Session Title: Quick Fire Free Paper 2
Session Date/Time: Thursday 11/09/2014 | 11:00-12:30
Paper Time: 11:10
Venue: Boulevard D
First Author: : A.Mathai INDIA
Co Author(s): : M. Nicholson R. Reddy Pappuru
1. To study the abnormal fundus autofluorescence patterns seen in acute central serous chorioretinopathy. 2. To evaluate the diagnostic accuracy of fundus autofluorescence in localizing the area of RPE leak in comparison to fluorescein angiography. 3. To analyze the correlation of the duration of symptoms with the type of autofluorescence at the point of leak.
The study was performed in the retina clinics of a tertiary care eye institute in south India. It was a prospective, observational case series with institutional review board approval. The study included consecutive patients with a diagnosis of acute central serous chorioretinopathy, seen over a period of 14 months.
All consecutive patients with a diagnosis of acute central serous chorioretinopathy, duration of symptoms less than 4 months and single leak on fluorescein angiography were included in the study. Both fundus autofluorescence and fluorescein angiography were performed on the Heidelberg retina angiograph 2. Autofluorescence was excited at a wavelength of 488 nm and detected above 500nm. The area of leak on the fluorescein angiography was marked by an observer who was a retina specialist, using Adobe Photoshop CS3 Extended Version 10.0. The fluorescein angiography image was considered as the gold standard in this study. The area of RPE defect were marked on the fundus autofluorescence images by 2 independent masked observers (both retina specialists) with good prior agreement. The fundus autofluorescence image was then superimposed on the fluorescsein angiography image to see how well the two images corresponded. Fellow eyes of patients with unilateral central serous chorioretinopathy, with a normal fundus and no abnormalities on fluorescein angiography and autofluorescence imaging were used as controls. A further analysis of the correlation of the duration of symptoms with the type of autofluorescence at the leak was done using a Wilcoxon rank-sum test for non parametric data and Pearson chi square test.
Fifty eyes of 48 patients with acute central serous chorioretinopathy were included in the study. The age of the patients ranged from 25 to 59 years, with a mean of 37.6 ± 6.74 years. The study included 43 males and the median duration of symptoms was 27.5 days ( 1st and 3rd quartiles = 10, 45 days). The condition was unilateral in 46 patients and bilateral in 2 patients. Controls included 27 normal fellow eyes of 27 patients. Fundus autofluorescence corresponded accurately with the area of leak on fluorescein angiography in 27 eyes. Thus the sensitivity of fundus autofluorecence to detect the area of RPE leak was 54%. In the control eyes, autofluorescence abnormality was not detected in any eye, a specificity of 100%. The commonest abnormal autofluorescence noted at the area of RPE leak was hypoautofluorecence, seen in 48% of eyes. Mixed hypo and hyperautofluorescence (44%) was the commonest abnormality seen around the area of leak. Eyes with hypoautofluorescence at the point of RPE leak had a shorter duration of symptoms (median = 19 days, 1st and 3rd quartiles= 10, 30 days), while eyes with hyperautofluorescence had a longer duration of symptoms (median = 30 days, 10, 60 days).
Our study showed that fundus autofluorescence had a sensitivity of 54% in detecting the leak, while the specificity was 100%. With such low sensitivity, it is not possible to use fundus autofluorescence alone, as a diagnostic modality to detect the RPE leak in eyes with acute central serous chorioretinopathy. Hypoautofluorecnce was the commonest abnormal autofluorescence seen at the area of leak while mixed hypo and hyperautofluorescence was seen surrounding the area of leak.