Spatial Choroidal Analysis under Mid-Phase Hyperfluorescent Plaques Demonstrates Unique Signatures in Central Serous Chorioretinopathy: Macula Society International Central Serous Chorioretinopathy Research Network Report Number 20.

PURPOSE: To evaluate the spatial relationship between mid-phase hyperfluorescent plaques (MPHP) and choroidal vascularity in central serous chorioretinopathy (CSCR) using choroidal vascularity index (CVI) heat maps and enrichment ratio (ER) analysis.

DESIGN

Retrospective multicenter study.

SUBJECTS: Forty eyes from 40 patients with CSCR presenting MPHP on indocyanine green angiography (ICGA) at both baseline and follow-up were included.

METHODS

Choroidal vascularity index was calculated from spectral-domain OCT scans using an automated algorithm generating en face CVI heat maps. Mid-phase hyperfluorescent plaques areas were manually segmented after overlaying with ICGA images. Spatial association between MPHP and high-CVI regions was assessed using ER analysis at absolute CVI thresholds of 0.75 and 0.90. Eyes were further stratified according to MPHP area dynamics (increased vs. decreased) at follow-up.

MAIN OUTCOME MEASURES: Mean CVI inside versus outside the MPHP area; ER values at CVI thresholds of 0.75 and 0.90; intralesional CVI distribution; ER values by MPHP area dynamics subgroup.

RESULTS

Mean CVI was significantly higher within the MPHP area (0.72 ± 0.09) compared with the surrounding choroid (0.70 ± 0.09; paired Wilcoxon P < 0.01; mean difference, 0.022; 95% confidence interval, 0.010-0.033; Cohen d = 0.57). Enrichment ratio analysis demonstrated preferential localization of MPHP within high-CVI regions at the CVI threshold of 0.90 (ER > 0.90 = 1.67). Qualitative assessment revealed nonuniform intralesional CVI distribution in 70% of eyes. In subgroup analysis, eyes with increasing MPHP area showed a directional trend toward greater enrichment within regions of highest CVI values (ER > 0.90: median 1.43 vs. 0.84; t test P = 0.04, Mann‑Whitney P = 0.260), an exploratory finding.

CONCLUSIONS

Mid-phase hyperfluorescent plaques in CSCR are spatially associated with regions of increased choroidal vascularity, supporting a spatially driven model of disease. These hypothesis-generating findings highlight the potential value of CVI-based spatial mapping for improving disease characterization and, pending prospective validation, therapeutic targeting.

FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.