C Nathaniel Roybal, Elisabeth Sledz, Yasser Elshatory, Li Zhang, David R P Almeida, Eric K Chin, Brice Critser, Michael D Abramoff, Stephen R Russell

To study the effect of changing perfusion pressures on retinal and choroidal structure in central serous chorioretinopathy (CSC). This prospective observational case series included seven healthy volunteers (14 eyes) and seven patients (14 eyes) with CSC. Each patient underwent spectral domain optical coherence tomography with enhanced depth imaging in the upright (sitting) and supine positions. Image segmentation focused on central macular thickness, subretinal fluid, total macular volume, choroidal thickness, and choriocapillaris thickness. Blood pressure and heart rate were measured in the upright and supine positions. Choriocapillaris thickness was thicker in CSC participants (34.23 μm; range, 30.9-36.5 μm) compared with healthy controls (13.96 μm; range, 7.15-23.87 μm) (P ≤ 0.001). The choroid was similarly thicker in CSC participants (371.4 μm; range, 200.2-459.4 μm) compared with healthy controls (231.4 μm; range 161.8-287.5 μm) (P ≤ 0.001). Choroidal thickness increased in patients with CSC when transitioning from upright (371.4 μm) to supine (377.8 μm) (P ≤ 0.01). By contrast, there was an 11.97% decrease in choroid thickness in normal controls when transitioning from upright (231.4 μm) to supine (203.9 μm). There were no significant hemodynamic changes. We demonstrated that choroidal thickness increased in response to increased perfusion pressures in patients with CSC and not in normal controls. These findings likely represent an autonomic dysregulation of choroidal blood flow in patients with CSC.