Observation of vortex venous anastomosis in central serous chorioretinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Liu Pei ¹ , An Guangqi ¹ , Zhang Min ¹ , Fang Haixin ¹ , Yang Fan ¹ , Du Liping ^1,2 ,  Jin Xuemin ^1,2

1. The First Affiliated Hospital of Zhengzhou University, Henan Eye Hospital, School of Medical Sciences of Zhengzhou University, Zhengzhou 450003, China;
2. Institute of Fundus Diseases, Zhengzhou University, Zhengzhou 450000, China;

Corresponding author：

Jin Xuemin, Email: 2740913223@qq.com

Keywords：

Central serous chorioretinopathy; Scanning source optical coherence tomography; Vortex vein anastomosis; Choroidal vascular index; Choroidal thickness

DOI：

10.3760/cma.j.cn511434-20220804-00437

Video：

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Objective To observe the anastomotic status of the vortex veins in patients with central serous chorioretinopathy (CSC). Methods A cross-sectional study of clinical practice. From July 2021 to July 2022, 50 cases (50 eyes) of monocular CSC patients diagnosed through ophthalmic examination at the First Affiliated Hospital of Zhengzhou University were included in the study. Among them, there were 37 males (74.0%, 37/50) and 13 females (26.0%, 13/50), with the mean age of (44.30±9.59) years old. The course of disease from the onset of symptoms to the time of treatment was less than 3 months. The affected eye and contralateral eye of CSC patients were divided into the affected eye group and contralateral eye group, respectively. Fifty healthy volunteers of the same age and gender were selected as the normal control group with 50 eyes. The macular area scanning source optical coherence tomography (OCT) vascular imaging examination was performed with Visual Microimaging (Henan) Technology Co., Ltd. VG200D. Horizontal watershed vortex veins anastomosis rate and asymmetric vortex-venous dilation rate were observed by en face OCT. The device comes with software to calculate the central foveal choroidal thickness (SFCT), mean choroidal thickness (MCT), and choroidal vascular index (CVI). One-way analysis of variance and χ² test were used to compare the three groups. When variances were unequal between groups, nonparametric tests were performed. Results The SFCT values of the affected eye group, contralateral eye group, and normal control group were (567.12±129.02), (513.26±133.17), (327.64±97.40) μm, respectively; MCT were (407.38±97.54), (388.24±94.13), (275.46±60.55) μm, respectively; CVI were 0.34±0.05, 0.32±0.04, and 0.27±0.04, respectively; anastomosis rates of vortex veins were 98% (49/50), 78% (39/50), and 40% (20/50), respectively; asymmetric dilation rates of vortex veins were 96% (48/50), 88% (44/50), and 48% (24/50), respectively. The differences of SFCT (F=53.974), MCT (Z=51.415), CVI (F=28.082), vortex vein anastomosis rate (χ²=43.056), asymmetric dilation rate of vortex veins (χ²=37.728) among three groups were statistically significant (P＜0.001). Compared with the contralateral eye group, the SFCT, MCT, CVI, vortex vein anastomosis rate, and vortex vein asymmetric dilation rate in the affected eye group were significantly higher than those in the contralateral eye group. Among them, the differences of SFCT (t=2.054), CVI (t=2.211), and vortex vein anastomosis rate (χ²=9.470) were statistically significant (P＜0.05); the differences of MCT (Z=7.490), asymmetric dilation rate of vortex veins（χ²=2.714) were not statistically significant (P=1.000, 0.140). Conclusions SFCT, MCT, and CVI in the affected and contralateral eyes of monocular CSC patients significantly increase. The anastomotic rate and asymmetric dilation rate of the vortex vein in the opposite eye were lower than those in the affected eye.

Citation： Liu Pei, An Guangqi, Zhang Min, Fang Haixin, Yang Fan, Du Liping, Jin Xuemin. Observation of vortex venous anastomosis in central serous chorioretinopathy. Chinese Journal of Ocular Fundus Diseases, 2023, 39(4): 307-311. doi: 10.3760/cma.j.cn511434-20220804-00437 Copy

