Structure-Function Correlation in Patients With Central Serous Chorioretinopathy During Initial Disease Activity and After Ten Years

Purpose: To evaluate association of retinal morphological alteration with retinal sensitivity (RS) based on a point-to-point correlation with optical coherence tomography (OCT) and microperimetry in a 10-year follow-up of patients with central serous chorioretinopathy (CSC). Methods: Macular OCT and microperimetry of patients with an acute CSC episode were acquired prospectively at disease onset and 12 weeks after fluid resorption. Ten years later patients were invited for a cross-sectional follow-up visit including Spectralis-OCT and microperimetry. Multivariable models evaluated point-to-point correlation of RS2 and OCT parameters. Results: Thirty patients were included in the acute setting and 23 patients were included for the 10-year follow-up. In the acute setting, RS2 is associated with subretinal fluid (SRF; estimate = 37.01; P = 0.014), SRF height (estimate = -32.95; P < 0.001), irregularities in the ellipsoid zone (estimate = -35.28; P < 0.001), and interdigitation zone (estimate = -14.86; P < 0.001), patient age (estimate = -1.26; P = 0.03), and prior photodynamic therapy (estimate = -33.14; P = 0.001). Baseline parameters affecting RS2 after fluid resolution were SRF height (estimate = -11.93; P < 0.001), retinal pigment epithelium (RPE)/Bruch's membrane thickening (estimate = -55.34; P < 0.001), and prior photodynamic therapy (estimate = -118.05; P < 0.001). For the 10 -year follow-up RPE detachment (estimate = -89.02; P < 0.001), RPE atrophy (estimate = -377.14; P < 0.001), female sex (estimate = -81.50; P = 0.014), and prior photodynamic therapy (estimate = -162.18; P < 0.001) were associated with worse RS2. Conclusions: Long-term functional outcome in CSC is mainly determined by chronic structural damage, especially RPE atrophy and persistent RPE detachment. The association with prior photodynamic therapy reflects disease chronicity rather than treatment-related harm. Early recognition of high-risk morphological features may reduce irreversible functional loss.