Spectral OCT-Angiography in En Face Mode for Detection of Morphological Changes in the Retinal Pigment Epithelium before and after Selective Micro-Pulse Laser Exposure in Patients with Central Serous Chorioretinopathy

Purpose — to study the morphological changes of the retinal pigment epithelium (RPE) by optical coherence tomography-angiography (OCT-A) in En Face mode before and after selective micropulse laser irradiation in patients with central serous chorioretinopathy (CSC), determine the correspondence between the topographic location of RPE defects and detachment on the OCT-angiogram in En Face mode and points of leakage on the FAG.

Patients and methods. There were 20 patients (21 eyes) with CSC before and after laser treatment under the observation. All patients underwent high-resolution FAG and OCT-A using Angio Retina 2×2 or 3×3 mm protocol and Angio Retina HD 6×6 mm. The treatment was carried out in a selective micropulse mode with individual selection of parameters using the Navilas 577s navigation laser system (OD-OS, Germany) or the IQ 577 laser system (IRIDEX, USA).

Results were evaluated at 2 weeks and 1 month after treatment. Results. In all cases, the leaking points of the subretinal fluid on FAG corresponded to the topographic location of defects and detachments of RPE detachment on OKT-A En Face. According to OCT-A En Face, the following morphological changes were revealed: in 5 cases — single defects of RPE, in 7 cases — multiple defects of RPE, in 9 cases of slit-like detachment of RPE, in 3 patients a combination of slit-like detachment and defect RPE. The sizes of RPE defects varied in the range from 21 to 159 microns, while their rounded shape prevailed. 1 month after the selective micropulse laser effect on OCT-A in the En Face mode, the defects were closed and the RPE detachments fit in all patients, which resulted in resorption of the subretinal fluid and the neurosensory retina attachment.

Findings. OCT-A in En Face mode is a highly informative diagnostic method that allows noninvasive detection of morphological changes in RPE with a clear topographic localization relative to the retinal vascular network, as well as evaluating the effectiveness of selective micropulse laser treatment in patients with CSC. 

1. Shchegoleva I.V., Budzinskaya M.V. Etiology and pathogenesis of Central serous chorioretinopathy. Annals of Ophthalmology = Vestnik oftal’mologii 2010;3;55–58 (in Russ.).

2. Bonini Filho M.A., De Carlo T.E., Ferrara D., Adhi M., Baumal C.R., Witkin A.J., Reichel E., Duker J.S., Waheed N.К. Association of Choroidal Neovascularization and Central Serous Chorioretinopathy With Optical Coherence Tomography Angiography. JAMA Ophthalmol. 2015;133(8);899–906. DOI: 10.1001/jamaophthalmol.2015.1320

3. Costanzo E., Cohen S.Y., Miere A., Querques G., Capuano V., Semoun O., El Ameen A., Oubraham H., Souied E.H. Optical Coherence Tomography Angiography in Central Serous Chorioretinopathy. JAMA Ophthalmol. 2015; 2015:134783. DOI: 10.1155/2015/134783

4. McClintic S.M., Jia Y., Huang D., Bailey S.T. Optical Coherence Tomographic Angiography of Choroidal Neovascularization Associated With Central Serous Chorioretinopathy. JAMA Ophthalmol. 2015;133(10);1212–1214. DOI: 10.1001/jamaoph thalmol.2015.2126

5. Quaranta-El Maftouhi M., El Maftouhi A., Eandi C.M. Chronic central serous chorioretinopathy imaged by optical coherence tomographic angiography. Am J Ophthalmol. 2015;160(3);581–587. DOI: 10.1016/j.ajo.2015.06.016

6. Kitaya N., Nagaoka T., Hikichi T., Sugawara R., Fukui K., Ishiko S., Yoshida A. Features of abnormal choroidal circulation in central serous chorioretinopathy. Br J Ophthalmol. 2003;87;709–712.

7. Kachalina G.F., Zheltov G.I., Ivanova E.V. Optimization of operating modes of IRIS Medical IQ 577 laser selective action onto pigment epithelium. Ophthalmology. Eastern Europe = Oftal’mologiya. Vostochnaya Evropa. 2015;27(4):69–77 (In Russ.).

8. Kachalina G.F., Zheltov G.I., Ivanova E.V. Modern approaches for the use of micropulse mode for the treatment of central retinal diseases. Tauride Medical-Biological Annales = Tavricheskij mediko-biologicheskij vestnik. 2012;15:225–227 (In Russ.).

