Evaluation of Choroidal Vein Distribution Pattern and Choroidal Vessel Parameters in Patients With Central Serous Chorioretinopathy Using Widefield ICGA and Widefield OCTA.

Abstract

To evaluate the choroidal vein distribution pattern in eyes with central serous chorioretinopathy (CSC) using widefield indocyanine green angiography (WF-ICGA) and widefield optical coherence tomography angiography (WF-OCTA). Retrospective, comparative validity and reliability analysis. Patients diagnosed with CSC between September 2022 and September 2024. WF-ICGA and WF-OCTA were performed to obtain widefield imaging. Choroidal venous drainage paths were classified as symmetry or asymmetry based on the presence of a dominant vein. In asymmetrically distributed eyes, the number and location of dominant vortex veins were recorded. Additionally, choroidal parameters were quantitatively assessed and compared among eyes with different choroidal vein distribution patterns. 105 subjects were included in this study, with a mean age of 46.32 years, of whom 86 were male. In the 151 affected eyes, WF-ICGA and WF-OCTA detected similar rates of asymmetric distribution (76.82% vs. 78.14%, P = .783). The number and location of dominant vortex veins also showed no significant differences (P > .05 for all). WF-ICGA and WF-OCTA recognized the highest proportion of cases with 1 dominant vortex vein (43.71% and 49.01%, respectively), followed by cases with 2 dominant veins (33.11% and 29.14%, respectively), and finally, those with symmetric venous distribution (23.18% and 21.85%, respectively). The WF-OCTA results displayed strong agreement with WF-ICGA results (κ = 0.838, P < .001). Among the 21 cases (13.91%) with inconsistent results, the discrepancy was attributed to the limited nasal field of view in WF-OCTA (7 eyes), misidentification of choroidal venous anastomoses as dominant vortex veins (10 eyes), and poor vessel visualization on WF-OCTA (4 eyes). Compared to eyes with symmetric venous distribution and those with 2 dominant veins, cases with 1 dominant vortex vein exhibited worse visual acuity and lower choriocapillaris flow density (P = .009 and P = .008, respectively). WF-OCTA offers results comparable to WF-ICGA for assessing choroidal vein distribution patterns, establishing it as a reliable alternative for evaluating CSC choroidal vasculature.