Inner Choroidal Fibrosis: An Optical Coherence Tomography Biomarker of Severity in Chronic Central Serous Chorioretinopathy

Saarang Hansraj; Jay Chhablani; Umesh Chandra Behera; Ritesh Narula; Raja Narayanan; Niroj Kumar Sahoo

doi:10.1016/j.ajo.2024.02.025

Inner Choroidal Fibrosis: An Optical Coherence Tomography Biomarker of Severity in Chronic Central Serous Chorioretinopathy

Am J Ophthalmol. 2024 Feb 28:264:17-24. doi: 10.1016/j.ajo.2024.02.025. Online ahead of print.

Authors

Saarang Hansraj¹, Jay Chhablani², Umesh Chandra Behera³, Ritesh Narula¹, Raja Narayanan¹, Niroj Kumar Sahoo⁴

Affiliations

¹ From the Anant Bajaj Retina Institute (S.H., R.N., R.N.), Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India.
² UPMC Eye Center (J.C.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
³ Anant Bajaj Retina Institute (U.C.B.), Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India.
⁴ Anant Bajaj Retina Institute (N.K.S.), Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, India. Electronic address: nirojsahoo71@gmail.com.

PMID: 38417570
DOI: 10.1016/j.ajo.2024.02.025

Abstract

Purpose: To describe a potential biomarker termed as inner choroidal fibrosis in cases of chronic central serous chorioretinopathy (CSCR) presenting to a tertiary referral center.

Design: Observational case series.

Methods: Five eyes of 4 patients with CSCR were noted to have a gray-white subretinal lesion in the macula, which was analyzed with multimodal imaging.

Results: The lesions were hypofluorescent on autofluorescence, fundus fluorescein angiography, and indocyanine angiography. In all cases, a characteristic heterogeneous, hyperreflective lesion in the inner choroid was seen on optical coherence tomography (OCT), corresponding to the white subretinal lesions. The lesion was distinct from the adjacent choroid, with greater reflectivity and greater thickness than the adjacent compressed choroidal vasculature. The dilated outer pachyvessels were pushed outward or sideways in all cases. On OCT-angiography, the corresponding lesion showed flow void areas. We have termed this zone of inner choroidal hyperreflectivity "inner choroidal fibrosis." Upon analyzing the clinical course, 3 of the patients had a history of choroidal neovascularization. The contralateral eye in 2 of these 3 patients also developed choroidal neovascularization. Three of the eyes had an overlying focal choroidal excavation.

Conclusions: We report a potential biomarker of CSCR termed "inner choroidal fibrosis" in 4 cases of chronic CSCR. It can best be identified on enhanced depth or swept source OCT as a region of heterogeneous hyperreflectivity in the inner choroid. This fibrosis could be regarded as a degenerative process secondary to more severe disease in the past.