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Published on: February 12, 2018
Applying Lincoff's Rule to Central Serous Chorioretinopathy: The Macula Society International CSCR Research Network
Niroj Kumar Sahoo1, Giulia Gregori1,2, Nasiq Hasan1
1Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Purpose:
To characterize subretinal fluid (SRF) accumulation patterns in central serous chorioretinopathy (CSCR) and develop a nonangiographic approach for predicting leak location, applying principles similar to Lincoff's rules for rhegmatogenous retinal detachment.
Design:
Retrospective, observational.
Participants:
The study examined 107 eyes of 106 patients with single-leak CSCR confirmed by fundus fluorescein angiography.
Methods:
En face OCT images were analyzed to map SRF boundaries and configurations. A best-fit circle placement method corresponding to the presumed "primary pool" was applied to predict leak coordinates. Prediction accuracy was evaluated by comparing predicted versus actual leak locations using mean absolute error (MAE) and intraclass correlation coefficients (ICCs). The relationship between SRF morphology, leak position, and ocular vectors was investigated.
Main Outcome Measures:
Accuracy of the predicted leak coordinates, compared with the true leak coordinates.
Results:
Four distinct SRF patterns were observed: extramacular collection (4.7%), foveal extension (2.8%), macular pooling (62.6%), and inferior gravitational extension (29.9%), which could represent a hypothetical sequence of SRF migration. On internal validation, leak prediction demonstrated excellent agreement with actual locations (ICC of 0.97 for x-axis, 0.96 for y-axis), with MAE of 0.26 mm. Quadrant and hemisphere concordance of the predicted leak site falling within the correct hemisphere reached 84.1% and 97.2%, respectively. Asymmetric configurations of SRF yielded superior accuracy compared with symmetric or oval patterns. Two principal forces governed SRF distribution: centripetal vector toward fovea and gravity.
Conclusions:
Subretinal fluid morphology in CSCR follows predictable patterns and rules that are similar to Lincoff's rule, being influenced by macular pooling capacity and gravity. The rules provided proof of concept for a nonangiographic approach to leak site estimation that warrants prospective validation.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
