The role of vortex veins in the pathogenesis of central serous chorioretinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Xiao Bei ^1,2 ,  Song Yanping ^1,2 , Yan Ming ² , Ye Ya ² , Huang Zhen ²

1. The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China;
2. Department of Ophthalmology, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan 430070, China;

Corresponding author：

Song Yanping, Email: drsongyanping@163.com

Keywords：

Central serous chorioretinopathy; Vortex vein; Pathogenesis; Review

DOI：

10.3760/cma.j.cn511434-20231024-00430

Video：

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Abstract Full text Figures/Tables Video References Cited by

Central serous chorioretinopathy (CSC) is one of the main causes of impaired visual function in middle-aged men. CSC is characterized by a thickening of the choroid and hyperpermeability of the choroidal vessels, resulting in serous subretinal fluid. The pathogenesis of CSC is not fully understood. Since the introduction of indocyanine green angiography, the detection of the influence of the vortex veins in CSC, it has been established that the presence of a thick choroid may be caused by congestion of the vortex vein, resulting in new choroidal drainage through a vortex vein anastomosis. The study of vortex venous blood hemodynamics has elucidated the new concept of the pathogenesis of CSC, deepened our understanding of the disease, and provided a theoretical basis for new treatment methods. With a better understanding of the pathogenesis of CSC, we expect to be able to stratify patients at risk in the clinic and evaluate optimized treatment options for patients with CSC

Citation： Xiao Bei, Song Yanping, Yan Ming, Ye Ya, Huang Zhen. The role of vortex veins in the pathogenesis of central serous chorioretinopathy. Chinese Journal of Ocular Fundus Diseases, 2024, 40(4): 319-323. doi: 10.3760/cma.j.cn511434-20231024-00430 Copy

