Venous overload choroidopathy: A hypothetical framework for central serous chorioretinopathy and allied disorders

Progress in Retinal and Eye Research, vol. 86, pp. 100973

Abstract

In central serous chorioretinopathy (CSC), the macula is detached because of fluid leakage at the level of the retinal pigment epithelium. The fluid appears to originate from choroidal vascular hyperpermeability, but the etiology for the fluid is controversial. The choroidal vascular findings as elucidated by recent optical coherence tomography (OCT) and wide-field indocyanine green (ICG) angiographic evaluation show eyes with CSC have many of the same venous patterns that are found in eyes following occlusion of the vortex veins or carotid cavernous sinus fistulas (CCSF). The eyes show delayed choroidal filling, dilated veins, intervortex venous anastomoses, and choroidal vascular hyperpermeability. While patients with occlusion of the vortex veins or CCSF have extraocular abnormalities accounting for the venous outflow problems, eyes with CSC appear to have venous outflow abnormalities as an intrinsic phenomenon. Control of venous outflow from the eye involves a Starling resistor effect, which appears to be abnormal in CSC. Similar choroidal vascular abnormalities have been found in peripapillary pachychoroid syndrome. However, peripapillary pachychoroid syndrome has intervortex venous anastomoses located in the peripapillary region while in CSC these are seen to be located in the macular region. Spaceflight associated neuro-ocular syndrome appears to share many of the pathophysiologic problems of abnormal venous outflow from the choroid along with a host of associated abnormalities. These diseases vary according to their underlying etiologies but are linked by the venous decompensation in the choroid that leads to significant vision loss. Choroidal venous overload provides a unifying concept and theory for an improved understanding of the pathophysiology and classification of a group of diseases to a greater extent than previous proposals.

Authors 14

1. Richard F. Spaide corresponding

   Vitreous Retina Macula Consultants of New York

   Affiliation as printed

   Vitreous, Retina, Macula Consultants of New York, New York, NY, USA. Electronic address: rickspaide@gmail.com

   Vitreous, Retina, Macula Consultants of New York, New York, NY, USA

2. Chui Ming Gemmy Cheung

   SingHealth · Singapore National Eye Center · Singapore Eye Research Institute

   Affiliation as printed

   Singapore Eye Research Institute, Singapore National Eye Centre, Singapore. Electronic address: gemmy.cheung.c.m@singhealth.com.sg

   Singapore Eye Research Institute, Singapore National Eye Centre, Singapore

3. Hidetaka Matsumoto

   Gunma University

   Affiliation as printed

   Department of Ophthalmology, Gunma University Graduate School of Medicine, Japan. Electronic address: hide-m@gunma-u.ac.jp

   Department of Ophthalmology, Gunma University Graduate School of Medicine, Japan

4. Shoji Kishi
   Affiliation as printed

   Maebashi Central Eye Clinic, Japan. Electronic address: shojikishi@gunma-u.ac.jp

   Maebashi Central Eye Clinic, Japan

5. Camiel J. F. Boon Aachen Department of Ophthalmology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: cjfboon@hotmail.com

   Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands

6. Elon H. C. van Dijk Aachen Department of Ophthalmology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: E.H.C.van_Dijk@lumc.nl

   Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands

7. Martine Mauget‐Faÿsse

   Hôpital Rothschild · Fondation de Rothschild

   Affiliation as printed

   Clinical Research Department, Rothschild Foundation Hospital, Paris, France. Electronic address: mgfaysse@me.com

   Clinical Research Department, Rothschild Foundation Hospital, Paris, France

8. Francine Béhar‐Cohen

   Assistance Publique – Hôpitaux de Paris

   Affiliation as printed

   Assistance Publique - Hôpitaux de Paris in France, Paris, France. Electronic address: francine.behar@gmail.com

   Assistance Publique – Hôpitaux de Paris in France, Paris, France

9. M. Elizabeth Hartnett

   University of Utah

   Affiliation as printed

   John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA. Electronic address: ME.Hartnett@hsc.utah.edu

   John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA

10. Sobha Sivaprasad

    Moorfields Eye Hospital

    Affiliation as printed

    Moorfields Eye Hospital, London, UK. Electronic address: senswathi@aol.com

    Moorfields Eye Hospital, London, UK

11. Tomohiro Iida

    Tokyo Women's Medical University

    Affiliation as printed

    Tokyo Women's Medical University, Tokyo, Japan. Electronic address: iida@twmu.ac.jp

    Tokyo Women's Medical University, Tokyo, Japan

12. David M. Brown

    Retina Consultants of Texas

    Affiliation as printed

    Retina Consultants of Texas, USA. Electronic address: dmbmd@houstonretina.com

    Retina Consultants of Texas, USA

13. Jay Kumar Chhablani

    University of Pittsburgh · UPMC Health System · University of Pittsburgh Medical Center

    Affiliation as printed

    University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA. Electronic address: jay.chhablani@gmail.com

    University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA

14. Peter M. Maloca

    Institute of Molecular and Clinical Ophthalmology Basel

    Affiliation as printed

    Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland. Electronic address: peter.maloca@iob.ch

    Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland