Spectrum of Retinal Pigment Epithelium Abnormalities in Central Serous Chorioretinopathy as Revealed by Ultra-Widefield Autofluorescence

Abstract

 

Purpose

 

To document the wide array of ultra-widefield autofluorescence (UWF-AF) presentations in central serous chorioretinopathy (CSCR) and to compare these to clinical exam, standard color and UWF color images, spectral domain OCT and, in select cases, to visual fields (VFs) and UWF fluorescein angiography.

 

Methods

 

A retrospective review from 3 facilities of 20 eyes from 13 patients diagnosed with CSCR by standard criteria and who had UWF-AF images available to analyze and correlate with other procedures such as SD OCT.

 

Results

 

Nine of the 13 patients were male and age ranged from the third to the sixth decade. Eleven were symptomatic and two were detected during routine exams. Although a wide spectrum of UWF-AF patterns was discovered, in 11 of the 20 affected eyes, descending “gravitational” tracts were documented. Most often, these gravitational tracts extended to the equator inferiorly and even beyond. In nearly all cases, the tract was hypo AF with a surrounding hyper AF zone. Outer retina involvement (loss of the ellipsoid aka PIL on OCT) corresponded to both hypo and hyper AF lesions. A 41 year old male physician presented with 20/10 VA OD but with a large noticeable superior nasal blind spot (following a motorcycle accident) and was found to have a large, corresponding descending tract without foveal involvement (figure 1). The most profound case in the series was a 45 year old female being treated for 19 years with steroids for SLE with VA of 20/80 OD and FC at 6 ft OS. Both SD OCT and FA confirmed CSCR OD; OS with long standing VA reduction demonstrated total hypo AF in 3 full quadrants extending beyond the equator with only minimal hyper AF in the superior quadrant (figure 2) and only an inferior quadrant of the VF remaining.

 

Conclusions

 

UWF-AF imaging is quite useful in patients with CSCR to document the extent of RPE damage, often not recognized on clinical exam. SD OCT of lesions revealed by UWF-AF documents loss of photoreceptor integrity and predicts VF defects. UWF-AF is perhaps the preferred non-invasive technology to monitor change in CSCR patients with widespread involvement.

 

 

Ultra-widefield AF of a 41 year old male physician as discussed in results above.

 

 

UWF-FA of a 45 year old female as noted in results with profound hypo AF and loss of the photoreceptors in 3 of 4 retinal quadrants OS.

 

Keywords: 701 retinal pigment epithelium • 550 imaging/image analysis: clinical • 451 chorioretinitis