The role of intracranial hypertension in the pathogenesis of central serous chorioretinopathy

Abstract

Central serous chorioretinopathy (CSCR) is a pachychoroid condition, but the causes of pachychoroid development remain unknown. Taking into account the anatomical features of the blood supply to the eyeball, it was suggested that the phenomena of pachychoroid can be caused by intracranial hypertension. Purpose. Evaluate blood supply disorders at the level of eyeball vessels, intracranial vessels and vertebrobasilar basin in patients with CSCR. Material and methods. 10 patients with CSCR were examined, 4 of them additionally underwent magnetic resonance imaging (МРТ) of the brain and cervical spine, intra-and extracranial arterio-and venography, and ultrasound of extra-and intracranial vessels. Results. By OCT data, all patients had significant increase in the choroidal thickness both in eyes with CSCR, and in fellow eyes. OCT of the optic disc revealed subarachnoid space expansion - a marker of intracranial hypertension. By ultrasound B-scan data, 8 patients with CSCR showed moderate expansion of the perineural space of the optic nerve and significant expansion of orbital vessels, which also indicates intracranial hypertension. By MRI data, all patients showed signs of internal hydrocephalus, which may indicate intracranial hypertension. In addition, the presence of signs of cervical osteochondrosis and asymmetry in the vertebral arteries was established. In 50% of cases, there was a decrease in intravascular blood flow along the orbital vein on the side of the affected eye, and an asymmetry of venous blood flow along the transverse and cavernous sinuses. By ultrasound dopplerography signs of intracranial venous hypertension of extra-and intracranial vessels were revealed. Conclusion. The role of pathological changes of central genesis in the development of CSСR has been established, requiring interdisciplinary research and expansion of therapeutic measures aimed at limiting the identified disorders. Key words: central serous chorioretinopathy, pachychoroid condition, intracranial hypertension.