Evaluation of the effect of choroidal vascular layers on prognosis in optical coherence tomography images of patients with central serous chorioretinopathy

Objective: The aim of this study was to evaluate the relationship between choroidal Haller and Sattler layer vessel diameters, areas, and morphological changes measured on cross-sectional optical coherence tomography (OCT) images using ImageJ software, subretinal fluid (SRF) parameters, and their effect on prognosis in patients diagnosed with Central Serous Chorioretinopathy (CSCR). Materials and Methods: This retrospective cross-sectional study included 42 eyes of 40 patients diagnosed with CSCR who presented to the Retina Clinic of the Department of Ophthalmology at Balıkesir University Health Practice and Research Hospital between October 2021 and August 2025, after obtaining approval from the Balıkesir University Rectorate Non-Interventional Clinical Research Ethics Committee. Patients were divided into two groups based on whether subretinal fluid regressed during the 3-month follow-up period (Group 1: resolved SRF group; Group 2: persistent SRF group). Using ImageJ software (National Institutes of Health, Bethesda, MD, USA) on cross-sectional OCT images, the following parameters were measured: subfoveal choroidal thickness, subretinal fluid height, area and basal width, choroidal vascularity index, subfoveal Haller vessel diameter, Haller vessel area, and Sattler vessel area. Measurements obtained at baseline and at the third-month visit were compared. Statistical analyses were performed using SPSS version 30.0. A p-value <0.05 was considered statistically significant. Results: While no significant difference was found between the groups in terms of age, a significant difference was observed in gender distribution (p <0.05), with male sex being more predominant in the persistent SRF group. No statistically significant differences were observed between the groups at baseline in terms of SRF height, basal width, area, subfoveal choroidal thickness, or choroidal vascularity index (p>0.05). Similarly, no significant differences wereobserved between the groups for these parameters at the third-month visit. At baseline, a significant positive correlation was found between subfoveal choroidal thickness and Haller vessel area (r=0.397, p<0.05). Likewise, Haller vessel diameter showed a significant positive correlation with subfoveal choroidal thickness (r=0.468, p<0.05). At the third-month visit, the significant positive relationship between subfoveal choroidal thickness and both Haller vessel diameter (r=0.509, p<0.001) and Haller vessel area (r=0.439, p<0.05) persisted. At the third-month evaluation, SRF area and height were significantly reduced in the resolved SRF group (p<0.05), whereas no significant change was observed in the persistent SRF group. Compared with baseline measurements, Haller vessel area and diameter showed a tendency to decrease in the resolved SRF group, while no marked change was observed in the persistent SRF group. Finally, in the change analysis between the first and third visits, a significant positive correlation was found between the change in Haller vessel area and the change in SRF (r=0.344, p=0.026). This finding suggests that narrowing of the Haller vessel area may be associated with subretinal fluid resorption. Conclusions: Our study demonstrates that changes in Haller vessel area and diameter in patients with CSCR parallel disease activity. In particular, the significant reduction in Haller vessel area observed in cases with SRF resorption supports the concept that choroidal vessel dilatation accompanies disease activity. These findings indicate that choroidal vascular enlargement is not only a structural but also a dynamic parameter and suggest that Haller vessel morphology may serve as a potential biomarker for CSCR prognosis. Keywords: Haller vessel area, Haller vessel diameter, ImageJ, Central Serous Chorioretinopathy, Subretinal fluid