1.	Spaide RF, Hall L, Haas A, et al. Indocyanine green videoangiography of older patients with central serous chorioretinopathy[J]. Retina, 1996, 16(3): 203-213. DOI: 10.1097/00006982-199616030-00004.
2.	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://pubmed.ncbi.nlm.nih.gov/34029721/. DOI: 10.1016/j.preteyeres.2021.100973.
3.	Matsumoto H, Hoshino J, Mukai R, et al. Pulsation of anastomotic vortex veins in pachychoroid spectrum diseases[J/OL]. Sci Rep, 2021, 11(1): 14942[2021-07-22]. https://pubmed.ncbi.nlm.nih.gov/34294774/. DOI: 10.1038/s41598-021-94412-0.
4.	Jung JJ, Yu D, Ito K, et al. Quantitative assessment of asymmetric choroidal outflow in pachychoroid eyes on ultra-widefield indocyanine green angiography[J]. Invest Ophthalmol Vis Sci, 2020, 61(8): 50. DOI: 10.1167/iovs.61.8.50.
5.	Spaide RF. Choroidal blood flow: review and potential explanation for the choroidal venous anatomy including the vortex vein system[J]. Retina, 2020, 40(10): 1851-1864. DOI: 10.1097/IAE.0000000000002931.
6.	Spaide RF. The ambiguity of pachychoroid[J]. Retina, 2021, 41(2): 231-237. DOI: 10.1097/IAE.0000000000003057.
7.	Yu PK, Tan PE, Cringle SJ, et al. Phenotypic heterogeneity in the endothelium of the human vortex vein system[J]. Exp Eye Res, 2013, 115: 144-152. DOI: 10.1016/j.exer.2013.07.006.
8.	Yu DY, Yu PK, Cringle SJ, et al. Functional and morphological characteristics of the retinal and choroidal vasculature[J]. Prog Retin Eye Res, 2014, 40: 53-93. DOI: 10.1016/j.preteyeres.2014.02.001.
9.	Kutoglu T, Yalcin B, Kocabiyik N, et al. Vortex veins: anatomic investigations on human eyes[J]. Clin Anat, 2005, 18(4): 269-273. DOI: 10.1002/ca.20092.
10.	Lim MC, Bateman JB, Glasgow BJ. Vortex vein exit sites. Scleral coordinates[J]. Ophthalmology, 1995, 102(6): 942-946. DOI: 10.1016/s0161-6420(95)30930-x.
11.	Tarabishy AB, Ahn E, Mandell BF, et al. Central serous retinopathy[J]. Arthritis Care Res (Hoboken), 2011, 63(8): 1075-1082. DOI: 10.1002/acr.20485.
12.	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.
13.	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.
14.	Aichi T, Terao N, Imanaga N, et al. Scleral thickness in the fellow eyes of patients with unilateral central serous chorioretinopathy[J]. Retina, 2023, 43(9): 1573-1578. DOI: 10.1097/IAE.000000 0000003850.
15.	Terao N, Imanaga N, Wakugawa S, et al. Short axial length is related to asymmetric vortex veins in central serous chorioretinopathy[J/OL]. Ophthalmol Sci, 2021, 1(4): 100071[2021-10-26]. https://pubmed.ncbi.nlm.nih.gov/36246946/. DOI: 10.1016/j.xops.2021.100071.
16.	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.
17.	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.
18.	Sachsenwenger R, Lukoff L. Animal experimental studies on the sequelae of surgical occlusion of the vortex veins[J]. Klin Monbl Augenheilkd Augenarztl Fortbild, 1959, 134(3): 364-373.
19.	Kaye R, Chandra S, Sheth J, et al. Central serous chorioretinopathy: an update on risk factors, pathophysiology and imaging modalities[J/OL]. Prog Retin Eye Res, 2020, 79: 100865[2020-05-11]. https://pubmed.ncbi.nlm.nih.gov/32407978/. DOI: 10.1016/j.preteyeres.2020.100865.
20.	Ramtohul P, Cabral D, Oh D, et al. En face ultrawidefield OCT of the vortex vein system in central serous chorioretinopathy[J]. Ophthalmol Retina, 2023, 7(4): 346-353. DOI: 10.1016/j.oret.2022.10.001.
21.	Bacci T, Oh DJ, Singer M, et al. Ultra-widefield indocyanine green angiography reveals patterns of choroidal venous insufficiency influencing pachychoroid disease[J]. Invest Ophthalmol Vis Sci, 2022, 63(1): 17. DOI: 10.1167/iovs.63.1.17.
22.	Matsumoto H, Hoshino J, Arai Y, et al. Quantitative measures of vortex veins in the posterior pole in eyes with pachychoroid spectrum diseases[J/OL]. Sci Rep, 2020, 10(1): 19505[2020-11-11]. https://pubmed.ncbi.nlm.nih.gov/33177540/. DOI: 10.1038/s41598-020-75789-w.