9. Takhchidi Kh.P., Kachalina G.F., Zheltov G.I., Ivanova E.V. A new technology of visual functions restoration, based on the selective effect of short pulses of laser radiation on the retinal pigment epithelium. Ophthalmology in Belarus = Oftalmologiya v Belarusi. 2010; 4(07):79–83 (In Russ.).

10. Zheltov G.I., Glazkov V.N., Ivanova E.V. Selective action of laser pulses on the retinal pigment epithelium. Physical basics. ARSMEDICA = ARSMEDICA. Fizicheskiye osnovy. 2012;58(3):78–85 (In Russ.).

11. Volodin P.L., Ivanova E.V., Solomin V.A. The possibilities of modern diagnostic methods and computer data processing using the “FemtoScan” program to identify weak thermal damage of retinal pigment epithelium cells. Laser Medicine = Lazernaya medicina. 2018;1:52–57 (In Russ.).

12. Panova I.E., Shaimov T.B., Shaimova V.A.. Morphometric and angiographic parallel with different variants of the course of Central serous chorioretinopathy. Annals of Ophthalmology = Vestnik oftal’mologii. 2017;2;11. (In Russ.). DOI: 10.17116/oftalma2017133210-17

13. Huang D., Jia Y., Gao S.S., Lumbroso B., Rispoli M. Optical Coherence tomography angiography using Optovue device. Basel, Karger. 2016;56:6–12. DOI: 10.1159/000442770

14. Hamada M., Ohkoshi K., Inagaki K., Ebihara N., Murakami A. Correction to: Visualization of microaneurysms using optical coherence tomography angiography: comparison of OCTA en face, OCT B scan, OCT en face, FA, and IA images. Jpn J Ophthalmol. 2018;62(2);176–178.

15. Volodin P.L., Ivanova E.V. Computer simulation of laser action in the regime of single micropulse and reactions of proteins chorioretinal complex for selective and effective action on the retinal pigment epithelium cells. Laser Medicine = Lazernaya medicina. 2018;1:61–66 (In Russ.).

16. Volodin P.L., Zheltov G.I., Ivanova E.V., Solomin V.A. Calibration of the parameters of micropulse mode of the IRIDEX IQ 577 laser by computer simulation and diagnostic methods of eye fundus diagnosis. Modern Technologies in Ophthalmology = Sovremennye tekhnologii v oftal’mologii. 2017;1:52–54 (In Russ.).

17. Volodin P.L., Ivanova E.V., Solomin V.A., Pismenskaya V.A., Khrisanfova E.S. The first experience of the use of selective micropulse laser treatment (577 nm) with individual selection of parameters for acute central serous chorioretinopathy. Practical Medicine = Prakticheskaya meditsina. 2017;110(9)2:55–59 (In Russ.).

18. Ivanova E.V., Doga A.V., Volodin P.L., Solomin V.A., Khrisanfova E.S. Personalized treatment of central serous chorioretinopathy by individual selection of micropulse mode parameters on NAVILAS 577s laser system. Modern Technologies in Ophthalmology = Sovremennye tekhnologii v oftal’mologii. 2018;21(1):162–165 (In Russ.).

19. Karakousis P.C., John S.K., Behling K.C., Surace E.M., Smith J.E., Hendrickson A., Tang W.X., Bennett J., Milam AH. Localization of pigment epithelium derived factor (PEDF) in developing and adult human ocular tissues. Mol Vis. 2001;30(7):154–163.

20. Guro M.Yu., Potapova V.N., Hzardzhan Yu.Yu., Sharifova O.Sh. The value of registration of autofluorescence of the fundus and scanning laser ophthalmoscopy in the diagnosis and treatment of central serous chorioretinopathy. Annals of Orenburg State University = Vestnik Orenburgskogo gosudarstvennogo universiteta. 2012;12:41–43 (In Russ.).

21. Roider J., Hillenkamp F., Flotte T.J., Birngruber R. Microphotocoagulation: selective effects of repetitive short laser pulses. Proc. Nat. Acad. Sci. USA. 1993;90;8643–8647.

22. Yu D.Y., Cringle S.J., Su E., Yu P.K., Humayun M.S., Dorin G. Laser-induced changes in intraretinal oxygen distribution in pigmented rabbits. Ophthalmol. Vis. Sci. 2005;46(3); 988–999. DOI: 10.1167/iovs.04-0767