Widefield Analysis of Choroidal Vascular Characteristics in Central Serous Chorioretinopathy With Different Choroidal Vein Drainage System

Purpose: To explore the choroidal vasculature changes in central serous chorioretinopathy (CSC) with symmetric and asymmetric choroidal venous drainage system using widefield optical coherence tomography angiography (WF-OCTA). Methods: In this retrospective study, choroidal characteristics were evaluated in CSC eyes through WF-OCTA. Eyes were classified based on choroidal venous drainage patterns: symmetric, one dominant vortex vein (DVV), and two DVV patterns. The location of DVVs was mapped to four quadrants: superotemporal, inferotemporal, superonasal, and inferonasal. Quantitative parameters including choroidal thickness (CT), choroidal volume (CV), choroidal vascularity index, and choriocapillaris flow density (CCFD) were analyzed both globally and within each quadrant. Results: Of 187 eyes from 146 patients, 43 eyes (22.99%) showed symmetric and 144 eyes (77.00%) demonstrated asymmetric choroidal venous drainage patterns. In the asymmetric cases, 78 eyes (41.71%) exhibited one-DVV and 66 eyes (35.29%) showed two-DVV patterns. One-DVV cases demonstrated significantly increased CT and CV, but decreased CCFD in DVV-related quadrants compared to symmetric cases (P < 0.05 for all), except for CCFD in cases with inferonasal-located DVV (P = 0.110). Moreover, when DVVs were located in superotemporal or superonasal quadrants, a significant reduction in overall CCFD was also observed (P = 0.010 and P = 0.021, respectively). In contrast, two-DVV cases exhibited predominant choroidal vascular alterations in the quadrants near the DVV locations. Overall CCFD was significantly lower in one-DVV cases (46.94% ± 1.30%) compared to two-DVV cases (47.92% ± 1.70%, P < 0.001). Conclusions: CSC eyes with asymmetric venous drainage demonstrated more significant choroidal alterations than symmetric cases, particularly when DVVs were located in superior quadrants. In contrast to one-DVV cases, two-DVV patterns showed more balanced choroidal circulation, likely through compensatory intervortex anastomoses. Translational Relevance: This study investigates the relationship between choroidal parameters and varying patterns of preferential choroidal venous drainage in CSC eyes, showing that CSC eyes with asymmetric pattern demonstrated more significant choroidal alterations than symmetric cases.