23.	Kishi S, Matsumoto H. A new insight into pachychoroid diseases: remodeling of choroidal vasculature[J]. Graefe's Arch Clin Exp Ophthalmol, 2022, 260(11): 3405-3417. DOI: 10.1007/s00417-022-05687-6.
24.	Spaide RF, Ledesma-Gil G, Gemmy CC. Intervortex venous anastomosis in pachychoroid-related disorders[J]. Retina, 2021, 41(5): 997-1004. DOI: 10.1097/IAE.0000000000003004.
25.	Jeong S, Kang W, Noh D, et al. Choroidal vascular alterations evaluated by ultra-widefield indocyanine green angiography in central serous chorioretinopathy[J]. Graefe's Arch Clin Exp Ophthalmol, 2022, 260(6): 1887-1898. DOI: 10.1007/s00417-021-05461-0.
26.	Funatsu R, Sonoda S, Terasaki H, et al. Choroidal morphologic features in central serous chorioretinopathy using ultra-widefield optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2023, 261(4): 971-979. DOI: 10.1007/s00417-022-05905-1.
27.	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.
28.	Baek J, Lee JH, Jung BJ, et al. Morphologic features of large choroidal vessel layer: age-related macular degeneration, polypoidal choroidal vasculopathy, and central serous chorioretinopathy[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(12): 2309-2317. DOI: 10.1007/s00417-018-4143-1.
29.	Kuroda S, Ikuno Y, Yasuno Y, et al. Choroidal thickness in central serous chorioretinopathy[J]. Retina, 2013, 33(2): 302-308. DOI: 10.1097/IAE.0b013e318263d11f.
30.	Matsumoto H, Mukai R, Saito K, et al. Vortex vein congestion in the monkey eye: a possible animal model of pachychoroid[J/OL]. PLoS One, 2022, 17(9): e274137[2022-09-01]. https://pubmed.ncbi.nlm.nih.gov/36048858/. DOI: 10.1371/journal.pone.0274137.
31.	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.
32.	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.
33.	Brinks J, van Dijk E, Meijer OC, et al. Choroidal arteriovenous anastomoses: a hypothesis for the pathogenesis of central serous chorioretinopathy and other pachychoroid disease spectrum abnormalities[J]. Acta Ophthalmol, 2022, 100(8): 946-959. DOI: 10.1111/aos.15112.
34.	Kishi S, Matsumoto H, Sonoda S, et al. Geographic filling delay of the choriocapillaris in the region of dilated asymmetric vortex veins in central serous chorioretinopathy[J/OL]. PLoS One, 2018, 13(11): e206646[2018-11-09]. https://pubmed.ncbi.nlm.nih.gov/30412594/. DOI: 10.1371/journal.pone.0206646.
35.	van Dijk E, Feenstra H, Bjerager J, et al. Comparative efficacy of treatments for chronic central serous chorioretinopathy: a systematic review with network meta-analyses[J]. Acta Ophthalmol, 2023, 101(2): 140-159. DOI: 10.1111/aos.15263.
36.	Kang K, Bacci S. Photodynamic therapy[J]. Biomedicines, 2022, 10(11): 2701. DOI: 10.3390/biomedicines10112701.
37.	van Rijssen TJ, van Dijk E, Yzer S, et al. Central serous chorioretinopathy: towards an evidence-based treatment guideline[J/OL]. Prog Retin Eye Res, 2019, 73: 100770[2019-07-15]. https://pubmed.ncbi.nlm.nih.gov/31319157/. DOI: 10.1016/j.preteyeres.2019.07.003.
38.	Robertson DM. Anterior segment ischemia after segmental episcleral buckling and cryopexy[J]. Am J Ophthalmol, 1975, 79(5): 871-874. DOI: 10.1016/0002-9394(75)90748-5.
39.	Doi N, Uemura A, Nakao K. Complications associated with vortex vein damage in scleral buckling surgery for rhegmatogenous retinal detachment[J]. Jpn J Ophthalmol, 1999, 43(3): 232-238. DOI: 10.1016/s0021-5155(99)00009-x.
40.	Cheung N, McNab AA. Venous anatomy of the orbit[J]. Invest Ophthalmol Vis Sci, 2003, 44(3): 988-995. DOI: 10.1167/iovs.02-0865.
41.	Kita M, Negi A, Kawano S, et al. The effects of vortex vein ligation and partial scleral resection on the subretinal fluid resorption[J]. Nippon Ganka Gakkai Zasshi, 1990, 94(3): 263-268.
42.	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.
43.	Sutoh N, Muraoka K, Takahashi K, et al. Remodelling of choroidal circulation in carotid cavernous sinus fistula[J]. Retina, 1996, 16(6): 497-504. DOI: 10.1097/00006982-199616060-00005.

