The aim of this study was to assess the rate of choroidal neovascularisation (CNV) in chronic central serous chorioretinopathy (CSR) patients with flat irregular pigment epithelial detachments (PEDs) by optical coherence tomography angiography (OCTA). Data of all consecutive patients with chronic CSR (more than six months duration) who had an OCTA during a one year period were retrospectively reviewed. Eighty-eight eyes with chronic CSR had an OCTA. Patient mean (±SD) age was 54.5±12.2 years (range: 34-84). Forty-eight patients (78.7%) were males. Best-corrected visual acuity ranged from 1.3 to 0 LogMAR (Snellen equivalent 20/400–20/20) with a mean (±SD) of 0.28±0.3 (Snellen equivalent 20/40). The mean (±SD) subfoveal choroidal thickness was 452.6±145.6µm. Fundus examination was suggestive of CNV in only one eye showing subretinal haemorrhages. Fifty-nine (67%) eyes had a flat irregular PED on SD-OCT; 21 (35.6%) of these eyes had a CNV detected by OCTA. Using the combination of FA, ICGA and SD-OCT, CNV was detected in 13 out of the 52 eyes (25%). In 6/52 (11.5%) eyes in which CNV was detected by OCTA, it could not be visualised with the other modalities (FA/ICGA/SD-OCT). The eyes with CNV (vascularised FIPEDs) had a lower visual acuity than those without CNV. While there was no statistically significant difference in the rates of subretinal and intraretinal fluid between eyes with CNV and without, the subfoveal choroidal thickness was thinner in the CNV group (possibly due to previous photodynamic therapy (PDT) use). All hyporeflective flat irregular PEDs were avascular (no CNV). The area, width and height of the flat irregular PED was larger in the CNV group. The authors conclude that in this series OCTA did not miss any CNV that were detected by a combination of other imaging modalities, while 11.5% of CNV were missed when OCTA was not used.

Optical coherence tomography angiography of flat irregular pigment epithelium detachment in chronic central serous chorioretinopathy.
Bousquet E, Bonnin S, Mrejen S, et al.
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Saruban Pasu

Moorfields Eye Hospital, London, UK.

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