Assessing central serous chorioretinopathy with deep learning and multiple optical coherence tomography images.

Central serous chorioretinopathy (CSC) is one of the most common macular diseases that can reduce the quality of life of patients. This study aimed to build a deep learning-based classification model using multiple spectral domain optical coherence tomography (SD-OCT) images together to diagnose CSC. Our proposed system contains two modules: single-image prediction (SIP) and a final decision (FD) classifier. A total of 7425 SD-OCT images from 297 participants (109 acute CSC, 106 chronic CSC, 82 normal) were included. In the fivefold cross validation test, our model showed an average accuracy of 94.2%. Compared to other end-to-end models, for example, a 3D convolutional neural network (CNN) model and a CNN-long short-term memory (CNN-LSTM) model, the proposed system showed more than 10% higher accuracy. In the experiments comparing the proposed model and ophthalmologists, our model showed higher accuracy than experts in distinguishing between acute, chronic, and normal cases. Our results show that an automated deep learning-based model could play a supplementary role alongside ophthalmologists in the diagnosis and management of CSC. In particular, the proposed model seems clinically applicable because it can classify CSCs using multiple OCT images simultaneously.

Classifying central serous chorioretinopathy subtypes with a deep neural network using optical coherence tomography images: a cross-sectional study.

Central serous chorioretinopathy (CSC) is the fourth most common retinopathy and can reduce quality of life. CSC is assessed using optical coherence tomography (OCT), but deep learning systems have not been used to classify CSC subtypes. This study aimed to build a deep learning system model to distinguish CSC subtypes using a convolutional neural network (CNN). We enrolled 435 patients with CSC from a single tertiary center between January 2015 and January 2020. Data from spectral domain OCT (SD-OCT) images of the patients were analyzed using a deep CNN. Five-fold cross-validation was employed to evaluate the model's ability to discriminate acute, non-resolving, inactive, and chronic atrophic CSC. We compared the performances of the proposed model, Resnet-50, Inception-V3, and eight ophthalmologists. Overall, 3209 SD-OCT images were included. The proposed model showed an average cross-validation accuracy of 70.0% (95% confidence interval [CI], 0.676-0.718) and the highest test accuracy was 73.5%. Additional evaluation in an independent set of 104 patients demonstrated the reliable performance of the proposed model (accuracy: 76.8%). Our model could classify CSC subtypes with high accuracy. Thus, automated deep learning systems could be useful in the classification and management of CSC.

To evaluate the microcirculation of retinochoroid capillary between acute and chronic central serous chorioretinopathy with OCTA.

ABSTRACT: To investigate the difference in chorioretinal microcirculation between acute central serous chorioretinopathy (aCSC) and chronic central serous chorioretinopathy (cCSC) using optical coherence tomography angiography.In total, 65 patients previously diagnosed with central serous chorioretinopathy (33 aCSC and 32 cCSC) were included in our cross-sectional study. All patients underwent complete ophthalmologic assessment including logarithm of the minimum angle of resolution best-corrected visual acuity, fundus fluorescein angiography, and optical coherence tomography angiography. Sixty eyes of 60 refractive error and age matched healthy people were selected as control.The vessel density of inner retina in patients with aCSC were higher than that in patients with cCSC (51.32 ±â€Š2.01 vs 49.15 ±â€Š3.68, P = .004), however, the vessel density of superficial choroid layer in aCSC were significantly lower than that in cCSC (49.83 ±â€Š6.96 vs 53.42 ±â€Š6.28, P = .033). Further analysis of the data reveals the presence of a distinct choroidal neovascularization (CNV) in 8 patients (25%) with cCSC while there was no evidence of CNV in patients with aCSC.Our study can contribute to a better understanding of the difference in retinochoroid microcirculation between aCSC and cCSC. The vessel density of inner retina was lower and the vessel density of superficial choroid was higher in cCSC, and patients with cCSC were more susceptible to CNV than patients with aCSC.

Pachychoroid Spectrum Disease: Underlying Pathology, Classification, and Phenotypes.

