Large Veins Can Experience Sausaging in Central Serous Chorioretinopathy

Large choroidal veins can undergo a process of sausaging and bulbosities in the setting of central serous chorioretinopathy (CSCR), according to a report published in Retina. Additionally, researchers found no corresponding abnormalities in the retinal vessels, suggesting that CSCR is a choroidal abnormality. 

“Characterization of these features adds to the list of abnormal choroidal vascular features, particularly involving venous outflow, found in eyes with [CSCR] and may help in understanding the pathophysiology of the disease,” the researchers report.

The researchers evaluated the caliber of the choroidal veins in the eyes of patients with CSCR and aimed to identify risk factors associated with the disease.

They retrospectively evaluated both sausaging (defined as 3 or more contiguous fusiform dilations varying by at least 50% from the narrowest to largest diameters) and bulbosity (defined as a focal 2x dilation of a blood vessel compared with the diameter of the surrounding host vessel) in patients treated at a community-based retinal practice.

The study included 73 eyes of 41 patients (mean age, 53.5 years; 73% men, 27% women). The researchers observed sausaging of vessels in a mean and median of 3 quadrants per eye (range, 0-4) and found that 35.6% of eyes had bulbosities. They found that quadrants affected by sausaging were significantly more likely to be affected by bulbosities (P =.019).

The team found that the only significant risk factor for sausaging was the use of corticosteroids (β, 0.22; 95% confidence interval [CI], 0.098-0.33; P >.001). They also demonstrated that age (β, 23.7; 95% CI, 26.9-20.55; P =.021) and proportion of quadrants involved by sausaging (β, 236.1; 95% CI, 128.2-344; P <.001) were significant predictors of subfoveal choroidal thickness. 

“The findings of this study, sausaging and bulbosities of the choroidal veins, may arise from dilation and remodeling of larger choroidal veins due to increased choroidal venous pressure,” the study authors explain. “Sausaging and bulbosities in the choroid serve as a clue that the venous outflow from the choroid is not normal, and the outflow problem may secondarily affect choriocapillaris performance.”

Limitations of the study included the retrospective analysis of eyes having ICG angiography and the unknown proportion of eyes with sausaging and bulbosities in CSC eyes not having ICG angiography.

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