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Diabetic Retinopathy and Medical Retina Free Papers DIABETIC RETINOPATHY AND MEDICAL RETINA Chairman: Dr. Tewari H.K.; Co-Chairman: Dr. Mary Varghese Convenor: Dr. Muralidhar N.S.; Moderator: Dr. Rajamohan M. Combined SD OCT, FA and ICGA Features of Idiopathic Central Serous Chorioretinopathy (ICSC) Dr. Navneet Mehrotra, Dr. Manish Nagpal, Dr. Gaurav Paranjpe, Dr. Jainendra Shivdas Rahud Central serous chorioretinopathy is a sporadic self – limited disease of unknown cause that affects predominantly men, usually during the fourth and fifth decade of the life. It is characterized by a blister like neurosensory and retinal pigment epithelial detachment in the posterior pole of the eye – usually involving the macular retina. 1 CSC symptomatically manifests in one eye and is bilateral at initial presentation in 5% to 18% of cases. 2-5 Although there is documentation of findings suggestive of CSC by fluorescein angiography (FA) and by indocyanine green angiography (ICGA) in the fellow asymptomatic eyes in several reports, only a few studies have primarily analysed these findings. 6-18 Nadelet al 19 after analysis of 69 cases observed pathology (clinical and/or fluorescein angiography) in 50% of the fellow asymptomatic eyes. Although the recovery of visual acuity is upto the normal level, the quality of vision is not the same as before. The patient may noticemetamorphopsia, decrease in contrast sensitivity and alteration in the color vision in the affected eye for several months (Gas et. al. 1967). Eyes with acute central serous chorioretinopathy (CSC) have focal leakage at the level of the retinal pigment epithelium (RPE) seen on fluorescein angiography (FA). Indocyanine green angiography in eyes with CSC shows multiple areas of inner choroidal staining. 17 OCT reveals many anatomical aspects of CSC ranging from subsensory fluid, pigment epithelial detachment (PED) and retinal atrophy in cases of chronic CSC. With Fourier domain OCT (FD-OCT) dense scans could be passed through the site of leakage which depicts the various pathologic features like PED and pigment layer irregularities. We did simultaneous fluorescein angiography, indocyanine green angiography and OCT to get additional information about the morphologic changes at the site of leakage and changes in the fellow eyes in these cases. MATERIALS AND METHODS We prospectively studied 96 eyes of 48 patients with acute CSC with Heidelberg retinal angiograph (HRA) (Heidelberg Engineering Inc., Heidelberg, Germany) 855
70th AIOC Proceedings, Cochin 2012 between September 2010 and July 2011 at Retina Foundation, Ahmedabad. This study was approved by the institutional review board, and informed consent was obtained from all patients. A diagnosis of acute CSC was made based on the presence of a serous detachment of the neurosensory retina, focal dye leakage on FA, and the duration of recent subjective symptoms within 3 months. Polypoidalchoroidal vasculopathy, which is sometimes difficult to differentiate from CSC by FA, was excluded by the absence of polypoidalchoroidal vascular lesions on indocyanine green angiography. Eyes with other macular abnormalities and neovascularlesions were excluded. A fundus examination, measurement of the best-corrected visual acuity (BCVA), and SD OCT imaging were performed atevery visit. Simultaneous fluorescein and indocyanine green angiography were performed using HRA. A fundus examination and measurement of the best-corrected visual acuity (BCVA) were performed at every visit. Simultaneous fluorescein angiography, indocyanine green angiography, autofluorescence and OCT were done in the first visit. OCT passing through the areas of leakage was taken as a reference and repeated later in each visit. Detailed horizontal OCT scans with 49 sections, 30 microns apart were passed through the site of leakage. An area of 15 deg x 5 deg on the retina was scanned. For simultaneous confocal scanning laser angiography, we inject 1.5 ml of the solution prepared from mixing 3 ml of 20% fluorescein to indocyanine green powder (25 mg). The mixture was injected as a bolus into the vein. After we recorded preinjection images,simultaneous angiograms were obtained during the early, mid and late phases. RESULTS Patient characteristics 96 eyes of 48 patients of ICSC underwent imaging using spectralis of which included 43 males and 5 females. The mean age of the 48 patients was 40.8 years (range - 25 - 63). The duration of symptoms ranged from 2 days to 6 months. Three eyes had recurrent disease, and 8 patients had CSC in the fellow eye. The mean BCVA at baseline was 0.3(on log mar scale). Forty two eyes (75%) showed ink blot pattern of leakage, six eyes (10.7%) showed smokestack pattern and eight eyes (14.3%) showed no definite leak in angiogram. 34 eyes had one leakage point, seven eyes had two leakage points and three eyes had more than two leakage points. The indocyanine green angiography showed increased hyperfluorescence of the choroidal vein around the leakage site in all eyes. Mean number of examinations in the follow up period were 3.6 (range: 2-7). Laser photocoagulation was done in 30 patients. 856
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