PURPOSE: Pachychoroid spectrum disease encompasses a set of macular disorders secondary to an abnormally thick choroid. However, the pathological process underlying pachychoroid spectrum disease and its overlap with age-related macular degeneration (AMD) remain unclear. This review aimed to understand the underlying pathology, classification, and phenotypes of pachychoroid spectrum disease. METHODS: This comprehensive literature review was performed based on a search of peer-reviewed published papers relevant to the current knowledge of pachychoroid disease spectrum. RESULTS: Pachychoroid is primarily a bilateral phenomenon; the main pathological lesions include choriocapillaris attenuation and abnormally dilated pachyvessels. Chronic central serous chorioretinopathy (CSC) and pachychoroid neovasculopathy (PNV) show similar morphological changes and angiogenic cytokine levels. The subretinal fluid in PNV may not accurately indicate PNV activity. Besides, types 1 and 2 of choroidal neovascularization (CNV) may be involved in primary pachychoroidal disease. Both choroidal arteriosclerosis and higher hydrostatic pressure contribute to hyalinized choroidal arteries and aneurysmal dilatations, resulting in PNV progression to polypoidal choroidal vasculopathy (PCV). Thus, pachychoroid-related type 2 CNV and chronic CSC could be considered as PNV (IIIc) and as a precursor of PNV (IIIa), respectively. Tangled PCV on optical coherence tomography angiography that fails to develop aneurysms should be classified as a subtype of PNV or a forme fruste of PCV. CONCLUSIONS: Multiple disorders of the pachychoroid spectrum are considered as a continuous disease process, ultimately stimulated by choroidal malfunction. PCV overlaps both AMD and pachychoroid disease, especially for thin-choroid and bilateral types. The terminology and classification of pachychoroid spectrum disease should be used cautiously.

REVISED CLASSIFICATION OF THE OPTICAL COHERENCE TOMOGRAPHY OUTER RETINAL BANDS BASED ON CENTRAL SEROUS CHORIORETINOPATHY ANALYSIS.

PURPOSE: To evaluate the optical coherence tomography (OCT) imaging findings in recent onset neurosensory retinal detachments induced by central serous chorioretinopathy and to attempt to corroborate these findings with proposed anatomical correlates. METHODS: Retinal detachments due to central serous chorioretinopathy of less than 3 months' duration and the surrounding area were scanned with OCT. The imaging of the outer retinal bands was evaluated according to proposals by Cuenca et al and the IN•OCT Consensus classification. RESULTS: Optical coherence tomography findings in 11 eyes (11 patients) with CSC showed that all hyperreflective bands above Band 4 were variably continuous within the outer portion of the serous detachment. We then attempted to reconcile inconsistencies in current explanations for the outer retinal bands to propose changes to the outer retinal OCT nomenclature. CONCLUSION: Our patients' OCT findings support the current standard that Band 3 is an outer retinal structure and that Band 4 represents the retinal pigment epithelium/Bruch complex. Confusion exists regarding whether the interdigitation zone extends halfway up or for the full length of the outer segments, and the hyporeflective band between Bands 3 and 4 has yet to receive an appropriate term. We therefore propose a modification to the IN•OCT Consensus classification by renaming the trilaminar hyporeflective, hyperreflective, and hyporeflective bands between Bands 2 and 4 as the outer segment-interdigitation zone complex consisting of the inner, middle, and outer segment-interdigitation zone, respectively.

Intravitreal injections during COVID-19 outbreak: Real-world experience from an Italian tertiary referral center.

We report our experience during COVID-19 outbreak for intravitreal injections in patients with maculopathy. We proposed a treatment priority levels and timings; the "High" priority level includes all monocular patients; the "Moderate" is assigned to all patients with an active macular neovascularization; the patients affected by diabetic macular edema or retinal vein occlusion belong to the "Low" class. This organization allowed us to treat the most urgent patients although the injections performed had a 91.7% drop compared to the same period of 2019.

Discrepancy in current central serous chorioretinopathy classification.

AIM: To report the discordance in central serous chorioretinopathy (CSCR) classification among practising retina specialists. METHODS: The study conducted was a multicentre survey. Multimodal retinal images along with relevant clinical details of 100 cases diagnosed as CSCR (from six centres) were circulated among six retina specialists across the globe. The image sets included colour fundus photographs, fundus autofluorescence images, optical coherence tomography b-scans, fluorescein and indocyanine green angiography of the study and fellow eyes. The graders were asked to classify the disease of study eye, according to their own criteria. The graders were masked to the responses of other graders. The final analysis of the pooled response data was done based on the diagnosis of study eye only. The main outcome measure was degree of agreement between six independent observers using Fleiss Kappa statistics. RESULTS: Grading for 100 eyes of 100 patients (men, 93%) was included in the analysis. 20 patients had a history of steroid use. The graders provided 36 different terms to classify the disease, with poor agreement among graders (Fleiss Kappa=0.134). The consistency in diagnosing acute CSCR was statistically higher than for either chronic (p=0.012) or recurrent CSCR (p<0.0001). When collapsing descriptors into six main terms, agreement remained poor (Fleiss Kappa=0.218). CONCLUSION: The high discordance among experienced retina specialists in describing CSCR clinical subtypes is highlighted. The current work demonstrates the limitations of current empirical CSCR classification methods and the need for a more objective and refined system to bring uniformity in diagnosis and prognostication of the disease.

