In Central Serous Chorioretinopathy, Vortex Vein, Systemic Factors Play Pathogenic Role

Acute central serous chorioretinopathy
Acute central serous chorioretinopathy
Enhanced depth imaging of swept-source OCT facilitates examination of widefield choroidal thickness in eyes with central serous chorioretinopathy.

Enhanced depth imaging of swept-source optical coherence tomography (SS-OCT) can be used to analyze changes to choroidal thickness in patients with central serous chorioretinopathy (CSCR), according to research published in Ophthalmology Retina.

Researchers conducted an observational study to examine widefield changes in the choroidal thickness of eyes with CSCR using enhanced depth imaging of SS-OCT. The SS-OCT viewing angle was vertical 20 mm by horizontal 23 mm, and the team developed a grid comprising 9 subfields, with diameters of 3 mm, 9 mm, and 18 mm and inner and outer rings enclosed by circles with diameters of 3 mm and 9 mm and 9 mm and 18 mm, respectively. These were divided into 4 subfield regions: superotemporal, inferotemporal, superonasal, and inferonasal.

The study included 22 eyes of 22 patients with treatment-naïve unilateral CSCR (mean age, 52.4±12.0 years; 91% men and 9% women) and 28 normal eyes of 28 age-matched healthy participants (mean age, 57.4±16.1; 75% men and 25% women).

At examination, the estimated mean duration from the presumed onset of CSCR was 6.8±3.1 months. The researchers found that the choroidal thicknesses of the eyes with CSCR were significantly greater in all subfields of the grid compared with those of normal eyes (P <.020 for fellow eyes; P <.001 for control eyes). 

In this study, the choroidal thicknesses of eyes with CSCR were significantly greater in the superonasal and inferonasal subfield regions (P <.001 for outer superonasal and inferotemporal), but not in the outer superotemporal and inferonasal subfield regions, and in all inner subfield regions (P <.001 for all) compared with those of fellow eyes.

In areas with dilated vortex veins, the researchers observed choroidal thickening from the vicinity of the vortex vein ampulla to the macula along the courses of the veins. They also found that choroidal thickening on the dominant side was significantly greater than that of the non-dominant side (P = .015 for the nasal subfield of the inner ring; P = .003 and P <.001 for temporal subfields of the inner and outer rings, respectively).

“Our results using [enhanced depth imaging of widefield] SS-OCT may provide evidence for the involvement of blood flow stasis or overload in the affected vortex vein in CSCR pathogenesis,” researchers explain. “The imaging protocol used in this study will facilitate elucidating the physiology of the choroidal circulation, and pathologies of chronic or atypical CSCR and other pachychoroid spectrum diseases.”

The primary limitations of the study included a lack of ancestral diversity among patients (all Japanese), difficulty precisely determining the onset of CSCR, inability to simultaneously conduct SS-OCT imaging while capturing the vortex vein ampulla, and potential distortion of widefield SS-OCT at the periphery.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  


Ishikura M, Muraoka Y, Nishigori N, et al. Wide field choroidal thickness of eyes with central serous chorioretinopathy examined by swept-source optical coherence tomography. Ophthalmol Retina. Published online April 15, 2022. doi:10.1016/j.oret.2022.04.011