from eccentricity from the fovea.

Conclusion: Choriocapillaris flow voids colocalize with choriocapillaris thinning and deep choroidal vessel dilation in CSCR eyes. Age and CSCR severity influence choriocapillaris flow, a key contributor to CSCR pathophysiology and clinical expression.

Choriocapillaris flow signal voids on optical coherence tomography angiography of central serous chorioretinopathy eyes colocalize with choriocapillaris thinning and deep choroidal vessel dilation. Older age and more advanced central serous chorioretinopathy type are associated with more extended choriocapillaris flow signal voids, suggesting that they may represent a potential imaging marker related to central serous chorioretinopathy severity.

*Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland;

Inserm, U1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Université Paris Descartes Sorbonne Paris Cité, Centre de Recherche des Cordeliers, Paris, France; and

Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland.

Reprint requests: Francine Behar-Cohen, MD, PhD, Inserm, UMR1138, 15 rue de l'Ecole de Médecine, 75006 Paris, France; e-mail:

Supported by grants from the Swiss National Fund (#320030_156401, F.B.-C.) and from the Faculty of Biology and Medicine Research Commission Fund, University of Lausanne, Switzerland (A.M.).

None of the authors has any conflicting interests to disclose.

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© 2018 by Ophthalmic Communications Society, Inc.