Analysis of SS-OCT and SS-OCTA imaging characteristics in patients with central serous chorioretinopathy between different sexes

Objective  To analyze the imaging characteristics of swept-source optical coherence tomography (SS-OCT) and swept-source optical coherence tomography angiography (SS-OCTA) between male and female patients with central serous chorioretinopathy (CSC).

Methods  A cross-sectional study was conducted. A total of 141 patients (155 eyes) with newly diagnosed and untreated CSC at the Ophthalmology Department of the First Affiliated Hospital of Zhengzhou University from September 2021 to August 2024 were enrolled. Participants were divided into the female group (47 patients, 52 eyes) and the male group (94 patients, 103 eyes) according to their sex. All subjects underwent SS-OCT and SS-OCTA examinations. The incidences of pigment epithelial detachment (PED), flat irregular PED (FIPED), retinal and choroidal high-reflective foci, focal choroidal excavation (FCE), pachydrusen, choroidal neovascularization (CNV), serous retinal detachment (SRD), and subretinal fibrin were recorded, as well as the presence of vortex vein anastomosis and vortex vein asymmetric dilation. Device-built software was used to measure subfoveal choroidal thickness (SFCT), central macular thickness (CMT), SRD height and width, PED height and width, choroidal vascular volume (CVV), and choroidal vascularity index (CVI). This study followed the Declaration of Helsinki, and the study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University (No. 2024-KY-1660). All subjects were fully informed of the study content and voluntarily signed the informed consent form.

Results  The average age of the female group was (48.64±10.18) years, which was significantly greater than (43.76±8.60) years of the male group ( t=2.985, P=0.003). The SFCT and CVV of the male group were (542.06±127.47)μm and 3.97(3.46, 4.33) mm ^3, which were significantly greater than (474.12±120.36)μm and 3.31(2.91, 4.13) mm ³ of female group, respectively ( t=-3.191, P=0.002; Z=-3.106, P=0.002). The SRD height and CVI of the male group were 163.70(87.10, 239.90)μm and 0.31(0.28, 0.34), which were significantly lower than 216.90(128.40, 291.88)μm and 0.32(0.30, 0.36) of the female group, respectively ( Z=-2.236, P=0.025; Z=-2.362, P=0.018). No significant differences in CMT, PED height and width, or SRD width were found between the two groups (all P>0.05). Subgroup analysis showed that among patients aged <50 years, there were significant differences in SFCT, CVV, and CVI between the two groups ( t=-2.373, P=0.019; Z=-2.169, P=0.030; Z=-2.142, P=0.032), and no such differences were observed in patients aged ≥50 years ( t=-0.863, -0.503, -1.588; all P>0.05). The incidence of choroidal high-reflective foci in the male group was 55.3%(57/103), which was significantly higher than 36.5%(19/52) in the female group ( χ ² =4.888, P=0.027), and the incidence of FIPED in the male group was 31.1%(32/103), which was significantly lower than 50.0%(26/52) in the female group ( χ ² =5.289, P=0.021). The rate of vortex vein anastomosis in the male group was 84.5%(87/103), which was significantly higher than 69.2% in the female group ( χ ² =4.896, P=0.027). Logistic regression analysis identified male gender as a significant risk factor for choroidal high-reflective foci and vortex vein anastomosis (odds ratio [ OR]=2.410, P=0.017; OR=2.686, P=0.020), while increasing age was a significant risk factor for FIPED ( OR=1.059, P=0.004).

Conclusions  Compared with female patients, male CSC patients exhibit increased choroidal thickness, choroidal vascular dilation, and higher perfusion. These characteristics are more pronounced in patients under 50 years of age. Male gender is a risk factor for the occurrence of choroidal high-reflective foci and vortex vein anastomosis in CSC patients.