Association between vortex vein dilatation patterns and choroidal thickness changes in patients with central serous chorioretinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

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

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

Corresponding author：

Yan Ming, Email: YAN1044768526@tom.com

Keywords：

Central serous chorioretinopathy; Choroidal thickness; Choroid; Vortex vein; Ultra wide-field swept-source optical coherence tomography angiography

DOI：

10.3760/cma.j.cn511434-20231207-00476

Video：

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Objective To observe the changes of chorioidal thickness (ChT) in patients with central serous chorioretinopathy (CSC) in different mode of vortic venous dilation. Methods A clinical cross-sectional study. A total of 80 patients with 89 eyes (CSC group) diagnosed in Department of Ophthalmology, General Hospital of Central Theater Command from April to October 2023 were included in the study. Among them, 64 males had 71 eyes and 17 females had 18 eyes. A total of 15 healthy volunteers matched in age and sex were selected as the control group. Among them, 14 men had 26 eyes and one woman had two eyes. The macular region was examined by ultra-wide-angle scanning frequency source optical coherence tomography (OCTA) with BM400K BMizar made by TowardPi (Beijing) Medical Technology Co., LTD. Scanning rate 1 536 A scanning×1 280 B scanning, scanning range 24 mm×20 mm. The accompanying software delineated nine subfields (superotemporal, upper, superonasal, temporal, central, nasal, inferotemporal, lower, inferonasal regions) to record choroidal thickness (CT). En-face OCTA mode was utilized to observe the anatomy and functional anastomosis of the vortex veins above and below the choroidal blood layer. Eyes in the CSC group were further categorized into upper-dominant, symmetrical, and lower-dominant groups based on the difference in vortex vein expansion shown in the choroidal layer of the en-face image, with 36, 35, and 18 eyes respectively. Statistical analysis included the use of independent samples t-test or Mann-Whitney test for comparison between two groups, one-way analysis of variance or Kruskal-Wallis H test for comparison between multiple groups, and the χ test or Fisher test for categorical variables. Results Compared with the control group, ChT in the CSC group was thickened in the foveal area and different areas of the macula, with the greatest difference in the fovea, and the differences were statistically significant (t=3.345, 5.018, 2.902, 4.667, 7.276, 3.307, 3.868, 4.795, 2.583; P＜0.05). Compared with the ChT of the control group, there was no statistically significant difference in the superotemporal, region of the upper-dominant group (t=1.510, P＞0.05); in other regions, the differences were statistically significant (t=3.207, 5.163, 2.526, 4.310, 6.285, 2.656, 3.812, 2.173; P＜0.05). The differences in the foveal area and other areas in the symmetrical group were statistically significant (t=4.488, 5.554, 3.457, 5.314, 7.256, 3.507, 5.584, 6.019, 2.994; P＜0.05). In the superotemporal, and superonasal, regions of the lower dominant group, the differences were not statistically significant (t=1.150, 1.465; P＜0.05); in other regions, the differences were statistically significant (t=2.278, 4.168, 5.244, 2.783, 5.040, 3.432, 2.095; P＜0.05). Conclusion The dilated distribution of vortex veins on En-face ultra-wide-angle OCTA has a corresponding relationship with ChT. In eyes with CSC, the superior vortex vein drainage system may be the primary route for choroidal drainage.

