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R. W. Chen, V. J. Srinivasan, J. S. Duker, E. Reichel, C. R. Baumal, A. H. Rogers, T. Hedges, M. Wojtkowski, J. S. Schuman, J. G. Fujimoto; Staging of Central Serous Chorioretinopathy With High-speed Ultrahigh Resolution OCT. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2621.
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© ARVO (1962-2015); The Authors (2016-present)
To examine central serous chorioretinopathy (CSCR) with Ultrahigh resolution optical coherence tomography and high-speed, ultrahigh resolution OCT (UHR-OCT) based on spectral / Fourier domain detection. To investigate the impact of improved visualization of internal retinal layers on staging of CSCR.
22 patients with a clinical diagnosis of CSCR were scanned at the New England Eye Center with either a prototype UHR-OCT time domain instrument or a high-speed UHR-OCT instrument from January 2004 to November 2006. Both instruments achieved 3 - 3.5 µm axial image resolution, compared to ~10 µm resolution obtained by Stratus OCT. The high-speed UHR-OCT instrument images at a rate ~60 times faster than standard OCT, resulting in decreased motion artifacts and images with high transverse pixel density.
Three stages of CSCR were identified based on UHR-OCT image photoreceptor and retinal pigment epithelium (RPE) characteristics. Stage 1a patients (7 cases) had a uniformly elevated neurosensory retinal detachment with a smooth, normal thickness photoreceptor outer segment (PR OS) contour. Stage 1b patients (4) demonstrated a stalactite/stalagmite appearance on the outer segments and RPE, respectively. Stage 2 patients (4) lacked the protrusions of stage 1b, but the detached neurosensory retina had an irregular retinal contour and an unevenly thinned PR OS contour. Stage 3a patients (2) had resolved detachments without permanent sequelae. Stage 3b patients (9) had resolved detachments with marked PR OS and focal outer nuclear layer atrophy compared to both Stage 1 and normal retinas.
Previous studies categorized CSCR patients into acute and chronic phases of disease, but to date, no staging methods have been described. Our findings suggest that it is possible to accurately and practically stage CSCR patients based upon clinical examination and UHR-OCT imaging. This ability may help in differentiating patients who require intervention to preserve vision from those who may be observed without treatment.
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