Choroidal thickening patterns in central serous chorioretinopathy using ultra-widefield optical coherence tomography

To classify choroidal thickening patterns in central serous chorioretinopathy (CSC) using ultra-widefield (UWF) optical coherence tomography (OCT) choroidal thickness maps.

A retrospective study included 72 eyes of 63 patients with CSC. All patients underwent UWF-OCT (105°) imaging. Based on the spatial distribution of the choroidal thickness maps, eyes were classified into two groups: the Posterior pole type, where thickening was confined to the posterior pole, and the Peripapillary type, where the zone of maximum thickening extended nasally beyond the optic disc. Additionally, 31 eyes underwent ultra-widefield indocyanine green angiography (ICGA) to evaluate choroidal vascular hyperpermeability (CVH).

Of the 72 eyes, 52 (72.2%) were categorized as the Posterior pole type and 20 (27.8%) as the Peripapillary type. The Peripapillary type was significantly more hyperopic and exhibited larger choroidal volumes in both central 50° (55.5 ± 11.5 vs. 46.2 ± 10.6 mm³, p < 0.01) and peripheral areas (116.2 ± 20.6 vs. 90.8 ± 18.2 mm³, p < 0.001). Furthermore, the Peripapillary type exhibited a significantly higher number of CVH areas on ICGA compared to the Posterior pole type (5.1 ± 2.5 vs. 2.9 ± 1.9, p < 0.05).

Choroidal thickening in CSC can be categorized into Posterior pole and Peripapillary types using UWF-OCT choroidal thickness maps. While most cases (Posterior pole type) show localized thickening, the Peripapillary type may reflect a venous overload-related phenotype characterized by peripheral thickening and extensive hyperpermeability on UWF-ICGA. Recognizing these patterns is essential for understanding the diverse pathophysiology of CSC.