| Objective:To characterize morphology features of the retinal pigment epithelium (RPE) and choroid in eyes using en face OCT, and blood flow of the choriocapillary using OCT angiography(SSADA), with central serous chorioretinopathy (CSC). Combing with the multifunctional imaging as fundus autofluorescence(FAF), near-infrared fundus autofluorescence(NIA), Spectral domain optical coherence tomography(SD-OCT), fundus fluorescein angiography(FFA), and indocyanine green angiography(ICGA), suppose the pathophysiology of disease.Methods:To observe morphology of the RPE and individual choroidal layers, and blood flow of the choriocapillary, with FAF, NIA, SD-OCT, FFA, ICGA, en face OCT, and SSADA examinations in clinical diagnosed CSC patients.Results:In CSC, low levels of autofluorescence correspond to the area of the neurosensory detachement. At leakage points there is a mixed picture of decreased and increased autofluorescence. The appearance of NIA is the similar with FAF. Neurosensory detachement and pigment epithelial detachment(PED) can be detected clearly with SD-OCT. Material on the outer surface of the elevated retina in CSC may represent accumulation of the photoreceptor outer segments. Leakage points are the most common type of FFA. PED and RPE atrophy could also be observed. ICGA show multifocal increased fluorescence at early and middle stage, and typical choroidal increased fluorescence spots and decreased fluorescence vessel shadows are seen at the late stage. Absence of SS-OCT signal at the RPE level corresponded to RPE detachment or loss and was observed in all eyes. The areas of RPE dysfunction are corresponding to the SD-OCT, FFA and ICGA. In all affected eyes, the choriocapillaris dilation were grossly underlying RPE changes, either PED or RPE loss on b-scans and further documented on fundus autofluorescence and FA. Choroidal en face SS-OCT imaging at the level of Sattler’s layer and Haller’s layer revealed dilation of medium-sized choroidal vessels in two distinct patterns, focal choroidal dilation and diffuse choroidal dilation. And they could be inconsistent at two layers. SSADA found increased blood flow of choriocapillaris in CSC, the degree and range could be deeper and larger than that in en face OCT.Conclusions:FAF is useful to distinguish between acute and chronic recurrent forms of CSCR. It also can be a useful investigation in CSCR to guide prognosis. FAF can be useful in aiding the clinician to identify patients who would not benefit from laser therapies. NIA is more sensitive than FAF, which indicates the phagocytosis and metabolism of RPE. The leakage points in FFA has an important guiding function in Focal photocoagulation and photodynamic dynamic therapy afterwards. ICGA imaging indicates the choroidal hyperpermeability, but it has its limitations in identify specific morphology changes in the choroid. The topographic analysis allowed by en face imaging facilitates the comparison between multiple imaging modalities and permits a better characterization of the morphology and extent of choroidal changes. en face imaging is superior to cross-sectional imaging for visualizing these features.3-dimensional OCT visualization of the macular area suggest that our observation might be related to pronounced choroidal vascular dilation or remodeling, or to extracellular fluid accumulation. En face OCT also offers a new approach in the assessment of CNV and might offer an alternative noninvasive investigative tool in the diagnosis and management of CNV. SSADA obtains the blood flow of the choroidal vessels, and could present en face OCT at the same time. Its sensitivity is higher than en face OCT. The increasing blood flow of the choriocapillary may happens before dilation. Hence we suppose that dilation may be the consequence of angioplerosis. Characterizing morphology features of the retinal pigment epithelium (RPE) and choroid in eyes using en face OCT, and blood flow of the choriocapillary using OCT angiography(SSADA), are the core creativities of our study. |
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