Detection of Silent Type I Choroidal Neovascular Membrane in Chronic Central Serous Chorioretinopathy Using En Face Swept-Source Optical Coherence Tomography Angiography

Figure 2

(a) The colored photo and FFA of the left eye of a 46-year-old male with bilateral chronic CSCR of approximately 1.5-year duration. The posterior pole shows diffuse retinal pigment epitheliopathy in the macular area measuring approximately 5 disc diameters (DD) in size along with shallow subretinal fluid and peripapillary PED. FFA shows a large hyperfluorescent area caused by window defect that corresponds to the area of retinal pigment epitheliopathy seen in the colored photo. In addition, the macular area shows multiple hyperfluorescent leaking points that gradually increase in intensity throughout later phases with a typical inkblot pattern of leakage (arrows). (b) SS-OCT image. A 12.0 mm radial scan is selected to include the peripapillary area. The scan shows subfoveal neurosensory detachment extending to the peripapillary area, which is associated with subretinal deposits. A single large regular smooth PED is seen in the peripapillary area. A subfoveal shallow PED with an undulating thickened surface and sub-RPE hyperreflective amorphous deposits is shown (open arrow). The subfoveal choroidal vessels are engorged (black stars). Subfoveal choroid thickness is 455 μ. (c) The en face SS-OCTA image of the same eye taken at the level of the outer retina in a 4.5 mm × 4.5 mm field. Note the hyperintense signal caused by increased blood flow within the CNV complex. The complex is composed of a network of tiny arborizing capillaries with frequent anastomosis and looping in the periphery of the lesion (white arrow heads). (d) The corresponding color-coded density map reflecting blood flow at the level of the outer retina. Note the entire background has variable shades of blue typical of avascular outer retina. The CNV complex stands out with its bright red signal indicating dense blood flow. (e) The en face SS-OCTA image of the same lesion at the level of the choriocapillaris (black arrow heads). (f) The en face SS-OCTA image after manual adjustment of the segmentation slab to a deeper position into the choroid to demonstrate two abnormally dilated choroidal vessels corresponding to increased subfoveal choroidal thickness on SS-OCT (black stars).

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