Evaluation of retinal and choroidal changes in pre- and post-adrenalectomy Cushing's syndrome patients using widefield SS-OCTA.

Abstract

To characterize the structural and vascular alterations of central and peripheral retina/choroid in eyes of individuals with Cushing's syndrome (CS) using widefield (24×20mm2) swept source optical coherence tomography angiography (SS-OCTA), and explore the relationship between systemic factors and ocular indicators. A total of 60 CS patients (120 eyes) due to unilateral adrenal adenoma and 60 comparable healthy controls (HC, 120 eyes) were enrolled. Ocular parameters assessed via SS-OCTA included choroidal thickness (ChT) and choroidal vascular index (CVI) as primary outcomes, while choroidal vessel/stromal volume per unit area (CVV/a, CSV/a), retinal thickness (RT), and retinal deep capillary plexus vessel density (DCPVD) were considered as secondary outcomes. SS-OCTA images were divided into 3 × 3 grid, with its grid center as central area and the rest as peripheral area. Cortisol levels were analyzed for correlations with choroidal parameters. Compared to HC, CS patients exhibited increased ChT, CVI, CVV/a, CSV/a, and DCPVD (P < 0.05). After adrenalectomy, decreased cortisol levels were accompanied with reduced ChT, CVI, CVV/a, and CSV/a (P < 0.05), while no change was found in DCPVD. After controlling confounding factors, both SFCT and mean peripheral ChT were significantly correlated with 24-hour urine-free cortisol and 8AM cortisol (P < 0.05). CS patients demonstrate abnormal choroidal thickness and volume. Further correlation analysis show choroidal thickness is positively related to endogenous cortisol levels, suggesting potential links between cortisol and ocular health.