Fig. 17.1
Central serous chorioretinopathy in swept source optical coherence tomography (SS-OCT). This image presents long-standing CSC with elongated photoreceptors (top arrow)
Fig. 17.2
Central serous chorioretinopathy. Top left, Scanning laser ophthalmoscopy and fluorescein angiography showing pooling. Arrow added to the fluorescein angiography early phase indicates the spot to be lasered. Top right, SS-OCT before and after laser photocoagulation. Please note that choroidal thickness did not change after laser photocoagulation. Middle row, Swept source optical coherence tomography angiography (SS-OCTA) performed on the same day as fluorescein angiography. Middle row from left to right, Superficial retinal vessels; deep retina vessels (white arrow indicates the spot to be lasered, corresponding to early phase of fluorescein angiography, the central area with decreased vessels visibility, marked with yellow lines, corresponds to serous retinal detachment); avascular retinal pigment epithelium; choroidal vasculature presents a hyporeflective central area, corresponding to serous retinal detachment (yellow lines), additionally a dilated vessel (green arrow), which probably is leaking, attached to a hyporeflective spot (red arrow), probably the leakage site. Please note that in spectral-domain OCTA leakage sites are very rarely observed [5, 6]. Bottom row, SS-OCTA after laser photocoagulation. Bottom row from left, Superficial retinal vessels; deep retina vessels (yellow arrow indicates the lasered spot); avascular retinal pigment epithelium; choroidal vessels
Choroidal thickness is crucial in distinguishing CSC from age-related macular degeneration (AMD) in doubtful cases. The choroid is always thickened is CSC (see Fig. 17.1, double-headed arrow) and thinned in AMD. These suggest that CSC might be associated with increased hydrostatic pressure in the choroid [3]. As the disease is self-limiting in most cases, the common practice is to observe acute cases for about 3 months.
Treatment of CSC is still being discussed. Choroidal thickness does not decrease after laser photocoagulation, but choroidal thickness normalizes after photodynamic therapy (PDT). Theoretically, PDT should occlude only choriocapillaries without affecting deep choroidal vessels. However, Izumi et al. [4] reported that especially the diameter of large choroidal vessels decreased after PDT.
17.2 Polypoidal Choroidal Vasculopathy
Fig. 17.3
Polypoidal choroidal vasculopathy. Top, SS-OCT image showing the double layer sign—typical for PCV. It seems as though the retinal pigment epithelium (RPE) is split into two layers, whereas in fact we can see RPE and Bruch’s membrane (BM). Another pathognomonic feature of PCV are polypoidal lesions filled with moderately hyperreflective material (asterisk) [7]. Middle, Fluorescein angiography. Lower left, SS-OCT after photodynamic therapy in this patient. Lower right, Indocyanine green angiography
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
