Optical coherence tomography biomarkers in central serous chorioretinopathy: a review

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Abstract

Central serous chorioretinopathy is characterized by focal dysfunction of the retinal pigment epithelium associated with choroidal vascular hyperpermeability, which causes subretinal fluid to accumulate and serous detachment of the neurosensory retina to form, accompanied by detachments, defects, or other alterations of the retinal pigment epithelium. Optical coherence tomography (OCT) and OCT angiography are indispensable in central serous chorioretinopathy for diagnostic verification, exclusion of complications, determination of management strategies, and subsequent patient monitoring.

Based on the conducted exploratory and analytical review, it should be noted that, despite the large body of research on OCT diagnostics in central serous chorioretinopathy, many issues remain insufficiently investigated. In particular, further clarification is required regarding the criteria for distinguishing acute and chronic disease courses, the capabilities of OCT for verification of presumed leakage areas, and its role in detecting choroidal neovascularization. Further research is also necessary to refine the criteria for disease progression, recurrence, positive and negative treatment response, and the development of complications.

To structure the data on diagnostic and management approaches to central serous chorioretinopathy, the investigation of OCT biomarkers appears especially relevant. Owing to numerous clinical studies in recent years, the potential clinical applications of OCT biomarkers in central serous chorioretinopathy have expanded. OCT biomarkers of recurrence, as well as predictive and prognostic OCT biomarkers of favorable and unfavorable disease outcomes, have been identified. Thus, the primary clinical value of OCT biomarkers lies in their ability to support individualized patient management, enabling a personalized approach to treatment based on the specific characteristics of disease course.

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About the authors

Sofia I. Belianina

National Medical Research Center “Inter-industry Scientific Technical Complex "Eye Microsurgery" named after academician S.N. Fedorov”

Author for correspondence.
Email: sofiabelyanina00@mail.ru
ORCID iD: 0000-0002-5982-9396
SPIN-code: 6312-7830

MD

Russian Federation, Moscow

Elena V. Ivanova

National Medical Research Center “Inter-industry Scientific Technical Complex "Eye Microsurgery" named after academician S.N. Fedorov”

Email: elena-mntk@yandex.ru
ORCID iD: 0000-0001-9044-3400
SPIN-code: 5002-2460

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Pavel L. Volodin

National Medical Research Center “Inter-industry Scientific Technical Complex "Eye Microsurgery" named after academician S.N. Fedorov”

Email: volodinpl@mntk.ru
ORCID iD: 0000-0003-1460-9960
SPIN-code: 9296-0976

MD, Dr. Sci. (Medicine)

Russian Federation, Moscow

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2. Fig. 1. Neurosensory retinal detachment: a — neurosensory retinal detachment in the acute form of central serous chorioretinopathy, dome-shaped (asterisk); b — neurosensory retinal detachment in the chronic form of central serous chorioretinopathy, flat and irregular shape (asterisk).

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3. Fig. 2. Increased reflectivity of the retinal pigment epithelium (short arrows) around the defect, retinal pigment epithelium defect (long arrows).

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4. Fig. 3. Retinal pigment epithelium detachment: a — dome-shaped retinal pigment epithelium detachment in the acute form of central serous chorioretinopathy (arrow); b — flat irregular retinal pigment epithelium detachment in the chronic form of central serous chorioretinopathy (arrow).

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5. Fig. 4. OCT “double-layer” biomarker: a — OCT “double-layer” biomarker on a cross-sectional scan (long arrow); b — type 1 choroidal neovascularization on en face OCT angiography in the projection of retinal pigment epithelium changes (short arrow). OCT — optical coherence tomography.

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6. Fig. 5. Hyporeflective “lucency” biomarker. Hyporeflective “lucency” (arrow) in the area of subretinal hyperreflective fibrin deposition.

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7. Fig. 6. Hypertransmission of the OCT signal: a — bright lines in the projection of the choroid on cross-sectional OCT scans (long arrows); b — bright areas on en face OCT angiography (short arrows). OCT — optical coherence tomography.

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8. Fig. 7. Changes in the photoreceptor outer segments: a — elongation of the photoreceptor outer segments in the acute form of central serous chorioretinopathy (long arrow); b — elongation and disruption of the regularity of the photoreceptor outer segments over time (short arrow).

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9. Fig. 8. Thinning of the photoreceptor outer segments: a — local thinning of the photoreceptor outer segments in the projection of the leakage point in acute central serous chorioretinopathy on a cross-sectional OCT scan (long arrows); b — en face OCT angiography in the projection of the photoreceptor outer segment layer (short arrows). OCT — optical coherence tomography.

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10. Fig. 9. Photographs of a patient with chronic central serous chorioretinopathy and symptom duration of more than two years: a — cross-sectional OCT scan: diffuse thinning of the photoreceptor outer segments (long arrow), thinning of the outer nuclear layer (short arrow); b — en face OCT angiography in the projection of the photoreceptor outer segment layer: diffuse thinning of the photoreceptor outer segments; c — decreased central retinal sensitivity in the area of photoreceptor degeneration (according to computerized microperimetry).

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11. Fig. 10. Hyperreflective foci: a — subretinal (long arrows); b — intraretinal (short arrows).

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