PMC5733975_01
(a) The colored photo and FFA of the right eye of a 52-year-old male during acute CSCR. The macular area shows neurosensory detachment, measuring approximately 3 DD. Corresponding FFA shows a typical smoke-stack leaking pattern. (b) The colored photo and FFA of the same eye 2 years later. The posterior pole shows minimal retinal pigment disturbance in the inferior portion of the macular area along with subretinal deposits. On FFA, the old site of acute leakage demonstrates early pinpoint hyperfluorescence with increasing intensity through late frames suggestive of chronic point of leakage (open arrow). The area of pigment epitheliopathy seen in the colored photo shows hyperfluorescence due to window defect. (c) The corresponding SS-OCT image in a radial scan mode shows shallow PED with surface undulations and hyperreflective sub-RPE deposits (open arrow). There is associated disruption of ELM and IS/OS layers in the vicinity of the PED. Note the generalized dilatation of the choroidal vessels that is most marked in the area beneath the PED (star). Subfoveal choroidal thickness is 737 mu. (d) The en face SS-OCTA image of the same eye taken at the level of the outer retina in a 6 mm x 6 mm field. Note the hyperintense signal caused by increased blood flow within the vascular network of tiny interlacing capillaries (white arrow heads). The neovascular complex is surrounded by a hypointense hollow zone intervening between the lesion and the surrounding normal outer retina that generates a hypointense signal due to the absence of blood flow and is displayed as a dark-grey background. (e) The en face SS-OCTA image of the same lesion at the level of the choriocapillaris (black arrow heads).
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fig1
SS-OCTA of the same eye clearly demonstrated the decorrelation signal characteristic of blood flow within an abnormal vascular network of active CNV (Figure 1). SS-OCTA of the left eye was normal.
PMC5733975_02
(a) The colored photo and FFA of the left eye of a 46-year-old male with bilateral chronic CSCR of approximately 1.5-year duration. The posterior pole shows diffuse retinal pigment epitheliopathy in the macular area measuring approximately 5 disc diameters (DD) in size along with shallow subretinal fluid and peripapillary PED. FFA shows a large hyperfluorescent area caused by window defect that corresponds to the area of retinal pigment epitheliopathy seen in the colored photo. In addition, the macular area shows multiple hyperfluorescent leaking points that gradually increase in intensity throughout later phases with a typical inkblot pattern of leakage (arrows). (b) SS-OCT image. A 12.0 mm radial scan is selected to include the peripapillary area. The scan shows subfoveal neurosensory detachment extending to the peripapillary area, which is associated with subretinal deposits. A single large regular smooth PED is seen in the peripapillary area. A subfoveal shallow PED with an undulating thickened surface and sub-RPE hyperreflective amorphous deposits is shown (open arrow). The subfoveal choroidal vessels are engorged (black stars). Subfoveal choroid thickness is 455 mu. (c) The en face SS-OCTA image of the same eye taken at the level of the outer retina in a 4.5 mm x 4.5 mm field. Note the hyperintense signal caused by increased blood flow within the CNV complex. The complex is composed of a network of tiny arborizing capillaries with frequent anastomosis and looping in the periphery of the lesion (white arrow heads). (d) The corresponding color-coded density map reflecting blood flow at the level of the outer retina. Note the entire background has variable shades of blue typical of avascular outer retina. The CNV complex stands out with its bright red signal indicating dense blood flow. (e) The en face SS-OCTA image of the same lesion at the level of the choriocapillaris (black arrow heads). (f) The en face SS-OCTA image after manual adjustment of the segmentation slab to a deeper position into the choroid to demonstrate two abnormally dilated choroidal vessels corresponding to increased subfoveal choroidal thickness on SS-OCT (black stars).
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fig2
SS-OCTA of the left eye revealed the characteristic hyperintense signal of blood flow within the interlacing capillary network with looping and vascular anastomosis that was indicative of active CNV (Figure 2). SS-OCTA of the right eye was normal.
