The role of en face imaging of retinal pigment epithelium alterations in rapid classification of central serous chorioretinopathy using widefield swept-source optical coherence tomography

Purposes: To investigate the role of widefield en face imaging of retinal pigment epithelium (RPE) alterations using swept-source optical coherence tomography (SS-OCT) for rapid classification of central serous chorioretinopathy (CSCR). Methods: In this cross-sectional, single-center study, eyes diagnosed with unilateral CSCR were included. Volume SS-OCT scans (12-mm ×12-mm) were obtained for all the participants. High-quality structural en face images were automatically generated at the level of Bruch’s membrane based on artificial intelligence to evaluate the RPE alterations. Results: The study included 122 affected eyes from patients with unilateral CSCR, with a mean age of 46.3 ± 9.1 years. In 51 out of the 122 cases, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and en face imaging were assessed simultaneously. Among these, 17 eyes were categorized as complex CSCR. FAF exhibited the highest detection rate of RPE abnormalities (94.1%). En face imaging revealed RPE abnormalities in 15 out of 17 eyes (88.2%), while ICGA detected RPE abnormalities in 12 out of 17 eyes (70.6%). Only 6 out of 17 eyes (35.3%) showed RPE abnormalities in FFA. The RPE alterations in the remaining 71 eyes with CSCR were evaluated solely using en face imaging, wherein 17 eyes were designated as complex CSCR and 54 eyes were categorized as simple CSCR. Conclusion: Evaluation of RPE alterations using widefield en face imaging has potential as a reliable, noninvasive approach to rapid classification of CSCR using the latest classification system, particularly when combined with contralateral eye imaging results.