ObjectiveTo assess the occurrence of CNV in patients presenting with flat irregular pigment epithelial detachments (FIPED). MethodsForty-five patients (49 eyes) with FIPED on OCT were enrolled in this retrospective study. There were 25 males (28 eyes) and 20 females (21 eyes). The mean age was 61.022±9.292 years. FFA, ICGA, spectral domain OCT and OCT angiography (OCTA) were performed in all patients during the same period. The FIPED was defined as an irregular elevation of the RPE allowing distinct visualization of Bruch’s membrane on OCT B-scan. The abnormal vascular signals from the deep retinal layer to the choroid layer on OCTA was defined as CNV. The CNV was classified into a type 1 CNV and a type 2 CNV according to the OCT characteristics. The CNV was classified into a typical and occult CNV according to the characteristics of the FFA image. Of all 49 eyes, fundus angiography revealed 18 eyes (36.7%) with CNV, and 31 eyes (63.3%) with no characteristic signs of CNV. FFA examination found that CNV in 8 eyes (classic CNV in 1 eyes, occult CNV in 7 eyes), which confirmed by OCT were type 1 CNV; transmitted fluorescence in 41 eyes. ICGA examination showed that CNV-like hyperfluorescence spots in 18 eyes, suspicious hyperfluorescence spots in late stage in 20 eyes, and choroidal high permeability in 11 eyes, respectively; and 18 CNV eyes were confirmed to be type 1 CNV by OCT. To compare the detection of CNV by OCTA and fundus angiography. ResultsOf the 49 eyes with FIPED, OCTA detected 36 eyes (73.5%) of type 1 CNV, and full or partial strong reflex signals were seen in FIPED; 13 eyes (26.5%) were not associated with CNV, and some strong reflection signals were found in FIPED in 9 eyes, 4 eyes with weak reflection signal. The FFA was examined for 1, 7 eyes of the classic and occult CNV, which confirmed to be type 1 CNV by OCTA. Among the 18 eyes with CNV which detected by ICGA, OCTA also found type 1 CNV. Among the 20 eyes with ICGA’s late suspicious strong fluorescent spots, OCTA showed 17 eyes of type 1 CNV; in 11 eyes with high choroidal permeability, OCTA showed type 1 CNV in 1 eye. Among the 36 eyes with CNV which detected by OCT, there were SRD in 32 eyes, no SRD in 2 eyes and retinal interlamellar cavities in 2 eyes. ConclusionOCTA can detect 73.5% of FIPED eyes with CNV. Compared with traditional fundus angiography, OCTA has a higher detection rate of CNV under FIPED. The FIPED of the internal strong reflection signal has a certain diagnostic value for the type 1 CNV.
ObjectiveTo investigate the imaging characteristics of flat irregular pigment epithelial detachment (FIPED) in eyes with central serous chorioretinopathy (CSC), identify factors associated with its presence, and evaluate its association with choroidal neovascularization (CNV). MethodsA retrospective clinical study. From March 2021 to May 2025, 206 patients (211 eyes) with CSC diagnosed at the Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University were included in the study. Eyes were divided into a FIPED group and a non-FIPED group, and the FIPED group was further subdivided into acute CSC (aCSC) and chronic CSC (cCSC) subgroups according to disease duration. All eyes underwent best-corrected visual acuity (BCVA), swept-source optical coherence tomography (SS-OCT), and SS-OCT angiography. Subfoveal choroidal thickness, the width and height of serous retinal detachment (SRD), and the height and width of FIPED were measured. Pigment epithelial detachment type, subretinal hyperreflective deposits, dilated large choroidal vessels beneath FIPED, CNV, and the correspondence between FIPED and choriocapillaris flow voids were evaluated. Univariate comparisons and logistic regression were used to analyze factors associated with FIPED. ResultsAmong 211 eyes, 94 (44.55%) had FIPED. The mean height and width of FIPED were (48.93±51.03) μm and (898.96±447.01) μm, respectively. FIPED corresponded to dilated large choroidal vessels in 93.62% (88/94) of eyes and to choriocapillaris flow voids in 88.30% (83/94). Compared with eyes without FIPED, eyes with FIPED were older, had worse BCVA, a higher proportion of cCSC, greater SRD width, and more frequent subretinal hyperreflective deposits (all P＜0.05). Among eyes with FIPED, the cCSC subgroup showed greater FIPED width and a higher CNV detection rate than the aCSC subgroup (P＜0.05). Logistic regression analysis showed that age [odds ratio (OR)=1.045, 95% confidence interval (CI) 1.003-1.090, P=0.037], cCSC (OR=5.052, 95%CI 2.550-10.009, P＜0.001), and subretinal hyperreflective deposits (OR=3.126, 95%CI 1.405-6.954, P=0.041) were independently associated with the presence of FIPED. ConclusionsFIPED is an important imaging manifestation of CSC, particularly cCSC. Its presence is associated with older age, chronic disease course, and subretinal hyperreflective deposits, and with a higher likelihood of detectable CNV, especially in cCSC.