Association of Central Serous Chorioretinopathy with Psychosocial Factors is Dependent on Its Phase and Subtype.

PURPOSE: To analyze the psychosocial factors associated with central serous chorioretinopathy (CSC) according to its phases and subtypes and to correlate the factors with the extent of choroidal hyperpermeability. METHODS: Age- and sex-matched CSC patients and controls (n = 37 in each group) were enrolled, and their psychosocial factors were compared. CSC was divided into two phases (active and inactive), and active CSC was further divided into two subtypes (acute and chronic). The correlations between the size of the hyperpermeable choroidal lesion identified on indocyanine green angiography and psychosocial factors were examined. RESULTS: Active CSC patients experienced more stressful events (p = 0.030), were more depressive (p = 0.037), and felt less emotional (p = 0.014) and informational (p = 0.014) support than the matched controls, whereas inactive CSC patients were comparable to the matched controls in all psychosocial factors. Among the active CSC patients, acute patients were more depressive (p = 0.029), while chronic patients experienced more stressful events (p = 0.024) than their matched controls. The size of the hyperpermeable choroidal lesion was correlated with the severity of depression in acute patients. CONCLUSIONS: Association of CSC with psychosocial factors was dependent on the phase and subtype of CSC. Psychosocial factors were associated with CSC in the active phase, and severity of depression was correlated with the size of the choroidal pathology in acute active CSC. Further prospective studies to investigate if psychosocial factors can trigger CSC are warranted.

Evolution of fundus autofluorescence patterns over time in patients with chronic central serous chorioretinopathy.

PURPOSE: To determine the evolution of fundus autofluorescence (FAF) patterns in chronic central serous chorioretinopathy (CSCR) over time. METHODS: We retrospectively studied the changes in FAF patterns over time in 157 eyes of 112 patients with chronic CSCR using the Heidelberg Retina Angiography with a 488-nm excitation light and a 500-nm cutoff barrier filter. RESULTS: The mean duration of follow-up was 37.2 months. The most common baseline pattern was that of granular hypoautofluorescence (51.0%). The earliest change in chronic CSCR is diffuse hyperautofluorescence and it occurs approximately 4 months after the reported first episode. The most common change observed at this stage is a change within areas of hyperautofluorescence where hyper-reflective dots appeared or disappeared. Change in FAF patterns from areas of hyperautofluorescence to hypoautofluorescence was slow. Only 25% of eyes showed such a change in pattern by 36 months. It takes an average of 24 months for granular hypoautofluorescent pattern to develop confluent hypoautofluorescence. There were no predictive patterns for the development of confluent CSCR. CONCLUSION: Fundus autofluorescence (FAF) changes in CSCR evolve very gradually and so is not a good outcome measure for clinical trials.

Fundus autofluorescence imaging patterns in central serous chorioretinopathy according to chronicity.

PurposeTo investigate the time-period characteristics associated with morphologic changes in central serous chorioretinopathy (CSC) using fundus autofluorescence (FAF).Patients and methodsRetrospective, cross-sectional observational case series. Patients were classified into three groups: acute and chronic according to the onset of subjective symptoms of 6 weeks and sequelae patients who have history and symptoms but no serous retinal detachment (SRD). We compared FAF images to obtain characteristic findings according to the chronicity.ResultsA total of 52 eyes were included in this study. Acute CSC eyes were characterized by decreased FAF intensity at the leakage point in 13/22 eyes (56.5%) and staining patterns with various levels of fluorescence signal (hyperautofluorescent (10 eyes, 43.5%), hypoautofluorescent (1 eye, 4.3%), and minimal changes (12 eyes, 52.2%)) in the area of SRD. In chronic CSC eyes, hyperautofluorescent (14 eyes, 63.6%) or minimal changes (8 eyes, 36.4%) were observed in the area of SRD. Discrete dots with increased FAF intensity were observed in chronic CSC eyes (P<0.001). Eyes with sequelae of CSC had mixed FAF patterns over areas of retinal pigment epithelium (RPE) atrophy in seven eyes (100%, P<0.001)) and descending tracts which showed various FAF intensities according to the RPE and photoreceptor status (P<0.001).ConclusionFAF imaging patterns in CSC eyes differ according to the course of the disease, reflecting RPE and outer retinal changes. Detailed investigation using FAF could help to estimate the duration of CSC and determine the proper treatment modality.

