Choroidal Layer Analysis Under Flat Irregular Pigment Epithelial Detachments in Central Serous Chorioretinopathy

To compare choroidal layer thickness beneath flat irregular pigment epithelial detachments (PEDs) between uncomplicated chronic central serous chorioretinopathy (uCSC) and CSC complicated by type 1 macular neovascularization (cCSC).

Retrospective cross-sectional study.

This retrospective study included 94 treatment-naïve eyes (45 uCSC, 49 cCSC) with flat irregular PEDs. Using swept-source optical coherence tomography, we measured choriocapillaris-Sattler layer complex thickness and Haller's layer thickness beneath the PEDs. Measurements were performed in the central segments of three equal divisions under each PED.

Mean Sattler layer complex thickness was significantly lower in cCSC compared to uCSC (47.2 ± 18.6 µm vs 81.4 ± 22.4 µm, P = .002). Similarly, Haller's layer thickness was reduced in cCSC (265.3 ± 45.8 µm vs 334.5 ± 43.2 µm, P = .008). Other characteristics, including age (56.1 ± 7.9 vs 54.3 ± 8.4 years, P = .28), disease duration (11.2 ± 3.1 vs 8.4 ± 2.6 months, P = .08), and PED dimensions were comparable between groups.

cCSC eyes show significant thinning of both the choriocapillaris-Sattler complex and Haller's layer under flat irregular PEDs compared to uCSC eyes. These findings suggest that progressive choroidal thinning may be a key feature of neovascular transformation and could serve as a potential biomarker to identify eyes at risk for neovascular complications.