MIDPHASE HYPERFLUORESCENT PLAQUES AS A BIOMARKER OF DISEASE ACTIVITY IN CENTRAL SEROUS CHORIORETINOPATHY

PURPOSE: To investigate the association between midphase hyperfluorescent plaques (MPHP) with subretinal fluid (SRF) dynamics in central serous chorioretinopathy (CSCR) and to assess response across different therapeutic modalities using a validated quantitative approach. METHODS: This was a retrospective, multicenter study in patients with CSCR. All patients underwent baseline and follow-up indocyanine green angiography and enhanced depth imaging optical coherence tomography. MPHP were measured on midphase indocyanine green angiography images, and changes in MPHP number and area were correlated with various imaging parameters. Response of MPHP to different treatment modalities were also evaluated. RESULTS: The study included 96 eyes of 60 patients, 50 men (83.33%) and 10 women (16.67%) with CSCR. Over a median follow-up of 31 months, significant reductions were observed in central macular thickness ( P = 0.003), SRF height ( P = 0.02), subfoveal choroidal thickness ( P = 0.001), and MPHP area ( P = 0.02), while MPHP number and best recorded visual acuity remained stable. Photodynamic therapy (PDT) and laser induced greater SRF reduction (-125.0 ± 143.2 µ m and -123.8 ± 139.5 µ m) and MPHP area decrease (-4.14 ± 6.13 mm 2 and -1.75 ± 2.98 mm 2 , respectively) compared with Eplerenone and observation ( P < 0.01). Multivariable analysis confirmed PDT as the strongest independent predictor of MPHP area regression ( P ≤ 0.001), while baseline SRF height and symptom duration predicted final SRF height ( P ≤ 0.02). CONCLUSION: MPHP represent a frequent and dynamic angiographic feature in CSCR, closely associated with disease activity. PDT significantly reduced MPHP area and promoted SRF resolution, supporting its role as an effective treatment.