Ultra-Widefield Fundus Autofluorescence Imaging in Central Serous Chorioretinopathy

Abstract

 

Purpose

 

To describe the spectrum of ultra-widefield fundus autofluorescence (UWFAF) imaging findings in a large cohort of patients with central serous chorioretinopathy (CSC) of varying durations and to correlate these features with the results of clinical examination and spectral-domain optical coherence tomography (SD-OCT).

 

Methods

 

This was a retrospective review of eyes with acute and chronic CSC that underwent UWFAF imaging, a technique that enables imaging of up to 200 degrees of the retina. Detailed analysis of the patterns of UWFAF was performed and correlated with the findings of clinical history and examination and SD-OCT imaging.

 

Results

 

Forty-two eyes of 25 patients (19 male, 6 female) with CSC were imaged using UWFAF. Mean age was 54.4±11.8 years and mean duration since diagnosis was 86.9±85.9 months. A wide spectrum of UWFAF patterns was observed often revealing more widespread disease than that observed clinically. Subretinal fluid (SRF) was typically associated with geographic areas of hyper and hypoautofluorescence that persisted in 31 eyes for up to 6 years after resolution of SRF. Areas of absent or decreased UWFAF corresponded to areas of retinal thinning and outer retinal atrophy when correlated with SD-OCT. Hypo and hyperautofluorescent gravitational fluid tracts were seen in 31 of 42 eyes with a mean 87.4±70.3 months since CSC diagnosis. In patients with gravitational tracts who reported sleeping on their side, the direction of the tract usually correlated with the side they slept on.

 

Conclusions

 

UWFAF imaging in patients with CSC revealed a variety of characteristic patterns that may not be evident on clinical examination or with SD-OCT. UWFAF patterns associated with disease activity persisted for many years following resolution of SRF making UWFAF a useful tool for monitoring disease activity over long periods.

 

 

UWFAF findings in CSC. A. Hypo-FAF gravitational fluid tract in a patient with chronic CSC. The fluid tract arches towards the right in this right-sided sleeper. B. UWFAF in a 2nd patient shows more diffuse disease than was suspected clinically or with OCT. C. UWFAF in a 3rd patient shows areas of SRF outside the macula helping to confirm the diagnosis of CSC. The macula OCT scans in this patient (D) show no evidence of SRF. Two separate areas of hyper-FAF outside the macula detected by UWFAF (E & F) prompted OCT imaging which revealed SRF.

 

Keywords: 688 retina • 550 imaging/image analysis: clinical • 452 choroid