1.	Hu J, Qu J, Piao Z, et al. Optical coherence tomography angiography compared with indocyanine green angiography in central serous chorioretinopathy[J]. Sci Rep, 2019, 9(1): 6149. DOI: 10.1038/s41598-019-42623-x.
2.	Iida T, Kishi S, Hagimura N, et al. Persistent and bilateral choroidal vascular abnormalities in central serous chorioretinopathy[J]. Retina, 1999, 19(6): 508-512. DOI: 10.1097/00006982-199911000-00005.
3.	Pollithy S, Höh A, Dobner B, et al. Are there diurnal variations in choroidal thickness?[J]. Ophthalmologe, 2015, 112(8): 665-669. DOI: 10.1007/s00347-014-3177-y.
4.	Yang J, Wang E, Yuan M, et al. Three-dimensional choroidal vascularity index in acute central serous chorioretinopathy using swept-source optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(2): 241-247. DOI: 10.1007/s00417-019-04524-7.
5.	Agrawal R, Chhablani J, Tan KA, et al. Choroidal vascularity index in central serous chorioretinopathy[J]. Retina, 2016, 36(9): 1646-1651. DOI: 10.1097/IAE.0000000000001040.
6.	Ambiya V, Goud A, Rasheed MA, et al. Retinal and choroidal changes in steroid-associated central serous chorioretinopathy[J]. Int J Retina Vitreous, 2018, 4: 11. DOI: 10.1186/s40942-018-0115-1.
7.	Rasheed MA, Goud A, Mohamed A, et al. Change in choroidal vascularity in acute central serous chorioretinopathy[J]. Indian J Ophthalmol, 2018, 66(4): 530-534. DOI: 10.4103/ijo.IJO_1160_17.
8.	Zeng Q, Luo L, Yao Y, et al. Three-dimensional choroidal vascularity index in central serous chorioretinopathy using ultra-widefield swept-source optical coherence tomography angiography[J/OL]. Front Med (Lausanne), 2022, 9: 967369[2022-09-07]. https://europepmc.org/article/MED/36160148. DOI:10.3389/fmed.2022.967369.
9.	Cheung C, Lee WK, Koizumi H, et al. Pachychoroid disease[J]. Eye (Lond), 2019, 33(1): 14-33. DOI: 10.1038/s41433-018-0158-4.
10.	Matsumoto H, Kishi S, Mukai R, et al. Remodeling of macular vortex veins in pachychoroid neovasculopathy[J]. Sci Rep, 2019, 9(1): 14689. DOI: 10.1038/s41598-019-51268-9.
11.	Sharma A, Parachuri N, Kumar N, et al. Vortex vein anastomosis and pachychoroid-an evolving understanding[J]. Eye (Lond), 2021, 35(6): 1545-1547. DOI: 10.1038/s41433-021-01423-2.
12.	Hiroe T, Kishi S. Dilatation of asymmetric vortex vein in central serous chorioretinopathy[J]. Ophthalmol Retina, 2018, 2(2): 152-161. DOI: 10.1016/j.oret.2017.05.013.
13.	Prünte C, Flammer J. Choroidal capillary and venous congestion in central serous chorioretinopathy[J]. Am J Ophthalmol, 1996, 121(1): 26-34. DOI: 10.1016/s0002-9394(14)70531-8.
14.	Imanaga N, Terao N, Nakamine S, et al. Scleral thickness in central serous chorioretinopathy[J]. Ophthalmol Retina, 2021, 5(3): 285-291. DOI: 10.1016/j.oret.2020.07.011.
15.	Pang CE, Shah VP, Sarraf D, et al. Ultra-widefield imaging with autofluorescence and indocyanine green angiography in central serous chorioretinopathy[J]. Am J Ophthalmol, 2014, 158(2): 362-371. DOI: 10.1016/j.ajo.2014.04.021.
16.	Takahashi K, Kishi S. Remodeling of choroidal venous drainage after vortex vein occlusion following scleral buckling for retinal detachment[J]. Am J Ophthalmol, 2000, 129(2): 191-198. DOI: 10.1016/s0002-9394(99)00425-0.
17.	Takahashi K, Kishi S, Muraoka K, et al. Radiation choroidopathy with remodeling of the choroidal venous system[J]. Am J Ophthalmol, 1998, 125(3): 367-373. DOI: 10.1016/s0002-9394(99)80148-2.
18.	Hayreh SS, Baines JA. Occlusion of the vortex veins. An experimental study[J]. Br J Ophthalmol, 1973, 57(4): 217-238. DOI: 10.1136/bjo.57.4.217.
19.	Tsuboi K, Sasajima H, Kamei M. Collateral vessels in branch retinal vein occlusion: anatomic and functional analyses by OCT angiography[J]. Ophthalmol Retina, 2019, 3(9): 767-776. DOI: 10.1016/j.oret.2019.04.015.
20.	Spaide RF, Gemmy CC, Matsumoto H, et al. Venous overload choroidopathy: a hypothetical framework for central serous chorioretinopathy and allied disorders[J/OL]. Prog Retin Eye Res, 2022, 86: 100973[2021-05-21]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(21)00034-3. DOI:10.1016/j.preteyeres.2021.100973.
21.	Baek J, Dansingani KK, Lee JH, et al. Choroidal morphology in eyes with peripapillary polypoidal choroidal vasculopathy[J]. Retina, 2019, 39(8): 1571-1579. DOI: 10.1097/IAE.0000000000002188.
22.	Matsumoto H, Hoshino J, Mukai R, et al. Vortex vein anastomosis at the watershed in pachychoroid spectrum diseases[J]. Ophthalmol Retina, 2020, 4(9): 938-945. DOI: 10.1016/j.oret.2020.03.024.
23.	Gäckle HC, Lang GE, Freissler KA, et al. Central serous chorioretinopathy. Clinical, fluorescein angiography and demographic aspects[J]. Ophthalmologe, 1998, 95(8): 529-533. DOI: 10.1007/s003470050310.
24.	Kitzmann AS, Pulido JS, Diehl NN, et al. The incidence of central serous chorioretinopathy in Olmsted County, Minnesota, 1980-2002[J]. Ophthalmology, 2008, 115(1): 169-173. DOI: 10.1016/j.ophtha.2007.02.032.
25.	Kleinberger AJ, Patel C, Lieberman RM, et al. Bilateral central serous chorioretinopathy caused by intranasal corticosteroids: a case report and review of the literature[J]. Laryngoscope, 2011, 121(9): 2034-2037. DOI: 10.1002/lary.21967.
26.	Hoshino J, Matsumoto H, Mukai R, et al. Variation of vortex veins at the horizontal watershed in normal eyes[J]. Graefe's Arch Clin Exp Ophthalmol, 2021, 259(8): 2175-2180. DOI: 10.1007/s00417-021-05130-2.