1. Spaide RF, Hall L, Haas A, et al. Indocyanine green videoangiography of older patients with central serous chorioretinopathy[J]. Retina, 1996, 16(3): 203-213. DOI: 10.1097/00006982-199616030-00004.
2. 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://pubmed.ncbi.nlm.nih.gov/34029721/. DOI: 10.1016/j.preteyeres.2021.100973.
3. Matsumoto H, Hoshino J, Mukai R, et al. Pulsation of anastomotic vortex veins in pachychoroid spectrum diseases[J/OL]. Sci Rep, 2021, 11(1): 14942[2021-07-22]. https://pubmed.ncbi.nlm.nih.gov/34294774/. DOI: 10.1038/s41598-021-94412-0.
4. Jung JJ, Yu D, Ito K, et al. Quantitative assessment of asymmetric choroidal outflow in pachychoroid eyes on ultra-widefield indocyanine green angiography[J]. Invest Ophthalmol Vis Sci, 2020, 61(8): 50. DOI: 10.1167/iovs.61.8.50.
5. Spaide RF. Choroidal blood flow: review and potential explanation for the choroidal venous anatomy including the vortex vein system[J]. Retina, 2020, 40(10): 1851-1864. DOI: 10.1097/IAE.0000000000002931.
6. Spaide RF. The ambiguity of pachychoroid[J]. Retina, 2021, 41(2): 231-237. DOI: 10.1097/IAE.0000000000003057.
7. Yu PK, Tan PE, Cringle SJ, et al. Phenotypic heterogeneity in the endothelium of the human vortex vein system[J]. Exp Eye Res, 2013, 115: 144-152. DOI: 10.1016/j.exer.2013.07.006.
8. Yu DY, Yu PK, Cringle SJ, et al. Functional and morphological characteristics of the retinal and choroidal vasculature[J]. Prog Retin Eye Res, 2014, 40: 53-93. DOI: 10.1016/j.preteyeres.2014.02.001.
9. Kutoglu T, Yalcin B, Kocabiyik N, et al. Vortex veins: anatomic investigations on human eyes[J]. Clin Anat, 2005, 18(4): 269-273. DOI: 10.1002/ca.20092.
10. Lim MC, Bateman JB, Glasgow BJ. Vortex vein exit sites. Scleral coordinates[J]. Ophthalmology, 1995, 102(6): 942-946. DOI: 10.1016/s0161-6420(95)30930-x.
11. Tarabishy AB, Ahn E, Mandell BF, et al. Central serous retinopathy[J]. Arthritis Care Res (Hoboken), 2011, 63(8): 1075-1082. DOI: 10.1002/acr.20485.
12. 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.
13. 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.
14. Aichi T, Terao N, Imanaga N, et al. Scleral thickness in the fellow eyes of patients with unilateral central serous chorioretinopathy[J]. Retina, 2023, 43(9): 1573-1578. DOI: 10.1097/IAE.000000 0000003850.
15. Terao N, Imanaga N, Wakugawa S, et al. Short axial length is related to asymmetric vortex veins in central serous chorioretinopathy[J/OL]. Ophthalmol Sci, 2021, 1(4): 100071[2021-10-26]. https://pubmed.ncbi.nlm.nih.gov/36246946/. DOI: 10.1016/j.xops.2021.100071.
16. 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.
17. 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.
18. Sachsenwenger R, Lukoff L. Animal experimental studies on the sequelae of surgical occlusion of the vortex veins[J]. Klin Monbl Augenheilkd Augenarztl Fortbild, 1959, 134(3): 364-373.
19. Kaye R, Chandra S, Sheth J, et al. Central serous chorioretinopathy: an update on risk factors, pathophysiology and imaging modalities[J/OL]. Prog Retin Eye Res, 2020, 79: 100865[2020-05-11]. https://pubmed.ncbi.nlm.nih.gov/32407978/. DOI: 10.1016/j.preteyeres.2020.100865.
20. Ramtohul P, Cabral D, Oh D, et al. En face ultrawidefield OCT of the vortex vein system in central serous chorioretinopathy[J]. Ophthalmol Retina, 2023, 7(4): 346-353. DOI: 10.1016/j.oret.2022.10.001.
21. Bacci T, Oh DJ, Singer M, et al. Ultra-widefield indocyanine green angiography reveals patterns of choroidal venous insufficiency influencing pachychoroid disease[J]. Invest Ophthalmol Vis Sci, 2022, 63(1): 17. DOI: 10.1167/iovs.63.1.17.
22. Matsumoto H, Hoshino J, Arai Y, et al. Quantitative measures of vortex veins in the posterior pole in eyes with pachychoroid spectrum diseases[J/OL]. Sci Rep, 2020, 10(1): 19505[2020-11-11]. https://pubmed.ncbi.nlm.nih.gov/33177540/. DOI: 10.1038/s41598-020-75789-w.
