CSCR insights in the Era of OCT-Angiography, sub-retinal fluid characteristics, choroidal flow abnormalities, and CSCR-related Choroidal Neovascular Membrane

Abstract Purpose To evaluate morphological characteristics of sub-retinal fluid, RPE changes and choroidal blood flow in different sub-types of central serous chorioretinopathy using OCT-Angiography. Methods A cross-sectional observational study included consecutive series of 146 eyes with various sub-types of CSCR. OCT-A evaluated the characters of sub-retinal fluid and choroidal flow. Outcome measures included characters of high reflective foci in SRF, RPE abnormalities, CNV characters and distribution of vascular changes in choroidal vasculature. Results High reflective foci were found in 85% of eyes with persistent CSCR and in 22% eyes with chronic CSCR and none in acute CSCR. Fine dispersed high reflective foci were prevalent if SRF persistent less than 6 months while coarse clumped foci were obvious in fluid persistent more than 6 months. All eyes with acute and persistent CSCR exhibited abnormal choriocapillaris with patchy areas of hypoperfusion confined to area of SRF. Chronic CSCR displayed multifocal patchy areas of choriocapillaris hypoperfusion not bounded by areas of SRF. Choroidal slabs revealed dilatation of choroidal vessels as compared to fellow unaffected eyes. Flat irregular PED was found in 58.3% and neovascular frond was found in 30.1%. CNV area was variable (Mean; 0.289 mm 2 ) and variable patterns were detected. Larger CNV area significantly correlated with larger area of sub-retinal fluid. Conclusion OCT-A highlighted a difference in SRF characters and distribution of choroidal vascular changes among various CSCR subtypes along with identification of CSCR-related CNV.