Objective To observe the morphological characteristics of flat irregular pigment epithelial detachment (FIPED) in eyes with chronic central serous chorioretinopathy (cCSC) and its association with choroidal neovascularization (CNV), and to evaluate the value of FIPED width as an early-warning imaging biomarker for CNV. MethodsA retrospective clinical study. A total of 198 patients with cCSC involving 213 eyes who were diagnosed at the Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University from February 2021 to July 2025 were included. The disease duration from symptom onset to the first visit was ≥3 months. All affected eyes underwent best-corrected visual acuity (BCVA), swept-source optical coherence tomography (SS-OCT), SS-OCT angiography (SS-OCTA), and fundus fluorescein angiography (FFA). BCVA was measured using the international standard visual acuity chart and converted to the logarithm of the minimum angle of resolution (logMAR) for statistical analysis. Subfoveal choroidal thickness (SFCT), central macular thickness (CMT), and the width and height of FIPED were measured using SS-OCT. FIPED was identified on SS-OCTA B-scan images. CNV was identified on SS-OCTA images as abnormal vascular signals extending from the deep retinal layer to the choroidal layer. According to the presence or absence of CNV, the patients were divided into the CNV group (16 patients, 16 eyes) and the non-CNV group (182 patients, 197 eyes). Eyes with CNV received intravitreal anti-vascular endothelial growth factor (VEGF) therapy, with a mean of 3.13 injections. The follow-up duration after treatment was ＞12 months. Age, sex distribution, logMAR BCVA, and SFCT were compared between the two groups. Changes in logMAR BCVA, SFCT, and FIPED width and height before treatment and at the final follow-up were compared in CNV group. Intergroup comparisons were performed using the independent-samples t test. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficacy of FIPED width for CNV and to determine the cut-off value. ResultsCompared with non-CNV group, patients in CNV group were older (t=3.838), had a lower proportion of males, thinner SFCT (t=?2.635), worse BCVA (Z=?3.807), and greater FIPED width (t=3.515); all differences were statistically significant (P＜0.05). There was no significant difference in FIPED height between the two groups (Z=?0.698, P＞0.05). FIPED was present in 16 eyes in CNV group (100.00%, 16/16) and 80 eyes in non-CNV group (40.61%, 80/197), with a statistically significant difference (P＜0.001). ROC curve analysis showed that the area under the curve of FIPED width for diagnosing CNV was 0.796, and the optimal cut-off value was 914.15 μm. At the final follow-up in CNV group, BCVA was significantly improved, and FIPED width and height were significantly reduced compared with those before treatment; the differences were statistically significant (t=2.487, 6.354, 3.046; P＜0.05). There was no significant difference in SFCT (t=0.989, P＞0.05). ConclusionsIncreased FIPED width (＞914 μm) is significantly associated with CNV and may serve as a potential imaging early-warning marker for predicting secondary CNV in cCSC. However, its predictive value requires further validation in prospective studies. Anti-VEGF therapy can effectively reduce CNV-associated FIPED and improve visual acuity.
