Alterations of retinal pigment epithelium in central serous chorioretinopathy

Background: To examine with en face optical coherence tomography (OCT) the alterations of retinal pigment epithelium (RPE) in central serous chorioretinopathy (CSC) and their role in the pathophysiology of CSC. Methods: We examined retrospectively 30 consecutive eyes of 30 patients with various phases of CSC. All patients underwent fluorescein angiography, indocyanine green angiography, and en face and longitudinal OCT examinations. Results: Of 25 eyes with acute CSC, en face OCT showed RPE abnormalities in 22 eyes (88%) with pigment epithelial detachment (PED) in nine eyes (36%) and a small bulge of RPE in the posterior pole in 15 eyes (60%). Of four eyes with chronic CSC, OCT showed PED in one eye (25%) and a small bulge of RPE in other three eyes (75%). Of 29 eyes with acute or chronic CSC, fluorescein angiography showed characteristic pinpoint leakage in 20 eyes (69%). Of these 20 eyes, a leaking point was located within PEDs in five eyes (25%) and was consistent with the bulge of RPE in nine eyes (45%). With indocyanine green angiography, 28 (97%) eyes showed choroidal vascular hyperpermeability. Ten of the 11 eyes with PED (91%) showed PED within the areas of choroidal vascular hyperpermeability. Sixteen of the 18 eyes with a bulge of RPE (89%) showed the bulge within areas of choroidal vascular hyperpermeability. The one eye in the quiescent CSC exhibited multiple small PEDs within the areas of choroidal vascular hyperpermeability by en face OCT. Conclusions: En face OCT enables us to detect alterations of RPE in eyes with CSC. Most alterations of RPE were associated with choroidal abnormalities.