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Retina Retinopathy Microstructural Changes in Central Serous Chorioretinopathy Documented by Spectral-domain Optical Coherence Tomography Dominik Odrobina, Piotr Gozdek, Mariusz Maroszy ń ski and Iwona Lauda ń ska-Olszewska Ophthalmology Clinic Boni Fratres Lodziensis Lodz, Poland Abstract Central serous chorioretinopathy (CSC) was first described more than 140 years ago. Due to the rapid development in modern imaging methods, better understanding of changes occurring in the retina in CSC is possible. Spectral-domain optical coherence tomography (SD- OCT) has increased our ability to study this disease, especially microstructural changes during active phase and after resolution of CSC. SD-OCT enables a highly detailed in vivo evaluation of the individual retinal layers especially external limiting membrane (ELM), the inner and outer segments of photoreceptors and changes in retinal pigment epithelium (RPE), which are the most essential and important in described disease. It allows us better understand pathogenesis of CSC. Keywords Spectral-domain optical coherence tomography, central serous chorioretinopathy, photoreceptor inner and outer segments, retinal pigment epithelium, visual acuity Disclosure: The authors have no conflicts of interest to declare. Received: 26 June 2013 Accepted: 21 July 2013 Citation: European Ophthalmic Review, 2013;7(2):98–101 Correspondence: Dominik Odrobina, Ophthalmology Clinic Boni Fratres Lodziensis, ul. Hippiczna 36 m 2, 94–049 Lodz, Poland. E: odro@vp.pl Central serous chorioretinopathy (CSC) is a disease characterised by idiopathic serous neurosensory retinal detachment secondary to leakage from retinal pigment epithelium (RPE). 1 This disease was first recognised in 1866 by Albrecht von Graefe. 2 Due to the rapid development of modern imaging methods, better understanding of changes occurring in the retina in CSC is possible. Also, their influence on functional results in active CSC and after resolution of subretinal fluid in CSC can be presented. Stratus optical coherence tomography (OCT) (Carl Zeiss Meditec, Inc., Dublin, California, US) shows many changes appearing in retinal layers, especially in the photoreceptor layer in the area of the serous detachments in CSC. 3,4 However, the details of the retinal layers are unclear because of the 10 µm axial resolution limitation. Spectral-domain OCT (SD-OCT) instruments offer two main advantages compared with the previous traditional time-domain (TD) OCT: higher speed and improved resolution (~3–7  μm). Multiple B-scan averaging technology permits the production of detailed, speckle-noise-reduced images of all the retinal layers. SD-OCT’s superior resolution allows highly detailed in vivo evaluation of the individual retinal layers, especially the external limiting membrane (ELM), the inner and outer segments (IS/OS) of photoreceptors and changes in RPE. 5,6 Several papers describing OCT findings in eyes with CSC have been published. Various abnormalities were described. OCT presents foveal destoration, cystic and macular changes, RPE detachment (PED) and small bulges protruding from RPE. 4,7,8 Some of the authors thought that part of these abnormalities can be artefacts due to the limited axial resolution of the OCT. 98 Retinal Thickness Using TD-OCT, it was difficult to measure each retinal layer in acute phase of CSC, thus these studies provided total retinal thickness. Different thickening of the retina during the active phase of CSC has been presented by various authors. Some claim that the thickness of the retina in CSC is thinner than in healthy eyes. 9 In our patients [unpublished data], mean foveal retinal thickness during the acute phase of CSC was similar to that of healthy eyes, and the results were similar among other authors. 10,11 In patients with chronic CSC the thickness of the retina is slightly reduced in comparison with healthy eyes [unpublished data]. Some authors thought that part of these abnormalities can be artefacts, because of the limited axial resolution of the OCT. Sun et al. also stated that the height of the detached retina at the fovea was similar to that of RRD. 12 High-speed, high-resolution OCT has expanded our ability to study these diseases, especially microstructural changes during the active phase and after the resolution of CSC. Photoreceptors Changes Changes in photoreceptors and RPE layers are the most essential and important changes in described disease. Matsumoto et al. analysed morphological changes in the photoreceptor segment of the detached retina in CSC. 10 The authors showed that outer nuclear layer (ONL) thickness (the measurement between the internal limiting membrane [ILM] and the ELM) in the central fovea was approximately 75  µm in CSC, and was statistically significant shorter than the average thickness of 135 µm in healthy eyes. ONL thickness correlated weakly with age, best corrected visual acuity (BCVA) and the duration of symptoms. Matsumoto also presented the elongation of photoreceptor OS. The average thickness of the longest outer photoreceptor segment was © Touc h ME d ic a l ME d ia 2013