Choriocapillaris Island: an optical coherence tomography angiography finding observed in central serous chorioretinopathy

PurposeTo report the observation of the choriocapillaris island (CCI) on optical coherence tomography angiography (OCTA) in eyes with active central serous chorioretinopathy (CSCR), and to investigate its associated clinical features.DesignRetrospective observational study.MethodsPatients diagnosed with active CSCR underwent OCTA imaging (Optovue Inc, Fremont, California, USA), and the software built-in en face choriocapillaris slab was examined to demonstrate CCI, defined as an area of detectable choriocapillaris flow surrounded by an area of undetectable or diminished flow. Electronic medical records (EMR) were reviewed for demographics, clinical data, other imaging modalities and any intervention, and these parameters were correlated with CCI findings.Results25 eyes of 25 patients were recruited. CCI was detected in all examined eyes and was best elucidated on the en face choriocapillaris density maps. 24 eyes had focal retinal pigment epithelium (RPE) alterations overlying CCI. All 14 eyes with simultaneous fundus fluorescein angiography (FA) showed actively leaking point(s) well corresponding to the CCI location. Resolution of sub-retinal fluid in 4 eyes was associated with disappearance of CCI on follow-up OCTA scans. 1 eye showed complicating neovascularization 5 months after the initial presentation at the same location of the CCI.ConclusionWe demonstrate the observation of the choriocapillaris island an OCTA finding in eyes with active CSCR underneath the area of neurosensory detachment. CCI may constitute an angiographic representation of the focal area of choriocapillaris structural and functional affection, with secondary RPE alteration jeopardizing its barrier function. Larger longitudinal studies are needed to further elucidate this finding.

Automated summary

This study reports the observation of choriocapillaris island (CCI) on optical coherence tomography angiography (OCTA) in eyes with active central serous chorioretinopathy (CSCR), suggesting that CCI may represent the focal area of choriocapillaris structural and functional affection, with secondary retinal pigment epithelium alterations compromising its barrier function. Larger longitudinal studies are required to further clarify this finding.