Linking increased anterior scleral thickness, pachychoroid, and macular microvascular changes in chronic central serous chorioretinopathy.

PURPOSE: To investigate the relationship between anterior scleral thickness (AST), subfoveal choroidal thickness (SFCT), and macular microvascular parameters in eyes with chronic central serous chorioretinopathy (cCSC) using anterior segment and macular optical coherence tomography (OCT/OCTA). METHODS: This retrospective study included 105 eyes from 58 patients with cCSC and 40 eyes from healthy controls. Quadrant-specific AST was measured 6 mm posterior to the scleral spur using anterior segment OCT. SFCT and macular OCTA vessel densities were obtained with a 3 × 3 mm macular scan centered on the fovea. Generalized estimating equations (GEE) were used for group comparisons and to assess AST-SFCT/OCTA associations while accounting for study group and inter-eye correlation. RESULTS: AST was significantly higher in all quadrants of cCSC eyes compared with both fellow and control eyes (all p < 0.001). SFCT was also increased in cCSC eyes (p < 0.001), while central macular thickness did not differ among groups (p = 0.109). OCTA revealed lower parafoveal vessel densities in the superficial, deep, and choriocapillaris layers of cCSC eyes versus controls (p < 0.05). However, after accounting for study group and inter-eye correlation, quadrant-specific AST was not independently associated with SFCT or parafoveal vessel density. CONCLUSION: Eyes with cCSC showed diffuse anterior scleral thickening, increased choroidal thickness, and reduced macular perfusion. These findings are consistent with the proposed venous-overload hypothesis, in which scleral outflow resistance may contribute to choroidal congestion and microvascular changes. Combined assessment of AST, SFCT, and OCTA parameters may improve disease characterization and monitoring. This study demonstrates that eyes with chronic central serous chorioretinopathy show increased anterior scleral and choroidal thickness accompanied by reduced macular microvascular density. These findings are consistent with the concept that scleral biomechanics may contribute to choroidal congestion and microvascular changes in chronic central serous chorioretinopathy.