Mid-Phase Hyperfluorescent Plaques as a biomarker of disease activity in Central Serous Chorioretinopathy: Clinical Course and Treatment Response – MICRoN report number Ten
Giulia Gregori, Niroj Kumar Sahoo, Nasiq Hasan, Marco Lupidi, Stanley Saju, Avery Zhou, Charles C. Wykoff, Lihteh Wu, Jay Chhablani,Purpose:
To investigate the association between mid-phase hyperfluorescent plaques (MPHP) with subretinal fluid (SRF) dynamics in central serous chorioretinopathy (CSCR) and to assess response across different therapeutic modalities using a validated quantitative approach.
Methods:
This was a retrospective, multicenter study in patients with CSCR. All patients underwent baseline and follow-up indocyanine green angiography (ICG-A) and enhanced depth imaging optical coherence tomography (EDI-OCT). MPHP were measured on mid-phase ICG-A images, and changes in MPHP number and area were correlated with various imaging parameters. Response of MPHP to different treatment modalities were also evaluated.
Results:
The study included 96 eyes of 60 patients, 50 males (83.33%) and 10 females (16.67%) with CSCR. Over a median follow-up of 31 months, significant reductions were observed in central macular thickness (p = 0.003), SRF height (p = 0.02), SFCT (p = 0.001), and MPHP area (p = 0.02), while MPHP number and BRVA remained stable. PDT and laser induced greater SRF reduction (−125.0 ± 143.2 µm and −123.8 ± 139.5 µm) and MPHP area decrease (−4.14 ± 6.13 mm 2 and −1.75 ± 2.98 mm 2 , respectively) compared with eplerenone and observation (p < 0.01). Multivariable analysis confirmed PDT as the strongest independent predictor of MPHP area regression (p ≤ 0.001), while baseline SRF height and symptom duration predicted final SRF height (p ≤ 0.02).
Conclusion:
MPHP represent a frequent and dynamic angiographic feature in CSCR, closely associated with disease activity. PDT significantly reduced MPHP area and promoted SRF resolution, supporting its role as an effective treatment.