Choroidal Rift: A New OCT Finding in Eyes with Central Serous Chorioretinopathy

Characteristics and Classification of Choroidal Caverns in Patients with Various Retinal and Chorioretinal Diseases

PURPOSE

To investigate the features of choroidal caverns in diverse retinal diseases with swept-source optical coherence tomography (SS-OCT).

METHODS

Subjects with normal eyes, retinitis pigmentosa (RP), wet age-related macular degeneration (wAMD), acute central serous chorioretinopathy (CSC), or chronic CSC were enrolled. The characteristics of choroidal caverns were evaluated with SS-OCT. The prevalence of choroidal caverns in retinal diseases and the correlations between the number, width and depth of choroidal caverns with the thickness of choroid were analyzed.

RESULTS

Among 315 eyes of 220 subjects, choroidal caverns were found in 110 eyes (34.9%). Choroidal caverns were divided into two categories based on their location and size. Type I was small and usually lobulated, presented in the choroidal capillary and Sattler's layers. Type II was larger, usually isolated, and presented in the Sattler's and Haller's layers. The prevalence of type I in subjects with normal eyes, RP, wAMD, acute CSC, or chronic CSC was 17.4%, 19.6%, 1.6%, 32.8%, and 85.2%, respectively, while that of type II was 0%, 0%, 21.3%, 13.8%, and 53.7%, respectively. The number, width, and thickness of type II choroidal caverns correlated positively with macular choroidal thickness.

CONCLUSIONS

Choroidal caverns could be divided into two categories. Type II choroidal caverns appeared associated with the pachychoroid spectrum and RPE atrophic diseases.

Bilateral choroidal caverns in a child with pachychoroid and anxious personality

Purpose

To report a case of a 7-year-old male patient with bilateral choroidal caverns (CC) and pachychoroid.

Observations

During the Italian COVID-19 lockdown, a 7-year old boy presented with bilateral vision decline that had started two weeks before. Structural optical coherence tomography revealed pachychoroid and CC bilaterally. Other ocular examinations were negative. The patient had an apprehensive personality and symptoms quickly resolved when he was provided with non-prescription glasses; his visual disturbances were thus considered to be functional and factitious.

Conclusions and Importance

Our patient's symptoms remind us that the distress imposed upon psychologically frail subjects by the COVID-19 pandemic may have multifaceted manifestations. The discovery of CC in a pediatric patient with healthy eyes presents us with new questions about the processes of degeneration thought to be the cause for CC. Further studies are needed to estimate the prevalence of CC in the general adult and pediatric populations, as well as in patients with chorioretinal diseases.

[Central serous chorioretinopathy]

Central serous chorioretinopathy (CSC) is the fourth most common disease of the macula after age-related macular degeneration, diabetic retinopathy and retinal vein occlusion and a cause of irreversible visual loss. This article gives an overview of the epidemiology, risk factors, pathophysiology, clinical presentation, multimodal imaging and discusses current therapeutic options for CSC.

Central Serous Chorioretinopathy Classification

Central serous chorioretinopathy is characterized by an idiopathic neurosensory detachment of the retina. This narrative review aims to discuss the classification system used for central serous chorioretinopathy. Based on our current knowledge, there is no universally adopted classification system. This is the result of the unknown aspects related to pathogenesis and clinical spectrum and evolution. The best option could be to aggregate multimodal pieces of information alongside temporal and phenotypic characteristics.