Retinal microcirculatory and choroidal structural characteristics of retinal vein occlusion-related macular edema with serous retinal detachment.

OBJECTIVE

To characterize retinal microcirculation and choroidal structure in treatment-naive retinal vein occlusion-related macular edema (RVO-ME) eyes with/without serous retinal detachment (SRD) using ultra-widefield swept-source OCT angiography (UWF-SS-OCTA).

METHODS

This retrospective single-center study included 69 treatment-naive RVO-ME eyes (35 CRVO and 34 BRVO) classified by OCT-defined SRD. Between-group comparisons included CMT, FAZ metrics, sectoral VFD of the SCP, MCP, and DCP, SFCT, and three-dimensional choroidal metrics (CVV, CSV, CVI, and CSI). The location and extent of the occluded retinal region were also analyzed in BRVO eyes.

RESULTS

Thirty-five CRVO and 34 BRVO eyes were included. In both subtypes, SRD eyes had shorter disease duration, greater CMT (CRVO: 795.19 ± 240.83 vs. 397.84 ± 136.56 μm; BRVO: 633.53 ± 214.39 vs. 366.47 ± 86.20 μm), and lower FAZ circularity index (CRVO: 0.64 ± 0.23 vs. 0.84 ± 0.06; BRVO: 0.80 ± 0.07 vs. 0.86 ± 0.08) than non-SRD eyes (all P < 0.05). CRVO-SRD eyes had worse BCVA and a higher proportion of ischemic eyes (13/16 vs. 6/19) than non-SRD eyes (both P < 0.05). In BRVO, occlusion location was similar between groups (superotemporal branch most common), but SRD eyes had more extensive retinal involvement (P < 0.05). BRVO-SRD eyes showed reduced retinal vascular flow density in most macular sectors. In CRVO-SRD eyes, middle capillary plexus flow density was consistently reduced across all sectors. BRVO-SRD eyes showed greater SFCT, CSV, and CVV, whereas CRVO-SRD eyes showed higher foveal CSI and lower CVI in selected sectors.

CONCLUSIONS

In treatment-naive RVO-ME eyes evaluated by UWF-SS-OCTA, SRD was associated with greater macular thickening, more irregular FAZ morphology, and more pronounced retinal microcirculatory impairment, with MCP-VFD reduction as the most consistent feature. Choroidal volume expansion in BRVO and compositional remodeling in CRVO suggest subtype-specific choroidal involvement; together, these findings support the potential value of layer-specific retinal perfusion metrics and three-dimensional choroidal parameters for imaging-based stratification.