The presence of intervortex vein anastomosis and associated OCT findings in central serous choriorethinopathy

Abstract

Purpose:To evaluate the optical coherence tomography (OCT) findings of patients with central serous choriorethinopathy(CSC) according to the presence of intervortex vein anastomosis(IVA) on indocyanine green (ICG) angiography.Setting/Venue:Clinical records and OCT, fundus fluorocein and ICG angiography images of patients diagnosed with CSC were reviewed retrospectively. Patients without history of treatment for CSC were included and categorized in 2 groups according to presence or absence of intervortex vein anastomosis at presentation: presence of IVA (Group A) or absence of IVA (Group B). If OCT and angiography findings were in accordance with CSC, both eyes of patients were included, otherwise fellow eye was excluded.Methods:LogMAR visual acuity (VA), OCT findings including intraretinal cysts, serous retinal detachment (SRD), subfoveal choroidal thickness (SFCT), inner choroidal attenuation (ICA), classic or flat pigment epithelial detachment (PED), irregular lesions (deposits) on retina pigment epithelium(RPE), photoreceptor disruption (PD), intraretinal hyperreflective dots (IHD), choroidal excavation and angiographic findings including localization of IVA, leakage on IVA and smokestack configuration were evaluated.Photoreceptor disruption was classified into shaggy, atrophy or combined subtypes based on the appearance on OCT.Localization of IVA categorized in 3 areas according to ETDRS grid containing three concentric circles 1, 3, and 6 mm in diameter: inner 1mm circle (area 1), 1-3mm middle circle (area 2) and 3-6 mm outer circle (area 3).One sample t-test and Pearson Chi-Square test were applied to compare the numerical variables between 2 groups.Linear regression analyses were performed for the multivariable analyses of VA, OCT and angiography findings.P values less than 0.05 were considered significant.Results:Fifty-two eyes of 39 patients (23 males, 16 females) were included. Thirty-one eyes were in group A, 21 eyes were in group B. The mean ages of the patients at presentation were 52.5 ± 11.3 years in group A, 47.2 ± 11 years in group B (p<0.001). The mean VA of the patients were 0.38 ± 0.38LogMAR in group A and 0.19 ± 0.21 LogMAR in group B (p<0.001). The mean SFCT of the patients were 436.3±134.3µ in group A and 480.2±136.6µ in group B (p<0.001). There were no significant difference in the other OCT findings between 2 groups (p>0.05). Leakage on IVA was detected in 93.6% of patients. 35.5% of eyes had IVA in area 1, 38.7% of eyes in area 2, 25.8% of eyes in area 3. Localization of IVA in area 1 was correlated with both ICA and leakage on IVA(r=0.412, p=0.011 and r=0.371, p=0.02). Localization of IVA in area 3 was correlated with irregular lesions on RPE(r=0.314, p=0.042). Smokestack configuration, intraretinal cysts, ICA were significantly correlated with worse initial VA (p<0.001, p=0.001 and p=0.04). Shaggy subtype of PD was significantly associated with better initial VA (r=0.380, p=0.003).Conclusions:Intervortex vein anastomosis is recently defined entity in patients with CSC and/or pachychoroid spectrum disorders. IVA has also been reported in normal population. We detected older age, worse initial visual acuity and thinner SCFT in patients diagnosed with CSC and IVA. Long term follow-up of patients with and without IVA may exhibit the difference in treatment outcomes and development of neovasculopathy.