1. Hu J, Qu J, Piao Z, et al. Optical coherence tomography angiography compared with indocyanine green angiography in central serous chorioretinopathy[J]. Sci Rep, 2019, 9(1): 6149. DOI: 10.1038/s41598-019-42623-x.
2. Iida T, Kishi S, Hagimura N, et al. Persistent and bilateral choroidal vascular abnormalities in central serous chorioretinopathy[J]. Retina, 1999, 19(6): 508-512. DOI: 10.1097/00006982-199911000-00005.
3. Pollithy S, Höh A, Dobner B, et al. Are there diurnal variations in choroidal thickness?[J]. Ophthalmologe, 2015, 112(8): 665-669. DOI: 10.1007/s00347-014-3177-y.
4. Yang J, Wang E, Yuan M, et al. Three-dimensional choroidal vascularity index in acute central serous chorioretinopathy using swept-source optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(2): 241-247. DOI: 10.1007/s00417-019-04524-7.
5. Agrawal R, Chhablani J, Tan KA, et al. Choroidal vascularity index in central serous chorioretinopathy[J]. Retina, 2016, 36(9): 1646-1651. DOI: 10.1097/IAE.0000000000001040.
6. Ambiya V, Goud A, Rasheed MA, et al. Retinal and choroidal changes in steroid-associated central serous chorioretinopathy[J]. Int J Retina Vitreous, 2018, 4: 11. DOI: 10.1186/s40942-018-0115-1.
7. Rasheed MA, Goud A, Mohamed A, et al. Change in choroidal vascularity in acute central serous chorioretinopathy[J]. Indian J Ophthalmol, 2018, 66(4): 530-534. DOI: 10.4103/ijo.IJO_1160_17.
8. Zeng Q, Luo L, Yao Y, et al. Three-dimensional choroidal vascularity index in central serous chorioretinopathy using ultra-widefield swept-source optical coherence tomography angiography[J/OL]. Front Med (Lausanne), 2022, 9: 967369[2022-09-07]. https://europepmc.org/article/MED/36160148. DOI:10.3389/fmed.2022.967369.
9. Cheung C, Lee WK, Koizumi H, et al. Pachychoroid disease[J]. Eye (Lond), 2019, 33(1): 14-33. DOI: 10.1038/s41433-018-0158-4.
10. Matsumoto H, Kishi S, Mukai R, et al. Remodeling of macular vortex veins in pachychoroid neovasculopathy[J]. Sci Rep, 2019, 9(1): 14689. DOI: 10.1038/s41598-019-51268-9.
11. Sharma A, Parachuri N, Kumar N, et al. Vortex vein anastomosis and pachychoroid-an evolving understanding[J]. Eye (Lond), 2021, 35(6): 1545-1547. DOI: 10.1038/s41433-021-01423-2.
12. Hiroe T, Kishi S. Dilatation of asymmetric vortex vein in central serous chorioretinopathy[J]. Ophthalmol Retina, 2018, 2(2): 152-161. DOI: 10.1016/j.oret.2017.05.013.
13. Prünte C, Flammer J. Choroidal capillary and venous congestion in central serous chorioretinopathy[J]. Am J Ophthalmol, 1996, 121(1): 26-34. DOI: 10.1016/s0002-9394(14)70531-8.
14. Imanaga N, Terao N, Nakamine S, et al. Scleral thickness in central serous chorioretinopathy[J]. Ophthalmol Retina, 2021, 5(3): 285-291. DOI: 10.1016/j.oret.2020.07.011.