PMC5733975_03
(a) The colored photo and FFA of the left eye of a 40-year-old male with left chronic CSCR of approximately 1-year duration. The posterior pole shows retinal pigment epitheliopathy in the macular area. FFA of the same eye shows multiple hyperfluorescent leaking points in the macular area that gradually increase in intensity throughout later phases resulting in a diffuse ill-defined hyperfluorescence pattern. (b) The corresponding SS-OCT image in a radial scan mode shows subfoveal shallow neurosensory detachment with subretinal deposits and associated disruption of ELM and IS/OS layers. Note the double-humped irregular PED in the parafoveal area with underlying opaque hyperreflective material (open arrow). The choroid vessels underneath the PED are engorged (star). Subfoveal choroidal thickness is 315 mu. (c) The en face SS-OCTA image of the same eye taken at the level of the outer retina in a 6 mm x 6 mm field. Note the hyperintense signal caused by increased blood flow within the CNV complex composed of tiny intertwining vascular loops (arrow head). (d) The en face SS-OCTA image of the same lesion at the level of the choriocapillaris.
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fig3
SS-OCT were inconclusive for CNV formation. SS-OCTA of the same eye showed the characteristic hyperintense signal of blood flow within the abnormal tiny capillary network that was indicative of active CNV formation (Figure 3).
PMC5733975_04
(a) The colored photo and FFA of the left eye of a 35-year-old male with chronic CSCR of approximately 2-year duration. The macular area shows shallow neurosensory detachment. Corresponding FFA shows hyperfluorescent leaking points (arrows). (b) The radial scan SS-OCT image of the same eye demonstrates subfoveal neurosensory detachment with subretinal hyperreflective deposits. A subfoveal flat irregular PED associated with sub-RPE hyperreflective material is seen (open arrow). Subfoveal choroidal thickness is 400 mu. Note the engorged choroidal vessels beneath the PED (star). (c) The en face SS-OCTA image of the same eye at the level of the outer retina in a 4.5 mm x 4.5 mm field. Note the characteristic hyperintense signal of vascular flow within tiny interlacing capillaries in the foveal area (arrow head).
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fig4
SS-OCTA of the same eye revealed the characteristic hyperintense signal of blood flow within the tiny interlacing capillary network that was indicative of active CNV (Figure 4).
PMC5733975_05
(a) The colored photo and FFA of the right eye of a 61-year-old male with bilateral chronic CSCR of approximately 2.5-year duration. The posterior pole shows a subretinal yellowish-white elevated lesion in the macular area measuring approximately 2 DD. The lesion is surrounded by extensive subretinal hemorrhage that extends beyond the temporal vascular arcades. On FFA, there were two distinct patterns of hyperfluorescence. The first pattern corresponded to the yellowish-white lesion seen in the colored photo and consisted of early hyperfluorescence that gradually increased in intensity due to pooling into PED. The second pattern consisted of early stippled hyperfluorescence that increased in intensity throughout the angiogram resulting in an ill-defined hyperfluorescent area (open arrows). Note the blocked fluorescence corresponding to subretinal hemorrhage in the colored photo. (b) The composite FFA of the right eye shows extensive retinal pigment epitheliopathy in the macular area, extending inferiorly due to gravitation of subretinal fluid giving rise to the characteristic teardrop sign (atrophic RPE track). (c) The colored photo and FFA of the left eye showing diffuse retinal pigment epitheliopathy and the characteristic teardrop sign. (d) The radial scan SS-OCT of the right eye demonstrates neurosensory detachment along with subretinal hyperreflective heterogeneous material, sizeable subfoveal PED, and sub-RPE hyperreflective material. (e) The SS-OCTA of the right eye at the level of the outer retina in a 4.5 mm x 4.5 mm field revealed the characteristic hyperintense signal of a subfoveal neovascular complex composed of a main trunk with branching smaller vessels each terminating in polyp-like configuration reminiscent of PCV (arrow heads). In addition, there was another juxtapapillary larger neovascular complex composed of dense capillary arborization. At least two feeder vessels could be identified (open arrows). (f) The corresponding color-coded density map reflecting blood flow at the level of the outer retina. Note the intense red signal denoting high flow within the neovascular complexes seen, contrasting with the blue background typical of avascular outer retina.
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fig5
In addition, there was another juxtapapillary larger neovascular complex composed of dense capillary arborization and feeder vessels (Figure 5).