Optical Coherence Tomography Angiography Quantitative Assessment of Choriocapillaris Blood Flow in Central Serous Chorioretinopathy

[...]we acknowledge that the use of swept-source OCTA could be more suitable for CC flow assessment.3 Whereas flow signal cannot usually be properly assessed in medium and large choroidal vessels with OCTA, several recent studies support the hypothesis of a CC hypoperfusion in CSC patients using this imaging modality.4,5 These findings are consistent with areas of CC hypoperfusion detected by indocyanine green angiography (ICGA). Furthermore, areas of CC thinning can be observed with enhanced depth imaging (EDI) OCT, colocalizing with pachyvessels in ICGA and flow signal voids in OCTA, that is not suggestive of an increased blood volume with slower blood velocity within the CC.5,6 We hypothesize that a chronic ischemic insult at the CC level along with an increased hydrostatic pressure originating from the underlying congested choroidal vessels may lead to RPE–Bruch membrane complex damage, outer blood-retinal barrier breakdown, and subsequent SRD. [...]we appreciate these thoughtful suggestions, which will help promote further discussions in the field of blood flow dynamics in CSC and other pachychoroid spectrum disorders.