15. Pang CE, Shah VP, Sarraf D, et al. Ultra-widefield imaging with autofluorescence and indocyanine green angiography in central serous chorioretinopathy[J]. Am J Ophthalmol, 2014, 158(2): 362-371. DOI: 10.1016/j.ajo.2014.04.021.
16. Takahashi K, Kishi S. Remodeling of choroidal venous drainage after vortex vein occlusion following scleral buckling for retinal detachment[J]. Am J Ophthalmol, 2000, 129(2): 191-198. DOI: 10.1016/s0002-9394(99)00425-0.
17. Takahashi K, Kishi S, Muraoka K, et al. Radiation choroidopathy with remodeling of the choroidal venous system[J]. Am J Ophthalmol, 1998, 125(3): 367-373. DOI: 10.1016/s0002-9394(99)80148-2.
18. Hayreh SS, Baines JA. Occlusion of the vortex veins. An experimental study[J]. Br J Ophthalmol, 1973, 57(4): 217-238. DOI: 10.1136/bjo.57.4.217.
19. Tsuboi K, Sasajima H, Kamei M. Collateral vessels in branch retinal vein occlusion: anatomic and functional analyses by OCT angiography[J]. Ophthalmol Retina, 2019, 3(9): 767-776. DOI: 10.1016/j.oret.2019.04.015.
20. Spaide RF, Gemmy CC, Matsumoto H, et al. Venous overload choroidopathy: a hypothetical framework for central serous chorioretinopathy and allied disorders[J/OL]. Prog Retin Eye Res, 2022, 86: 100973[2021-05-21]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(21)00034-3. DOI:10.1016/j.preteyeres.2021.100973.
21. Baek J, Dansingani KK, Lee JH, et al. Choroidal morphology in eyes with peripapillary polypoidal choroidal vasculopathy[J]. Retina, 2019, 39(8): 1571-1579. DOI: 10.1097/IAE.0000000000002188.
22. Matsumoto H, Hoshino J, Mukai R, et al. Vortex vein anastomosis at the watershed in pachychoroid spectrum diseases[J]. Ophthalmol Retina, 2020, 4(9): 938-945. DOI: 10.1016/j.oret.2020.03.024.
23. Gäckle HC, Lang GE, Freissler KA, et al. Central serous chorioretinopathy. Clinical, fluorescein angiography and demographic aspects[J]. Ophthalmologe, 1998, 95(8): 529-533. DOI: 10.1007/s003470050310.
24. Kitzmann AS, Pulido JS, Diehl NN, et al. The incidence of central serous chorioretinopathy in Olmsted County, Minnesota, 1980-2002[J]. Ophthalmology, 2008, 115(1): 169-173. DOI: 10.1016/j.ophtha.2007.02.032.
25. Kleinberger AJ, Patel C, Lieberman RM, et al. Bilateral central serous chorioretinopathy caused by intranasal corticosteroids: a case report and review of the literature[J]. Laryngoscope, 2011, 121(9): 2034-2037. DOI: 10.1002/lary.21967.
26. Hoshino J, Matsumoto H, Mukai R, et al. Variation of vortex veins at the horizontal watershed in normal eyes[J]. Graefe's Arch Clin Exp Ophthalmol, 2021, 259(8): 2175-2180. DOI: 10.1007/s00417-021-05130-2.

Chinese Journal of Ocular Fundus Diseases

Observation of vortex venous anastomosis in central serous chorioretinopathy

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