1.	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.
2.	Spaide RF, Gemmy Cheung CM, 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.	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.
4.	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.
5.	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.
6.	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.
7.	Pauleikhoff L, Agostini H, Lange C. Central serous chorioretinopathy[J]. Ophthalmologe, 2021, 118(9): 967-980. DOI: 10.1007/s00347-021-01376-7.
8.	Jung JJ, Yu DJG, 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.
9.	Hoseini-Yazdi H, Vincent SJ, Collins MJ, et al. Wide-field choroidal thickness in myopes and emmetropes[J/OL]. Sci Rep, 2019, 9(1): 3474[2019-03-05]. https://pubmed.ncbi.nlm.nih.gov/30837507/. DOI: 10.1038/s41598-019-39653-w.
10.	Daruich A, Matet A, Dirani A, et al. Central serous chorioretinopathy: recent findings and new physiopathology hypothesis[J]. Prog Retin Eye Res, 2015, 48: 82-118. DOI: 10.1016/j.preteyeres.2015.05.003.
11.	Guyer DR, Yannuzzi LA, Slakter JS, et al. Digital indocyanine green videoangiography of central serous chorioretinopathy[J]. Arch Ophthalmol, 1994, 112(8): 1057-1062. DOI: 10.1001/archopht.1994.01090200063023.
12.	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.
13.	Imamura Y, Fujiwara T, Margolis R, et al. Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy[J]. Retina, 2009, 29(10): 1469-1473. DOI: 10.1097/IAE.0b013e3181be0a83.
14.	Ishikura M, Muraoka Y, Nishigori N, et al. Widefield choroidal thickness of eyes with central serous chorioretinopathy examined by swept-source OCT[J]. Ophthalmol Retina, 2022, 6(10): 949-956. DOI: 10.1016/j.oret.2022.04.011.
15.	Mori K, Gehlbach PL, Yoneya S, et al. Asymmetry of choroidal venous vascular patterns in the human eye[J]. Ophthalmology, 2004, 111(3): 507-512. DOI: 10.1016/j.ophtha.2003.06.009.
16.	Ikuno Y, Kawaguchi K, Nouchi T, et al. Choroidal thickness in healthy Japanese subjects[J]. Invest Ophthalmol Vis Sci, 2010, 51(4): 2173-2176. DOI: 10.1167/iovs.09-4383.
17.	Mihara N, Sonoda S, Terasaki H, et al. Sex- and age-dependent wide-field choroidal thickness differences in healthy eyes[J]. J Clin Med, 2023, 12(4): 1505. DOI: 10.3390/jcm12041505.
18.	Yang L, Jonas JB, Wei W. Choroidal vessel diameter in central serous chorioretinopathy[J/OL]. Acta Ophthalmol, 2013, 91(5): e358-e362[2013-05-07]. https://pubmed.ncbi.nlm.nih.gov/23647989/. DOI: 10.1111/aos.12059.

1. 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.
2. Spaide RF, Gemmy Cheung CM, 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. 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.
4. 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.
5. 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.
6. 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.
7. Pauleikhoff L, Agostini H, Lange C. Central serous chorioretinopathy[J]. Ophthalmologe, 2021, 118(9): 967-980. DOI: 10.1007/s00347-021-01376-7.
8. Jung JJ, Yu DJG, 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.
9. Hoseini-Yazdi H, Vincent SJ, Collins MJ, et al. Wide-field choroidal thickness in myopes and emmetropes[J/OL]. Sci Rep, 2019, 9(1): 3474[2019-03-05]. https://pubmed.ncbi.nlm.nih.gov/30837507/. DOI: 10.1038/s41598-019-39653-w.
10. Daruich A, Matet A, Dirani A, et al. Central serous chorioretinopathy: recent findings and new physiopathology hypothesis[J]. Prog Retin Eye Res, 2015, 48: 82-118. DOI: 10.1016/j.preteyeres.2015.05.003.
11. Guyer DR, Yannuzzi LA, Slakter JS, et al. Digital indocyanine green videoangiography of central serous chorioretinopathy[J]. Arch Ophthalmol, 1994, 112(8): 1057-1062. DOI: 10.1001/archopht.1994.01090200063023.
12. 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.
13. Imamura Y, Fujiwara T, Margolis R, et al. Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy[J]. Retina, 2009, 29(10): 1469-1473. DOI: 10.1097/IAE.0b013e3181be0a83.
14. Ishikura M, Muraoka Y, Nishigori N, et al. Widefield choroidal thickness of eyes with central serous chorioretinopathy examined by swept-source OCT[J]. Ophthalmol Retina, 2022, 6(10): 949-956. DOI: 10.1016/j.oret.2022.04.011.
15. Mori K, Gehlbach PL, Yoneya S, et al. Asymmetry of choroidal venous vascular patterns in the human eye[J]. Ophthalmology, 2004, 111(3): 507-512. DOI: 10.1016/j.ophtha.2003.06.009.
16. Ikuno Y, Kawaguchi K, Nouchi T, et al. Choroidal thickness in healthy Japanese subjects[J]. Invest Ophthalmol Vis Sci, 2010, 51(4): 2173-2176. DOI: 10.1167/iovs.09-4383.
17. Mihara N, Sonoda S, Terasaki H, et al. Sex- and age-dependent wide-field choroidal thickness differences in healthy eyes[J]. J Clin Med, 2023, 12(4): 1505. DOI: 10.3390/jcm12041505.
18. Yang L, Jonas JB, Wei W. Choroidal vessel diameter in central serous chorioretinopathy[J/OL]. Acta Ophthalmol, 2013, 91(5): e358-e362[2013-05-07]. https://pubmed.ncbi.nlm.nih.gov/23647989/. DOI: 10.1111/aos.12059.

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