Visualization of Choroidal Features in Central Serous Chorioretinopathy Across Disease Stages Using Wide-Field SS-OCTA

PURPOSE: This study employed wide-field swept-source optical coherence tomography angiography (SS-OCTA) to conduct precise assessments in a cohort of eyes with central serous chorioretinopathy (CSC) across distinct stages, characterizing both central and peripheral choroidal vascular perfusion characteristics and vortex vein distribution patterns. METHODS: This study enrolled 99 participants (37 acute CSC, 34 chronic CSC, 28 matched controls). All participants received SS-OCTA examinations to measure choroidal volume (CV), choroidal capillary blood flow density (VDcc), medium-to-large choroidal vessel density (VDmlc), choroidal vascularity index (CVI), and unit area choroidal vessel volume (CVV/a) across nine subregions (superotemporal, superior, superonasal, temporal, central, nasal, inferotemporal, inferior, inferonasal subregions). RESULTS: After Bonferroni correction, no pairwise comparison for vortex vein dilation was statistically significant (Pa = 0.034, Pc = 0.047, Pb = 1.000). For vortex vein anastomosis, only the chronic CSC versus control comparison remained significant (Pc < 0.001); the acute versus chronic (Pa = 0.066) and acute versus control (Pb = 0.064) comparisons were not significant. Acute CSC eyes exhibited larger CVV/a and CV across all nine subregions, along with increased VDmlc (temporal, inferior, nasal, and inferonasal regions) and higher CVI (temporal, central, and nasal subregions) versus controls. When compared to chronic CSC, acute CSC showed higher CV (superotemporal and central subregions), higher CVV/a (inferotemporal, superior, inferior, superonasal, nasal, and inferonasal subregions), and higher VDmlc (superotemporal, temporal, inferotemporal, central, inferior, superonasal, and inferonasal subregions). CONCLUSION: Acute and chronic CSC demonstrate distinct choroidal hemodynamic profiles, with acute CSC showing more extensive choroidal hyperperfusion in both peripheral and central subregions, mainly in medium-to-large choroidal vessels. The application of wide field SS-OCTA may provide further insights into CSC pathogenesis.