Hyperreflective choroidal foci may predict pachychoroid macular atrophy development in central serous chorioretinopathy.

PURPOSE: To evaluate hyperreflective choroidal foci (HCF) in Sattler's and Haller's layers as predictive biomarkers for treatment response and pachychoroid macular atrophy (pMA) development in chronic central serous chorioretinopathy (CSC).

METHODS

Retrospective analysis of 70 treatment-naïve patients with recurrent CSC classified according to Chhablani's criteria. HCF were quantified separately in choroidal layers using spectral-domain OCT at baseline and 12-month follow-up. Patients received photodynamic therapy (n = 20), eplerenone (n = 16), or subthreshold micropulse laser (n = 34). Primary outcomes included treatment response (complete fluid resolution) and pMA development.

RESULTS

At baseline, no significant differences in HCF counts existed between future responders (n = 36) and non-responders (n = 34). At 12 months, responders showed significant HCF reduction in Sattler's layer (-9.17 foci, p = 0.001) and Haller's layer (-3.19 foci, p = 0.039), while non-responders demonstrated increased Sattler's foci (+4.62, p = 0.041). pMA developed in 15 patients (21.4%), more frequently in non-responders (32.4% vs 11.1%, p = 0.001). Baseline total HCF count was the strongest predictor of pMA development (β = 0.465, R² = 0.324, p < 0.001), with final HCF counts showing even stronger associations (β = 0.512, R² = 0.348, p < 0.001).

CONCLUSIONS

Layer-specific HCF quantification provides valuable prognostic information for treatment response and pMA risk in chronic CSC. These biomarkers may guide therapeutic decisions and identify patients requiring closer monitoring for atrophy development.