PMC8455221_01
(a, e) Fundus autofluorescence (FAF), (b, f) fluorescein angiography (FA), (c, d, g, h) indocyanine green angiography (ICGA), and (i, j) enhanced depth imaging optical coherence tomography (EDI-OCT) of the first case. Retinal hyperreflective bands in different layers of the retina, serous retinal detachment (SRD) at the macula, and increased choroidal thickness on EDI-OCT can be observed. FAF and FA were nearly normal, and the ICGA showed a single hot spot at the center of the fovea. This spot appeared from the early phase and lasted until the late phase with multiple late hypercyanescence dots scattered at the macular area and outside of arcades, especially at superotemporal, and hyperpermeability of large choroidal vessels.
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fig1
The EDI-OCT (Spectralis OCT manufactured in Heidelberg Engineering, Heidelberg, Germany) revealed retinal hyperreflective bands in different layers of the retina, serous retinal detachment at the macula, and increased choroidal thickness (Figure 1).
(a, b) Fundus autofluorescence and (c, d) enhanced depth imaging optical coherence tomography of the first case following three months of treatment with Eplerenone showing completely resolved SRD. The choroid seems to be still thickened.
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After 3 months, CSC responded very well to Eplerenone 25 mg every 12 hours a day and SRF was resolved completely (Figure 2).
PMC8455221_02
Enhanced Depth Imaging Optical Coherence Tomography of the (a, c, e) right and the (b, d, f) left eyes of the second case. Hyperreflective bands of the (c, d, arrows) outer plexiform layer, pachychoroid with dilated choroidal vessels and pachyvessels, and (d, f, asterisks) retinal pigment epithelium changes like pachychoroid pigment epitheliopathy can be seen in both eyes.
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Moreover, there was retinal pigment epithelial changes resembling pachychoroid pigment epitheliopathy and hyperreflective bands in the outer plexiform layer (Figure 3).
(a, e) Fundus autofluorescence, (b, c, f, g) indocyanine green angiography (ICGA), and (d, h) fluorescein angiography (FA) of the (a-d) right and the (e-h) left eye of the second case. The fundus autofluorescence demonstrated hyperautofluorescence foci corresponding to the leakage areas. The FA disclosed hyperfluorescent dots and leakage in both eyes. In the right eye, a hyperfluorescent focus superior to the disc was found on FA and fundus autofluorescence. The ICGA revealed dilation and hyperpermeability of choroidal vessels in the mid- and late phases, multiple small hypercyanescence dots out of the macular area in both eyes, and a hot spot corresponding to an inferotemporal SRD in the left eye.
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Moreover, there was a hot spot in the left eye which corresponded to the inferotemporal serous retinal detachment (Figure 4).
(a, b) Fundus autofluorescence and (c-f) enhanced depth imaging optical coherence tomography of the second case after two months of treatment disclosing completely resolved subretinal fluid in different parts of the macula, which were affected before. Choroidal thickening and dilation of choroidal vessels are still visible.
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After 5 months, CSC responded to Eplerenone 25 mg every 12 hours and SRF was resolved (Figure 5).
PMC8455221_03
The indocyanine green angiography of the third case disclosed dilation and hyperpermeability of choroidal vessels in the early phase associated with multifocal hypercyanescence (hot spots) and diffuse leakage at the posterior pole in the late phase in the (a, b) right and the (e, f) left eyes. Enhanced depth imaging optical coherence tomography revealed (c, d) pachyvessels in the choroid and SRF in the macula of the right eye and (g, h) pigment epithelial detachment (PED) in the left eye.
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Moreover, bilateral hypercyanescence as hot spots was obvious bilaterally (Figure 6).
Optical coherence tomography of the (a, c) right eye and (b, d) left eye of the third patient one month after photodynamic therapy, even in the (a, b) horizontal or (c, d) vertical, shows complete fluid resorption and also outer retinal atrophy.
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Two months later, SRF and PED were completely resolved with small defect in the outer retinal layers and BCVA was improved to 20/20 in the right eye (Figure 7).
PMC8455221_04
Fundus autofluorescence (FAF) and enhanced depth imaging optical coherence tomography of the fourth case. (a, c, e, g) The right eye images. (b, d, f, h) The left eye images. FAF of (a, b) both eyes disclosed no abnormality. In infrared reflectance taken with (c-h) OCT, bilateral hyperreflective dots were visible in both eyes. (c-h) Enhanced depth imaging optical coherence tomography depicted bilateral pachychoroid and pachyvessels accompanied by bilateral small, shallow, and multifocal retinal pigment epithelial (RPE) detachments and changes over the pachyvessels, hyperreflectivity of outer retinal layers, and multiple hyperreflective tiny dots scattered at the inner retinal layers in both eyes.
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In infrared reflectance, bilateral hyperreflective dots were visible (Figure 8).