Corneal Nerve Abnormalities in Chronic Central Serous Chorioretinopathy.

Objective: Central serous chorioretinopathy (CSCR) is associated with abnormal neural regulation of choroidal blood flow and with systemic dysautonomia. Although choroidal neuropathy has been observed in rodent models of pachychoroid, its presence in human chronic CSCR remains unclear and difficult to examine. Because the long ciliary nerves send fibers to both the cornea and the choroid, this study used in vivo confocal microscopy to examine corneal nerve fiber (CNF) morphology in chronic CSCR patients compared with age-matched controls. Design: The case-control study included chronic CSCR and control participants without signs or symptoms of corneal disease to detect the presence of nerve abnormalities. Subjects: The study analyzed corneal nerves in 15 chronic CSCR patients and 11 control subjects with subfoveal thickness ≤360 μm. Methods/Testing: In vivo confocal microscopy was used to image and systematically analyze the subepithelial area, Bowman layer (BL), anterior stroma, intermediate stroma, and deep stroma. Corneal nerve fiber abnormalities were scored according to their types, location, and number in the different layers by 2 graders in a blind manner. Corneal nerve fibers were quantified in the sub-basal nerve plexi in both groups (chronic CSCR and controls), and subfoveal choroidal thickness was measured using OCT enhanced depth imaging mode. Main Outcome Measures: Scores of CNF abnormalities in all layers and quantification of CNF in the sub-basal plexi. Statistical difference between CSCR and controls. Results: In the control group, 8 of 11 individuals showed no CNF abnormalities, whereas 3 had moderate abnormalities in specific corneal layers. In contrast, nearly all CSCR patients exhibited significant CNF abnormalities, including hypertrophic subepithelial nerve plexi, loops, neuromas, cell clusters, dendritic cells activation, and nerve rarefaction. In addition, quantification of BL innervation shows a significant reduction in CSCR patients, indicating corneal nerve abnormalities. Conclusions: In vivo confocal microscopy reveals morphological nerve abnormalities in chronic CSCR patients, potentially reflecting underlying choroidal neuropathy and subsequent blood flow dysregulation. These findings suggest corneal nerve changes may serve as a noninvasive marker warranting investigation into shared neuropathic mechanisms. Further studies are needed to confirm these preliminary findings and assess their prognostic value. Financial Disclosures: The authors have no proprietary or commercial interest in any materials discussed in this article.