The role of en face imaging of retinal pigment epithelium alterations in rapid classification of central serous chorioretinopathy using widefield SS-OCT

Purposes: To investigate the role of wide-field en face imaging of retinal pigment epithelium (RPE) alterations in rapid classification of central serous chorioretinopathy (CSCR) using swept-source optical coherence tomography (SS-OCT), in accordance with the latest novel classification system.
Methods: In this retrospective cross-sectional single-center study, eyes diagnosed CSCR were recruited. Volume scans (12-mm ×12-mm square field) were obtained while SS-OCT angiographic scans for all the participants. High-quality structure en face images were automatically generated at the level of Bruch membrane by the machine. Areas with signals different from a uniform background were further evaluated by cross-sectional SS-OCT to confirm whether there were RPE alterations. Some participants underwent fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), and indocyanine green angiography (ICGA).
Results: One hundred and twenty-two eyes with unilateral CSCR were included in the study, involving 122 patients (94 males and 28 females) with a mean age of 46.3 ± 9.1 years. In 51 out of 122 cases, FAF, FFA, ICGA, and en face SS-OCT were assessed simultaneously. Among these cases, 17 were categorized as complex CSCR. Notably, FAF exhibited the highest positive rate of RPE abnormality (94.1%,). En face SS-OCT imaging closely followed, with 15 out of 17 eyes (88.2%) showing positive findings, while ICGA detected RPE abnormality in 12 out of 17 eyes (70.6%). FFA had the lowest positive rate, with only 6 out of 17 eyes (35.3%). The RPE alteration in the remaining 71 eyes with CSCR was evaluated solely through en face SS-OCT imaging. Among these, 17 eyes were designated as complex CSCR, while 54 eyes were categorized as simple CSCR.
Conclusion: FAF stands out as the most sensitive method for detecting RPE alteration. En face SS-OCT imaging of RPE alterations offers a dependable, noninvasive, and expeditious method to support the rapid classification of CSCR according to the latest novel classification system, particularly when combined with contralateral eye imaging results.