Abstract
Purpose
To study the changes in the choroidal vascular pattern of the deep choroidal layer and choriocapillaris in the eyes with central serous chorioretinopathy (CSC) before versus after photodynamic therapy (PDT) as visualized by optical coherence tomography angiography (OCTA).
Methods
This comparative case series study included patients who underwent a half-dose of PDT as a therapy for CSC. Using OCTA and manually shifting the reference level into the deep choroidal layer, we assessed the density of the deep choroidal vascular layer and choriocapillaris.
Results
The study included 20 patients (17 men; mean age, 43.3 ± 10.9 years), with two patients showing bilateral CSC. In the eyes affected by CSC, the mean vascular density of the deep choroidal layer and choriocapillaris increased significantly from 54.2 ± 6.7% at baseline to 58.0 ± 4.7% at 1 month after PDT (P = 0.002) and from 58.1 ± 2.7% at baseline to 60.5 ± 2.7% at 1 month after PDT (P = 0.004), respectively. The difference between affected and unaffected eyes was significantly larger at baseline than at 1 month after PDT (deep choroidal layer 4.79 ± 6.02 versus 0.39 ± 3.46, P = 0.002; choriocapillaris 4.26 ± 3.94 versus 1.25 ± 3.44, P = 0.002) and larger than at 3 months after baseline (n = 11 patients), when the affected and unaffected fellow eyes no longer differed significantly (P = 0.66 and P = 0.37, respectively). As a corollary, the width of the large choroidal vessels in the deep choroidal layer decreased after the PDT. Comparing assessments by two blinded examiners revealed a kappa value of 0.90, indicating a good agreement for examination of the deep choroidal layer.
Conclusion
In conclusion, OCTA can be helpful to visualize the deep choroidal vascular layer by manually shifting the reference layer deeper into the choroid.
Similar content being viewed by others
References
Tittl MK, Spaide RF, Wong D, Pilotto E, Yannuzzi LA, Fisher YL, Freund B, Guyer DR, Slakter JS, Sorenson JA (1999) Systemic and ocular findings in central serous chorioretinopathy. Am J Ophthalmol 128:63–68
Haimovici R, Koh S, Gagnon DR, Lehrfeld T, Wellik S, Central Serous Chorioretinopathy Case-Control Study Group (2004) Risk factors for central serous chorioretinopathy: a case-control study. Ophthalmology 111:244–249
Gass JD (1967) Pathogenesis of disciform detachment of the neuro- epithelium. II. Idiopathic central serous choroidopathy. Am J Ophthalmol 63:587–615
Yannuzzi LA, Slakter JS, Gross NE, Spaide RF, Costa DL, Huang SJ, Klancnik JM Jr, Aizman A (2003) Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study. Retina 23:288–298
Chan WM, Lai TY, Lai RY, Tang EW, Liu DT, Lam DS (2008) Safety enhanced photodynamic therapy for chronic central serous chorioretinopathy: one-year results of a prospective study. Retina 28:85–93
Stanga PE, Lim JI, Hamilton P (2003) Indocyanine green angiography in chorioretinal diseases: indications and interpretation: an evidence-based update. Ophthalmology 110:15–21
Kotsolis AI, Killian FA, Ladas ID, Yannuzzi LA (2010) Fluorescein angiography and optical coherence tomography concordance for choroidal neovascularisation in multifocal choroidtis. Br J Ophthalmol 94:1506–1508
Jia Y, Bailey ST, Wilson DJ, Tan O, Klein ML, Flaxel CJ, Potsaid B, Liu JJ, Lu CD, Kraus MF, Fujimoto JG, Huang D (2014) Quantitative optical coherence tomography angiography of choroidal neovascularization in age-related macular degeneration. Ophthalmology 121:1435–1444
Jia Y, Bailey ST, Hwang TS, McClintic SM, Gao SS, Pennesi ME, Flaxel CJ, Lauer AK, Wilson DJ, Hornegger J, Fujimoto JG, Huang D (2015) Quantitative optical coherence tomography angiography of vascular abnormalities in the living human eye. Proc Natl Acad Sci U S A 112:E2395–E2402
Wang Q, Chan S, Yang JY, You B, Wang YX, Jonas JB, Wei WB (2016) Vascular density in retina and choriocapillaris as measured by optical coherence tomography angiography. Am J Ophthalmol 168:95–109
Xu Y, Su Y, Li L, Qi H, Zheng H, Chen C (2017) Effect of photodynamic therapy on optical coherence tomography angiography in eyes with chronic central serous chorioretinopathy. Ophthalmologica 237:167–172
Fujita K, Kawamura A, Yuzawa M (2017) Choriocapillaris changes imaged by OCT angiography after half-dose photodynamic therapy for chronic central serous chorioretinopathy. Ophthalmic Surg Lasers Imaging Retina 48:302–310
Kuroda Y, Ooto S, Yamashiro K, Oishi A, Nakanishi H, Tamura H, Ueda-Arakawa N, Yoshimura N (2016) Increased choroidal vascularity in central serous chorioretinopathy quantified using swept-source optical coherence tomography. Am J Ophthalmol 169:199–207
Nicolò M, Rosa R, Musetti D, Musolino M, Saccheggiani M, Traverso CE (2017) Choroidal vascular flow area in central serous chorioretinopathy using swept source optical coherence tomography angiography. Invest Ophthalmol Vis Sci 58:2002–2010