23. Kishi S, Matsumoto H. A new insight into pachychoroid diseases: remodeling of choroidal vasculature[J]. Graefe's Arch Clin Exp Ophthalmol, 2022, 260(11): 3405-3417. DOI: 10.1007/s00417-022-05687-6.
24. Spaide RF, Ledesma-Gil G, Gemmy CC. Intervortex venous anastomosis in pachychoroid-related disorders[J]. Retina, 2021, 41(5): 997-1004. DOI: 10.1097/IAE.0000000000003004.
25. Jeong S, Kang W, Noh D, et al. Choroidal vascular alterations evaluated by ultra-widefield indocyanine green angiography in central serous chorioretinopathy[J]. Graefe's Arch Clin Exp Ophthalmol, 2022, 260(6): 1887-1898. DOI: 10.1007/s00417-021-05461-0.
26. Funatsu R, Sonoda S, Terasaki H, et al. Choroidal morphologic features in central serous chorioretinopathy using ultra-widefield optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2023, 261(4): 971-979. DOI: 10.1007/s00417-022-05905-1.
27. 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.
28. Baek J, Lee JH, Jung BJ, et al. Morphologic features of large choroidal vessel layer: age-related macular degeneration, polypoidal choroidal vasculopathy, and central serous chorioretinopathy[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(12): 2309-2317. DOI: 10.1007/s00417-018-4143-1.
29. Kuroda S, Ikuno Y, Yasuno Y, et al. Choroidal thickness in central serous chorioretinopathy[J]. Retina, 2013, 33(2): 302-308. DOI: 10.1097/IAE.0b013e318263d11f.
30. Matsumoto H, Mukai R, Saito K, et al. Vortex vein congestion in the monkey eye: a possible animal model of pachychoroid[J/OL]. PLoS One, 2022, 17(9): e274137[2022-09-01]. https://pubmed.ncbi.nlm.nih.gov/36048858/. DOI: 10.1371/journal.pone.0274137.
31. 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.
32. 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.
33. Brinks J, van Dijk E, Meijer OC, et al. Choroidal arteriovenous anastomoses: a hypothesis for the pathogenesis of central serous chorioretinopathy and other pachychoroid disease spectrum abnormalities[J]. Acta Ophthalmol, 2022, 100(8): 946-959. DOI: 10.1111/aos.15112.
34. Kishi S, Matsumoto H, Sonoda S, et al. Geographic filling delay of the choriocapillaris in the region of dilated asymmetric vortex veins in central serous chorioretinopathy[J/OL]. PLoS One, 2018, 13(11): e206646[2018-11-09]. https://pubmed.ncbi.nlm.nih.gov/30412594/. DOI: 10.1371/journal.pone.0206646.
35. van Dijk E, Feenstra H, Bjerager J, et al. Comparative efficacy of treatments for chronic central serous chorioretinopathy: a systematic review with network meta-analyses[J]. Acta Ophthalmol, 2023, 101(2): 140-159. DOI: 10.1111/aos.15263.
36. Kang K, Bacci S. Photodynamic therapy[J]. Biomedicines, 2022, 10(11): 2701. DOI: 10.3390/biomedicines10112701.
37. van Rijssen TJ, van Dijk E, Yzer S, et al. Central serous chorioretinopathy: towards an evidence-based treatment guideline[J/OL]. Prog Retin Eye Res, 2019, 73: 100770[2019-07-15]. https://pubmed.ncbi.nlm.nih.gov/31319157/. DOI: 10.1016/j.preteyeres.2019.07.003.
38. Robertson DM. Anterior segment ischemia after segmental episcleral buckling and cryopexy[J]. Am J Ophthalmol, 1975, 79(5): 871-874. DOI: 10.1016/0002-9394(75)90748-5.
39. Doi N, Uemura A, Nakao K. Complications associated with vortex vein damage in scleral buckling surgery for rhegmatogenous retinal detachment[J]. Jpn J Ophthalmol, 1999, 43(3): 232-238. DOI: 10.1016/s0021-5155(99)00009-x.
40. Cheung N, McNab AA. Venous anatomy of the orbit[J]. Invest Ophthalmol Vis Sci, 2003, 44(3): 988-995. DOI: 10.1167/iovs.02-0865.
41. Kita M, Negi A, Kawano S, et al. The effects of vortex vein ligation and partial scleral resection on the subretinal fluid resorption[J]. Nippon Ganka Gakkai Zasshi, 1990, 94(3): 263-268.
42. 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.
43. Sutoh N, Muraoka K, Takahashi K, et al. Remodelling of choroidal circulation in carotid cavernous sinus fistula[J]. Retina, 1996, 16(6): 497-504. DOI: 10.1097/00006982-199616060-00005.

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