Multimodal imaging of pigment epithelial detachment: a guide to evaluation.

PURPOSE: To describe the spectrum of pigment epithelial detachments (PEDs) occurring mainly in age-related macular degeneration and central serous chorioretinopathy and also in other inflammatory, neoplastic and iatrogenic, retinal, and systemic disorders. METHODS: Pigment epithelial detachments are divided into drusenoid, serous, vascularized, or mixed categories. RESULTS: The clinical presentation, classification, and natural history of PEDs are reviewed as illustrated with multimodal imaging combining traditional and novel imaging techniques, including fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and spectral domain optical coherence tomography. Most PEDs occur because of pathophysiologic mechanisms taking place below the retinal pigment epithelium that are difficult to identify with conventional imaging modalities. Enhanced depth imaging optical coherence tomography and indocyanine green angiography allow a better analysis of the subretinal pigment epithelium compartment. CONCLUSION: The differentiation between various kinds of PEDs is essential because each PED type is a distinct entity that has a specific pathogenesis, natural history, prognosis, and optimal treatment strategy.

Time-periodic characteristics in the morphology of idiopathic central serous chorioretinopathy evaluated by volume scan using spectral-domain optical coherence tomography.

PURPOSE: To investigate the time-period characteristics associated with morphologic changes in idiopathic central serous chorioretinopathy (CSC) using volume scans acquired by spectral-domain optical coherence tomography (SD-OCT). DESIGN: Retrospective, observational, cross-sectional case series. METHODS: Patients underwent visual acuity measurements, fundus examinations, fluorescein angiography, indocyanine green angiography, and SD-OCT volume scans. Patients were classified into 5 categories-acute CSC, early chronic (EC) CSC, late chronic (LC) CSC, sequelae of CSC, or recurrent CSC-according to the chronicity and the recurrence. We investigated the relationship between our classification and the detailed morphologic changes of the retinal pigment epithelium and outer retina that were observed in the SD-OCT images. RESULTS: A total of 76 eyes from 75 patients were included in this study. Serous retinal detachment was relatively higher in acute CSC. Low to flat pigment epithelial detachments (PEDs) were most commonly observed in all stages of CSC, especially in LC CSC, but some semicircular PEDs were occasionally observed in eyes with acute or EC CSC. Retinal dragging with fibrin was most frequently observed in eyes that were in the early stage of acute CSC. A thickened posterior surface of the detached retina was most commonly observed in eyes with acute CSC, whereas a thinned posterior surface of the detached retina was observed in eyes with LC CSC. Hyperreflective dots and subretinal exudates were more commonly observed in eyes with EC and LC CSC than in eyes with acute CSC. In eyes with recurrent CSC, 2 different patterns of SD-OCT findings were observed; these patterns resembled those that were found in either acute CSC or LC CSC. CONCLUSIONS: SD-OCT finding patterns in CSC eyes differ according to the chronicity and the recurrence of the disease. Detailed investigation of the retinal pigment epithelium and outer retina using SD-OCT could be useful for estimating the duration of CSC.

[Central serous chorioretinopathy: etiology and pathogenesis].

The review of the literature is devoted to the topical problem of retinology, namely the etiology and pathogenesis of central serous chorioretinopathy (CSC). It presents historical facts of studying this problem, basic theories of the development of the disease, and principles of its classification. The bulk of the review touches upon the impact of stress on the development of choriocapillary-Bruch's membrane-retinal pigment epithelium system dysfunction. A human stress reaction is accompanied by the poorest hypokinetic type of circulation. This gives rive to a significant hypertensive reaction (the highest systemic pressure), by showing a considerable increase in the total peripheral vascular resistance; there is also a high baseline cortisol level with a tendency towards depleted reserves of the pituitary-adrenal system and imbalance in the pituitary-thyroid system. A chief role has been recently assigned to these changes in the recurrence and development of complications in CSC.