Intraocular Pressure and Ocular Perfusion Pressure in Central Serous Chorioretinopathy

Abstract

Purpose

To evaluate whether intraocular and ocular perfusion pressure (IOP and OPP, respectively) are significantly associated with central serous chorioretinopathy (CSCR) and compare their degree of disease prediction with that of anterior scleral thickness (AST).

Design

Cross-sectional study comparing cases and controls.

Subjects

Eighty patients with CSCR and 80 healthy controls.

Methods

Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were detected with an automatic electronic sphygmomanometer, and IOP was determined using Goldman tonometry. Mean OPP was calculated as MOPP = ⅔ [DBP + ⅓ (SBP-DBP)] - IOP. AST was obtained at nasal and temporal gaze positions. Logistic regression models were computed to determine the correlation between risk factors and the presence of the disease. The ROC curve was used to compare the disease probability across different classifier models and determine the best cut-off values ​to distinguish patient subgroups.

Main Outcome Measures

IOP, blood pressure measurements, and AST.

Results

Patients with CSCR showed greater AST (498 ± 55 vs 455 ± 40 μm, P = .03) and choroidal thickness (435 ± 106 vs 321 ± 76 μm, p < .001), higher blood pressure (SBP: 130.6 ± 13.4 vs 124.8 ± 5.6 mm Hg, P = .001; DBP: 82.8 ± 9.6 vs 77.0 ± 7.1 mm Hg, p < .001), and lower IOP (12.7 ± 1.8 vs 16.1 ± 1.6 mm Hg, P < .001) than the controls, resulting in higher MOPP (57.3 ± 6.6 vs 51.2 ± 3.9 mm Hg, p < .001). ROC curve analysis revealed IOP as the strongest disease predictor (AUC = 0.914), significantly superior to MOPP (AUC = 0.813, P = 0.0096) and AST (AUC = 0.737, P = 0.0001). Using best cut-offs (IOP ≤ 14 mm Hg; AST > 454.5 μm), we identified two distinct CSCR subgroups: 13 eyes with low IOP and 12 with high AST. Both groups displayed similar structural chorioretinal biomarkers and systemic hemodynamic findings.

Conclusions

This study demonstrates a significant association of low IOP, high MOPP, and high AST values with CSCR. IOP was a more significant predictor of CSCR than the other two factors, indicating its major role in the pathogenesis of the disease. Low IOP can promote CSCR pathogenesis by increasing the OPP, which favors choroidal overperfusion and exudation, and reducing the interstitial fluid clearance across the sclera.