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

TL;DR

Hyperreflective choroidal foci in the eye may predict treatment response and risk of macular atrophy in chronic central serous chorioretinopathy.

Contribution

Layer-specific quantification of HCF provides new prognostic biomarkers for chronic CSC.

Findings

Responders showed significant reduction in HCF in both Sattler’s and Haller’s layers at 12 months.

Non-responders had increased HCF in Sattler’s layer and higher pMA development rates.

Baseline and final HCF counts strongly predict pMA development.

Abstract

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).

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.

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).

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.

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