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Kristen A. Burwick, Michael B. Wells; Presence of Pigment Epithelial Detachment in Central Serous Chorioretinopathy using High Definition Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1161.
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Central serous chorioretinopathy (CSC) is a retinal disorder characterized by pigment epithelial decompensation leading to accumulation of serous fluid in the macula. Though this condition is typically self-limited, some patients have a more chronic course characterized by multiple recurrences, development of a choroidal neovascular membrane, and significant visual morbidity. Though optical coherence tomography (OCT) has helped in diagnosing and monitoring CSC, to our knowledge it has never been used to look for the presence of subclinical pigment epithelial detachments. Our hypothesis is that pigment epithelial detachment (PED) is more prevalent in CSC than was previously thought, which may be detected using high-definition optical coherence tomography (HD-OCT, Cirrus, Zeiss). The PED may also often be associated with leakage on the fluorescein angiogram (FA), which could potentially have important implications for treatment options for selected patients.
Both prospective and retrospective data were gathered from the ophthalmology clinic at the Havener Eye Institute in Columbus, OH. The Cirrus HD-OCT by Zeiss was used to detect presence or absence of a PED. If a PED was present, then the HD-OCT was compared to the FA to see if the PED corresponded to the point of leakage or the "hot spot".
IRB approval was obtained to enroll 20 patients. At this time 15 patients have been enrolled in the study. Of the 15 patients, 9 of them have a PED evident on HD-OCT (60%). Of the 9 patients with a PED, 8 (89%) of them had corresponding leakage on FA.
PED is a known occurrence in CSC. When it is present, it may be a reliable indicator of the spot of leakage on FA, and now may be reliably found on OCT. Though CSC is generally considered to be a self-limited disease, there are some people that may benefit from treatment. In the case that treatment is desired and the patient is not able to get a fluorescein angiogram (i.e. pregnant or nursing women, patients with a fluorescein allergy), the presence of a PED as detected on OCT may be helpful in guiding treatment.
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