Work

Multimodal imaging biomarkers of subretinal hyperreflective material accumulation in central serous chorioretinopathy

Year: 2025

Type: article

Abstract: • The pathogenesis and composition of subretinal hyperreflective material (SHRM) in central serous chorioretinopathy (CSC) remain unclear, though limited evidence suggests its choroidal vascular origin. • Our findings suggest that SHRM formation is strongly associated with choroidal vascular changes and RPE disruption, pointing to some of the potential pathophysiological mechanisms. • We propose SHRM can be a vital marker for assessing the severity of choroidal alteration in CSC eyes, especially when ICGA are unavailable. To identify multimodal imaging (MMI) biomarkers associated with subretinal hyperreflective material (SHRM) in central serous chorioretinopathy (CSC). This retrospective study enrolled eyes with primary and recurrent CSC with symptoms lasting less than 3 months. Eyes were categorized into two groups based on the presence or absence of SHRM, with SHRM-positive eyes further subdivided into three grades. A comprehensive analysis was performed using optical coherence tomography (OCT), fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), and indocyanine green angiography (ICGA). 259 eyes from 231 patients (216 males) were included. Eyes with SHRM showed higher choroidal vessel index (CVI) at the leakage site compared to those without, with P < 0.05 when leakage was located in the foveal, parafoveal, perifoveal, and peripapillary regions. Differences were also discovered in serous retinal detachment (SRD) dimensions, presence of pigment epithelial detachment (PED) and retinal pigment epithelium (RPE) defects in OCT, gravitational tracks and hyperautofluorescence contours in FAF, leakage patterns and dye pooling area in FFA, and focal choroidal vascular hyperpermeability (CVH) area in ICGA ( P < 0.05 for all). Furthermore, CVI at the leakage site, RPE defects presence and dye pooling area were identified as independent factors associated with SHRM presence, with odds ratios (OR) of 1.539 ( P < 0.001), 2.766 ( P = 0.023), and 1.062 ( P = 0.006), respectively. The presence of SHRM was associated with choroidal and RPE alterations, suggesting that changes in hydrostatic pressure and RPE function might be involved in SHRM formation in CSC. Relationship between choroidal alterations and subretinal hyperreflective material formation. (A) Normal structures. (B) Mild choroidal pathology causing minimal retinal pigment epithelium disruption with subtle fluid and minimal hyperreflective material. (C) Severe choroidal pathology leading to significant retinal pigment epithelium ruptures, substantial fluid accumulation, and extensive hyperreflective material deposition. Red arrow indicates disease progression.

Source: Photodiagnosis and Photodynamic Therapy

DOI: 10.1016/j.pdpdt.2025.104595