Lee WJ, Lee JW, Park SH, Lee BR (2017) En face choroidal vascular feature imaging in acute and chronic central serous chorioretinopathy using swept source optical coherence tomography. Br J Ophthalmol 101:580–586
Rochepeau C, Kodjikian L, Garcia MA, Coulon C, Burillon C, Denis P, Delaunay B, Mathis T (2018) Optical coherence tomography angiography quantitative assessment of choriocapillaris blood flow in central serous chorioretinopathy. Am J Ophthalmol 194:26–34
Yun C, Huh J, Ahn SM, Lee B, Kim JT, Hwang SY, Kim SW, Oh J (2019) Choriocapillaris flow features and choroidal vasculature in the fellow eyes of patients with acute central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 257:57–70
Nassisi M, Lavia C, Alovisi C, Musso L, Eandi CM (2017) Short-term choriocapillaris changes in patients with central serous chorioretinopathy after half-dose photodynamic therapy. Int J Mol Sci 18:E2468
Izumi T, Koizumi H, Maruko I, Takahashi Y, Sonoda S, Sakamoto T, Iida T (2017) Structural analyses of choroid after half-dose verteporfin photodynamic therapy for central serous chorioretinopathy. Br J Ophthalmol 101:433–437
Demircan A, Yesilkaya C, Alkin Z (2018) Early choriocapillaris changes after half-fluence photodynamic therapy in chronic central serous chorioretinopathy evaluated by optical coherence tomography angiography: preliminary results. Photodiagn Photodyn Ther 21:375–378
Ma DJ, Park UC, Kim ET, Yu HG (2018) Choroidal vascularity changes in idiopathic central serous chorioretinopathy after half-fluence photodynamic therapy. PLoS One 13:e0202930
Demirel S, Özcan G, Yanık Ö, Batıoğlu F, Özmert E (2019) Vascular and structural alterations of the choroid evaluated by optical coherence tomography angiography and optical coherence tomography after half-fluence photodynamic therapy in chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2019 Jan 7. https://doi.org/10.1007/s00417-018-04226-6
Chan WM, Lai TY, Lai RY, Liu DT, Lam DS (2008) Half-dose verteporfin photodynamic therapy for acute central serous chorioretinopathy: one year results of a randomized controlled trial. Ophthalmology 115:1756–1765
Maruko I, Iida T, Sugano Y, Ojima A, Ogasawara M, Spaide RF (2010) Subfoveal choroidal thickness after treatment of central serous chorioretinopathy. Ophthalmology 117:1792–1799
Jia Y, Tan O, Tokayer J, Potsaid B, Wang Y, Liu JJ, Kraus MF, Subhash H, Fujimoto JG, Hornegger J, Huang D (2012) Split-spectrum amplitude decorrelation angiography with optical coherence tomography. Opt Express 20:4710–4725
Spaide RF, Klancnik JM, Cooney MJ (2015) Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography. JAMA Ophthalmol 133:45–50
Chan SY, Wang Q, Wei WB, Jonas JB (2016) Optical coherence tomographic angiography in central serous chorioretinopathy. Retina 36:2051–2058
Teussink MM, Breukink MB, van Grinsven MJ, Hoyng CB, Klevering BJ, Boon CJ, de Jong EK, Theelen T (2015) OCT angiography compared to fluorescein and indocyanine green angiography in chronic central serous chorioretinopathy. Invest Ophthalmol Vis Sci 56:5229–5237
Costanzo E, Cohen SY, Miere A, Querques G, Capuano V, Semoun O, El Ameen A, Oubraham H, Souied EH (2015) Optical coherence tomography angiography in central serous chorioretinopathy. J Ophthalmol 2015:134783
Schmidt-Erfurth U, Hasan T, Gragoudas E, Michaud N, Flotte TJ, Birngruber R (1994) Vascular targeting in photodynamic occlusion of subretinal vessels. Ophthalmology 101:1953–1961
Kramer M, Miller JW, Michaud N, Moulton RS, Hasan T, Flotte TJ, Gragoudas ES (1996) Liposomal benzoporphyrin derivative verteporfin photodynamic therapy: selective treatment of choroidal neovascularization in monkeys. Ophthalmology 103:427–438
Funding
This study was funded by the Beijing Municipal Administration of Hospitals’ Ascent Plan (code: DFL20150201), Science and Technology Project of Beijing Municipal Science and Technology Commission (Z151100001615052), the National Natural Science Foundation of China (Nr.81570891), the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (ZYLX201307), the National Natural Science Foundation of China (81272981), the Beijing Natural Science Foundation (7151003), and the Advanced Health Care Professionals Development Project of Beijing Municipal Health Bureau (2014-2-003).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflicts of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Following the tenets of the Declaration of Helsinki, the research protocol was approved by the Medical Ethics Committee of the Beijing Tongren Hospital.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Jost B. Jonas and Wen Bin Wei share the last authorship.
Rights and permissions
About this article
Cite this article
Chan, S.Y., Pan, C.T., Wang, Q. et al. Optical coherent tomographic angiographic pattern of the deep choroidal layer and choriocapillaris after photodynamic therapy for central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 257, 1365–1372 (2019). https://doi.org/10.1007/s00417-019-04318-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-019-04318-x