Retinal and choroidal structural and microvascular alterations in chronic venous disease: a multimodal EDI-OCT and OCT angiography study

To evaluate retinal and choroidal structural and microvascular alterations in patients with chronic venous disease (CVD) and to investigate their relationship with clinical disease severity and lower-extremity venous Doppler parameters. This prospective cross-sectional study included 36 patients with CVD and 37 healthy controls. All participants underwent enhanced depth imaging optical coherence tomography (EDI-OCT) and optical coherence tomography angiography (OCTA). Subfoveal and peripapillary choroidal thicknesses, Haller and Sattler layer thicknesses, the Haller/SFCT ratio, and the choroidal vascularity index (CVI) were evaluated. OCTA parameters included superficial and deep capillary plexus vessel density (SCP and DCP), choriocapillaris flow deficit (CC-FD), and foveal avascular zone (FAZ) area. Between-group differences were evaluated using multivariable linear regression models adjusted for age, sex, and axial length. Associations between ocular imaging biomarkers and clinical or Doppler parameters were assessed using multivariable regression analyses. Compared with controls, patients with CVD exhibited significantly higher CVI, greater Haller layer thickness and Haller/SFCT ratio, and thinner Sattler layer (all q < 0.01). Only inferior peripapillary choroidal thickness was significantly greater in the CVD group, whereas total subfoveal choroidal thickness did not differ between groups. OCTA demonstrated significantly lower superficial and deep capillary plexus vessel density in patients with CVD, while FAZ area and choriocapillaris flow deficit were comparable between groups. Within the CVD group, higher CEAP clinical class was independently associated with lower subfoveal choroidal thickness but not with CVI. None of the lower-extremity Doppler parameters showed an independent association with CVI or subfoveal choroidal thickness after correction for multiple comparisons. Patients with chronic venous disease exhibit characteristic choroidal vascular remodeling accompanied by early retinal microvascular impairment. Increased CVI, preferential enlargement of Haller’s layer, thinning of Sattler’s layer, and reduced retinal capillary vessel density suggest that multimodal OCT imaging may detect ocular involvement before measurable changes in overall choroidal thickness become apparent.