Scleral thickness as a risk factor for central serous chorioretinopathy and pachychoroid neovasculopathy

Abstract Background/Objectives. While the exact pathophysiology of pachychoroid disorders remains unclear, scleral changes inducing increased venous outflow resistance are hypothesized to be involved. This work aims to investigate anterior scleral thickness (AST) as a risk factor for central serous chorioretinopathy (CSC) and pachychoroid neovascularization (PNV). Subjects/Methods. Randomized prospective case-control study performed at the Ludwig Maximilians-University, Department of Ophthalmology. 46 eyes of 46 patients were included, with 23 eyes in the CSC/PNV group (9 eyes with PNV) and 23 eyes in the control group. There was no difference in mean age (51.5 ± 8.0 (36 to 65) vs. 47.0 ± 12.9 (30 to 83) years; p = 0.122) or spherical equivalent (0.60 ± 2.23 (-5.5–4.6) vs. -0,93 ± 2.45 (-4.9–5.8); p = 0.441). In all patients, swept source OCT (SS-OCT) with an anterior segment module was used to measure AST. Subfoveal choroidal thickness (SFCT) was assessed using enhanced depth imaging OCT (EDI-OCT). AST and SFCT were then compared to an age and -refraction-matched control group. Results. A significantly higher AST was found in the CSC/PNV as compared to the control group (403.5 ± 68.6 (278 to 619) vs. 362.5 ± 62.6 (218 to 498) µm; p = 0.028). Moreover, the CSC/PNV group showed a higher SFCT (392.8 ± 92.8 (191–523) vs. 330.95 ± 116.5 (167–609) µm, p = 0.004). Conclusions. Compared to age- and refraction-matched controls, patients with CSC and PNV show a significantly thicker anterior sclera. Scleral thickness might contribute to the venous overload hypothesized to induce pachychoroid phenotypes.