Optical coherence tomography in assessment chorioretinal blood flow in patients with central serous chorioretinopathy

Introduction and purpose. Central serous chorioretinopathy - a disease that manifests itself serous detachment of the neurosensory retina and / or retinal pigment epithelium (RPE). Chronic course of pathological process may be complicated by the development of subretinal neovascularization, and is accompanied by a decrease in visual functions. Despite the large number of studies, there are no pathogenetically oriented and effective methods of treatment of central serous chorioretinopathy today, because there is no consensus on the causes of its origin. To evaluate the accuracy of the information content of chorioretinal blood flow changes in patients with central serous chorioretinopathy, to compare the degree of changes of RPE and hemodynamic disorders in different forms of the disease. Materials and Methods. The study involved 26 patients with central serous chorioretinopathy aged 35 to 54 years. To assess chorioretinal blood flow the optical coherence tomography (OCT) in retinal angiography mode was included in the volume of diagnostic examination. Results. It was demonstrated that the choroidal vessels and RPE are an original target in the realization of the pathological process in central serous chorioretinopathy. The changes in the pigment epithelium and the neurosensory retinal detachment, whose height ranged from 53.4 to 513.0 m (238.3 ± 80.4 - in acute and - 215.5 ± 129.9 - in chronic diseases) were revealed in all patients. In 45 % of cases of acute and 67 % in patients with a chronic form of disease the neurosensory retinal detachment combined with RPE detachment, preventing recovery of macular interface on a background of medical actions. Prolonged existence of ischemia and RPE detachment is accompanied by severe progressive degenerative changes in the retina as a whole, causing resistance to treatment. Conclusions. OCT in angiography mode in the diagnosis of various forms of chorioretinal central serous chorioretinopathy allows visualizing blood flow, evaluating the extent and nature of the structural changes of the retina taking into account hemodynamic disorders. The revealed changes of RPE and choroid, as classification and prognostic criteria of the disease, determine the effectiveness of treatment measures and prognosis of disease.

оптическая когерентная томография, центральная серозная хориоретинопатия, пигментный эпителий, optical coherence tomography, central serous chorioretinopathy, pigment epithelium

1. Злобина А. Н., Юрьева Т. Н. Центральная серозная хориоретинопатия. - Лазерная хирургия сосудистой патологии глазного дна / под ред. проф. А. Г. Щуко. М.: Офтальмология, 2014. С. 158-175.

2. Киселева Т. Н., Аджемян Н. А. Методы оценки глазного кровотока при сосудистой патологии глаза // Регионарное кровообращение и микроциркуляция. 2015. Т. 14. № 4(56). С. 4-10.

3. Котляр К. Е., Дроздова Г. А., Шамшинова А. М. Гемодинамика глаза и современные методы исследования. Часть I. Глазное кровообращение и его количественная оценка // Глаукома. 2003. № 3. С. 62-73.

4. Щуко А. Г., Злобина А. Н., Юрьева Т. Н. Оптимизация критериев диагностики центральной серозной хориоретинопатии // РМЖ «Клиническая Офтальмология». 2015. № 1. С. 24.

5. Dimitrova G. Colour Doppler Imaging of Ocular and Orbital Blood Vessels in Retinal Diseases // European Ophthalmic Review. 2011. 5(1). P. 16-9.

6. Drexler H. Endothelial dysfunction: clinical implications // Prog. Cardiovasc. Dis. 1997. Vol. 39. № 4. P. 287-324.

7. Friedman M., Byers S. O., Diamant J. et al. Plasma catecholamine response of coronary-prone subjects (type A) to a specific challenge // Metabolism. 1975. № 24. P. 205-210.

8. Gass J. D. Stereoscopic atlas of macular diseases. - St. Louis: Mosby Year Book, 1987. 441 р.

9. Gass J. D. Central serous chorioretinopathy and white subretinal exudation during pregnancy // Arch. Ophthalmol. 1991. № 109. P. 677-681.

10. Gass J. D. Bullous retinal detachments and multiple retinal pigment epithelial detachments in patients receiving hemodialysis // Graefes Arch. Clin. Exp. Ophthalmol. 1992. № 230. P. 454-458.

11. Guyer D. R., Yannuzzi J. S., Slakter et al. Digital indocyanine green videoangiography of central serous chorioretinopathy // Arch. Ophthalmol. 1994. № 112. P. 1057-1062.

12. Iida T., Kishi S., Hagimura N. et al. Persistent and bilateral choroidal vascular abnormalities in central serous chorioretinopathy // Retina. 1999. № 19. P. 508-512.

13. Iida T., Spaide S. G., Negrao R. F. et al. Central serous chorioretinopathy after epidural corticosteroid injection // Am. J. Ophthalmol. 2001. № 132. P. 423-425.

14. Imamura Y., Fujiwara T., Margolis R. et al. Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy // Retina. 2009. Vol. 29. Р. 1469-1473.

15. Khng C. G., Yap E. Y., Au-Eong K. G. et al. Central serous retinopathy complicating systemic lupus erythematosus: a case series // Clin. Exp. Ophthalmol. 2000. № 28. P. 309-313.

16. Lumbroso B., Huang D., Romano A., et al. Clinical En Face OCT Atlas. - New Delhi-London-Philadelphia-Panama: Jaypee - highlights Medical Publisher, Inc., 2013. 482 p.

17. Lumbroso B., Huang D., Jia Y., et al. Clinical Guide to Angio-OCT-Non Invasive Dyeless OCT Angiography. - New Delhi: Jaypee Brothers Medical Publisher, 2015. 100 p.

18. Lumbroso B., Huang D., Chen C. et al. Clinical OCT Angiography Atlas. - New Delhi-London-Philadelphia-Panama: The Health Sciences Publisher, 2015. 174 p.

19. Marmor M.F. New hypothesis on the pathogenesis and treatment of serous retinal detachment // Graefes Arch. Clin. Exp. Ophthalmol. 1988. № 226. P. 548-552.

20. Maruko I., Iida T., Sugano Y. et al. I. Subfoveal choroidal thickness after treatment of central serous chorioretinopathy // Ophthalmology. - 2010. - № 117. - P. 1792-1799.

21. Prunte C., Flammer J. Choroidal capillary and venous congestion in central serous chorioretinopathy // Am. J. Ophthalmol. 1996. № 11. P. 26-34.

22. Schubert H. Structure and function neural retina // Ophthalmology. - St. Louis: Mosby, 1999. P. 414-467.

23. Sekiryu T., Iida T., Maruko I. et al. Infrared Fundus Autofluorescence and Central Serous Chorioretinopathy // Investigative Ophthalmology & Visual Science. 2010. № 51(10). P. 4956-4962.

24. Wang M., Munch I. C., Hasler P. W. et al. Central serous horioretinopathy // Acta Ophthalmol. 2008. 86. P. 126-145.