Central Serous Chorioretinopathy And Subretinal Fibrin

Purpose:Through the multimodal image analysis of the fundus in patients with acute central serous chorioretinopathy(CSC),we studied the population characteristics,optical coherence tomography(OCT)manifestations under different fundus fluorescein angiography(FFA)leakage morphology patterns,and analyzed the factors that may affect the leakage patterns.We also studied the population characteristics,OCT and FFA characteristics of patients with fibrinous CSC,and analyzed the differences between them and non-fibrinous CSC,so as to provide help and reference for the clinical diagnosis,differentiation and pathogenesis of this disease.Methods:We reviewed the medical records of patients with acute CSC who had been visited in the ophthalmology department of our hospital from December 2020 to January 2022 with a symptom duration of ≤ 3 months.General information and imaging data of patients were collected.The present study contains two parts.First,the patients were divided into “ink-blot” group and “smokestack” group according to the FFA leakage pattern.The general data and OCT characteristic of the two groups were observed and compared to analyze the factors that might affect the leakage pattern.Secondly,patients were divided into fibrinous CSC group and non-fibrinous CSC group according to the presence or absence of fibrin.The imaging characteristics of fibrinous CSC group were summarized,and the differences of imaging features between the two groups were analyzed.Results:105 eyes of 105 patients with acute CSC were enrolled in this study,including 66 males and 39 females,with a male: female ratio = 1.7: 1.The mean age was 44.10 ±0.91 years(27-72 years),the mean duration of disease was 27.58 ± 2.45 days(3-90days),and the mean BCVA(log MAR)was 4.77 ± 0.22(4.0 to 5.0).1.According to the FFA leakage pattern,72 patients were enrolled into “ink-blot”group and 33 patients into “smokestack” group.The results of univariate analysis showed that the height of subretinal fluid(SRF),the presence of subretinal fibrin and the morphology of the retinal pigment epithelium(RPE)at the leakage point were significantly different between the two groups(P<0.05),while there were no statistical differences in gender,age,duration of disease,choroidal thickness at the fovea and the leakage point between the two groups(P>0.05).Multivariate logistic regression analysis showed that SRF height(OR=1.007,95% CI: 1.003-1.011)and subretinal fibrin(OR=0.151,95% CI: 0.046-0.491)were independent factors influencing the pattern of FFA leakage.2.According to the presence or absence of subretinal fibrin,the patients were divided into fibrinous group and non-fibrinous group,39 patients were enrolled in fibrinous group and 66 patients enrolled into the other group.The OCT morphology of the fibrinous group was divided into three manifestations: leakage point aggregation in23 cases(59.0%),subretinal dispersion in 7 cases(17.9%),and mixed type in 9 cases(23.1%).In addition,there were two OCT features accompanying with fibrinous group,namely the “vacuole sign” and the “dipping sign”.There were 12 cases(52.2%)with "vacuolar sign" in the leakage point aggregation type,and 5 cases(55.6%)in the mixed type.The location of "vacuolar sign" corresponded to the leakage point."Dipping sign" was found in 7 cases(30.4%)and 2 cases(22.2%)in the leakage point aggregation type and mixed type groups respectively.The subretinal dispersed type does not combine the above two characteristics.Univariate analysis was used to compare the imaging findings between the fibrinous group and the non-fibrinous group.The results showed that there were significant differences between the two groups in FFA leakage pattern,RPE micro-tear,Haller’s layer thickness,and the ratio of Haller’s layer to total choroidal thickness(P < 0.05).Conclusion:1.The height of subretinal fluid and the presence of subretinal fibrin are independent factors affecting the leakage pattern of FFA.The higher the degree of subretinal fluid detachment and the absence of subretinal fibrin,the higher the possibility that the FFA will show smokestack leakage.2.Fibrinous CSC has special OCT characteristics: “vacuole sign” and “dipping sign”,and the location of "vacuole sign" is closely related to the location of the leakage point of CSC.3.Compared with non-fibrinous CSC,fibrinous CSC has more significant to show“ink-blot” leakage,and the Haller’s layer of choroid is more significantly dilated,and is more likely to be combined with RPE micro-tear.